GLOBALIZATION AND PSYCHOLOGY TRAINING: AS A CASE STUDY

DISSERTATION

Presented in Partial Fulfillment of the Requirements for

the Degree Doctor of Philosophy

in the Graduate School of The Ohio State University

By

Natacha M.R. Foo Kune, M.A. *****.

The Ohio State University 2005

Dissertation Committee:

Pamela S. Highlen, Ph.D., Adviser Approved by

W. Bruce Walsh, Ph.D.

Felicissima C. Serafica, Ph.D. ______Adviser Department of Psychology

ABSTRACT

As knowledge travels more easily now due to globalization, especially through study abroad experiences, it becomes increasingly relevant to study the applicability of

such knowledge when transported to different contexts and cultures. This study focused

on how Mauritian mental health professionals adapt the psychology training they

received outside of Mauritius, primarily in Western nations, once they start practicing in

Mauritius. Twenty-six mental health providers who were working in Mauritius, and had

received their psychology training outside the country, were interviewed. They worked

in the counseling/clinical, educational and industrial/organizational realms. In addition,

questionnaires were distributed to these participants to establish base data about services

provided on the island. Cross-cultural competence, acculturation, biculturalism and

colonization theories were used as framework to understand the process of adaptation.

The findings highlight the fact that psychology is a new discipline in Mauritius, which

means lack of understanding from the public, supervisors and legal system, stigma of

seeking mental health services in the public’s mind, lack of resources for the public and

for mental health professionals, as well as lack of continuing education. Issues of cultural

competence were central for most participants as they adapted their training to the

Mauritian context. The adaptation process usually involved a trial-and-error approach,

ii with emphasis on seeking feedback from the client, and understanding how the client perceives his or her world. Participants indicated that their training did not prepare them adequately for dealing with the importance of family and spiritual beliefs, as well as dual relationships that inevitably occur in a small country, such as Mauritius. To address these issues, seeking a better grasp of the clients’ understanding of their mental health problems, better understanding of indigenous healers which may lead to cooperation with them, reducing use of norm-referenced tests in favor of more ecologically valid assessment, were recommended. Further, the recently formed association can be used to reduce the isolation, provide psychoeducation for the public, and provide continuing education for its members. Implications for students who study abroad, as well as programs who recruit and accept international students are discussed.

iii

Dedicated to those who are thoughtful in their art.

iv

ACKNOWLEGMENTS

I wish to thank my advisor, Pamela Highlen, for her support throughout this

process. Despite her many responsibilities, she provided 24-hour turnaround time when I

submitted sections to her, which is a manifestation of her dedication.

I thank Louise Douce, whose project in her year as president of the American

Psychological Association Division 17 (Society of Counseling Psychology) was

“Globalization of Counseling Psychology.” As her assistant, I was honored to participate

in the strategic planning meeting during the 2002 Multicultural Summit Conference.

This meeting helped crystallize my conceptualization of this research.

This project would not have been possible without the gracious participation of

Mauritian mental health practitioners. I thank them for their time, insightful comments,

and their hard work in adapting to the Mauritian context after studying abroad.

I am grateful to members of the Asian Pacific American Caucus who have

provided me with emotional and intellectual support throughout my graduate studies.

The interdisciplinary discussions provided good fodder for thought.

I am indebted to my partner Scott Fenton, who provided constant encouragement

throughout my graduate studies, as well as support on all levels. Our fruitful discussions provided me with a well-needed anchor.

Finally, I thank my family for their never-ending support and cheerleading.

v

VITA

August 15, 1975------Born-Curepipe, Mauritius

1997------Bachelor of Arts Psychology and Communication Studies Macalester College

1997-2000------Case Coordinator Tasks Unlimited, Minneapolis

2000-2002------Graduate Administrative Associate Asian American Student Services The Ohio State University

2002-2004------Graduate Administrative Associate Counseling and Consultation Service The Ohio State University

2004-2005------Pre-doctoral Intern Counseling Center University of California at Davis

FIELDS OF STUDY

Major field: Psychology Counseling Psychology

vi

TABLE OF CONTENTS Page

Abstract------ii Dedication------iv Acknowledgments ------v Vita------vi List of Tables ------ix

Chapters:

1. Introduction------1 The Mauritian Context ------2 Purposes of the Study------8 2. Literature Review ------9 Globalization of Psychology------9 Theoretical Framework------13 Multicultural Counseling Competencies ------16 Qualitative Methodology------21 Research Questions ------26 3. Method ------28 Participants------28 Design and Procedure------29 Data Analysis ------32 4. Findings ------35 State of Psychology in Mauritius------35 Industrial and Organizational Psychology------36 Educational and School Psychology ------37 Counseling and Clinical Psychology ------39 Mauritian Public’s Perception of Psychology------43 Efforts to Organize an Association ------50 Multicultural Counseling Competencies ------53 Perceived Adequacy of Training------53 Cultural Competency------56 Mauritian Context and Cultures------59 Colonization and Neo-Colonization------64 The Concept of Family, Domestic Violence and How to Raise Children ----- 69 Belief System, Religion and Shamanism ------74 The Process of Adaptation for Mental Health Practitioners------77

vii Ethics ------83 Competence in Providing Services to Different Cultures ------83 Dual Relationships and Confidentiality in a Small Country ------84 Accountability------88 Legal Issues------89 Professional Issues ------90 Providing Therapy Services ------90 Advertising and Media ------94 Continuing Education ------95 Research------97 Self-Care ------98 5. Discussion------100 Adaptation Process, Adequacy of Training and Colonization ------100 Multicultural Counseling Competencies------105 Limitations of the Study ------110 Conclusions, Recommendations and Suggestions for Future Research ------112

References ------119 Appendix A: Semi-Structure Interview ------127 Appendix B: Questionnaire about Services Provided by Mental Health Practitioners-- 130

viii

LIST OF TABLES

Table Page

4.1 Descriptive Characteristics of Clients Seen During 2002 ------41

ix

CHAPTER 1

INTRODUCTION

Globalization is an area that is gaining momentum in the field of counseling psychology (Bauserman, 1997; Hurley & Doyle, in press; Leong & Blustein, 2000;

Leong & Ponterotto, in press; Richie & Sabourin, 2001). For instance, the project of the

2002-2003 Division 17 President, Louise Douce, was the globalization of counseling psychology. In addition, The Counseling Psychologist devoted a special issue to this topic in 2000. Globalization within counseling psychology implies that researchers are doing research outside of their own country and that students choose to study in countries other than their own. A consequence of the process of globalization is the influence of the cultures of more industrialized nations on parts of the cultures of less industrialized nations (Appadurai, 2000). The focus of this research was to understand how Mauritian mental health providers—who received their training in psychology outside of

Mauritius—apply what they have learned to the Mauritian culture and context. Further, given that Mauritius is a multicultural society, this research examines how Mauritian psychologists and other therapists address issues of multicultural counseling.

1 The Mauritian Context

A provides an essential context for this research. The current

sources of power for the various Mauritian groups will be described. This background

knowledge will enhance understanding of this research and its purposes. Addison and

Hazareesingh (1993) and Selvon (2001) were consulted for the following summary.

Mauritius is a small African island in the Indian Ocean, located 500 miles east of

Madagascar and due to its location and size, Mauritius did not have any indigenous

peoples. It has been colonized by the Dutch, the French and the British. The Dutch

established a colony in 1638 and left in 1710 when they decided the colony was not

profitable. They were then followed by the French who colonized the island in 1725.

The French brought enslaved Africans to work in the sugar cane fields throughout their rule of the island. In 1810, the British invaded Mauritius, and they offered generous capitulation terms to the French colonizers, allowing them to stay, keep their property, and keep their way of life. Many of the French chose to do so. The British also worked to abolish slavery in 1835 and paid £2 million to compensate French owners of enslaved

Africans (Addison & Hazareesingh, 1993). In order to provide cheap labor for the sugar industry, the plantation owners imported indentured labor from . In the beginning, the conditions of life for the Indian laborers were barely better than those of the enslaved

Africans. These conditions improved over time, especially as a result of a law passed in

1922, which ended indentured labor practices. During the nineteenth century, Chinese immigrants fled China due to economic recession and famine, some of them heading to

Mauritius. Most of these immigrants opened small stores in rural areas to provide for the

2 needs of sugar cane laborers. Mauritius gained its independence from the United

Kingdom in 1968 as the result of a democratic vote.

Given this history, the ethnic cultural breakdown of the population of Mauritius as listed in the 1990 census (, 1990) is as follows:

• 51% Hindu Indo- (include Mauritians of Indian ancestry, and Tamil,

Telegu, Marathi, and Gujarati ethnicity)

• 27% Christian General Population—official census term which includes Creoles (of

African and Malagasy ancestry), multiracial people and White Franco-Mauritians

(who constitute less than 1% of the Mauritian population)

• 17% Muslim Indo-Mauritians (Mauritians of Indian ancestry)

• 5% Christian and Bhuddist Sino-Mauritians (Mauritians of Chinese ancestry)

Note that religion is included in the population segments listed above. While this may not be a common practice in the , religion is inseparable from one’s ethnic belonging in Mauritius. For example, a significant portion of the Muslim Indo-

Mauritians came from a region of India, which is now Pakistan and they consider themselves very different from the Hindu Indo-Mauritians.

Further, the above categories can all be sub-divided as described in the joint report from the Mauritius Alliance of Women, and Southern African research and

Documentation-Women in Development Southern African Awareness (1997). For instance, among the Hindu Indo-Mauritians, about 75% follow traditional rituals, whereas 25% follow the Arya Samaj, a reform movement. Among the Muslim Indo-

Mauritians, about 95% identify with the Sunni branch of Islam. Over time, Muslim Indo-

Mauritians have started to identify more with the Arab world than their Indian origin. 3 The several segments of the Mauritian population draw on several types of power

(Addison & Hazareesingh, 1993), which will be outlined in this section to provide the context in which Mauritian institutions operate, as well as to provide a description of how social class lines are drawn along ethnic lines. The Hindu Indo-Mauritians form the majority of the Mauritian parliament and government. Political influence is the main source of power of this ethnic group in Mauritius, although there are a growing number of Hindu Indo-Mauritians in business. The Hindu Indo-Mauritians span all social classes.

On the other hand, the White Franco-Mauritians’ power comes from the sugar plantations they own. Sugar used to be the main source of revenue for the country. However, with the advent of the textile industry and tourism, the importance of the sugar industry has been challenged, and consequently, the power of the White Franco-Mauritians has also diminished. Most of them are members of the upper-middle class to upper class. The main source of power for the Sino-Mauritians is their influence in commerce, and they are members of the middle to upper class. Members of the Muslim Indo-Mauritians and the Creoles do not have readily identifiable sources of power in the Mauritian society.

Some of the Muslim Indo-Mauritians can count on their middle class members to improve their chances of obtaining jobs. The Creoles are generally lower to middle class. Due to colorism (discrimination based on color of skin among people of African descent) and emigration, the Creoles who are members of the lower class do not tend to find support from middle class Creoles.

Like all former colonies, Mauritius has political independence, but it is still not free from forms of neocolonialism, which can be seen in institutions such as education and the media (inherited from former colonial powers and from the U.S.A.). Before

4 further discussion, I will clarify a few terms used in this research, based on definitions from Young (2001). Colonization and colonialism refer to the conquest of other people’s land and resources. Neocolonialism is the continuation of the domination of the so-called

“former” colonial power, through economic, educational and cultural means.

Colonization, colonialism and neocolonialism are forms of imperialism, which is a process where the “developed” nations dominate and control the “developing” nations for ideological and economic reasons (Young, 2001).

In Mauritius, a form of neocolonialism is seen in the media, where movies and programs from former colonial powers ( and ) and the United

States dominate. Because of colonization and neo-colonialism, Mauritius believes that it is inferior to countries of the First World; as a result, Mauritius has bought into the idea that “development” means Western industrialization. Mauritian standards of beauty are strongly affected by the White European and American standards. Moreover, Mauritius has a British education system, and many Mauritians pursue university degrees in

Western nations, furthering the process Frantz Fanon (1968) called the colonization of the mind. Due to its size, Mauritius has only one university. In the past, Mauritians preferred to study abroad as they considered the Mauritian university to be inferior. This attitude towards the Mauritius tertiary educational system is changing gradually, and the

University of Mauritius is now considered a good option for obtaining a college degree.

However, the range of majors is still limited; those presently offered are in agriculture, the humanities, business, law and some social sciences.

Currently, no psychology degree is offered at the University of Mauritius.

However, a Bachelor of Science degree in Social Sciences, with specialization in

5 psychology was offered for the first time in 2002. Consequently, all practicing Mauritian

mental health practitioners have received their psychology training in foreign countries

(primarily , , France, India, United Kingdom and United States). This

situation creates three issues. The first one is a cross-cultural problem (Cheung, 2000;

Jing & Fu, 2001; Mpofu, 2002; Nandy, 1983; Park, Upshaw & Koh, 1988; Sinha, 1990); that is, how to apply Western training to a different country, namely, Mauritius. Sinha

(1990) applies Berry’s acculturation model to the psychology profession when transported to a different country. Based on two dimensions (value placed on indigenous system, and value placed on imported system), there are four possible categories:

Integration, (high value placed on both systems), De-culturation (low value placed on both systems), Revivalism (high value placed on indigenous system only), and

Assimilation (high value placed on imported system only). Sinha’s proposition can help understand in which categories Mauritian psychology practitioners fit.

The second issue, related to the first, is about the application of the Western psychology training to the multicultural society in Mauritius. None of the training received caters specifically to any of the ethnic groups on the island. This situation is a similar dilemma to the one addressed in the multicultural psychology dialogues in the

United States (e.g., Pedersen, 1987; Ponterotto, Casas, Suzuki, & Alexander, 1995; Sue,

Bernier, et al., 1982; Sue & Zane, 1987), with a few specific differences. The discussion in the United States focus on the paucity of research and applied skills to work with clients who are not part of the White heterosexual middle class society (e.g., Fassinger,

1991; Speight, Myers, Cox & Highlen, 1991; Sue & Zane, 1987). In the case of

Mauritius, the general similarity comes from the multicultural societies in both countries.

6 The differences include not knowing how the research findings and training focusing on

U.S. diverse populations apply to any of the Mauritian diverse populations. For instance, do the issues that concern African Americans also concern Mauritian Creoles? Further,

U.S. multicultural counseling competencies focus on a White heterosexual middle class counselor, and anybody who does not fit in that category as the client (Sue, Carter et al.,

1998). However, in Mauritius, the psychologists are members of all the ethnic groups.

Most of them are also from middle to upper class background, and most of them are heterosexual. In general, the percentage of White people of European descent in

Mauritius is less than 1%, which is very different from the U.S. where the White

European Americans are the majority. A final difference between the U.S. and Mauritian contexts is that sexual orientation is more taboo in Mauritius, so that it is possible that

Mauritian psychologists are not addressing this issue, either due to lack of personal comfort, or due to under-utilization of services by would-be-clients who do not trust psychologists.

The third issue is that of language. All Mauritians speak a minimum of two languages. All speak , a language derived from French vocabulary and

African pronunciation and grammar, and due to the country’s history, all understand

French. However, the official language of the country is English, which is the language used in official government matters, and since the educational system is derived from the

British model, students learn all subjects in English, except for French. Additionally, the

Indo-Mauritians still speak their individual dialect at home (such as Tamil and Telegu), and many of them speak Hindi as well. The Sino-Mauritians did not keep their Hakka or

Cantonese dialect, and the Mauritian Creoles were not allowed to keep their native

7 dialects, so that younger generations of these two groups do not speak those languages.

Do Mauritian mental health practitioners use more than one language in counseling?

Moreover, do psychological terms that are common in the West (e.g., “co-dependency”) translate well in a Mauritian context, given the gulf of not just language, but also culture?

This research project provides an overview of the process of indigenization of psychology (or lack thereof) in Mauritius, where indigenization means deriving psychological concepts and techniques from practices developed locally, or adapted to a specific cultural group (Kim & Berry, 1993, Sinha, 1990). On a broader level, the results of this research provide a case study of how multicultural counseling competencies are applied in a different country. Finally, there may be implications for international students who are currently studying in Western nations, so they may seek the training that is best adapted to their home cultures(s). There may also be implications for programs that recruit and accept international students in terms of the training they provide.

Purposes of the Study

The present study has several purposes:

1. To examine how Mauritian mental health professionals who were trained in foreign

countries apply their psychology training to Mauritius;

2. To examine how language and issues of translation affect the services offered by

mental health professionals;

3. To examine how Mauritian mental health professionals practice in a multicultural

society; and

4. To examine issues of colonization, neo-colonialism and decolonization in how the

above processes take place.

8

CHAPTER 2

LITERATURE REVIEW

First, I examine the struggles faced by other countries which are in a similar

situation to that of Mauritius (that is, with most mental health professionals trained

abroad, and the countries having a history of colonization). Second, I introduce Fanon’s

theory of the process of colonization and the process of decolonization to provide an

analytical framework for this investigation. Third, I review the multicultural counseling

competencies literature briefly to provide a context to understand some of the issues

faced by Mauritian mental health professionals. Fourth, the qualitative paradigm and

methods used are described in detail.

Globalization of Psychology

The literature on the development of the psychological profession in non-Western

countries is limited. Gibbs (1995) observed that less than 2% or the 3300 indexed in the

Science Citation Index are published in developing nations. In a review of the psychology

literature, only 3.5% of the literature surveyed in 1994 originated from developing nations (Bauserman, 1997). Sub-Saharan Africa, which includes Mauritius, contributes

0.5% to the literature. Overall, Bauserman noted a growing trend of international representation from 1975 to 1994. He speculated that in developing nations, most psychologists focus on clinical issues and teaching, so that there are few resources for

9 research. He also discussed the lack of outlets for research originating in other countries.

A few journals provide this type of outlet, such as the International Journal of

Psychology, and Applied Psychology: An International Review. In a more recent review in 1997, Adair, Coelho and Luna (2002) indicated that 4.67% of the literature indexed in the PsycLit database came from developing countries. Only 0.43% of the literature surveyed came from the African continent, which is slightly lower than the number reported by Bauserman. Due to the short span of time (only three years) between the two surveys of the literature, it is too early to tell whether there is an upward or a downward trend in the number of publications from developing countries in general, and from

African countries in particular.

A few articles depicting the development of psychology in several regions of the world exist, namely, Canada (Berry, 1993), (de Zoysa & Ismail, 2002), Yemen

(Alzubaidi & Ghanem, 1997), the (Church & Katigbak, 2002), the African continent (Durojaiye, 1993), and sub-Saharan Africa (Mpofu, 2002). In his review of the development of psychology research in Canada, Berry (1993) provided a preliminary framework in the content, theories and methods employed in the country. He distinguished between imported, indigenous and universal categories. He contended that there could be a universal psychology, which applied to all human beings. In contrast, imported psychology was a psychology developed in a different country that was applied to the local country without regard for the local cultures. In other words, imported psychology was applied as if it was a universal psychology. Indigenous psychology was developed from or adapted to the local culture(s). He described the four main areas of

10 psychology research in Canada, as well as the progress accomplished in those areas, namely social, clinical, educational and work psychologies.

Another article which focused solely on research depicts the current state of psychology research in (Sanchez, 1999). This research surveyed psychologists, who were involved in research, where a questionnaire was mailed to the

100 psychologists who were identified as researchers in the country. This survey contained both closed-ended and open-ended questions, which yielded quantitative and qualitative data. Sanchez considered that the opinions of psychologists, and how they saw the development of psychology research in Venezuela, were crucial.

The articles on Yemen and Sri Lanka depicted the state of research, as well as the provision of psychological services and teaching of psychology in those countries. While in Yemen, there were discussions about the applicability (or lack thereof) of Western theories to Yemeni culture, there was no such awareness reported by de Zoysa and Ismail

(2002) in Sri Lanka. Both articles reported on the state of psychology in their respective countries, providing numbers of psychologists in the various areas of psychology

(teaching, research and practice). They also described the structures in place for the undergraduate study of psychology in their countries, in terms of courses offered and support from universities. While Yemen has a psychological association, de Zoysa and

Ismail (2002) called for the creation of such an association in Sri Lanka, to serve as a regulatory body for the practice and research in psychology. Both articles discussed briefly how the psychologists were viewed by the public and the institutions in their respective countries. Mauritius is probably closest to Sri Lanka in terms of the development of psychology. Both Mauritius and Sri Lanka are islands, with cultural

11 influence from India, which is not the case in Yemen. However, all three countries do

share histories of various forms of colonization and have several ethnic groups in

common.

While the two articles about Sri Lanka and Yemen were relatively similar, the

ones about the Philippines and sub-Saharan Africa addressed very different issues. In the

Philippines, indigenization of psychology is a current topic of discussion. So far, a

number of indigenous concepts have been created, but not many indigenous theories

encompassing these concepts have been developed (Church & Katigbak, 2002). As a

first step, the concepts sought to de-pathologize normative Pilipino behavior. The article

also depicted the various camps within the members of the indigenization movement.

Mpofu (2002) considered similar questions applied to the sub-Saharan context.

Given that his review spanned several countries, it was not entirely clear in which countries these discussions were taking place. In this article, Mpofu reversed the use of the terms majority and minority. He argued that the White Western population, which was often referred to as the majority, is a numerical minority in the world. He discussed the underlying assumption of individualism in Western theories, which did not apply to sub-Saharan societies. However, he thought that some Western theories might apply to majority societies (i.e., non-White Western societies). He argued for critical appraisal of these theories by local mental health providers based on research. He acknowledged the influence of colonization and neo-colonialism, by pointing out that Westernization was often equated with development. He offered recommendations for decolonization of

African psychology.

12 Theoretical Frameworks

Wampold (1996) contended that the application of a theory to a particular situation is the crux of research. In this case, three theories were selected to provide a framework for data collection and data analysis, due to the paucity of research done specifically about Mauritius, and due to the fact that no theory encompassed all the issues discussed above.

Acculturation Model. Sinha (1990) provided a useful framework to understand some of the issues discussed by Mpofu (2002). He used the acculturation model proposed by Berry (1986) to conceptualize the encounter of Western and indigenous psychology.

Berry proposed two dimensions (value put on indigenous system, and value put on imported system). The two by two matrix yielded four categories: Integration (where high value is placed on both systems), De-culturation (when low value placed on both systems), Revivalism (when high value is placed on the indigenous system only), and

Assimilation (when high value is placed on the imported system only).

Based on his experiences as an Indian psychologist, Sinha (1990) cautioned against revivalism for its own sake. He argued this would be inconsistent with how the indigenous system arrived at its current level of knowledge. He argued that any knowledge is invariably a mixture of truly indigenous practices and adaptation of foreign practices seen during travels, trade and other such encounters. He also cautioned against assimilation disguised as indigenization, where local expressions were used to describe

Western concepts, without in-depth examination of the relevance of these concepts to the local context. He disagreed with those who think that indigenous and Western systems of

13 psychology were parallel and could not be synthesized. He argued for critical analysis of both systems leading to a synthesis that best serves the needs of the local population.

Types of Biculturalism. To extend Sinha’s model, the different types of biculturalism (or integration) proposed by LaFromboise, Coleman & Gerton (1993) were used. They proposed that integration or biculturalism was a category with further subdivisions. Therefore, they defined several ways in which people are bicultural: alternating between the two cultures (Alternation), adapting bits and pieces from both cultures (Multicultural), and evolving parts from both cultures into a new culture

(Fusion). This exploration of biculturalism or integration is useful insight into the

Mauritian indigenization process as well.

Applying these two conceptualizations to Mauritius provides a useful heuristic to understand how different psychologists may apply their Western psychology training to

Mauritian culture. India and Mauritius both share a legacy of colonization.

Consequently, it is likely that psychologists in both countries may favor the Western view as superior because their minds have also been colonized (Fanon, 1968). However, due to the Mauritian multicultural population, the concept of indigenous psychology is multifaceted. In Mauritius, the term indigenous refers to ancestral cultures from India, various parts of the African continent, China and Europe. As a result, the Mauritian context does not fit nicely into Berry’s four categories. Nevertheless, the categories provided by Sinha, and LaFromboise and colleagues can still provide useful insight into the indigenization of psychology in Mauritius.

Decolonization. However, the above conceptualizations do not specifically address the issues of colonization, so that Fanon’s (1968) theory of the decolonization

14 process was selected as well. Frantz Fanon was a Black psychiatrist, from a current

French colony (Martinique Island), educated in France and assigned to a hospital in

Algeria during the French-Algerian war. His theory centered on the process of colonization and the process of decolonization, in post-independence situations.

He proposed that the mind can be colonized; much like a country can be colonized. He saw education as a primary tool to do so. He further argued that colonization continued through the “native bourgeoisie,” who was part of the elite of the former colony, whose mind had been colonized, and who perpetuated Western values and its system. The “native bourgeoisie” received their education from Western countries and were in a position of power in their country. Not willing to relinquish this power, they did not participate in the emancipation of their people.

However, through consciousness raising, decolonization can take place. He saw decolonization as both an individual process, and a communal process. In fact, the individual is defined in relation to the community and the community cannot exist without a collection of individuals (Mostern, 1994). Decolonization is an active process, where the colonized come to see themselves as human (whereas they were seen as sub- human before, fit for enslavement, genocide and in need of religious conversions).

Further, individuals cannot consider themselves free if their community is still colonized.

Intellectuals who consider themselves more enlightened than the people, and who do not engage with their fellow countrymen and women are oppressed by colonization and neocolonialism. It is important to note that decolonization is a lifelong process, and that one is never completely decolonized.

15 Fanon’s theory is very applicable to the Mauritian context. This theory was

developed specifically for countries in the aftermath of colonization. It can illuminate

both the process of neocolonialism and the process of decolonization that Mauritian

psychologists create for themselves and their community. Additionally, this research

explored ways in which this theory may not apply to the Mauritian context.

Multicultural Counseling Competencies

The advent of multicultural counseling competencies started in the United States,

due to a growing recognition that the current research, training and practice of

psychology was about and for the White heterosexual, middle class male (Hall, 1997,

Sue, Bernier, et al., 1982). In addition, counseling was no longer viewed as a neutral act

and instead, it was defined as a sociopolitical act (Katz, 1985). Psychologists started

providing resources for the practice of counseling in a multicultural society (e.g.,

Arredondo et al., 1996; Pedersen, 1987; Ponterotto, Casas, Suzuki, & Alexander, 1995;

Sue, Bernier, et al., 1982; Sue & Zane, 1987).

There are some similarities and differences between the multicultural societies of

the United States and Mauritius. The similarities include the history of colonization and

slavery, the existing media rhetoric that “White is better,” and the presence of more than

three major racial and ethnic groups. The differences include the U.S. having a much

larger population, the U.S. being considered part of the developed world, and the

presence of indigenous peoples in the U.S. However, both societies are undergoing the same process of acknowledging that the model of counseling based on White European middle class heterosexual values is not fully applicable to other members of the society who were raised with different values. Therefore, the model of multicultural counseling

16 competencies was adopted as a framework to discuss the development of psychology in

Mauritius.

Sue, Bernier, and colleagues (1982) and Sue, Carter, and colleagues. (1998) offer a comprehensive definition of multicultural counseling competencies. A slightly modified version of these competencies was recently passed as American Psychological

Association policy (APA, 2002). While the competencies were written primarily for the

White counselor working with clients of color within the U.S. context (Sue, Carter, et al.,

1998), the framework provides a useful blueprint for counselors working in multicultural settings. The definition of multicultural competence is based on several dimensions:

1. Awareness of own assumptions, values and biases;

2. Understanding the worldview of the client;

3. Having skills to develop culturally appropriate intervention strategies;

4. Understanding how organizational and institutional operations are a

reflection of the wider community, which often means from a white

privilege perspective in the U.S. context; and

5. Being able to define major characteristics of a culturally competent and

inclusive organization.

For each dimension—especially the first three—attitudes and beliefs, knowledge, and skills are described. The authors also stress that there are three levels of multicultural competence, at the personal, the professional and organizational levels.

The authors list four principles to help guide those who are trying to confront racism on a personal level:

17 1. Experience and learn about different cultures from as many sources as

possible;

2. Spend time with healthy and strong people from that culture;

3. Understand the cultural group, not only factually, but experience the

reality that the individuals from that culture live; and

4. Be constantly vigilant about our own biases and working to unlearn racist

attitudes.

On a professional level, they prescribe the following principles. Note that some of these principles are akin to a process of decolonization of mental health practices:

1. Recognize that U.S. conventional mental health practice reflects a Euro-

American worldview, and that culturally appropriate interventions (both in

and out of the therapist’s office) may not be traditional mental health

practice;

2. Learn and respect culture-specific information of the different cultural

groups in the U.S., including indigenous healing methods; and

3. Understand oneself as a racial and cultural being and how this impacts the

therapeutic interaction.

Organizational multicultural competence has a more systemic approach. Again, these principles describe a process of decolonization, whereby consciousness-raising among individuals is needed to change the organization. The following summarize recommendations by Sue, Carter and colleagues (1998):

1. Understand how institutions tend to perpetuate a particular culture, and

how their rules and regulations impede multiculturalism;

18 2. Being able to identify the characteristics of developing from a

monocultural to a multicultural organization, from the stages of cultural

destructiveness to the stage of advocacy; and

3. Being able to plan and implement measures that will increase the

organizational cultural competency.

The above competencies have spurred much research on the personal and professional levels (e.g., Atkinson, Casas & Abreu, 1992; Coleman, 1998; Constantine &

Ladany, 2000; D’Andrea Daniels & Heck, 1991; LaFromboise, Coleman & Hernandez,

1991; Leong, 1996; Pedersen, 2002; Ponterotto, Fuertes & Chen, 2000; Ponterotto, et al.,

1996; Sodowsky, Taffe, Gutkin & Wise, 1994).

Research provides initial support for the efficacy of the use of multicultural counseling competencies. For instance, in an analog study, Constantine (2002) found that clients’ ratings of their counselors’ multicultural competence accounted for significant variance in clients’ satisfaction with counseling. Further, the study showed

that the clients’ ratings of the counselors’ multicultural competence partially mediated the

relationship between general counselor competence and satisfaction with counseling.

This study fits within the broader question of whether general and multicultural

counseling competencies are separate constructs (Coleman, 1998).

Quantitative research on the competencies have focused on instrument

development (D’Andrea Daniels & Heck, 1991; LaFromboise, Coleman & Hernandez,

1991; Ponterotto, et al., 1996; Sodowsky, Taffe, Gutkin & Wise, 1994), and related

variables. One of the major criticisms of the instruments developed is their self-report

format, with the exception of the Cross-Cultural Counseling Inventory-Revised

19 (LaFromboise, Coleman & Hernandez, 1991). A growing body of literature linked self-

report measures of multicultural counseling competencies to social desirability attitudes

(Constantine & Ladany, 2000; Sodowsky, Kuo-Jackson, Richardson & Corey, 1998;

Worthington, Mobley, Franks & Tan, 2000). More importantly, researchers found no

significant correlation between multicultural case conceptualization ability and the self-

report measures (Constantine & Ladany, 2000; Ladany, Inman, Constantine & Hofheinz,

1997).

Qualitative studies on this topic are much rarer. Pope-Davis and colleagues

(2002) used qualitative methods to explore how the client perceives the counselor’s multicultural counseling competencies. One of the goals was to ascertain whether clients perceive counselors who do exhibit such competencies as more effective by their clients.

The results provided general support for multicultural counseling competencies.

However, they did uncover other factors as well, such as client self-identified needs, and how the counselor fulfilled those needs. This study is an example where qualitative research can help deepen understanding by pointing to new variables that influence the process.

To summarize, multicultural counseling competencies provide an important set of constructs that psychologists can use to guide them as they serve clients who are diverse in race, ethnicity, social class, and sexual orientation. Therefore, these competencies are crucial when examining Mauritian psychologists who are practicing in a diverse society, with diverse clients. The questions that can be posed are, to what extent are Mauritian psychologists aware of cultural differences and their impact on the counseling process.

20 Consequently, do they have the knowledge and the skills (or seek to acquire/deepen them) to be effective psychologists with clients who are different from themselves.

Qualitative Methodology

To explore the issues described above, I will use qualitative methods. Currently, there is increasing recognition that qualitative methods are a way to do scientific inquiry.

However, given the vast field of qualitative research, the assumptions underlying the various paradigms used in scientific research will be presented first. I will then situate the assumptions underlying the paradigm within which this research is situated.

Humans have always held the desire to understand, explain and predict events that occur in their lives and have used science to do so. Research is an attempt on some level to gain a more significant relationship with the world around us through description, understanding, prediction and if possible, control. The type of research selected depends on the assumptions of the researcher (Bower, 1998; Leahey, 1992).

It is important to note that the definition of science varies from one discipline to another (Bower, 1998). Researchers of a particular time in a particular discipline decide upon the new meaning of science, or accept the one handed down by their predecessors.

Historically, positivism had a monopoly on the definition of science (Bower, 1998).

Interestingly, one of the characteristics of positivism, objectivity (as we know it today) started in the mid nineteenth century (Bower, 1998). Gordon, Miller and Rollock (1990) explain that this shift to “impersonal” knowledge was a necessary step, indeed progress, to prevent undue influences from the church and the nobility.

Lincoln and Guba (2000) contend that the "cult of objectivity" (science) is central to the positivist (or modernist) paradigm. They further explain that positivists have the

21 most power in our current society. Power includes legitimacy, control, and influence of

policy-making, status and rewards. Lincoln and Guba (2000) described positivism as the

belief that there is such a thing as a single reality, which can be known through objective

and rigorous inquiry. Controlled experiments and hypothesis testing are the hallmark of

positivist science (Proctor & Capaldi, 2001).

Postpositivism, by contrast includes the various paradigms that do not have the

same epistemological and ontological assumptions as positivism (Lather, 1986). As a

result, postpositivism often uses different methodology, or different assumptions

underlying the use of positivist methodology. The main groupings of postpositivist

paradigms are described below.

Constructivism (which shares similarities to social constructionism) believes there are several realities based on the individuals’ point of view through their cultural lenses

(Gergen, 2001). The constructivist believes that knowledge is socially constructed based on an individual’s unique background, and mostly based on their culturally shared knowledge (Lincoln & Guba, 2000).

The critical theory camp argues that the world exists in power relations among people (Lincoln & Guba, 2000). Multiple realities exist and should be viewed equally in some way, however, the dominant reality must be replaced with one that shares power among people (Ladson-Billings, 2000). Ladson-Billings contends that the only way to achieve this is to emancipate those educated (indoctrinated) under the positivist regime.

This means to help them raise their consciousness, in order to understand their oppression and to take action to overcome that oppression.

22 Deconstructivism questions the reality of everything. Individuals construct their own reality (reality is not just socially constructed, but individually constructed) so that nothing is "real" and everything is a construction (Habermas, 1971). Therefore, we have no way of knowing what really exists, or that anything exists at all. Indeed, we are limited by language in our understanding of the world around us (Gergen, 2001).

Postmodernism and decolonization fit in this category (Habermas, 1971).

Decolonization is described in more depth because it is the paradigm used in this research. Decolonization is more often called postcolonialism. However, the latter is problematic as described by Aborigine activist Sykes (cited in Smith, 1999, p. 24),

“What? Post-colonialism? Have they left?” Smith explains that while the colonizers may no longer be the official governors of the colonized countries, they are the architects of World Trade Organization regulations, and they flood the colonized country with their media. They have already “educated” a new elite with their values, who will promote their system of education, governance and capitalism. The legacy of colonizers is too strong to call it post-colonialism. Instead, the term decolonization is an active process of awareness of how the colonizees have been colonized and how to reclaim themselves.

Fanon (1968) agrees that education is used to colonize people. For him, Western education functioned to reduce the amount of questioning and rebellion in the colonies.

Our minds are the lenses through which we understand the world. If those lenses systematically deem the Western system superior, then non-Westerners will see themselves as inferior. Mauritian people have been colonized by the French and the

British. Legacies from times of colonization include a British education system. Further, people who can afford to obtain a degree from another country, do so. As predicted by

23 Fanon, this situation results in Mauritians viewing what is Western as superior, and what

is Mauritian as inferior. An example of this phenomenon is that several families no

longer speak Mauritian Creole to their children, and instead use French.

I analyzed the data using the lens of decolonization. In qualitative research, it is

important to be up front with one’s motives and epistemological framework with the

reader. Using this piece of information with the data analysis, the reader can decide

whether the researcher derived the wrong conclusions from the data. However, I am not

implying that there is only one correct conclusion. A useful way of understanding this

issue is through a parallel situation: therapist’s theoretical orientation. A theoretical orientation is a set of lens through which the data, or information from the client, is processed. Conclusions and treatment plans are then derived based on the therapist’s theoretical orientation. A supervisor looking at how the therapist is working with the client has enough information to decide whether the therapist is drawing the correct conclusions. Many theoretical orientations exist, and more than one effective treatment plan are possible (Smith & Glass, 1977). Similarly, no one correct conclusion can be derived from the data. Instead, several conclusions are equally correct. However, the researcher, just like the therapist, could make mistakes. The goal is to provide the readers with enough information so that they can make that determination (Glesne, 1999).

Further, I will use member checks, where the result of the data analyses are discussed with the participants, as a way to have them be co-researchers in this process. In other words, member checks prevent the biases of one researcher from dominating the results.

Instead, the participants add the layers of their understanding experience.

24 Traditionally, the field of psychology has viewed qualitative methodology as an inadequate way of doing research (Hoshmand & Polkinghorne, 1992). However, a growing number of psychologists are starting to advocate the use of qualitative research

(Gergen, 1994; Gergen & Gergen, 2000; Highlen & Finley, 1996; Hill, Thompson &

Williams, 1997; Leong & Ponterotto, in press; Morrow & Smith, 2000, Polkinghorne,

1984, 1994; Walsh, 2001). They acknowledge that there are several ways of knowing, and that using several methods—quantitative and qualitative—is needed for a deeper understanding.

Another reason to use qualitative methods is based on the lack of published research on Mauritian psychology. Saying that there is a need for such research is an understatement. In a tradition of theory-driven research, it is important to develop theories to help understand the Mauritian worldview, with its diversity and contradictions. However, given the lack of previous studies done in Mauritius, developing theories without empirical data would be an exercise in “armchair” theory development. Qualitative methods provide an avenue for theory testing and theory development based on empirical evidence (Denzin & Lincoln, 2000). Further, qualitative methods provide a much-needed flexible research design, which can help identify the several interacting factors. Finally, given the small population of 11 potential participants (there are only 11 members in the Mauritian psychological association; D.

White, personal communication, March 23, 2003), even if the total population of psychologists were interviewed the sample would be too small for the use of quantitative statistical analyses; sampling may not yield significant differences using statistical methods.

25 A list of research questions that will guide the inquiry are listed below.

Research Questions

Mauritian psychologists and Fanon’s theory of decolonization

1. How do foreign-educated Mauritian mental health professionals see themselves and

their profession as perpetuating or reversing colonization?

2. How do Mauritian mental health professionals view the terms of colonization,

indigenization, biculturalism (and its various forms)?

Mauritian mental health professionals and Sinha’s model of acculturation

3. What processes do Mauritian mental health professionals use to identify which

Western concepts apply to the Mauritian culture, and which concepts do not apply?

4. How do language limitations and translation affect the services offered by mental

health professionals?

5. How do Mauritian mental health professionals assess their own and their clients’ level

of acculturation as a bi-dimensional construct?

Mauritian mental health professionals and multicultural counseling competencies

7. How do Mauritian mental health professionals provide services to clients who are

from a different racial, ethnic, socioeconomic status, religion and sexual orientation

than themselves?

8. Are Mauritian mental health professionals aware of their own biases when working

with clients from a different culture?

9. How much knowledge of the cultures of other segments of the population do

Mauritian mental health professionals have?

26 10. Do Mauritian mental health professionals use different skills with clients from

different cultures? If so, what are those skills?

11. How does the current fee-for-service system affect their client population?

27

CHAPTER 3

METHOD

Participants

In Mauritius, the phenomenon of psychology, as practiced in the Western model

(i.e., individual therapy) is a recent development. As a result, there are only 32 Mauritian psychologists and mental health providers, 26 (81%) who participated in this research.

Twenty of the participants received their training in the following Western nations:

Australia (n = 1), France (n = 15), United Kingdom (n = 6) and United States (n = 3).

Four participants received their training in India, and one person received an initial social work degree in Mauritius. Five people received training from more than one country

(France and Mauritius, France and United Kingdom, France and United States, India and

United Kingdom). The final degrees obtained, with the number of participants indicated in parentheses (as well as a short description of the degree if needed), are the Bachelor of

Arts (2), Bachelor of Science (1), Master of Arts (6), Master of Social Work (1), Diplôme d’Etudes Supérieures Specialisées (8; D.E.S.S.; terminal degree required to practice as a psychologist in France, obtained after a Master’s degree), Diplôme d’Etudes

Approfondies (2; D.E.A.; degree required to pursue doctoral studies in France, obtained after a Master’s degree or a D.E.S.S.), and the doctorate (4). Mauritius is a very small country, and therefore, to preserve the confidentiality of the participants this information will not be specified for individual participants.

28 At the time of the study, the majority (65%) of the participants practiced within a

clinical setting, and among them, six had a full-time private practice; six had a part-time

private practice, and four practiced within an organization. Of the people who had a part- time clinical practice, three had an administrative job, and two had a teaching position.

Three of the participants worked within the educational system. Two worked as industrial/organizational psychologists, two were in administration only, one person worked as a professor, and one person was retired. None of the participants was doing research.

Recruitment of participants occurred via varied strategies. Members of the

Société des Professionels en Psychologie provided names of fellow members, as well as other practitioners. The Yellow Pages provided other names. Finally, the snowballing sampling technique (Patton, 1990), which included asking participants for other potential participants, so as to invite all members of the population of Mauritian mental health professionals to participate in this study. Initially, I contacted some participants by e- mail. However, given a limited response rate, I contacted all participants by telephone to solicit their participation in this study. Of the six mental health professionals who did not participate, three declined participation due to their schedules. I was unable to locate contact information for two professionals, and one participant did not come to the scheduled interview due to health concerns.

Design and Procedure

A semi-structured interview was conducted with the participants. The interview assessed the following areas (see Appendix A for the guides for questions):

1. Mauritian psychologists and Fanon’s theory of decolonization

29 • Participants’ university education and experience in psychology;

• how their training is helpful to them in their current work;

• how they bridged gaps in their training in order to adapt to Mauritian cultures and

realities; and

• whether issues of colonization affect how they think about themselves and their work.

2. Mauritian psychologists and Sinha’s (1990) model of acculturation

• constructs they have learned that do not apply to the Mauritian population;

• what processes they use to determine the above; and

• whether language and translation are an issue in psychotherapy.

3. Mauritian psychologists and multicultural counseling competencies

• when working with clients from different ethnic, racial and/or religious background

than their own:

¾ the level of awareness of differences;

¾ the level of knowledge about the client’s culture; and

¾ the different skills used.

Answers to the above questions pertaining to multicultural counseling competencies helped address two issues: how Mauritian psychologists define community, and how connected they are to their community. I offered participants to conduct the interviews in English, French or Mauritian Creole, based on participants’ preference, given that I was fluent in these languages and would be able to understand the overt and more subtle meanings within these three languages.

Taping and transcription of the interviews took place in 23 of the 26 interviews.

Three people declined to be audiotaped and allowed me to take notes during the 30 interview. The first member check took place in December 2003, when I shared the

initial data analysis of interviews with 18 of the 26 participants and discussed their

feedback. I was not able to reach the other participants during the month of December.

Member checks are a type of triangulation, or a layer of validity test (Lather & Smithies,

1997), where the participants give feedback to the researchers. This feedback minimizes

researcher bias and ensures that the researcher did understand what the participant was

trying to convey. This procedure does not mean that the researcher and the participant

need to agree on every single point. Rather, the goal is to portray the many layers of the issue, including its outliers and its contradictions. The second and final member check occurred in March, 2004 when I sent participants quotes that I used from their specific interviews, as well as my interpretation of these quotes. Again, their feedback was incorporated in the final write-up.

On a broader level, triangulation involves asking the same questions in a different manner, or from a different angle (Lincoln & Guba, 1985). The resulting converging lines of evidence, as well as the disconfirming evidence, help the researcher better understand and theorize the data. Further, triangulation helps establish the trustworthiness of the data in the eyes of the reader (Lather, 1986).

Further triangulation took place in terms of data sources. I conducted a document analysis of the images portrayed by psychologists in the Mauritian print media. During a period of three months, from July 1st, 2003 to August 31st, 2003, newspaper articles

portraying the opinions of psychologists were collected and analyzed. The documents

collected helped answer the same questions asked during the interviews, as well as

provided further insight into the types of biculturalism to which Mauritian psychologists

31 ascribe. Finally, I observed a meeting of the Société des Professionels en Psychologie.

The topics discussed helped identify the issues that are salient to the profession of

psychology in Mauritius.

The second major part of the methodology of this study was quantitative and

provided base data for the current state of psychology in Mauritius. At the end of each

interview, I asked participants if they would be willing to fill out a questionnaire about

the characteristics of their current clientele, the services they provided to their clients in

2002, as well as some demographic information about themselves. The hope was to

provide a historical perspective on the development of psychology in Mauritius, and to

help provide beginning epidemiological data on the disorders currently present in

Mauritius. The lists of disorders provided in the questionnaire were derived from the

Diagnostic and Statistical Manual of Mental Disorders, fourth edition-text revision

(American Psychiatric Association, 2000), with the option of including disorders not listed in the DSM-IV-TR. Unfortunately, only eight participants out of 17 (47 %) returned the questionnaire. One participant was not practicing in 2002, four declined to participate

due to their schedules, and four did not return the questionnaire. Nine participants were

not asked to fill out the questionnaire because they did not have a clinical practice.

Data Analysis

In between the two data collection points (first data collection took place from

June to August 2003, and second data collection point in December 2003), I analyzed the

data (from interviews, observation and documents collected) using the qualitative

software Non-Numerical Unstructured Data Indexing Searching and Theorizing. The

interviews were coded to represent the issues and theories discussed (Glesne, 1999). Two

32 classes of codes: descriptive codes and analytical codes were employed. Descriptive codes describe the topic of discussion. On the other hand, analytical codes seek to explain the reason behind a particular issue or topic. Some of the codes were pre- determined based on the extant literature, while other codes were based on themes I derived from the data. For example, pre-determined codes derived from Fanon’s decolonization theory and from the Multicultural Counseling Competencies Guidelines include awareness of own prejudices, knowledge of client culture, and skills used when working with clients from a different culture. The result became a coding “tree,” with descriptive codes at the bottom, grouped under broader descriptive codes. In turn, these broader descriptive codes are grouped under analytical codes. The analytical codes are the base used to test the theory and to theorize the data further. Data from questionnaires were compiled to provide descriptive statistics regarding the demographics of clients served, including their diagnoses. These data also established base data on prognosis of various mental disorders.

Writing is a method of qualitative analysis of its own right (Richardson, 2000).

While collecting data, I analyzed these data in my reflexive journal. Several types of entries were made: personal notes, methodological notes, theoretical notes, and contextual notes. While methodological notes were notes to improve the process of data collection, the other types of notes helped analyze the data. The journal is termed

“reflexive journal” because it is a form of audit of the validity of the research as well.

Just as quantitative data sets can be audited by a different researcher to test that the proper analyzes were made, so can qualitative data be audited. The reflexive journal provides insight into the researcher’s biases.

33 The quantitative data obtained from the questionnaires were compiled into descriptive statistics.

34

CHAPTER 4

FINDINGS

State of Psychology in Mauritius

This chapter presents findings from the interviews, questionnaires, newspaper articles and member checks. All quotes are from interview data. I will look at the state of psychology in Mauritius through the perspectives of various areas within the mental health profession which are represented in the country, namely, industrial and organizational psychology, educational psychology, and counseling and clinical psychology. While the interviews and the member checks provided data for all three areas, the questionnaires and newspaper articles provided data only for the counseling and clinical area, due to the design of the questionnaire and the topic covered by the newspaper articles.

Throughout the findings and discussion chapters, based on guidelines proposed by

Hill, Thompson and Williams (1997) for consensual qualitative research, the terms

“general finding” or “all participants” will denote when all participants agreed or shared a common experience. The term “typical finding” will denote when an experience is shared by half or more of the participants. The term “variant finding” will apply to experiences shared by less than half of the cases, but more than two cases.

35 The first person with training in psychology started working in Mauritius in the

early 1960’s. He described his work as being more within the “career guidance” and

education realm. All participants expressed that psychology was a new discipline in

Mauritius. The following quote is representative of all participants’ opinions:

par rapport aux besoins mauriciens, je vous dirais, c'est plutôt le fait que la psychologie est à ses balbutiements ici.1

[Translation: In terms of the Mauritian needs, my answer is more about the fact that psychology is in its infancy here]

The areas of psychology represented in Mauritius are industrial/organizational (12%), education/school (19%), and clinical/counseling (69%), based on the present occupations of the participants. The training of participants is slightly more eclectic, with 4% trained in industrial/organizational psychology, 12% specialized in educational psychology, and 81% were trained in clinical and counseling psychology. All participants worked within the applied field of psychology. No participant was aware of anybody doing psychological research in Mauritius, other than for theses as part of a psychology training program.

Industrial and Organizational Psychology

Once they returned to Mauritius after their training, the psychologists who worked within the industrial/organizational (I/O) realm found their training prepared them well for some areas of their work. For example, all felt well prepared to increase teamwork, deal with restructuring of companies, address recruitment and selection issues, and increase awareness of group dynamics.

1 French and Mauritian Creole quotes from participants are presented in both their original and translated forms, to ensure that the original intent is not lost in translation. 36 On the other hand, they found they were not familiar with Mauritian labor laws and felt that the transition was easy because the local labor laws are relatively clear and simple. In addition, one participant felt that he “had to catch up on [finance training] training, because definitely, you had to know some finance background, the basics at least.” This participant explained that in Mauritius, I/O psychologists are often given a budget to manage because they are the supervisors within the human resources area.

Other challenges for which their training did not prepare them included their supervisors and employees within the agency not understanding the job responsibilities of an I/O psychologist. While one participant felt he had the support at the supervisory level, another participant did not feel he had such support. One participant reported it was possible to educate employees about the job responsibilities, by going out to talk to people who work for the agency and answer their questions. In this case, informal communication was crucial in getting employees to understand the job and the relevance to them. It remains that the concept of human resources is relatively new in Mauritius, so people working in this area feel that “people don’t understand, so you had to explain yourself constantly.”

Educational and School Psychology

The educational psychologists echoed some of the concerns of the I/O psychologists regarding the novelty of psychology within their field in Mauritius.

“There’s no setup, no structure!” shared one of the frustrated psychologists. Another participant shared that

You don’t have a good recognition of the field of psychology—because people are not open to new developments. We’ve been teaching the same courses for 10 to 15 years!

37 This participant felt that part of the problem was that in Mauritius, we did not have access to new journals and books, so that we were not always aware of these new developments. Even if a psychologist is aware of such developments, “the supervisors don’t understand your job, so your job description is written by people who don’t know

[what your competencies are],” and “innovation is not expected from down to top.”

Like I/O psychologists, they felt that supervisory support was both very important and often lacking.

Further, there is no support across organizations. For example, several ministries within the Mauritian government are trying to collaborate. “They [formed] committees but there are different people attending each time. Th truth is that decisions depend on higher authorities anyway.” Another example is the Mauritius Institute of Education

(MIE) did develop new modules and trained a group of specialized workers who could address psychological and cognitive problems in schools. However, the schools did not hire them because they did not recognize their degree.

The schools are recognizing that they need to provide some psychological help for their students. There are issues of “rape, family problems, reproduction of social evils such as drugs and [criminal activity].” There is “lack of discipline and violence in schools. I’m looking at perception of teachers and they see it as a worldwide phenomenon. If we are losing our identity in the process of globalization, it’s a problem.” This participant saw lack of discipline and violence as a problem in other countries, usually more industrialized nations. She felt neo-colonization through the media and contact via travels, was affecting the Mauritian youth who wanted to mimic youth from other parts of the world. While the problem was oversimplified, her point is

38 well taken that issues of identity may well provide a substantial part of the answer to problems of discipline and violence in schools.

Counseling and Clinical Psychology

The results of the questionnaire are reported in the counseling and clinical section. Only descriptive statistics were computed, given that the distribution of the sample was not a normal distribution and tended to be bimodal in many cases. Further, the sample was very small, and any further statistical manipulation would be misleading.

Ten out of 17 (59%) of practicing participants filled out the questionnaire. Seven did full-time clinical work, and three did part-time clinical work. There were three White

Mauritians, two Creole Mauritians, two Hindu Indo-Mauritians, two Muslim Indo-

Mauritians and one Chinese Mauritian. Forty per cent reported being of upper class background, while 60% reported being of middle class upbringing. They had an average of 6.2 years of experience, with a range of one year to 15 years of experience. There appeared to be a slight bimodal distribution, where three respondents had ten or more years of experience, while seven respondents had five years experience or less.

To report on the type of services they provide, the questionnaire provided mental health professionals with the option to provide an exact number of clients served versus checking one of the proposed categories (see Appendix B). During 2002, these 10 participants provided an approximate total of 8,500 hours of individual therapy, provided an approximate total of 2,600 hours of family or couple therapy, and did a range of 1,803 to 3,204 hours of assessment. While all therapists provided individual therapy, 2 of 10 did not provide family/couple therapy and another 2 clinicians out of 10 did not list assessment hours.

39 It was more difficult for them to assess the number of clients they served through outreach because several of these outreach efforts were through the media (newspapers, radio and television shows). The aggregate estimate is that more than 7,000 people were served through outreach programs. Regarding group therapy, the numbers indicated that between 201 and 1400 clients were served. However, this number was puzzling given that one participant was under the impression that “personne ne fait des thérapies de groupe à Maurice [Translation: ‘nobody does group therapy in Mauritius’].” As it turned out, four participants said they facilitated group therapy. This disparity points to the lack of communication among mental health providers, which will be addressed later in this chapter. Further, the range of number of clients served provided by participants was quite large. This large range was due, in part, to the answer options the questionnaire provided, which started with “less than 200 clients” as the lowest option participants could select if they did not provide an exact number. Finally, in terms of consultations, therapists said they provided between 516 and 602 consultations in 2002.

The average number of times a therapist saw a client ranged from 5 to 104. Again, there was a bimodal distribution where two therapists saw clients on average 52 or 104 times, whereas the remaining eight therapists ranged from five to 12 sessions per client. This wide range is related in part to the type of disorders that the clinician is treating. The respondents listed personality disorders and eating disorders as examples of diagnoses that require longer therapy.

The characteristics of the clientele varied widely depending on the therapist. The figures reported below are percentages. The Mauritian population percentages

(Mauritius Research Council, 1998) are listed for comparison purposes where available.

40 The data represented in Table 4.1 showed both the averages for all participants, as well as the range of percentages reported by different participants. The questionnaires showed that therapists tended to attract a particular clientele. For example, people who worked in institutions where the services were free saw more people from lower socioeconomic status. In the case of ethnicity, for 6 out of 10 therapists, the highest percentage of their clientele was people of their own ethnicity. As will be discussed in more depth later, participants reported that they had clients who said they were seeking a therapist of the same ethnicity because they felt they would be better understood. On the other hand, there were other clients who reported specifically not wanting to work with someone of their ethnicity because they were afraid of confidentiality issues. The topic of ethnicity and level of comfort, including that of the therapist, will be further addressed in the section on multicultural counseling competencies.

The sources of referrals were also different depending on the therapist. It appeared that for therapists who have been practicing for longer periods of time, word of mouth was their primary source of referral. There was no clear trend for source of referral for clinicians who had been practicing for relatively less time in Mauritius.

When compiled together, the most common source of referral was word of mouth, followed by family references, medical staff referrals, school personnel references, past client references, advertising, media outreach, with telephone book being the last source

of referrals.

41

Mauritian Population Client Characteristics Average Range Demographics

Ethnicity

Creole Mauritian 32.3 % 0-80 % 28 %

Hindu Indo-Mauritian 27.3 % 6-77 % 51.8 %

White Mauritian 19.7 % 0-60 % less than 1 %

Muslim Indo-Mauritian 9.9 % 0-30 % 16.5 %

Chinese Mauritian 5.3 % 0-12 % 3.2 %

Other (usually foreigners) 4.3 % 0-18 %

Socioeconomic class

Lower 35 % 5-85 % 8.3 %

Middle 44 % 10-75 % 77.6 %

Upper 21 % 5-60 % 14.1 %

Gender

Female 62.6 % 1-90 % 52 %

Male 36.4 % 10-99 % 48 %

Disorders

Anxiety 28.1 % 10-90 %

Mood 22.2 % 0-90 %

Continued

Table 4.1. Descriptive Characteristics of Clients Seen During 2002

42 Table 4.1 continued

Mauritian Population Client Characteristics Average Range Demographics

Disorders

Substance Abuse 11.2 % 0-40 %

Psychotic Disorders 2.4 % 0-8 %

Eating Disorders 3.8 % 0-10 %

Learning Disorders 10.9 % 0-20 %

Cognitive Disorders 4.9 % 0-15 %

Developmental disorders 10.9 % 0-10 %

Disruptive Behaviors 4.7 % 0-12 %

Personality Disorders 13.3 % 0-90 %

Sexual Disorders 1.4 % 0-5 %

Adjustment Disorders 2.7 % 0-15 %

Mauritian Public’s Perception of Psychology

The public’s perception of psychology is usually restricted to the clinical realm.

“People think that psychology is counseling” as one of the participants put it. Indeed, 17 of 26 participants are practicing mental health clinicians. In addition, clinicians authored all the newspaper articles related to psychology, fostering the public’s perception of psychology as clinical work.

43 What attitudes does the Mauritian public have of this clinical work? Participants

all agree that “the stigma is here.” Addressing how these attitudes are changing, one

participant said,

they're kinda scared of psychologists, of “mental,”2 it's changing but it's still in the beginning. They're not completely freaked out but they are weary when they first come. There's still that in Mauritius, you have to be conscious of [this weariness].

Some mental health providers chose to address the stigma with their clients:

[With] most patients, I discuss the stigma, like with adolescents and people in their 20s. So, I have to explain, that here, we [psychologists] meet with different people, doctors, who are here as patients, laureates, managers. So I had to explain these things, and explain [about] mental illness, psychological problem, physical problem, try to convince them that when you come here, you're not crazy, you're not mad.

More specifically,

sometimes it [clients appear disengaged] happens at first 'cause they're scared and it's better afterwards, they start to trust. I really try to help them through all this piece [about] confidentiality, or is she going to judge me or not?

Building trust and rapport is crucial in any psychotherapy setting, but as participants implied, it is even more important in a context where there is a strong stigma against seeking psychological help.

The stigma comes in part, from lack information, and one participant pointed out that “you've got to educate, but it's come a long way. Now, people accept to see counselors, psychologists, it's not the way it used to be a few decades ago.” On the other hand, one psychologist pointed out that stigma did in some ways facilitate the therapy process once the client did come to counseling:

2 In Mauritian Creole, “mental” means the psychiatric hospital. 44 quand il va voir un psychologue, surtout à Maurice . . . croyez-moi que, le travail était déjà moitié fait hein, parce qu'il était motivé, voulait s'en sortir, il collaborait facilement.

[Translation: when he goes to see a psychologist, especially in Mauritius . . . I’m telling you that the work was already halfway done hey, because he’s motivated, wanted to get out of it, cooperated easily]

In this case, due to the stigma associated with seeking psychological help, a person who did decide to enter therapy was often more motivated than s/he might be otherwise.

This positive outcome of stigma does not imply that practitioners should not work to reduce it. Indeed, stigma is probably preventing a significant proportion of people from accessing psychological help. During the meeting of the “Société des

Professionels en Psychologie,” one of the members brought up that Mauritius has a relatively high rate of suicide per capita, and suggested that the association do some work on this issue. Education is key to help reduce stigma, both at the public level as suggested by this member of the association, and at a more individual level, within therapy as suggested by one participant: “[they] don't really know the definition of psychology, so it's [important to] educate the patient first about this, and then we go further.” Much as the literature on counseling with people from different cultures suggests, Mauritian practitioners agree that when Western counseling is a foreign concept for a client, it is part of the counselor’s responsibility to make explicit the rules that underlie therapy (e.g., Root, 1998, Sue & Sundberg, 1996).

Such clarification about therapy process is important because the client may misperceive the therapist as distant for example, one practitioner mentioned that her agency received “feedback that some psychologists maintain too much of a distance.

Here [in Mauritius], I think it is important to not maintain that distance, and build

45 rapport.” One of the participants used the metaphor of a pedestal to explain this perceived distance: “usually as a psychologist, they put you on a pedestal, so the first thing is to come down the pedestal. Sometimes you're on the pedestal because of your culture, most of the time, it's because of what you represent.” In other words, the metaphor speaks to the distance due to the position of authority conferred to mental health professionals by their clients. This position of authority gets in the way of a person to person relationship which several participants felt was a key ingredient to building rapport. Elaborating on how to prevent clients from feeling their therapist was too distant because of this pedestal, another participant explained,

after 5 minutes, they didn't have that perception because I think one of the things which training has taught me is just, you know, forget who you are, and focus really on the person who is in front of you. Try to understand from within, and I think because a lot of these people didn't get the chance to be understood from within, and really it's the first for many of them.

All three mental health practitioners quoted here felt that empathy and rapport were very important in connecting with the client, and thereby preventing the feeling of distance.

Further, clarification of the process of psychotherapy was quite important given the general perception that therapy was only talk, and that therefore, “everyone in

Mauritius is a psychologist” because anybody can talk. One participant gave the following example:

a friend [of mine] went to see a psychologist and that person was telling me that there's nothing new, even a friend on the road could say the same thing to me. But then I had to explain to that friend that it was different, the catharsis, the listening, everything. And so I would say the attitudes, the mentalities, is that they expect a different thing than what you're giving. We give something but they don't want this, they want the other thing [advice]. And they think this [advice] is better.

46 In the above quote, the therapist is also expressing another dynamic: that of clients wanting some concrete gain from therapy.

In Mauritius, when we say, we have to go see a psychologist for counseling, we feel that counseling is about giving advice, and when I was doing my training, counseling is everything but advice. So, it's very different, and after a session like talking and doing your therapy, the patient or the client keeps on waiting when you're going to give advice. And when you don't give advice, [you’re] like the doctor not prescribing medications, and in Mauritius, if you don't prescribe medications, you're not a good doctor, just like the psychologist, not giving advice, [the client wonders] “well, why am I here?”

In the above example, the client and the therapist clearly had different expectations regarding what gains therapy could provide. What the client perceived as plain talk, the therapist perceived as process, catharsis, experiential or insight. What the client perceived as useful, the therapist perceived as not-therapy.

Another therapist who felt clients want both concrete and rapid gains, said,

“[clients] stop coming if they don't see results right away.” In both cases of clients wanting concrete and rapid gains, it seemed important to define the rules of therapy at the beginning of the sessions, and negotiate these rules as needed.

Beyond the fact that counseling was a foreign concept, therapists felt there are several reasons why clients seek rapid concrete gains. The data suggest several hypotheses. One hypothesis may be pragmatic financial reasons, “the lower-class people or middle-class people, sometimes they're helpless, they can't afford to pay.”

While there were free psychological services provided at the psychiatric state hospital, and at the Ministry of Women's Rights, and Child and Family Welfare, medical insurance did not usually pay for mental health care in Mauritius. One participant indicated that, “[clients] do not have time or resources to see a therapist for several years

47 once a week . . . However, they will keep coming if they are receiving those services through the government because it's free.” It is understandable that clients who pay out of pocket did not feel they have the luxury of several sessions to arrive to the answers they are seeking.

However, the data from the questionnaires do not support this hypothesis fully.

The means of the percentages of clients from varying socioeconomic status are 35% clients from lower class, 44% clients from middle class and 21% clients from upper class. From these numbers, no clear pattern emerged from the socioeconomic status of the client data. If money was the only issue, we would see the most clients from upper class, and the least clients from the lower class. Further, if we consider issues of representation, the lower class is over-represented, where 35% of clients are from the lower class, and only 8.3% of the population is lower class. Although less so that the lower class, the upper class is over-represented as well, with 21% of the clientele, when they form 14.1% of the Mauritian population.

Another hypothesis explaining why clients seek concrete and rapid gains is highlighted in the quote listed previously, which introduced the value clients place on advice. It seems that clients are applying a model that they know, namely the medical model to therapy. Their script for therapy may come from their script for a doctor’s appointment. One participant reported the following dialogue with several clients:

-Ou pas donne la moindre ordonance? -Non, mo pa donne médicaments. -Ah bon . . . -Non, bizin ale guette ène lotte doctère, moi mo conseille ou.

[Translation: -You don’t give prescriptions at all? -No, I don’t prescribe medications.

48 -Oh . . . -No, you need to go see another doctor, What I do is provide counseling to you.]

There is indeed confusion between the roles of medical doctors and therapists in the minds of clients. Feeling that it was the responsibility of mental health providers to prevent such confusion, and reflecting on the outcome of an eventful public debate about a mental health issue, one participant said,

[Le public a] commencé à se demander, mais c'est quoi la différence entre un psychologue et un psychiatre. Il comprenait pas très très bien . . . parce que, au départ, on était assimilé à des médecins. Et ça Dieu seul sait que les Francophones sont très très vigilants dessus, on n'est pas docteur, même si on a un Ph.D., ou un titre de docteur universitaire . . . pour éviter cette confusion justement pour les médecins et pour le patient. Notre approche n'est pas médicale.

[Translation: The public started asking itself what was in fact the difference between a psychologist and a psychiatrist. They did not understand it very well . . . because at first, we were seen as doctors. And God knows that Francophones are very careful about saying that we are not doctors, even if we have a Ph.D., or a title of doctor at a university . . . to avoid this confusion precisely for the medical doctors and for the patients. Our approach is not a medical approach.]

Certainly, it appears that differentiating mental health practitioners from doctors, and differentiating the psychotherapeutic context from the medical model is an ongoing process.

While there were negative perceptions of the field of psychology, there was also sometimes a misperception in the opposite direction:

On met la psychologie à toutes les sauces, de toutes les manières, ça peut résoudre tout, ça peut sauver tout, c'est un peu trop " bon dieu "

[Translation: Psychology is incorporated in anything, in any way, it can resolve everything, it can save everybody, it’s become a little too much “godlike”]

Beyond the Mauritian public, one participant points out that even the government and other overseeing authorities have an overly positive view of psychology:

49 Est-ce que les autorités savent ce que c'est qu'être psychologue? Ils associent la psychologie à tous les problèmes. Quand y a problème, il faut psychologie, c'est tout. Mais que doit faire un psychologue, ils ne savent pas.

[Translation: do the authorities know what it means to be a psychologist? They associate psychology with all the problems. When there’s a problem, psychology can solve it, period. But they don’t know what a psychologist should be doing.]

Increasingly, with time, Mauritians (both the public and the governing bodies) are

developing a better understanding of what psychologists can do for them.

De plus en plus, ils se disent, " vaux mieux une bonne consultation avec un psychologue, j;ai un avis sur mon enfant plutôt que le problème continue, je ne sais pas combien de temps. " Et ça, c'est nouveau, hein, j'en ai de plus en plus, des gens qui préfèrent venir parce que je sais que le psychologue va pouvoir me dire, ce qu'il y a. Et à partir de là, je prendrais une décision, est-ce qu'il faut que je retourne?

[Translation: More and more, they are telling themselves, “better a good consultation with a psychologist, I’ll have an opinion on my child rather than have the problem continue for I’m not sure how long.]

Efforts to Organize an Association

All participants agreed there was a need for an association. One of the main reasons related to licensure issues.

When I wanted to register to practice, there were no laws for me to register. My degree was not even mentioned in it. And psychologist, you had to be a Ph.D. from Stanford or Harvard, any other one, you can't register 'cause it's not on their list.[laughs] So there's lots of things to do!

The majority of participants mentioned the lack of regulation of the terms psychologist, counselor, or social worker.

Part of the problem is that here, there are no regulations about who is a psychologist. Some people practice with a B.A., and a lot of them go to the educational system, which means they provided therapy and assessment services in schools. The issue of qualification is central to the debate. People felt that their level of education was the

50 minimum required to be able to practice, regardless of whether it was the equivalent of a

Bachelor’s degree, a Master’s degree, or a post-Master’s degree.

Quelqu’un ayant une licence pouvait mettre une plaque devant sa porte se disant “psychologue et psychothérapeute” . . . les autorités comprennent que dalle

[Translation: Someone with a bachelor’s degree could put a shingle up saying “psychologist and psychotherapist” . . . the authorities do not have any inkling of understanding]

Those mental health professionals who felt they had adequate qualifications were worried about the image of the profession that could be damaged by people who did not have appropriate qualifications to perform the job.

One of the ways to address this issue has been to try to organize an association.

One participant reported wanting to do so since the 70’s after returning to Mauritius.

Over the past 30 years, the idea had resurfaced and disappeared several times. More recently, over the past two years and a half, one association was created, and it is called the “Société des Professionels en Psychologie.” The name of the association does not contain the word “psychologist” on purpose. The members felt that there were several qualified mental health professionals, not all of whom were trained in a psychology program. Given that there were not many mental health practitioners in Mauritius, the members decided to have a broader membership base. At the time of the study, the requirement for membership was to have the degree and practice requirements enforced in the country in which the person studied. Generally, it was the equivalent of five years of study, with one year of practice. The members felt that the association, along with the Code of Ethics they established, modeled after the French Code of Ethics, was “solid

work.”

51 However, the creation of this association led to different reactions from non- members. Some people criticized the fact that this was not an association of psychologists:

C’était une manière de ‘accommodate’ people mais c’est très ‘misleading’ parce que quand on voit l’association des métiers psychologiques, ben pour une personne qui n’est pas dans le domaine, ben pour lui, c’est des psychologues

[Translation: It was a way to accommodate people, but it is very misleading because when you see the association of the vocations in psychology, well, for someone who is not well versed in the field, it means an association of psychologists.]

Here, it seems that the integrity of the psychology profession is what is at stake for this participant.

Other people felt this association was a small “clique” of people who were mostly educated in France. At first, vague comments were made such as, ‘I prefer to stay away from all this.” However, when I brought up issues of division during the member check, everybody had something to say on this topic. The members of the association felt that the people who were complaining were those who were not able to join the association because they did not have the proper qualifications and were retaliating. The people outside the association felt that the association consisted of people of a few ethnicities and was not open to all.

These divisions are very important as the association is trying to formalize licensure regulations. Passing a bill in parliament would require as much of a unified voice as possible. Further, the process is currently alienating people, who feel that the association is a small clique, rather than bringing people together, and may predict a difficult future for the association.

52 Multicultural Counseling Competencies

Perceived Adequacy of Training

The following description of the practicing psychologist training components as

practiced in Australia, France, India, the United Kingdom, and the United States

provides background knowledge for the reader. The descriptions are based on the

experiences of the participants who studied in these countries, so that only a description

of their degrees will be represented. Further, the training for a counselor and a clinical

social worker in the United States will be described.

In Australia, the degree required to be a practitioner in psychology is the

Master’s degree, which can be a total of four years. The Bachelor’s degree takes three

years, where the first year focuses on theories, and broad introduction to psychology.

The second year focuses on research and some specialization. The third year offers

practica and research. Finally, the Master’s degree takes one year and focuses on

research.

In France, the practitioner degree for psychologists includes a total of five years of training. “The Diplôme d’Etude Universitaire Générale” (D.E.U.G.) takes two years and is the equivalent of an Associate’s degree in the United States. The “Licence” takes an additional year and is the equivalent of the Bachelor’s degree. The “Licence” provides a survey of the areas within psychology. Except for one participant, practicum opportunities start with the Master’s program, which they call the “Maîtrise.” The

“Maîtrise” takes one year, and they are placed in one to two practicum sites while taking courses and writing their thesis. Those interested in research would pursue a “Diplôme d’Etudes Approfondies,” followed by a “Doctorat,” which is the equivalent of a doctoral

53 degree. Those interested in practice choose a “Diplôme d’Etudes Supérieures

Specialisées” (D.E.S.S.), which requires one year. Again, students have courses and a practicum.

In India, the Master’s degree is also required for practitioners, for a total of five years. The Bachelor’s degree takes three years, with broad introduction to psychology in the first two years. In the third year, students choose a specialty. The Master’s training takes two years, which includes research and practitioner training. During the second year, students choose two of the following specialties: clinical, organizational behavior, cognitive and childhood and ageing. They also do an internship at a psychiatric hospital if they choose a clinical specialization.

In the United Kingdom, the first three years were more theoretical and provided a broad introduction to psychology, with some practice sessions starting the first year, once a week. The practical part intensifies through the second year, when students are videotaped. During the third to the fifth, year, the students participate in practica several times a week.

In the United States, the degree required for a practitioner degree in psychology is the doctorate degree, which takes about nine years. The Bachelor’s degree takes four years, with a broad introduction to psychology, and a liberal arts education. The

Master’s degree takes two years, and is often a combination of research and practitioner training. Practica start at the Master’s level. The Ph.D. takes three years, and requires dissertation research, and practica, including a one-year full-time internship.

Two other degrees which are recognized for mental health professionals are the

Master’s in Social Work (MSW), and the Master’s in Counselor Education (MCE). The

54 MSW which focuses on clinical social work, provided courses and much emphasis on practica and minimal emphasis on research. The MCE also focused on practical training.

The theoretical orientations taught in the English-speaking-countries were similar. In these countries students gained training in the following types of psychotherapy: psychodynamic, cognitive, behavioral, and humanistic. In comparison, the predominant theoretical orientation within the French system was psychoanalytic, and those participants were trained in the tradition of Freud or Lacan. While they did receive some exposure to other types of psychotherapy, they did not spend much time on these areas. Participants who studied in France emphasized more that they were strongly encouraged to seek psychotherapy during their graduate training. Participants who studied in other countries were also encouraged to seek psychotherapy, but with less emphasis.

All participants were satisfied with what their training taught them because their training taught them the basic skills needed for practice, one of which was “to learn, how to teach myself.” Even when they thought that their training did not prepare them for some of the Mauritian realities, the following quote reflects the general sentiment:

There were times where I got stuck. I didn't blame it on my training, I didn't feel that it was the training that was lacking. They could only give me an amount of information [in a limited amount of time].

A variant finding was that participants sought out training on cultural issues specifically because they thought it would be helpful when they return to Mauritius. For example,

55 one participant explained, “I thought it wise to study ethnology because I knew it would

be helpful in Mauritius.”

This process of mental health professionals teaching themselves once they

returned to Mauritius had many similarities. One participant described empathy as such a

similarity,

I've not invented any new tool, but I'm innovating with the tools, I'm using a lot of common sense but my guiding principle is "understand people from within."

The importance put on the client in this process of adaptation seemed shared by all

participants:

Bon, les outils sont là comme tremplin, mais il faut les dépasser. C'est la qualité d'écoute qui est primordiale.

[Translation: well, the tools are there as a starting point, but you need to go beyond that. It is the quality of how you listen that is of primary importance.]

Empathy at the deepest level is crucial in the process of adapting tools to a new culture.

In fact, “the genuineness of interest in people is part of the process, part of the healing process much more than the techniques,” as one of the participants pointed out.

Cultural Competency

This empathy required some knowledge of the new culture, so that the mental health professional could indeed understand clients from their perspective.

A lot of things which work in the US, would work here, but a lot of the things which work there doesn't work here, and a lot of the things which work here doesn't work there. And I think as professionals, we need to be what I call very sensitive to the element of culture, symbol, [and] religion.

Indeed, one participant was very clear that the type of psychotherapy practiced in one country fit the culture of that country:

in the school where I studied it was mostly Freudian dominant…but I think these things work when there is a thinking-dominant society or Cartesian type of 56 society, maybe like French culture. These things do work but in the States, I experienced the world of feelings. In France, everything was very logical, very clinical, very detached, very analytical, whereas in the States, the focus was much more on empathy

And if the therapist did not have the knowledge a priori, then,

we have to learn from what people have to tell us, and one of the things that for me, leads to multicultural counseling competencies is the fact that you need to ask the client, you need to give the client the opportunity to teach his or her culture to you.

The concept of cultural competency was crucial. One example illustrated how important

the knowledge of the client’s cultural context was

in Mauritius…because of the predominant superstitiousness, you ask somebody to talk to an empty chair, they might have a belief that I may upset the spirits that way, things like that. So, it means before implementing any technique, we need to really look at the cultural implications.

The belief that spirits can affect our lives in good and bad ways is part of Mauritian culture. People have several ways to ward off bad spirits, and to avoid upsetting them.

Such elements of Mauritian culture which need to be considered in therapy will be discussed further in the section on shamanism.

It appears that understanding cultural issues enhanced the credibility of the therapist,

“When I talk to a Hindu, Muslim or a Creole family, I use different words. For example, I use Urdu words with Muslim clients and I talk about “Allah’s wish.” People then respect and believe you.”

The clients would then feel that the therapist understood their worldview and that the treatment plan would therefore be adapted to their needs and adapted to their environment.

Je crois que c'est très important d'avoir une ouverture d'esprit pour comprendre tout le fondement social et culturel d'où émane le fonctionement particulier de l'individu, hein parce que la personne est impregnée de ça . . . mais je crois 57 pouvoir dire que tout en tenant compte de ces grands principes qui régissent le comportement humain a l'intérieur de ces paramètres [culturels], je crois pouvoir dire que les concepts psychologiques avec lequels nous travaillons peuvent quand même s'adapter, et peuvent quand même aider la personne a trouver peut-être un juste milieu . . . parfois, il y a des dysfonctionements liés à justement une trop grande imprégnation de ce contexte où l'individu est tellement englobé dans . . . la société, dans la famille, que justement parfois, il y perd son identité. Bien que cette identité est toute relative, parce que la notion de l'individu dans ces sociétés là est conditionée par d'autres critères que les nôtres, mais tout en tenant compte de ça, je crois que les conseils psychologiques avec lesquels nous travaillons peuvent aider la personne, qui tout en restant dans ces paramètres là, peut trouver un juste milieu à ce moment là entre son milieu et puis, et bien, une place pour lui-même, tout en ne rejetant pas et en ne se marginalisant pas de sa société.

[Translation: I believe that it is very important to have an open mind to understand the whole cultural and social foundation, from which the functioning of each individual is derived, because the person is impregnated by it . . . but I would say that while taking these principles that govern human behavior within these cultural parameters, I would say that the psychological concepts with which we work can be adapted, and can still help the person find an equilibrium . . . Sometimes, there are unhealthy functioning linked specifically to an over- identification with this context, where the individual is so immersed in . . . the society, in the family, that he sometimes loses his identity. Even though the notion of identity is relative, because the notion of the individual is determined by criteria that are different from ours, but still, while taking that into account, I believe that the psychological techniques with which we work can help the person who, while remaining within his parameters, can find an equilibrium, so that he has a place for himself while not rejecting his society, nor marginalizing himself from it.]

In the above quote, the therapist is pointing out that in any culture, excess can lead to mental disorders, and that mental health professionals had to work with clients to strike a balance that would reduce the excess while remaining connected to one’s community.

This participant felt that using Western psychological techniques with an open mind would be useful to the client.

One participant pointed out that those professionals who did not understand the element of culture were not successful practicing in Mauritius, and left subsequently.

58 They come, they try, they start, it fails, they are unable to build a clientele and they go back because their frame of reference, their training suits a certain setup but it's not going to click because they don't make that extra effort. You don't have to espouse the religious beliefs of people but you've got to understand the critical path…of how that individual constructs his world and his rapport to this world.

The above quote added another layer to how culture can be incorporated in adapting techniques within therapy. It was important not only to understand the cultural context, but it was also important to understand how individual clients related to that cultural context.

Mauritian Context and Cultures

This section describes the elements of Mauritian culture that therapists considered when adapting to the Mauritian context. When I asked participants this question, they all felt the question was too broad and shared the sentiment that, “it's difficult to talk of

Mauritian culture, we should be talking of Mauritian cultures.”

Comparing Asians (including Hindu Indo-Mauritians, Muslim Indo-Mauritian, and Chinese Mauritians) to Creoles3, one participant said,

compared to the Asian from the same low middle class, the Catholic lower class, it's easier to do counseling with them. I don't know why, maybe because they go to the church on Sunday…they're ready to listen, there's the philosophy there, they know what [psychotherapy] is all about. The Asian, it's different, they just come for advice, “why are you so quiet? Why don't you talk?” things like that. And…they just want quick results; they don't really know what [psychotherapy] is all about.

This quote was about cultural proximity (Hofstede, 1980) where culturally, Creole culture is closer to Western European culture which gave birth to psychotherapy. As

3 In Mauritius, Catholics refer to Creole Mauritians, due to the religion of this ethnic group. However, the communities in which catholicism is the main religion include European Mauritians, Chinese Mauritians and the “Tamoules Baptisés [translation: baptised Tamils].” The term that includes this broader group of Catholics in Mauritius is “Christian.” 59 speculated by the participant, religion played a role, and brought us back to the history of

slavery, when colonizers stripped enslaved Africans of their culture, using religion as one

of the tools to do so. Having had their culture taken away from them, Mauritian Creoles

were left with the culture of the colonizers, so that they are nowadays culturally closer to

Western European culture, compared to Asian Mauritians who immigrated and did not

have to face such a severe and programmed deculturation process.

Another observation based on this quote was the similarity with what the

literature said about therapy with Asian Americans (e.g., Root, 1998). Here, the

importance of being more directive and active at the outset of the therapy process seemed

to apply to both Asian Americans and Asian Mauritians. This spoke to the similarities

among diasporic Asians, and might suggest that the literature on providing services to

Asian Americans could be helpful when applied carefully to Asian Mauritians.

When speaking more specifically of Hindu Indo-Mauritians, therapists saw marriage as the salient concept within this community (typical finding). Specifically, arranged marriages are more common within this community, and one therapist shared the comparative research he did on marital satisfaction:

[for] those who had love marriage…the marital satisfaction dropped just after the honeymoon, [and kept] falling up to five years, compared to those arranged marriage, after the honeymoon, it doesn't really grow but it's stable for the next five years. Sometimes there has been a growth, I don't know, but it's more stable, the courtship after the marriage, things like that. So, the culture was really important and I compared my study with one study done in India I think, it was the same results. Before I thought…that the marriage satisfaction would be higher for love marriages.

This participant speculated that the expectations of the couple who had an arranged marriage were very different from those of the couple who had a love marriage. Since

60 satisfaction is heavily correlated with expectations, it explained the differences in the findings.

Marriage was also a salient issue typically mentioned by therapists when talking about the Muslim Indo Mauritian community.

Issues of marriage, for somebody with Muslim background, somebody from Christian background, we're not talking of the same thing. The rapport between men and women can be much more advanced in people coming from Islamic background than in people coming from perhaps…you can be surprised.

Here, the participant addressed a stereotype that within Muslim couples, the was subordinate to the man, and shared that in his experience, this was not the case. Although he did not refer to Christians explicitly in his last statement, the person felt relationships within the Muslim community to be even “more advanced” than relationships within the

Christian community

When speaking of Creoles, therapists typically saw the long lasting impact of slavery as an issue for this community,

the Creoles are portrayed as you know lazy . . . but when you study racism and the impact of racism, you understand why they're that way, they got nothing to hang on to . . . The Hindus . . . could hold on to their tradition and their religion, that's why it's easier for them to go up the ladder, the cultural and social ladder and it's easy for them to have a culture of education that the Creole don't have. They don't have a base and you can't even blame them. That doesn't mean it's an excuse for what's not happening to them . . . But as a group, it's understandable that they're the ones who are poorer and would go for the show-off and would go…it's been built-up from what had happened to the culture itself, their absence of culture.

This participant pointed out a stereotype of Creoles, and explained it from a historical perspective. Again, it seemed that aspects of the Creole Mauritian culture were similar to

African American culture, probably due to a similar history of enslavement and forced migration. Therefore, the literature on therapy with African Americans might be helpful

61 when applied carefully to Creole Mauritians. One therapist conceptualized this as “stolen

identity of a group [which led to] fatalism,” and felt it was “important for Creoles to

reclaim that identity, in order to improve their self-esteem.”

Another issue within the Creole community mentioned by one participant, was

that of colorism, where those with lighter skins were of a higher socio-economic status,

and tended to stay among themselves,

Les créoles clairs restent entre eux, aussi, beaucoup. Et je vois ça parmi les jeunes aussi . . . Comment est-ce que les gens peuvent continuer à vivre comme ça, sans que ça leur pose question?

[Translation: the light-skinned Creoles stay among themselves, quite a lot. And I see that among the young generation too . . . how can people continue to live like that without wondering whether this makes sense?]

Colorism, term borrowed from the literature about African Americans (e.g., Hughes &

Hertel, 1990), is also a legacy of slavery and it is even more overt in Mauritian society than in the United States.

Within the Chinese community, one mental health practitioner shared the perception that “they won't ask for help, it's very rare that they ask for help and boy they're in need, but the whole society is very much in need.” When they do seek therapy, the therapist reported that they “are completely closed up and it's hard for them to open up and get to talk about feelings. They're just not used to it.” Again, we see similarities with the Asian American literature, where expressing feelings to a stranger can be quite taboo within diasporic Chinese communities.

Within all communities, mental health professionals typically saw issues of socioeconomic class,

62 ceux qui ont pas réussi ne peuvent pas fréquenter [certains lieux]. Pareil pour les mariages tout ça, ils voudraient pas qu'il y ait ce mix du tout. Si ça arrive, peut- être qu'ils pourront pas faire grand chose. Ça existe, cette catégorisation aussi à l'intérieur [des communautés]

[Translation: those who did not succeed are not allowed to be seen in certain spaces. Same for marriages, they would prefer that there is no such mix. If it happens, they may not be able to do much about it. It’s there, this categorization within the communities.]

However, those who are part of the educated professional middle class do socialize across ethnic lines to some extent.

Cette classe moyenne là ne regarde pas trop les couleurs . . . se fréquente dans les mêmes boîtes de nuit, dans les mêmes clubs privés. Donc, c'est une classe qui est catégorisée par le côté réussite professionelle . . . Ils ont toujours leurs références communautaires, mais ils acceptent de se fréquenter

[Translation: This middle class does not pay too much attention to color . . . its members socialize in the same nightclubs or private clubs. So, this is a class that’s grouped together because of their success on the professional front. They still have their ethnic references, but they accept to socialize with each other.]

Another participant felt that a specific aspect of socioeconomic status, namely level of education, was really what determined differences among his clients,

I think it's more about the education because the Chinese, the Muslim, Indian people or other people in Mauritius, the difference is not that huge . . . because they have been living in [the same Mauritian] society, especially the generation after, those coming from other countries . . . When I got a patient who is well educated, university patient or secondary school patient . . . I could do my counseling like I learned in the UK; I could apply even cognitive therapy. I couldn't explain cognitive therapy to those who didn't go to school . . . it was difficult for them to do the homework, it was difficult for them to understand the self-awareness and all this stuff.

Education level determined the applicability of certain types of therapy. The fact that psychotherapy that works within Western cultures also works with the group who had at least thirteen years of education suggest that secondary or tertiary education made clients culturally closer to Western culture. In fact, the Mauritian education system is modeled

63 after the British education system for the majority of the schools, and modeled after the

French system for the other schools.

Another diversity issue that only one participant brought up was that of disability, using the example of educational services, “the concept of treating all treating all children the same in the classroom doesn’t work.

Colonization and Neo-Colonization

The above quote brought up the issue of the continuing effects of colonization.

When Mauritius obtained its independence from the United Kingdom, the country kept the British education system. After their tenth and thirteenth year of schooling, students take the Cambridge School Certificate exam, and the Higher School Certificate exam respectively. Cambridge University in England prepares these exams, as well as the curriculum taught in schools to prepare students for these exams. This education system trains Mauritians into a Western worldview, which may help explain the difference in the applicability of specific psychotherapies.

Colonization continues to have several effects on the Mauritian society, including people finding that “everything that's foreign is beautiful. In America, what's foreign is scary, here no, it's better.” Along similar lines, marrying a White foreigner reflects well on a family; however, marrying outside one’s ethnic group is considered a disgrace for the family. Speaking about a Hindu Indo Mauritian who married an English woman,

si ti marie ek ene tifi creole, ti pou laguerrre pou empesse li. Mai la ba, ine pren ene Anglaise, alor, sa l'epok la, zot ti pense ene Anglaise, ti ene gran zafere,

[Translation: if he had wanted to marry a Creole woman, they would have fought to prevent him from doing so. But over there, he married an English woman, so at that time, they thought marrying an English woman was prestigious]

64 It seems that Mauritians prefer a White foreigner to another Mauritian who is not from

the same ethnic group, which says the extent to which our minds have been colonized.

One participant worried that “ene vrai culture pena parski tou se ki dehor nou pren pren!

[Translation: we don’t even have a real culture because everything that comes from

abroad, we take in!]” However, another participant feels that this state of affairs is

changing, “I think there was more of a craze before when everything that came from

Europe was good for example. Now, this is not as much of a craze.”

Another way in which colonization continues to affect Mauritians is in a type of

submissiveness. Answering a question about how colonization affects people today, one

participant said,

Je pense que quelque part, il y a quand même une certaine soumission, . . . parce que les patients que je vois, bien souvent quand ils ont des problèmes, on voit beaucoup plus le côté apathique . . . ”bon ben, pourquoi faire?” Ils sont bloqués quelques fois . . . à trouver les ressources en eux-mêmes, pour se débattre. Je pense que ça, inconsciemment, c'est resté.

[Translation: I think that somewhere, there is a certain submissiveness . . . because the patients that I see, very often, when they encounter problems, we see more the apathic side of them . . . ”well, why bother?” They’re stuck sometimes, they have difficulty finding the resources inside themselves, to fight. I think that unconsciously, this has remained.]

It appears that the lasting effects of colonization affect our mental health and resiliency.

This observation contradicted a previous quote from a participant who felt that in

Mauritius, due to the stigma and costs, people were very motivated by the time people decided to come to therapy. This discrepancy might be explained by the fact that the mental health professional who saw motivated clients was in private practice, whereas the other professional worked in a public institution. The difference may be due to the differing socioeconomic status of the people who sought services in those two settings.

65 Broadening how the submissiveness could be seen, not only at the individual

level, but also at the national level, another participant said,

On est un pays colonisé . . . je crois qu'on est un pays qui a du mal à s'assumer seul. On a toujours besoin de big brother derrière pour pouvoir se dire qu'on existe, et je trouve ça dommage parce qu'on aurait pu être quand même assez . . . être Mauriciens! Sans être forcément Américains ni Européens. On pourrait avoir cette particularité-là qui fait quand même notre richesse.

[Translation: We are a colonized country . . . I think that we are a country that has difficulty to stand on its own feet. We always need big brother to support us to be able to tell ourselves that we exist, and I find that too bad because we could have been rather . . . we could have been Mauritians! Without necessarily being Americans nor Europeans. We could have that particularity which contributes to our richness.]

Another participant felt that part of the problems we had as a nation comes from the fact that we have forgotten how to dream,

You hear about rape, murder and crime, these are symptoms of a deeper issue. This country is not helping people to dream. We're talking about maintenance, not mission or vision. We think any job will do, we're not concerned about a vocation. We definitely need to train people here, to inculturate it to the local context.

The last statement links culture to the ability to have aspirations, or lack thereof.

Connecting the dots, one might speculate that knowing one’s culture leads to a firmer cultural identity. This firm base of cultural identity then allows people to have aspirations and to dream.

The line between colonization and neo-colonization can be blurry. We get media from countries that were previous colonizers for example. Through media, we get exposure to other cultures, primarily Western cultures, and because we have an inferiority complex as addressed previously, we are more likely to want to change to conform better to the images we see through the media. One participant gave the example of young people who “don't' realize that happiness depends on themselves. Here, with media, TV, 66 etc, people are in love with the feeling of being in love, especially teenagers.” Pushing

this point further, another participant expressed his opinion about Mauritian youth,

It's a new era, where they're engulfed by modern technology. I think teenagers have trouble separating themselves from the heroes they see in the media. They are unable to be "I." This…trend [is one] that professionals have to go into if they are to be able to describe what is going on.

This quote is echoing a participant’s sentiment depicted at the beginning of this chapter

about how the lack of identity is affecting youth.

Another consequence of neo-colonization includes Mauritians’ increased valuing

of individuality, which brings some of the following consequences, for example, “the

concept of collaboration is getting eroded. Now, people are more into competition

against one another. There is a disparity between the haves and the have-nots. There is

less trust.”

Proposing how to address the issue of neo-colonization, one participant suggested

the following,

In today's society, we have the dilemma of having a culture and moving towards a new culture. And talking about colonization, Fanon saw the extent of deculturation and for him, the answer was to throw away colonizers. Today, we live in a neo-colonial world where Mauritian leaders have adopted a similar stance. With globalization, we're expected to go beyond this, maybe with a different approach. Instead of dominants and dominees, we should look more a strata structure with horizontal categories, as well as vertical categories. So, in one category, I may be more privileged than you, but less so in another category. This will lead to a more open and complex understanding of society . . . Maybe, we can use part of what Fanon said, and transcend by listening.

Rather than a simplistic understanding of oppressors and oppressed, this participant

suggested that we look at issues of power in different contexts, and varying degrees of privilege. Intersections of those contexts would also be crucial to our understanding of the Mauritian society, which would allow us to propose a different vision of the

67 Mauritian identity. The bridge during this process would be listening to other people’s

experiences.

Not all participants agreed on issues of colonization and neo-colonization. Below

are opinions expressed by individual participants. For instance, another participant felt

that while we were subject to outside influences, we did maintain a cultural core, an

identity,

there is an evolution . . . with internet, with television, satellite television, the wide exposure to multimedia and so on and so forth, people are exposed to other walks of life, other trends, other currents, and it does influence, but there is a core of…a rich cultural core.

Another participant felt that we could learn from studying in Western nations, especially

on issues of racism,

le seul, on dirait le ballon d'oxygène, . . . quand tu as des jeunes qui vont étudier à l'extérieur, qui reviennent avec un peu d'ouverture d'esprit,

[Translation: the only breath of fresh air is when there are young people who go to study abroad, and come back with more of an open mind]

In this case, the participant is pointing out that we also gain through contact with the former colonizers. While this person referenced Western nations when making this comment, it made sense to the participant that any experience with cultures outside of our realm of experience led to broadening of one’s horizons, which led to an increasingly open mind. Balancing the broadening of one’s mind and being willing to envision change in one’s own country, while finding strength in the cultures within the motherland is the challenge that Mauritians who study abroad face.

Another positive impact of neo-colonization cited by a participant was the fact that media provided a vehicle for useful information,

68 je trouve que ça fait plus de bien que de mal, c’est-à-dire que ça amène quand même de l’information. Si on a autant de patients aujourd’hui dans les ministères, c'est quand même qu’il y a une certaine information qui passe, et que y a pas plus d'enfants abusés aujourd’hui, c'est beaucoup plus dit aujourd’hui.

[Translation: I find that it does more good than harm, that is, it diffuses information. If we have so many patients nowadays in the ministries, it is because there is at least some information that is being transmitted, and the fact that there aren’t more abused children today, it’s because people speak up more nowadays.]

While previous quotes addressed how this tool, the media, did much harm, this participant is addressing how the media can also be used as an empowering tool.

However, we have to be careful of how we address issues of domestic violence given the different cultural context.

The Concept of Family, Domestic Violence and How to Raise Children

All participants mentioned how the concept of family is different in Mauritius, as opposed to where they did their studies.

La psychothérapie là-bas, c’est adapté pour une culture . . . avec une certaine mentalité, un certain style de vie que les gens ont là-bas, et ici, c’est vrai, j’ai du, m’ajuster au contexte mauricien. Tu sais, à Maurice, tout est famille . . . Ici, il faut comprendre la dimension familiale, c’est très très important. Parfois, je vois une delegation d’une famille qui vient, seulement pour une personne . . . j’apprécie aussi la demarche de l’individu, j’apprécie aussi la demarche familiale.

[Translation: Psychotherapy there, it’s adapted to a culture, with a certain way of thinking, a certain way of life and here, it’s true that I had to adjust myself to the Mauritian context. You know, in Mauritius, everything is about family . . . Here, you need to understand the family dimension, it’s very important. Sometimes, I see a delegation of a family who comes, only for one person . . . I appreciate the individual initiative, I also appreciate the family initiative]

In the above quote, the family is expressing, through accompanying the client, that they want to be part of the person’s treatment, and suggests that it may be helpful to incorporate them more into the treatment plan. While biological families are certainly

69 important, a typical finding was that Mauritians understand family in a much broader way. A proposed definition to expand the term family beyond biological ties follows:

Very often you would be dealing with what I call the "community" type of family. It's even larger than the extended family, it's not, you're not living only with your in-laws, or your father, , brothers and sisters. They all get married and they flock around, but there is a community 'cause you see, the great uncles, the great aunts, some people have four or five grandmothers in Mauritius. People that you know, have been enthroned or ordained as grandmothers, and they are everyone on the same par, and the techniques there won't apply here

Family therapy took on a different dimension given the above understanding of family.

Implicit within this quote was the “respect for elders,” the great-uncles, the great-aunts and the grandmothers, which is very important in Mauritius. Further, another participant described other factors to take into consideration when working with a family, such as,

“are they an open family? Are they a closed family? Are they traditional or very…people have traveled a lot in the family or not? . . .You have to know the background.”

Given the understanding of the common concept of family in Mauritius, therapists reported many problems in interethnic couples. Often, they are Mauritians who met someone while studying abroad, married that person and they came back to live in

Mauritius together.

As long as they were overseas, the marriage was beautiful, but once they come back here, God, they don't recognize their husband, 'cause their husband comes from a community type of family. He could adjust to an individualistic type of society thinking on his own, making his own decisions with his wife, consulting his wife, but when he comes back to Mauritius, poor wife she doesn't understand why he's always consulting with his sister, he's always consulting with his mother, he's always consulting with cousin X, cousin Y.

70 In this case, mental health professionals trained in Western psychology were actually in the helpful position of understanding both cultures, so they could help broker compromises that were acceptable to both parties.

In cases of domestic violence, there were additional considerations of which the mental health professional needed to be aware, such as the fact that

they have to live in the same country, and it's small, and in the same town. And family is so important that you can't just split. Family is not that important in America. They can find a new job on their own merit, here they can't. You will be a culprit by the rest of society, the rest of your life, even if they don't know your family, so things like that, so there's the island culture, family problems and culture.

Working with someone who is within such a dynamic can be very difficult. There are laws regarding domestic violence and they are enforced, but the stigma of having had a divorce is still very strong in the country, although this is changing over time.

In cases of child abuse, one participant shared the changes that the Mauritian system has implemented, and personal thoughts about the long-term effects of these changes:

say in situations of child abuse. In some schools [abroad], especially when the abuse is sexual, when we would go, for clear separation between the abuser and the abusee. In Mauritius, it can work, maybe with people of higher education, but it will never work with people of lower education. You can't work alone in that process. You've got to network with social workers, you need to network, I think like everywhere, with medical people and so on and so forth. And there is a tendency in Mauritius now to really create the maximum of distance, between the parent abuser and the child abusee. But I can tell you that it makes things worse in the end, because it raises the anxiety level in many of those children, because now the family is split because of the economic situation, the family is getting poorer. "If I had not reported that, mum would have been happy." and other members now harassing the victim. So, I think there needs to be a much more comprehensive approach...

71 Although the participant did not frame it in such terms, the debate was about the implications of implementing Western policies on child abuse without an understanding of the long-term impact of such policies. This ethical dilemma comes up in many policy changes in Mauritius, where advocates of a particular change cite precedents in industrialized Western nations. While the intention is usually good, in this case stopping a perpetrator from abusing a child, what works in other countries fit their cultural context, which is different from the Mauritian cultural context. As the participant candidly acknowledges not knowing the definite answer, nobody does. There is no way to resolve this ethical dilemma, and the best way to serve the people whom the policy changes hope to serve is to put much forethought into the process. Perhaps research from other former colonies that have attempted similar policy implementation could be helpful if it is available,

The following participant’s comment also showed how Mauritian mental health professionals were asking themselves questions about the applicability of Western concepts to the Mauritian context, here in the case of raising children,

La culture occidentale prône que l'enfant ait sa chambre dès la naissance, si jamais il passe un peu trop de temps avec ses parents, ça devient un peu pathologique . . . Si on applique cette culture là ici, ça veut dire que 75% de familles mauriciennes sont pathologiques. Bon, evidemment que non.

[Translation: Western culture advises that the child should have his own room from birth, that if he spends too much time with his parents, then it’s considered pathological . . . If we apply that culture here, it would mean that 75% of the Mauritian families are pathological. Of course not.]

The participant was pointing out that sharing a bed with your parents through preschool age was considered pathological in one culture and normative in another. However, she continued by noticing the difference in maturity level,

72 Mais on peut quand même voir qu’il y a une différence de maturité entre les deux cultures . . . On ne reconnait pas la personnalité de cet enfant, alors qu'il en a une dès un an, et qu'il peut l'exprimer. Donc, ça contribue à ce que lui ne sente pas le droit de parler en son nom.

[Translation: But you can still see a difference of maturity level between the two cultures . . . We do not acknowledge the personality of this child, even though he has one since the age of one, that he can express. So, this contributes to the child not feeling that he has the right to speak for himself.]

Here, it seemed that children raised within the Western culture were better off, and were more psychologically healthy. How to integrate these often contradicting pieces of information is the dilemma that all mental health professionals encounter, as they are sifting through which concepts from their training do apply to various Mauritians cultures, while not minimizing mental health problems under the guise of culture.

Several mental health professionals felt that the way Mauritian children were raised could lead to mental health problems in the future. The above quote spoke to the importance of self expression. Another participant made a related observation about how

parents assume that the child cannot hear certain things,

A un moment donné, les parents peuvent dire, " Voilà, je voudrais vous dire des choses sans l'enfant." Or c'est des choses qu'on peut très bien dire devant l'enfant, donc, je fais re-rentrer, et puis on lui demande de redire la même chose parce que ça concerne l'enfant.

[Translation: At some point, the parents can say, “well, I would like to tell you certain things without the child present.” It turns out these are things that you can say with the child present, so I bring the child back in and ask the parents repeat the same thing because it concerns the child.]

There was a tendency within the Mauritian culture to minimize the ability of a child to understand certain issues.

Another participant pointed out how “in my education, we were always criticized,” which can affect self esteem. Further, this participant described her process

73 of “learning to give compliments, to give positive feedback. And that has worked well

here too now, very well.” This change is an example of taking what is good from one’s

training and finding that Mauritians respond well to positive feedback.

Belief Systems, Religion and Shamanism

Belief systems were another topic that therapists felt were salient in their work

because such systems underlie much of how Mauritians view families, view the proper

way to raise children, and view spirituality. One therapist pointed out that “beliefs are

not necessarily religious. I can believe that the work should be done diligently, with

much proficiency, it should be professional. These are all other types of beliefs about

work.” In counseling, it was therefore important to have such an understanding of the

client’s belief system,

The color of the skin can be the same, but the reading of the event, the reading, the understanding can be [very different], usually in my first interview with people, I would always probe how the belief is articulated, the belief system.

This mental health professional felt it was important to assess those beliefs early in the therapy process. This was a typical finding.

In Mauritius, the religious belief system is central to the culture. In fact, “in

Mauritius, a lot of the techniques that you can learn in your schools are not applicable because I think there is an overdominant aspect of the symbolism, culture, religion which we have to understand first.” All mental health professionals agreed that “spirituality is something you've got to get in Mauritius.” They did have different approaches in working with issues of spirituality. One participant always checked with clients who were religious whether they went to see the priest, the imam or the pandhit for example.

This person felt the goal of the question was two-fold. First, if the clients did draw

74 strength from their religion, the mental health professional could encourage accessing this resource. Second, the use of the appropriate language based on the client’s religious practices (i.e., using “priest” for a Christian, and “imam” for a Muslim) helped the clients feel understood in all aspects of their lives.

Typically, mental health professionals saw religion as a strength, recommending clients to talk with their spiritual leader if appropriate. One participant framed why religion is so helpful to clients in terms of irrational beliefs,

I find that people who are spiritual have much less psychological conflict. For example, if you take Ellis' irrational belief of "this shouldn't happen to me," you find that people who are religious are more likely to believe that things happen to them for a reason, and that there is a greater being taking care of them. So, it is easier for them to accept a difficult situation. People without a meaning in life find it harder to adjust. If you think that someone has your back, it helps you.

This therapist also saw religion as a “protective factor” from mental disorders to some extent explaining that “the more people believe in a higher being, and have a strong faith, the easier it is for them to deal with problems.” Another therapist who also used religion in her practice cautioned that it was important to ask the question, “is it really a strength for them or is it really like a damage, the guilt feeling thing.” Depending on how clients view their religion, she would address the issue accordingly.

Another aspect of spirituality which is very present in Mauritius is what fits under the broad rubric of shamanism. All mental health professionals felt that their training did not prepare them to treat clients for whom the etiology of their disease was from evil spirits.

I don't think my training prepared me to listen or to deal with people who find . . . the spirits of evil, and who interprets sickness or diseases as a curse or as some kind of charm that is sent to them.

75 It was not simply evil spirits acting of their own volition, it is often because somebody else cursed you. One therapist reported how clients would explain their problems to her,

“J'ai ma fille qui a mal au ventre parce que son oncle est jaloux de nous, alors on lui a jeté un sort [Translation: My daughter has a stomach ache because her uncle is jealous of us, so they put a curse on her].” A similar etiology is invoked as an explanation for schizophrenia, “when you hallucinate, they will think maybe it's something connected with witchcraft.”

Mauritians are often very careful not to offend the spirits. Some of the techniques used in therapy could be seen as such, and one participant was careful about using visual imagery during relaxation, and explained that it depended on “how motivated is the patient, how much the patient believes in visualization, whether it's witchcraft or things like that.” The empty chair technique was also mentioned earlier as another technique that could be interpreted differently by clients.

When clients sought psychological help and believed that evil spirits were the cause of the problem, it seemed that the client might see both psychologists and shamans as some type of magicians,

Beaucoup de personnes faisaient vite le lien entre la sorcellerie, les marabouts et les choses comme ça, et il y a des gens qui sont venus me voir me disant, “voilà, je viens vous voir mais je suis déjà allé voir le traiteur d'à côté,” . . . donc c'était une vision un petit peu magique de la psychologie auquel je n'étais pas du tout confrontée [durant mes études.]

Translation: Many people quickly linked psychology and witchcraft, the witchdoctors and things like that, and there are people who came to see me, telling me, “OK, I come to see you but I already went to see the shaman next door.” So it was more of a magical view of psychology to which I had not been exposed during my studies.]

Discussing the similarities, one participant said,

76 Both of them listen and reflect. There's lots of reflection. If the person goes to see the traitere4, the traitere will take all that information [to make the person think they know things without needing to be told]. So the traitere is much higher than the psychologist, even the doctor. So, belief, trust, all that are important.

This participant is addressing the fact that the client’s beliefs were what mattered. At the same time, certain skepticism was being expressed about the powers of the shaman.

Different mental health professionals had different opinions of the shamans and different ways to deal with their clients’ belief in shamanism. A typical finding was that while therapists were skeptical of such beliefs, they accepted it as any other belief that their client might hold, “rarely I challenge them on these issues; it's a belief they have.”

Another therapist reported about “research on shamans [which] found that these people were effective due to placebo effect.” Indeed a therapist shared a one-time experiment where the client was hearing voices and believed that his neighbor had put a curse on him,

Li dir moi, "vine pre ou tande." Mo oussi mo fere ene zeste, mo dir, “bon li pe koze.” Li dir moi, “ki li pe koze?” Mo dir li, “mo pa kompren, mo tane vou a dirai ene la voix.” Mo dir ou mo atrape so racines, mo atrape so seveux koum sa mo risse, hein. Mo dir "sorti, kite li alle!" Be menti tou sa la, li li ti croir dimounes fere li mesansete . . . Mo dir mai sa boug la, li pappou gueri par aukene methode a parte sane methode la. Parski line fini kroir ladan li. Mone risse so seveux . . . be ou konne sa boug la ine bien.

[Translation: He told me, “come closer, you’ll hear.” I pretended and said “ok, the voice is talking.” He asked me, “What is it saying?” I told him, “I don’t understand, I hear some sort of voice.” I tell you, I grabbed the roots of his hair and I pulled and I said, “Get out, leave him!” It was all false, he thought people put a curse on him . . . I figured this guy would not be cured by any other method than this one. Because he believed in it. I pulled his hair . . . and you know what, he was cured.]

The above anecdote seems to support the placebo effect hypothesis, as posited by Torrey

(1972) for example.

4 In Mauritian Creole, a “traitere” is a type of shaman. 77 Part of what fueled the skepticism of the mental health practitioners was the fact

that some people pretended to be shamans and made money off of people’s sufferings,

On the newspaper once . . . they discussed that these traiteres, they use the patients, they abuse them, they blackmail them, emotional damage you know. They charge Rs2,000, Rs 5,000 just to cut the chicken, the “poule noire”5. And, you see what . . . And some people, every session, they charge a huge amount of money, and there's nothing changing. Sometimes it's quick, they're listening, the catharsis

In the above quote, the mental health practitioner was both expressing doubts about the honesty of the shamans, and was also acknowledging that they could be helpful through listening and catharsis that the client might experience.

The Process of Adaptation for Mental Health Practitioners

The above description of the Mauritian context, and how it differs from the

nations in which the mental health practitioners studied, implies that the practitioners had

to adapt their practice once they returned to Mauritius. The descriptions of how they

applied the techniques and concepts they learned at the university to the Mauritian

context fit broadly within four categories of techniques and concepts:

1. used in the exact same way as they were taught,

2. adapted to the Mauritian cultures,

3. no longer in use, and

4. developed specifically to address Mauritian needs

The techniques that they used exactly as they were taught include “relaxation

techniques like deep breathing.” In terms of concepts, one participant reported, “I find

that principles of resistance are very applicable. I find Beck applicable, stress inoculation works, better than psychoanalysis. Cognitive therapy works better, because there are immediate results.”

78 Examples of adapted techniques included modifying questions on inventories to adapt them to the Mauritian context (example which all participants who used tests provided):

the WISC asks you who's the President of the US, but here, you can't expect a child to know this, so you can change it to "Who is the President of Mauritius?" Language is also an issue; a child whose native language is English will perform better on this test.

Such use of tests brought up the question of norms. One participant said about the Raven

Progressive Matrices,

Un moment, j'avais pensé . . . voir avec les psychologues [Reunionais] si on pouvait faire [un étalonage] qui soit représentatif de l'Océan Indien. Mais là, ils m'ont dit, “tu sais, tu rêves, parce que c'est un gros gros travail, que de faire ce genre de recherches et puis, après, de toutes manières, nous n'aurons pas l’autorisation. Seul le Centre de Psychologie Appliquée de Paris a le droit de faire ce genre de travail.

[Translation: At some point, I thought about . . . discussing with psychologists from Reunion Island, whether we could do some norming that would be representative of the Indian Ocean. But they told me, “In your dreams, because it’s a big big job to do this type of work, and in any case, we won’t obtain the authorization. Only the Center for Applied Psychology in Paris is allowed to do this type of work.”]

At the time of the study, all practicing psychologists except for three participants used tests with some of their clients. They felt that the norms were about “equivalent,” based on their experience administering these tests in Mauritius.

Another example of a tool that a participant adapted was rational emotive therapy

(RET),

When I started [working in Mauritius], I thought that what we learn in terms of therapy was not applicable to Mauritius, I would use RET, have my stock questions to uncover irrational beliefs, and I was not getting the results I was hoping for. Now, with experience, I am seeing that RET is applicable, except with different irrational beliefs.

5 The “poule noire” is literally a black chicken that is associated with the practices of shamans. 79 In this case, the concept of rational emotive therapy was still applicable, but the techniques used to work with the client had to be adapted because different irrational beliefs operated within the Mauritian cultures.

Some tools that mental health practitioners reported not using anymore included tests that they found impractical and listed “Test du Village” and the Rorschach as examples. A variant finding was two practitioners who reported that they did not use verbal tests because they wanted to avoid cultural biases inherent in verbal tests. One participant shared that he does not use hypnotherapy here because he found it difficult to translate the terms in Creole and still obtain the results, due the importance of the literal understanding of the words.

In addition, therapists reported developing tools that specifically addressed they clients’ needs. They explained that their process was often to try new things. One therapist gave the example of using holistic understanding of the chakras to help a client who had severe psychosomatic complaints in the abdomen region that her medical doctors were not able to resolve. She shared that her process was exploratory and was a partnership with the client,

I'm like a partner with them in their therapy, I'm just a guide and partner. I keep looking for information, feeding them information, at some point, something will come up. I don't have all the answers, they've got it, so I'm trying to help them and that was it and since she found out she was a lesbian, I helped her through all the coming out, the whole process of telling parents, now she's fine, no more disease, no more. She lost so many jobs and spent so much money before she came out.

Another practitioner reported that she developed relationships with schools in her private practice.

80 au niveau de ma pratique, quelque chose que j'ai développé à Maurice que ne font pas les psychologues, je suis en contact avec les écoles. Je passe un coup de téléphone . . . si les parents sont d'accord si je peux collaborer avec le professeur.

[Translation: In terms of my practice, something that I developed in Mauritius that psychologists don’t do, is that I am in touch with the schools. I call the parents . . . if they agree to it, I can collaborate with the teacher]

At the time of the study, there were no multidisciplinary teams in Mauritius, in the way

that often existed within a mental health agency in Western nations. As a result, mental

health practitioners developed their own network of people with whom they collaborated.

For the above participant, this network included teachers.

Another tool that all practitioners developed was the language they used to

explain issues to the client. They all shared how important it was

to break [things] down and explain people, and people tend to like it, they tend to trust you more , and you physically you can see the change in their body language, they fell reassured, and I think . . . we should never try to impress, we should rather try to explain.

A typical finding was that instead of giving only a diagnosis, the mental health

practitioners spent much time describing the symptoms, and implications of the diagnosis

and of the treatment for the individual and his/her environment,

J'explique toujours dans les mots les plus simples possible, c’est-à-dire en décrivant les symptomes par example . . . il faut vraiment dire ce que ça veut dire au quotidien, là oui, ca marche . . . Qu'est-ce que ça veut dire pour les enfants, pour la famille, qu'est-ce qu’il faudra changer, qu'est-ce qu'il faudra adapter, dans le quotidien.

[Translation: I always explain with the simplest words possible, which means to describe the symptoms for example . . . You really need to explain what it implies for their daily lives, then yes, it works . . . What does it mean for the children, for the family, what will need to change, what will need to be adapted, in their daily lives.]

Practitioners explained that in Western nations, psychological jargon was more part of daily language, so there was not as much of a need to describe diagnoses in detail there. 81 Another typical finding is that the use of images and metaphors was very helpful

in explaining issues to clients,

When there's a theory, I usually make it into a very visual image, for example . . . depression is how dopamine and everything works, I use the idea of a tap closing up and opening up and how you know, you've got to open it otherwise you just get flooded. Visual images they really get easily and they get something.

Further, the use of images that were part of the Mauritian context was especially

important in helping explain things to the client.

Another way in which mental health practitioners changed their practice was in

how they use silence or non-directiveness. As addressed earlier, Mauritian clients felt

very uncomfortable with silence, especially at the beginning of therapy. A general

finding is that therapists are much more goal oriented now,

I've developed a style where it's very solution-oriented. I've noticed that in Mauritius, people won't stay…well, it's my style but also people who come to me won't stay very long in therapy and I don't want them to, it's a monetary thing also.

Sometimes, they even feel that giving advice can be helpful, whereas many people

learned from their training that they should never give advice.

Ce qui était important je crois, c'est de s'adapter un petit peu au besoin des gens. Quand les gens viennent vous demander quelque chose dans un petit bout de temps, et puis proposer des choses qui sont réalisables, réaliste pour eux, acceptables et . . . ben donner des conseils.

[Translation: What was important was to adapt to the needs of the people. When people came to ask you for help and you had little time to help them, to propose things that they could accomplish, that were realistic for them, acceptable to them, and . . . well, give advice.]

Giving advice in various forms was a typical finding. For some therapists, giving advice meant skill building, such as communication skills.

82 Taking into consideration the needs of the clients seemed central to how the mental health professionals adapted and how successful they were with their clients. It is important to note that two therapists did not feel that culture was an important variable in therapy. All the other therapists either explicitly talked about the importance of cultural competency, or demonstrated it through their behavior. The discussion section will address possible explanations for this finding.

Ethics

Competence in Providing Services to Different Cultures

In the previous section, participants shared that their training did not prepare them to deal with Mauritian realities and cultures. However, all of them also felt that they could not expect their programs to address the Mauritian context, since they received their training abroad. While this position is understandable, the question of the competence of the therapist who just started to practice in Mauritius is a concern. The fact that many mental health practitioners are isolated compounds this lack of bridging.

One participant expressed:

Moi, je perçois un grand manque ici, un grand isolement ici à Maurice. Je suis quelqu’un qui a besoin d’être supervisée dans ma pratique, je me pose 3000 questions sur la manière de mener à bien une prise en charge

[Translation: Personally, I perceive great a great lack here, we’re very isolated here in Mauritius. I am someone who needs to be supervised in my practice, I ask myself 3000 questions on the way to take care of clients]

The isolation, added to the lack of supervision, present an ethical issue as the therapist is bridging what they learned during their training abroad to the Mauritian context and cultures. From a historical perspective, psychology is still a new discipline in Mauritius, and the hope is that as the numbers of mental health practitioners increase, the

83 opportunities for supervision and consultation for beginning mental health practitioners will increase.

Dual Relationships and Confidentiality in a Small Country

Because Mauritius is a small country, dual relationships are inevitable. One therapist shared the following example:

J'étais invitée à un anniversaire de mariage. Sur 50 personnes, il y a avait 30 que j'avais vu, et chacun pensait être l'unique quoi . . . Parfois les gens ont honte qu'on sache. Donc, vous vous devez faire comme si vous connaissez pas la personne alors que vous la connaissez vachement bien.

[Translation: I was invited to a marriage anniversary. Out of 50 people, I had seen 30 of them, and each of them thought they were the only one . . . Sometimes people are ashamed about other people finding out. So, you have to act as if you don’t know the person when you know them really well]

The above example is common in Mauritius because we have relatively tight-knit social groups—often along racial-ethnic and socioeconomic lines. Therefore, mental health professionals may not personally know their client, but the client and the therapist will likely have common friends or acquaintances. Another therapist shared that “when I know the victim, I usually know the abuser, and I deal with the abuser on a personal level sometimes.” All therapists agreed that their training did not prepare them to deal with such issues around dual relationships.

In addition, some clients also sought therapists that they knew, because they felt more comfortable sharing things with them than with a stranger:

il a des clients qui viennent vers vous en disant, " Ah ben, je vous connais, je préfère venir vous voir." J'essaie de dire, “mais justement, c'est parce qu'on se connaît que j'aurais préféré que vous alliez voir . . . ” Bon, il y a des moments où on réalise que la personne est dans une démarche affective, elle a besoin d'ça, après, on pourra peut-être . . . Une ou deux fois, j'ai accepté pour aider la personne

[Translation: there are clients who come to you saying, “Well, I know you, I prefer to see you.” I try to tell them, “it’s precisely because we know each other 84 that I would prefer that you go see . . . ” Well, there are times when you realize that the person is in a fragile state and needs this, after, we could maybe . . . Once or twice, I’ve accepted to help the person.]

Therapists pointed out the fact that family members would sometimes ask for psychological services as well. In the above quote, the mental health professional indicating that she had one or two clients whom she knew well and accepted to see them for a limited amount of time. She felt that the clients needed help but would not seek therapy from another professional. This participant also expressed some discomfort, which may be due to the fact that the ethics code that she was taught during her training contradicted elements of her culture.

This is an ethical dilemma viewed through the lens of a different culture. On the one hand, there are ethical pitfalls that can arise from dual relationships, because of problems such as power dynamics present within the therapeutic relationship, as well as issues of transference and counter transference. On the other hand, the Western model sees dependency as something that always impedes the therapeutic process, whereas in other cultures, the healer is often a full member of the clients’ social environment.

Ethical dilemmas will be further addressed later in this section, when discussing the ethics code of the Société des Professionels en Psychologie.

Another type of dual relationships includes treating clients who have relationships with each other:

And one thing that's very specific to Mauritius is you get information about your client from other people. And you get a different idea. And I must say, sometimes I used it to know what was other people's view . . . to know whether my sense of what was happening was also the sense of what other people were seeing in their family…so it kinda gave me additional information. I don't know if it's very professional or correct . . . but I was getting [the information] anyway,

85 so I might as well use it, I'm always trying to use it for the benefit of the client. If the intent is good, I hope it's good, and I had nobody to ask about it anyway.

This quote raised several points. First, the issue of dual relationship, which resulted in the therapist being privy to outside information about her client more often that she would in the country where she was trained. The professional could have referred the client, but this would have brought the additional dilemma of explaining to the client the reason of the referral without breaking the confidentiality of the other client. The second issue raised by this quote was what the therapist should do with the information she now had about her client. This participant applied the principle of beneficence, that is, to benefit the client. The third issue spoke to the isolation of mental health professionals in

Mauritius. This therapist did not have anyone with whom to consult. The section on the state of psychology in Mauritius addressed this point, and we see here specific ramifications in terms of ethical concerns for practitioners.

Mental health professionals shared their process in adjusting to a different social context than the one in which they received their training:

Le secret professionnel, évidemment, je suis extrêmement vigilante, et en plus, moi, j'ai rajouté des consignes. Quand je reçois des personnes, c'est la première chose que je leur dis, " Je vous rappelle que je suis sous le secret professionnel." Et quand c'est un enfant, je lui demande s'il sait ce que c'est, s'il sait pas, je lui explique. Premièrement, ils me disent, " ah, heureusement, ah, c'est très important. " Et deuxiemement, je rajoute . . . " nous sommes à Maurice, nous sommes appelés peut-être à nous rencontrer ailleurs, si cela était, nous ne parlerons pas de la consultation. "

[Translation: Confidentiality, of course, I am extremely careful about that, and further, I’ve added steps to my protocol. When I see clients, it’s the first thing I tell them, “I remind you that I am bound by confidentiality.” And if it is a child, I ask him if he knows what it means, and if he doesn’t know, I tell him. First, they tell me, “ah, I’m happy to hear this, ah, it’s very important.” Secondly, I add . . . ”we are in Mauritius, we may run into each other, if that were to be the case, we will not discuss the session.”]

86 Addressing the concerns that the client might have about confidentiality, this therapist

was very clear with her clients regarding her policies in the first session. Similarly,

another therapist routinely addressed confidentiality with the client:

I had to adapt [by] telling them how to deal with that when we see each other . . . it's up to you. I will say hello from far, if you want to come and talk to me, it's your choice, you don't have to but I will be happy to, but I won't come to you to preserve your confidentiality

Both therapists shared how they adapted to the fact that Mauritius is a small country and

how they maintain their clients’ confidentiality.

Some clients will select their therapist based on the race or ethnicity. Previously,

participants shared how clients felt more comfortable with a therapist of the same

ethnicity because they felt the person would understand them better. However, some

clients had concerns that a therapist of the same community might mean that what they

share during sessions would not remain confidential:

L'île Maurice est petite . . . donc, ils ont peur que tout se colporte, que la confidentialité n'existe pas et que bon, ben cette personne va raconter à . . . Donc, à ce moment-là, ils préfèrent, le psychologue qui est autre que leur communauté.

[Translation: Mauritius is small . . . so [clients] are afraid that of gossip, that confidentiality may be nonexistent, and that this person is going to tell . . . Therefore, they prefer to seek the psychologist who is not a member of their community.]

In Mauritius, the word “community” is often used to refer to someone’s race or ethnicity.

Given the issues of dual relationships described above, such concerns about confidentiality are certainly warranted.

Confidentiality is also an issue with parents who want to know about their child’s progress in therapy: “il faut être très vigilant, les ados, quand les parents téléphonent pour soutirer des informations par exemple; [Translation:you need to be very careful with 87 teenagers, when the parents call to get more information than what they are entitled to,

for example.]” This particular type of confidentiality issue is not that uncommon in the

country where the people were trained. However, in Mauritius, the concept of privacy is

not as valued as in some Western countries. Therefore, some parents may view the

therapist’s attempt to maintain that privacy, as the therapist withholding valuable

information that they could use to help their child.

Accountability

Two mental health practitioners mentioned accountability explicitly and stated that “in your practice, you need to be very ethical, you need the accountability otherwise, you become a crook.” One practitioner shared that he participated in a monthly case conference as a way to have some of the accountability among colleagues. No other participant reported having such an arrangement, and as mentioned previously, all agreed that they were isolated.

Until very recently, there was no recourse if clients felt their therapists took advantage of them. The Société des Professionnels en Psychologie was working on an ethics code over the years 2001-2003. They used the French Ethics Code as a template, and modified the ethical standards based on the members’ feedback and on Mauritian law. One member shared that “we’ve been discussing almost for two and a half years, we've got that association and . . . we've got a code of ethics . . . very forceful code of ethics.” This attempt to have a psychological practice ethics code in Mauritius was the first effort of its kind. At this point, adherence to the ethics code is tied to membership privileges, and does not have legal ramifications.

88 Legal Issues

Participants brought up some of their legal difficulties. One therapist provided an example:

I knew something about [a] crime. I was really lost as to, what do I do with the information. Some innocent might pay because I got some information that…and I didn't know who to talk to. Eventually, I went to a friend psychologist and asked him, that's my dilemma, it's confidential; it's got to be confidential with you,

At the time of the above situation, the therapist did not have any guide to help, such as an ethics code, and in the above case, was able to seek consultation.

Another type of legal problem is that of divorce and custody of children.

Currently, in a case of custodial care, the parents can each choose to have a mental health professional to do a psychological evaluation on their child(ren). Often, the mental health practitioners heard only the version of one of the parents, so that they tended to favor their client in cases of custody. This practice has caused much damage in terms of relationships within the group of mental health professionals, since they were often at odds with their colleagues. During my research, some participants alluded to the fact that they did not think that a particular colleague was competent because of the report that they submitted to the court.

To conclude this section, Mauritian mental health practitioners encountered ethical dilemmas in their practice but often did not have the support that supervision or consultation could provide. In addition, until recently, there was no ethics code which could act as collective wisdom of past practitioners to guide therapists who had to make difficult choices. Mauritius is undergoing an evolving process; there is now an ethics code developed by a specific organization. The French ethics code was used as a

89 template, so that the Western influence remains present in the standards. However, with time and experience, my hope is that the code will change and be better suited to the

Mauritian needs and cultures, as it evolves to become a Mauritian code of ethics.

Professional Issues

Providing Therapy Services

Length of therapy was briefly addressed when the results of the questionnaire were presented in the “State of Psychology in Mauritius” section. Participants typically indicated that

what works best also in Mauritius, as far as I’m concerned, is brief therapy, three to five sessions with people…I've got also a few clients who've been very long- term with me, but I think in Mauritius, people are more prepared for more short- term, and some people think you know, in one session, everything is [fine].

The last part of the above quote pointed out the misperception from some Mauritians that one therapy session was sufficient. The expectation of one visit to the professional as sufficient came from the medical model, and was due to the confusion between medical doctors and therapists in the mind of the public as addressed in the beginning of the chapter. The first part of the quote indirectly addressed the fact that clients usually pay out of pocket for therapy services, so it made sense that they would be more concerned about the length of therapy.

However, it did not seem that payment itself was an issue. The people who did seek therapy made sure they were able to pay, as in the example provided by this participant:

Une famille qui avait pris le bus, qui avait économisé à la fin du mois, et qui veulent payer…J'ai jamais eu des gens qui ne payaient pas, absolument pas. Tout le monde m'avait dit, " tiens, tu verras . . . les Mauriciens, etc."

90 [Translation: A family who had taken the bus, who had saved money at the end of the month, and who is willing to pay. I’ve never had clients who did not pay, never. Everybody told me, “you’ll see…Mauritians, etc.”]

Here, this participant referred to the stereotype that Mauritians will try to avoid paying if

they can, but stated that this has not been her experience.

Another professional issue was the length of one session given the Mauritian

cultural context which is less time-driven than in Western cultures. The general finding

was that all therapists tended to follow the Western 50-minute-hour format. They felt

that keeping the time frame was therapeutic in and of itself, “because [the session] can't

extend beyond [50 minutes], it would be too long, and there wouldn't be an effect.”

However, maintaining such a timeline was not always easy:

You can see they're relieved at the end of those sessions. They're willing to talk and sometimes they don't really want to leave after 50 minutes…they're not willing to leave, they want to stay and keep on going, but I mean, I try my best to see what they're looking for, and try to give it to them.

This participant shared how she dealt with the conflict between her belief in the 50-

minute-session, and the Mauritian client’s less rigid sense of time. While she tried to

keep to her schedule, she also tried to meet the needs of the client.

However, there were also instances of slightly shorter sessions, specifically 45

minutes, as a variant finding. One participant had a notice on the door of her office,

indicating that appointments would now last 45 minutes. This change in session length

was in response to client concerns about confidentiality. The shorter sessions increased time between sessions, thereby allowing for more time for one client to leave before the other client came in. Mauritius is a small country, and people could easily recognize your car in the parking lot.

91 Another professional issue was that of intra-disciplinary and inter-disciplinary

work. For example, with the increasing number of mental health providers, it became

possible to refer to a colleague. The following quote came from a therapist with many

years of experience who talked about referring to younger therapists:

donc je commence à faire un peu ce qui me plaît. C'est l'avantage de dire, " Bon, ça, j'envoie ça à une jeune psychologue qui rentre. " [Translation: So, I am starting to do what I want. It’s the advantage of being able to say, “OK, I’m sending this client to a new psychologist who just got back.”]

A typical finding was also psychologists who talked about using a team approach when

working with families. For example, one psychologist would see the parents, and the

other would see the child, and the two professionals agreed with the family that they

would consult with the other professional periodically to provide the best continuity of

care.

The extent of interdisciplinary work was described by this participant:

Nobody can say, “OK, what I'm doing stops here,” you've got to work with the medical doctor, you've got to work with the nurse, you've got to work with the priest, you've got to work with the imam, you've got to work with the ayer6, you've got…because you know, you need that setup, and I think this is, in my own experience, this is what works best.

The effective interdisciplinary work spanned a larger group of care providers than just within the health profession. Specifically, working with religious leaders was not training that Mauritian mental health professionals received while studying abroad. In addition, this participant indirectly pointed out that it was important to be able to work with religious leaders of different faith traditions.

6 religious leaders 92 All participants saw interdisciplinary collaboration within the mental health realm, between psychiatrists and therapists, as important when the client needed medications:

In many cases where people go see a psychiatrist, but really need both psychiatric and psychological services. I think that it is important to have both. There is not much teamwork between psychiatrists and psychologists here. [A psychiatrist at Brown Sequard] realized the importance of both for effective treatment. In fact, research has shown that people who undergo CBT therapy have long-term benefits, whereas people who use medications have short-term benefits.

The above statement implied that the converse was not true. Not all psychiatrists seemed to value collaborations with therapists.

However, the small number of mental health professionals limited the ability to refer people to other mental health professionals. So, if they felt that a particular client might benefit from seeing a specialist, they did not have anybody to whom they could do a referral, or with whom they could consult. This lack of colleagues with different specialty areas led to a feeling of isolation, which was a general finding.

Donc, c'était plutôt la difficulté d'être isolée, d'être vraiment débordée, et d'avoir à accepter parfois des clients qu'on aurait préféré référer à un spécialiste plutôt, mais c'est comme ça.

[Translation: So, it was more the difficulty about being isolated, of being really overworked, and sometimes to have to take in clients that one would prefer to refer to a specialist instead, but that’s the way it is.]

A typical finding was that with the increasing number of mental health providers, people are feeling less isolated. Over time, people were learning to trust their colleagues more. This process was described by a member of the Société des Professionnels en

Psychologie,

We've [SPP] taken time, there's trust existing between people coming from different countries, different background, interactions, they're learning to appreciate each other, nurture each other, it's picking up. 93 The added dimensions to trusting one’s colleagues meant trusting the university training

that these colleagues had, as well as trusting colleagues of different race and ethnicity.

This increasing level of trust might lead colleagues to consult each other more on cultural issues, whereas, a general finding during the present study was that no therapist consulted other therapists on cultural issues.

Advertising and Media

The topic of advertising and sources of referrals was introduced in the section on the “State of Psychology in Mauritius” during the discussion of the survey results. In the survey results, word of mouth was the primary source of referral, and during the interviews, word of mouth was the only source of referral that participants discussed as a general finding. For example, one therapist shared that she received referrals for

lots of adolescents, this is word of mouth. Parents know very quickly that I have one adolescent and I get along very easily with them, it's hard…adolescents, usually if you don't get them it just doesn't work…I treat them like normal people and they like it.

Another therapist considered a recommendation from someone as a necessary condition in Mauritius, for people to seek therapy from a particular professional:

[Les] gens qui insistent pour me voir, moi. A Maurice, ça marche comme ça, à travers le bouche à oreille. Les gens ne vont pas voir quelqu'un à moins que quelqu'un leur ait dit qu'ils ont été voir cette personne et qu'ils en ont été contents.

[Translation: People who insisted to see me. In Mauritius, that’s the way it works, through word of mouth. People don’t go to see someone unless someone else told them that they went to see that person and they were happy with their services.]

Another phenomenon specific to Mauritius was that we have fewer sources of media than in larger countries. Therefore, when a psychologist participated in a radio or television show, or was interviewed for a newspaper article, a much wider section of the

Mauritian public was reached through a single radio, television show or newspaper 94 article. Hence, media is effective at generating publicity, both for individual professionals, and for education on psychological and mental health topics. Therefore, the local media could be seen as a positive tool. However, mental health professionals had mixed feelings about the power of the local media. The first example was that of new mental health professionals who received the message that using the media as a tool to advertise was discouraged, such as “Tu fais trop de pub. [Translation: You do too much advertising.]”

Another example was dispensing of controversial advice through the media. One therapist felt that although she agreed with the statement a colleague made on the radio, she felt that such a public statement discredited the profession given the religious climate in the country:

This other psychologist [name is not used for confidentiality reasons] was on the radio. This person was not trained as a psychologist. People were calling in, and a woman called in about the sexual fantasy of her husband to sleep with two women at the same time. The psychologist asked her if she was OK with it, and she said she was. So, the psychologist said that it was no problem if she was OK with it. There are certain things you can say when you see clients privately, but that you can't say in public because Mauritian society is quite conservative.

The other issue raised by this quote is the fact that the mental health practitioner was not trained as a psychologist. As discussed in the section “Efforts to Organize an

Association,” psychologists felt very strongly about who can call themselves psychologists. They wanted to protect the profession from being discredited due to insufficiently trained practitioners who may be doing damage to their clients.

Continuing Education

All participants lamented the lack of continuing education opportunities in

Mauritius.

95 Ce que j'ai plutôt regretté, c'est le fait par la suite de ne pas pouvoir être update. Ça, ça me manque, pour mon well-being personnel, parce qu'il y a plein de choses qui m'intéressent.

[Translation: What I have regretted instead is the fact that I was not able to keep up to date after my studies. I do miss it for my own well-being, because there are plenty of things in which I am interested.]

A variant finding was that some participants sought other means to continue learning

through the acquisition of new books or participation in workshops abroad:

I keep going to other seminars or workshops [in ] and I get to learn by doing it still. I keep going on, learning from them.

This participant also felt that issues of culture were an area where she wished to have

continuing education, both on an experiential level and on a knowledge level:

[Culture] influences you a lot. That's what I keep going to seminars. I just came back from a workshop in South Africa, experiential work, a very deep one, boy it was rough, got me thrown back and forth, and I've got to learn to keep working on myself too, as a person so I can be even better, hmm, but also to clarify where I stand, so I don't need to fear that, and the culture, of course, it will interfere, I would like to learn more, have people to talk to who practice in Mauritius, I don't get much, very many people who've done work on knowing their culture. When I get somebody, I ask a ton of information, what they know about their culture, and what they've learned about differences and how they portray me.

Such an interest in learning more about other cultures in Mauritius was a typical finding, although the level of awareness of this participant was a variant finding. Here, she stated that she wanted an increased understanding of her stimulus value, and therefore an increased understanding of issues of transference.

The above quote also alluded to the fact that mental health practitioners in

Mauritius can also learn from local resources. Only one participant shared having regular training along with a monthly case conference, while working in an agency,

and for anything in the world, we wouldn't skip it. And we plugged it also for some training for our social workers so we spent two hours, one hour training, one hour for [discussing cases], each of us taking fifteen minutes.” 96 One participant entertained the idea of publishing about practicing in Mauritius, which would provide invaluable resources to mental health practitioners:

I think now in Mauritius, we could be publishing our own observation . . . I would try to see where can I refine, where can I improve it, but unfortunately, I keep it in my notes, maybe one day, I just need to get all the notes and do some serious writing.

Research

Related to the lack of continuing education was the fact that there was no centralized location for psychological resources and research. A general finding among participants who were interested in research was the lack of resources, such as an accessible library. In addition, there was a lack of access to current research journals:

I came back to Mauritius [since] five to six years, and things have changed and I have not been updating myself on my own. But in Mauritius, we are far from what is really happening in the universities, the most recent trends and developments in the field of psychology.

Students for their Master’s and doctoral theses, often did the psychology research that was taking place in Mauritius at the time of the present study. Unfortunately, there was no centralized location for this research, so that often, other Mauritians did not benefit from the results of the research. One participant shared that things are changing:

Ya, we don't have the actual resources, data about research done in Mauritius, now I think it's really starting . . .

One irony was the report of a therapist who had better access to Mauritian research while abroad:

I learned so much more [about Mauritian research] there than I would have learned being in Mauritius because in Mauritius, you can't have the information. It's all locked up. They're starting to, it's coming but it's not computerized. Not easily accessible. It would take ages to find information.

97 The two previous quotes highlighted that there were changes in the right direction but that they were slow.

One participant shared her informal research on the prevalence of sexual abuse, usually by taking an anonymous poll at the presentations that she did:

[I was] kind of shocked, I didn't know there were so much. I knew in America, it was one in four, I can tell you in Mauritius, it's one in four, men and women, statistics are very much the same. Whatever the community, whatever the level of living.

The above example showed how mental health professionals were using creative ways to get a sense of the salient issues in Mauritius, given the lack of research, and the lack of accessibility to the existing research.

Self-care

A general finding was the importance of “[learning ] to take care of yourself, because psychologists take care of everybody but nobody takes care of them.” A typical finding was the process of creating better boundaries for themselves over time:

In the beginning, I found it very painful the accounts, all the sadness, and the distress, but I got used to it eventually. So, I think this is also very imp to emphasize, to understand and to try to, just the need to be non-judgmental. And, yeah, the human distress, it is quite painful, but this is the job.

Another participant offered her way of coping with clients’ distress and preventing it from affecting her family life:

Il faut garder un équilibre personnel quand même, une qualité un peu. Je peux pas rentrer chez moi..au début, évidemment, ça tourne beaucoup dans notre tête, mais avec le temps, la pratique et l'expérience, on arrive à séparer.

[Translation: You need to keep a personal balance. I can’t go home . . . At first, you think about it all the time, of course, but with time, practice and experience, you are able to separate.]

98 One issue that was specific to Mauritius was the fact of its small size, which resulted in therapists and clients running into each other very often. One therapist shared that she had to tell clients at the beginning of therapy that her rule was to keep session content within the therapy room:

Au début, dans les supermarchés, "Ah oui, je voulais vous dire.. " Vous savez, pour eux, la psychologie, c'est un état d'être permanent. Faut comprendre que c'est un métier, et puis, quand on a fini le métier, ben on ferme la porte. On passe à autre chose, quoi.

[Translation: In the beginning, in the stores, “Oh yes, I wanted to tell you . . . ” You know, for the, psychology is a permanent state. You need to understand that it is a profession, and when you’re done with your work, you close the door. You go so something else.]

The above quote showed how this participant set boundaries to take care of herself.

99

CHAPTER 5

DISCUSSION

Adaptation Process, Adequacy of Training and Colonization

Based on participants’ descriptions, there were several steps to the general process of adaptation that Mauritian mental health practitioners seemed to undergo. First, people who returned to Mauritius after their studies tried to apply what they learned in their training. Second, in a process of trial-and-error, mental health practitioners used feedback from their clients to decide which techniques and concepts were applicable to the Mauritian context, and to specific Mauritian subcultures. Participants reported that some people became discouraged and left the country at this stage, when they realized they were unable to adapt to the Mauritian context. Others moved to the third stage of gradually modifying certain techniques and concepts after listening to their clients and seeking to understand their worldview. Not all participants described this process of understanding the client’s worldview as culturally based. A variant finding was a more individualistic framework, where therapists expressed seeking to understand the individual’s unique way of perceiving the world around them.

Sinha’s (1990) application of the adaptation process originally proposed by Berry

(1986) seems applicable to Mauritian mental health practitioners. The adaptation process consists of four categories, based on the two dimensions of value attached to indigenous

100 system versus value attached to imported system. The categories are Integration (valuing

both indigenous and imported systems), De-culturation (not valuing either system),

Revivalism (valuing only indigenous system) and Assimilation (valuing only imported

system). The data suggest that Mauritian mental health providers fall into the

Assimilation and Integration categories. All participants were satisfied with their training

abroad, implying that they valued the imported system. Further, all participants preferred

to work with clients who were similar to clients they encountered during their training,

that is, educated, psychologically minded, and middle to upper class. A typical finding was that participants (80.8%) valued both the imported system and local cultures, seeking to use the client’s worldview. Therefore, these mental health practitioners could be characterized as belonging to the Integration category. A variant finding was that some participants (19.2%) exclusively endorsed the imported system, and in fact looked down upon the local cultures (e.g., seeing Mauritians as not open enough to new changes imported from the West). Assimilation would characterize these participants. No participants fell in either Revivalism or De-Culturation categories.

However, during the interviews, participants did not show evidence of assessing their own level of acculturation, as well as that of their client as a bi-dimensional construct. Instead, participants used client’s level of education to estimate how effective

Western techniques would be with that client. Indirectly, participants were using education as an approximate measure of level of acculturation.

Among those participants who valued both systems and cultures, the data suggested that their Biculturalism was expressed mostly in a Multicultural way

(LaFromboise, Coleman & Gerton, 1993). Multicultural Biculturalism meant that they

101 adapted bits and pieces from both cultures. For example, the same therapist who used

rational emotive therapy techniques also placed much emphasis on understanding the

client’s religious beliefs. Nobody showed evidence of alternating between cultures; rather, the techniques and concepts used seemed integrated into a coherent whole when mental health providers articulated their theoretical orientation. For example, one therapist’s theoretical orientation was primarily Rogerian, which allowed for understanding the client from within, especially on a cultural level. In addition, this therapist would also use cognitive techniques because they provided quick results as well as tools that clients could use on their own. Such techniques were adapted to the

Mauritian context where therapy is not covered by insurance, and clients want quick results. Likewise, no evidence was found of practitioners evolving parts from both cultures into a new culture. In fact, a typical finding was that participants felt the term

“indigenization” was not applicable to Mauritius, since psychology is such a new discipline in Mauritius.

Two possible barriers may prevent or slow the indigenization process: the legacy of colonization and the multitude of cultures and subcultures in Mauritius. Colonization has repercussions on the Mauritian public at large and on mental health providers. One example of the effects of colonization on the Mauritian people is placing higher value on the imported system. In general, people from former colonies, that is, the Third World, learned to devalue their own culture(s) and chose to value the more powerful colonizer’s culture(s).

Such devaluing of one’s own culture can lead to identity issues. Fanon (1968), after working in psychiatric hospitals in colonized countries, concludes that colonization

102 “forces the people it dominates to ask themselves the question constantly: ‘In reality, who am I?’” (p. 250). While understanding the need for a model to help shape identity, he suggests finding something different, “so long as we are not obsessed by the desire to catch up with Europe,” (p. 312) and seek to move forward instead. His recommendation is not necessarily to return to indigenous values entirely, nor to reject the colonizer’s values entirely. While he did not explicitly state his thought process, he may well have come to that conclusion because he recognized the fluidity of culture. The decolonization process requires self examination followed by the forging of a new path that fits the people, rather than blindly adhering to Western worldview.

Another type of colonization was found in the realm of education. The more educated a client, the more traditional Western psychotherapy was likely to benefit him or her. In other words, education helps people think and feel more like Westerners.

Education is a vehicle, and is not inherently a tool of colonization. In Mauritius, where the British curriculum dictates the education system, education becomes such a tool.

However, education can also be used as a way to help raise consciousness, and therefore can act as a vehicle for the decolonization process.

Unexamined education in Western countries can certainly contribute to colonization of the mind. Therefore, mental health providers who have studied abroad could be further susceptible to being colonized. Superimposing the legacy of colonization and the acculturation model, the participants who were in the Assimilation category did not feel that there was a need for indigenization because they felt the imported system was adequate, consistent with Fanon’s (1968) predictions. As stated earlier, even those mental health providers (80.1%) who did value understanding the

103 cultural worldview of their clients still preferred to have their clients fit their training,

rather than adapting their therapeutic techniques to the clientele.

When asked how colonization affected the Mauritian culture(s), about half the

participants had several examples in mind, whereas the other half found it more difficult

to give examples, or did not feel that colonization affected the present Mauritian

culture(s). Only one participant expressed that the very profession of psychology, having

originated and developed in Western countries was likely to perpetuate colonization,

unless the practitioner took time to examine his or her practice.

The colonial history of the country also meant that Mauritians were not as knowledgeable about their own ancestral cultures, due to programmed de-culturation for enslaved Africans, or due to immigrants feeling that they needed to give up part of their own culture so their children could better adapt to the new country. As mental health providers seek to develop a more indigenous psychology, the several cultures and subcultures in Mauritius can contribute another barrier. Given the history of the country, indigenous practices referred to ancestral practices for each of the groups and subgroups within the Mauritian population. The lack of a unified set of indigenous practices made it more difficult to find a starting point for the research or practice that could lead to indigenization. Evolving a practice that was “Mauritian” would probably mean that

mental health practitioners would integrate contributions from many Mauritian

subcultures to form a new practice, as well as to develop theories specifically addressing

the various Mauritian populations. The lack of knowledge of other groups’ cultures as a

general finding suggested that evolving such a practice would be difficult for most

practitioners. One recommendation derived from this lack of knowledge of other group’s

104 cultures, is that mental health practitioners would benefit from continuing education in

this area.

Use of language may be a starting point in the development of a new practice.

The general finding was that participants modified the words they use to improve

services to their clients. For instance, they used metaphors that were part of Mauritian

context; and they avoided the use of jargon by taking time to describe diagnoses. In

addition, they used Creole, French or English depending on the language with which the

client felt most comfortable. However, only one therapist mentioned doing therapy in

bhojpuri (Indian dialect) and no other therapists talked about use of Asian languages

within therapy. Given that issues of ancestral languages might pertain more to older generations, it is possible that elders form a segment of the Mauritian population that is not being served. Therefore, it is important to address the needs within this population, and whether they include the need for translation services or awareness of therapists who provide therapy in their native language. Overall, perhaps a systematic assessment of the needs for services from all groups would be a recommendation for the new professional association.

Multicultural Counseling Competencies

All Mauritian mental health professionals found it difficult to describe Mauritian characteristics, and responded that there was no such thing as a unified Mauritian culture.

Rather, they felt more comfortable using the plural form, “Mauritian cultures.” However, most participants shared having little knowledge of cultures other than their own. This

lack of knowledge leads to the topic of national identity. It is my perception that while

residing in Mauritius, we Mauritians tend to not see ourselves “as one people, as one

105 nation”7 and are more likely to perceive the differences amongst the ethnic groups. Yet,

even with the awareness of the differences, few mental health professionals chose to

expand their knowledge beyond their own cultural group, again reinforcing the need for

multicultural training.

On the level of awareness, a typical finding was that mental health practitioners

had awareness of how their culture and that of their clients, as well as their own biases,

affected the therapeutic process. Paradoxically, a general finding was that mental health

providers did not report the need to consult on cultural issues. The few therapists who

did seek consultations on this topic usually consulted outside of the mental health field.

This finding suggested limited amounts of communication among practitioners, including a lack of knowledge about who may be an expert on mental health issues within a specific community. When asked if they provided different types of services based on the client’s culture(s), about half of the participants were aware of tailoring their interventions to the needs of the client based on cultural knowledge. A list of contact information of professionals and resource links or persons could be established by the profession to increase knowledge and to encourage more cross-cultural consultation.

Generally, it appeared that those people who had a diverse training program, in

terms of both colleagues and professors, were more likely to be aware of cultural issues.

This finding points to the importance of fostering a diverse training program at the

university level as a way to increase awareness of cross-cultural issues in students. A

diverse training program would mean having faculty members and students from diverse

backgrounds, races, ethnicities and nationalities. Such diversity within a program seems

7 These are partial lyrics of the Mauritian . 106 to be linked with an increased multicultural awareness for all graduates of that program, through course offerings, and infusion of multicultural content and discussions in all classes.

As indicated earlier, mental health professionals had little cultural knowledge about other groups. A variant finding was that a few therapists had a firm grasp on understanding the worldview of clients when the therapist and the clients did not share a common culture. Some expressed the interest in learning more about other cultures to help within the therapy process. Part of the problem stems from the fact that Mauritians are not encouraged to learn about other communities (Mauritius Research Council, 1998).

Instead, Mauritians learn to mistrust people who are different from us. We are aware only of the superficial parts of culture: celebrations of the other groups, and foods that crossed racial and ethnic boundaries. To become better therapists, Mauritian practitioners could benefit from unlearning some of their prejudices and apathy towards cultural issues. Again, continuing education providing concrete culture-specific tools as much as possible would be helpful to achieve such unlearning. Given that some practitioners may not see the value in such trainings, it might be useful to have respected mental health practitioners emphasize the importance of culture within their practice. In addition to formal training, other ways include presentations made at regular meetings of the professional organization, as well as establishing a listserv on which subscribers could post questions about cultural issues, and receive answers from knowledgeable subscribers.

Further, while participants were generally aware of clients’ beliefs in shamans, a typical finding was that mental health professionals looked down upon clients consulting

107 such indigenous healers. One of the difficulties stems from the fact that it is not clear who are indigenous healers, and who are taking advantage of clients. No collaboration exists between indigenous healers and therapists, when it seems that such collaboration might benefit the client. Torrey (1972) provides useful insight about how therapists and indigenous healers are similar, and discusses four “critical ingredients” for healing to take place in both systems. These critical ingredients are a shared worldview, therapist’s or healer’s ability to create a working alliance, patient expectations, and similar techniques, including confession, suggestion, hypnosis, psychoanalytic techniques, conditioning, group therapy, and drug therapy. It may be helpful to have this book assigned to classes within psychological training programs who want to increase multicultural competence.

The APA (2002) Guidelines on Multicultural Education, Training Research, Practice and Organizational Change for Psychologists indicate that multicultural competence include working with indigenous healers, but many practitioners know little about indigenous healers, which may lead to negative images and stereotypes of indigenous healers. In this vein, Torrey’s book would help bridge such difficulties. Further,

Mauritian research on its own shamans would be helpful to help demystify what they do and increase understanding of what they can do for client welfare. Such research may also help discern shamans from charlatans. The list of resources recommended earlier could potentially include reliable shamans as well.

The level of multicultural skills exhibited by Mauritian therapists varied. A general finding was that, in their case conceptualization and treatment plan, practitioners saw the importance of understanding the universal, group and individual levels of identity during case conceptualization and treatment as suggested by Sue, Ivey and Pedersen

108 (1996). Another general finding was the use of assessment tools that were developed in

Western nations, and for which there are no norms for use in Mauritius, such as the

Wechsler Intelligence Test for Children, Revision III (WISC-III). While all participants who used the WISC-III modified questions to adapt them to the local context, only two participants shared their concerns regarding issues of test norms, and nobody discussed issues of equivalence (Lonner & Ibrahim, 2000). This finding suggests a lack of multicultural skills within the assessment field, and potentially lack of emphasis on assessment principles within their training.

Such use of tests without appropriate norms raises several questions. First, how should mental health professionals proceed when they are in a country that does not have any normative information for assessment tools? On the one hand, tests do provide useful information when providing psychological services, and not using these tests means losing richness of the data they provide. This loss of information source is especially crucial in an environment where there are no other testing alternatives. On the other hand, such use of tests lead to multiple problems, including a lack of assurance that data collected, using tests without appropriate norms, provide us accurate or even useful information. In addition, problems of cultural equivalence arise when using inventories across cultures. This dilemma will continue to be an issue for Mauritian practitioners unless Mauritian tests, as well as Mauritian equivalence and norms are established for existing tests. Such work could be done at the university level, or through the newly formed association.

The organizational level of multicultural competence was not as salient within the scope of this study because most participants were in private practice. However, with the

109 creation of the organization of mental health professionals, and members of specific racial ethnic groups feeling excluded, the question of organizational multicultural competence becomes an issue. The fact that there is a sense of exclusion and lack of communication shows that both sides would benefit from examining issues of culture and how it impacts the formation process of this organization.

On the broader level of institutional and societal impact on clients, less than half of the participants seemed to have an understanding of the legacies of enslavement, colonization, immigration, and emigration. These legacies continue to influence present- day socioeconomic categories and race relations in Mauritius. Mauritian mental health practitioners did not see themselves as change agents in society. Given that the majority of practitioners worked in private practice, they were exposed to a rather privileged clientele, although participants reported increasingly diverse clients from a socioeconomic standpoint over time. Such diversification may lead Mauritian practitioners to examine issues of social justice more in depth, and assess their level of responsibility within the Mauritian system of institutions. The newly formed SPP can be a leader in the training and education of its members in these matters.

Limitations of the Study

The study was designed on the assumption that practitioners within psychological fields were all within the counseling and clinical psychology realm. Therefore, the interview questions, as well as the questionnaire focused on clinical issues. However, during data collection, it became clear that there were practitioners within the educational and industrial/organizational areas as well. When interviewing these participants, I used the same guide for questions as with practitioners within the clinical and counseling

110 realm. However, I did not ask them to fill out the questionnaire because it was not

relevant to their practice. It would have been helpful to have a questionnaire that took

into consideration their areas of practice.

Also, information about client age demographics was missing because age range

of clients was not included in the questionnaire. In fact, it would have been useful for the questionnaire to have a section for children/adolescents and a section for adult clients,

because the type and proportion of disorders within these two populations are different.

Also, providing categories that respondents could check on the questionnaire contributed

to a lack of accuracy. While the categories were provided for the convenience of the

respondent, it would have been more useful to ask participants to give an estimate of the

number of clients served.

Another limitation is that the study focused on a broad range of topics, at the

expense of depth. It would be helpful for future studies to focus on a specific topic such

as use of indigenous healers within the Indo Mauritian cultures.

Finally, given the nature of qualitative research, subjectivity is even more of a

factor in the research method, data analysis and discussion of such analyses. While there

are ways to limit the subjectivity through triangulation and member checks, it is also

useful to know the biases of the researcher so the reader can better decide on the

reliability and validity of the research. My personal biases included feeling that

Mauritian mental health practitioners would tend more towards assimilation than

integration or revivalism, due to our history of colonization leading to the colonization of

our minds. Having studied in the United States myself, I am biased toward the training

that I received compared to the training offered in other countries. Further, I believe that

111 culturally relevant therapy is crucial to help clients heal, and conversely, that imposing a culturally irrelevant therapy is detrimental to the client. Finally, I was also biased toward believing that discussing issues of race and ethnicity would be difficult for participants due to a politically correct public arena, so I apologized to participants if I felt they were getting uncomfortable with the topic.

Conclusions, Recommendations, and Suggestions for Future Research

We live in a global world, where people are more mobile, leading to colonization, diasporas, voluntary and involuntary migration, study abroad, and exportation of culture through products and mass media. Mauritius is a case study of the confluence of all these forces. As such, Mauritius provides rich data for understanding how globalization leads to the traveling of disciplines through people who study abroad. The present study focused on psychology training in this global context. In addition, due to the relatively new introduction of psychology to Mauritius, the present study may also shed light on issues faced by countries that are undergoing a similar process.

The present study also provides avenues for Western universities who wish to expand their training so they can prepare mental health professionals to improve service to multicultural populations and non-Western countries. For instance, this study supported the hypothesis that a diverse student and faculty body helped teach students to be more sensitive to issues of culture. Requesting feedback from international students who have returned to their home country after studying abroad would provide valuable information about the parts of their training that was applicable to their home country’s culture(s). For instance, a questionnaire sent to graduates after five years back in their country of origin, followed up by interviews may provide valuable information about the

112 applicability of the training of mental health practitioners across cultures. Universities may use this information if they wish to make their training more culturally competent. In an increasingly global world, where cultures travel through immigration, media, products, and education, universities accepting foreign students and international students face several questions. First, how to share responsibility about addressing such issues of cultural diaspora, and how they affect psychotherapy? The second question is linked to the legacy of colonization, where people from former colonies go to study in the colonizing country. This second question revolves around how to share the responsibility of limiting colonization of the mind while raising consciousness.

These questions can be helpful to current and aspiring mental health providers, because it is likely to change how people practice, and it is likely to change the type of education that students seek during their psychology training. Further, longitudinal research on these topics would provide invaluable information to universities, international students, and practicing mental health professionals who have pursued their psychology training outside of the country where they currently practice.

On the Mauritian level, it appears that mental health practitioners would benefit from multicultural training, both general cultural competencies training and culture- specific training. One such tool to increase general cultural competency by helping understand of the client’s worldview is Kleinman’s (1980) eight questions. Kleinman is a psychiatrist and medical anthropologist who developed eight questions which help the therapist better understand how the clients understand their illness, and are listed below:

1. What do you call the problem?

2. What do you think has caused the problem?

113 3. Why do you think it started when it did?

4. What do you think the sickness does? How does it work?

5. How severe is the sickness? Will it have a short or long course?

6. What kind of treatment do you think the patient should receive? What are the most

important results you hope the patient receives from this treatment?

7. What are the chief problems the sickness has caused?

8. What do you fear the most about the sickness?

For example, the training could start with culture-specific worldview information, followed by an introduction to the Kleinman’s questions as well as demonstrations of how to apply them. Another possible outcome from these questions, if clients indicate that they believe in seeking indigenous healers for treatment, is that there may be more collaboration among therapists and indigenous healers (Fadiman, 1997; Torrey, 1972).

Research assessing Kleinman’s eight questions effectiveness in cross-cultural training could add another tool available to multicultural counseling trainers.

Research on culture specific issues is needed as well, given most participants’ limited knowledge of Mauritian cultures other than their own, and given the fact that some clients actively sought therapists outside their culture for confidentiality purposes.

This includes research on race and ethnicity, but also on socioeconomic class, disability, age, sexuality and gender issues, as well as intersections within these categories.

Furthermore, outcome research and research on barriers for seeking psychological help may help underscore the importance cultural competence.

In addition, Mpofu’s (2002) suggestion is to engage in intra-cultural debate with the community on psychological constructs and their relevance to that community. Such

114 debates could take place in an informal setting, as well as a more formal training session or research taking place within a particular community. Spending more time in the community would also help the practitioner and researchers better understand the environment in which the client lives. If used in a systematic manner, this method could help benefit the research of the Mauritian culture(s), as well as the applicability of psychological constructs. Such involvement with the community can also encourage research on indigenous healers within specific communities. In turn, this knowledge could help with guidelines on how mental health practitioners can collaborate with indigenous healers to maximize benefits to the client.

A general recommendation is to have regular continuing education sessions, focusing on cultural issues, as well as other issues such as self-care and legal issues. This training would help alleviate the vacuum that practitioners reported because they found it difficult to stay current in their knowledge and practice of psychology. The members could start by polling their areas of specialties, or areas where they feel competent, and conducting trainings for each other.

Another recommendation is to avoid over-reliance on norm-referenced tests

(Mpofu, 2002) because the norms are not established for the culture, and because the tests may be measuring psychological constructs that are not relevant to the client’s environment. Instead, Mpofu (2002) recommended curriculum-based assessment in schools, and assessment of coping abilities of the client and their family. Such assessment ensures that the data obtained is useful in developing a treatment plan that is helpful to the client. Research helping establish such an inventory of coping abilities would be useful within the mental retardation field for example. Further, research could

115 be used to develop indigenous measures. Cheung (2004) showed that an indigenously developed Chinese inventory of personality and psychopathology—the Chinese

Personality Assessment Inventory—had better predictive validity for that population than well established Western tests such as the NEO Personality Inventory or the Minnesota

Multiphasic Personality Inventory.

The above recommendations focus on working with the client. However, the data suggest that cross-cultural difficulties are present among colleagues as well. Therefore, cross-cultural training would also help improve cross-cultural communication among mental health practitioners. Such improved communication could then help the Société des Professionnels en Psychologie (SPP) be more efficient in reaching its goals.

One of the goals of the SPP is to legitimize the professionals in the mental health field. Indeed, there seems to be a need in Mauritius to ensure quality psychological services to clients. Currently, the SPP recognizes as psychologists, counselors or social workers as those who are qualified to practice as such in the country where they received their degree. This requirement is a good starting point. In the long run, it may be useful to establish Mauritian criteria regarding what type of training (theoretical and practical) is recognized in Mauritius. Further, it seems that all participants reported being isolated and struggling when they first started practicing in Mauritius. Therefore, one recommendation is to establish a system of supervision, where new mental health practitioners work with an experienced supervisor as they adapt their practice to

Mauritian cultures. The supervision can help speed the transition process, ensure quality services to clients, and reduce isolation among practitioners. It may also be useful to use

116 a “grandfather clause” to include those professionals who may not have the required degree, but who have acquired valuable experience over the years of practice.

On the topic of collegial relationships, the data suggest that mental health professionals may not have as high an opinion of each other in Mauritius. First, consider the example of a client who is not satisfied with his or her therapist and decides to try another one. The second therapist is likely to hear how the first therapist did not fulfill the needs of the client. This process is exacerbated by the fact that Mauritius is small, so that a particular mental health practitioner may have heard from five different clients that a particular therapist did not suit their needs. It is easy to conclude that this particular therapist is not competent. However, this conclusion would be based on biased data, because those clients who are satisfied with the services of said not-competent therapist do not seek services from another therapist. The second source of the problem is linked to the legal system in Mauritius, especially in divorce and custody cases. Each spouse and parent seeks his or her own mental health professional to write a report for the court.

This situation leads mental health professionals to be at odds with their colleagues.

Therefore, interacting with this colleague within the context of the SPP may lead to a different perception of the person, and hopefully better relationships. Another recommendation, suggested by one of the participants was to change the legal system, so that the court would have a list of qualified mental health practitioners for cases of divorce and custodial care. The parents would then agree on a practitioner that they both felt were competent, and only one report would be presented to the court, with balanced information.

117 Another recommendation, also linked to one of the SPP’s goals, is the education of the Mauritian public about the role of a psychologist. This would both help reduce the stigma, and provide accurate expectations for potential clients. It may also be helpful to discuss expectations at the beginning of the therapeutic process to ensure that the therapist and the client are working on a similar set of assumptions.

In conclusion, the present study provided a foundation to broach topics of globalization in psychological training. As Western psychology travels to different countries, it is important for the people who carry such knowledge and tools in their suitcase to examine the relevance of Western psychology when applied to a different context. As Sinha (1980) and Mpofu (2002) suggested, Third World nations can gain in the process by examining which parts of this Western psychology are adapted to the local culture(s). Critical thinking, trial and error, and increased local research can help in the process of integration, and potentially fusion, when adapting Western psychology to new destinations.

118

REFERENCES

Adair, J.G., Coêlho, A.E., & Luna, J.R. (2002). How is international psychology? International Journal of Psychology, 37, 160-170.

Addison, J., & Hazareesingh, K. (1993). A New History of Mauritius (revised ed.). Rose-Hill, Mauritius: Editions de l’Océan Indien.

Alzubaidi, A.S., & Ghanem, A. (1997). Perspectives on psychology in Yemen. International Journal of Psychology, 32, 363-366.

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.: Author.

American Psychological Association (2002). Guidelines on multicultural education, training, research, practice and organizational change for psychologists. Retrieved March 23, 2003, from http://www.apa.org/pi/multiculturalguidelines.pdf.

Appadurai, A. (2001). Grassroots globalization and the research imagination. In A. Appadurai (Ed.), Globalization (pp. 1-21). Durham: Duke University Press.

Arredondo, P., Toporek, R., Brown, S.P., Jones, J., Locke, D.C., Sanchez, J. & Stadler, H. (1996). Operationalization of Multicultural Counseling Competencies. Journal of Multicultural Counseling and Development, 24, 42-78.

Atkinson, D.R., Casas, A., & Abreu, J. (1992). Mexican-American acculturation, counselor ethnicity and cultural sensitivity, and perceived counselor competence. Journal of Counseling Psychology, 39, 515-520.

Bauserman, R. (1997). International representation in the psychological literature. International Journal of Psychology, 32, 107-112.

Berry, J.W. (1986). Multiculturalism and psychology in plural societies. In L.H. Ekstrand (Ed.), Ethnic minorities and immigrants in a cross-cultural perspective. Lisse: Swets and Zeitlinger, B.V.

Berry, J.W. (1993). Psychology in and of Canada: One small step toward a universal psychology. In U. Kim, & J.W. Berry (Eds.), Indigenous psychologies: Research and experience in cultural context (pp. 260-276). Newbury Park, CA: Sage

119 Bower, B. (1998). Objective visions: Historians track the rise and times of scientific objectivity. Science News, 154, 360-362.

Cheung, F.M. (2000). Deconstructing counseling in a cultural context. The Counseling Psychologist, 28, 123-132.

Cheung, F.M. (2004). Use of Western and indigenously developed personality test in Asia. Applied Psychology: An International Review, 53, 173-191.

Church, A.T., & Katigbak, M.S. (2002). Indigenization of psychology in the Philippines. International Journal of Psychology, 37, 129-148.

Coleman, H.L.K. (1998). General and multicultural counseling competency: Apples and oranges? Journal of Multicultural Counseling and Development, 26, 147-156.

Constantine, M.G. (2002). Predictors of satisfaction with counseling racial and ethnic minority clients’ attitudes toward counseling and ratings of their counselors’ general and multicultural counseling competence. Journal of Counseling Psychology, 49, 255-263.

Constantine, M.G., & Ladany, N. (2000). Self-report multicultural counseling competence scales: Their relation to social desirability attitudes and multicultural case conceptualization ability. Journal of Counseling Psychology, 47, 155-164.

D’Andrea, M., Daniels, J., & Heck, R. (1991). Evaluating the impact of multicultural counseling training. Journal of counseling and development,70, 143-150.

Denzin, N.K., & Lincoln, Y.S. (Eds.). (2000). Handbook of Qualitative Research (2nd ed.). Thousand Oaks, CA: Sage Publications.

Durojaiye, M.O.A. (1993). Indigenous psychology in Africa: The search for meaning. In U. Kim, & J.W. Berry (Eds.), Indigenous psychologies: Research and experience in cultural context (pp. 211-220). Newbury Park, CA: Sage Publications.

Enriquez, V.G. (1992). From colonial to liberation psychology: The Philippine experience. Quezon City, Philippines: University of the Philippines Press.

Fadiman, A. (1997). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus and Giroux.

Fanon, F. (1968). The wretched of the earth. New York: Grove Press.

Fassinger, R.E. (1991). The hidden minority: Issues and challenges in working with lesbian women and gay men. The Counseling Psychologist, 19, 157-176.

120 Gergen, K.J. (1994). Exploring the postmodern: Perils or potentials? American Psychologist, 49, 412-416

Gergen, K.J. (2001). Psychological science in a postmodern context. American Psychologist, 56, 803-813.

Gergen, K.J., & Gergen, M.M. (2000). Qualitative Inquiry: Tensions and Transformations. In N.K. Denzin, & Y.S. Lincoln (Eds.), Handbook of Qualitative Research (2nd ed., pp. 1025-1046). Thousand Oaks, CA: Sage Publications.

Gibbs, W.W. (1995). Lost Science in the Third World. Scientific American, 273, 92-99.

Glesne, C. (1999). Becoming qualitative researchers (2nd ed.). White Plains, NY: Longman.

Gordon, E.W., Miller, F., & Rollock, D. (1990). Coping with communicentric bias in knowledge production in the social sciences. Educational Researcher, 19, 14-19.

Government of Mauritius (1990). Housing and Population Census. Port-Louis, Mauritius: Government of Mauritius.

Habermas, J. (1971). Knowledge and human interests (J.J. Shapiro, Trans.). Boston: Beacon.

Hall, C.C.I. (1997). Cultural malpractice: The growing obsolescence of psychology with the changing U.S. population. American Psychologist, 52, 642-651.

Highlen, P.S., & Finley, H.C. (1996). Doing qualitative analysis. In F.T.L. Leong & J.T. Austin (Eds.), The psychology research handbook: A guide for graduate students and research assistants (pp.177-192). Thousand Oaks, CA: Sage Publications.

Hill, C.E., Thompson, B.J., & Williams, E.N. (1997). A guide to conducting consensual qualitative research. Counseling Psychologist, 25, 517-572.

Hofstede, G. (1980). Culture’s Consequences: International differences in work-related values. Beverly Hills, CA: Sage.

Hoshmand, L.T., & Polkinghorne, D.E. (1992). Redefining the science-practice relationship and professional training. American Psychologist, 47, 55-66.

Hughes, M., & Hertel, B.R. (1990). The significance of color remains: A study of life choices, mate selection, and ethnic consciousness among Black Americans. Social Forces, 68, 1105-1120.

Hurley, G. & Doyle, M.S. (in press). Counseling psychology: From industrial societies to sustainable development.

121 Jing, Q., & Fu, X. (2001). Modern Chinese psychology: Its indigenous roots and international influences. International Journal of Psychology, 36, 408-418.

Kim, U., & Berry, J.W. (Eds.). (1993). Indigenous psychologies: Research and experience in cultural context. Newbury Park, CA: Sage Publications.

Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine and psychiatry. Berkeley, CA: University of California Press

Ladany, N., Inman, A.G., Constantine, M.G., & Hofheinz, E.W. (1997). Supervisee multicultural case conceptualization ability and self-reported multicultural competence as functions of supervisee racial identity and supervisor focus. Journal of Counseling Psychology, 44, 284-293.

Ladson-Billings, G. (2000). Racialized discourses and ethnic methodologies. In N.K. Denzin, & Y.S. Lincoln (Eds.), Handbook of Qualitative Research (2nd ed., pp. 257-277). Thousand Oaks, CA: Sage Publications.

LaFromboise, T., Coleman, H.L.K, & Gerton (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395-412.

LaFromboise, T.D., Coleman, H.L.K., & Hernandez, A. (1991). Development and factor structure of the Cross-Cultural Counseling Inventory-Revised. Professional Psychology: Research and Practice, 22, 380-388.

Lather, P. (1986). Issues of validity in openly ideological research: Between a rock and a soft place. Interchange, 17, 63-84.

Lather, P., & Smithies, C. (1997). Troubling the Angels: Women Living with HIV/AIDS. Boulder, Co: Westview/Harper Collins.

Leahey, T.H. (1992). The mythical revolutions of American psychology. American Psychologist, 47, 308-318.

Leong, F.T. L. (1996). Toward an integrative model for cross-cultural counseling and psychotherapy. Applied & Preventive Psychology, 5, 189-209.

Leong, F.T.L., & Blustein, D.L. (2000). Toward a global vision of counseling psychology. The Counseling Psychologist. 28, 5-9.

Leong, F.T.L., & Ponterotto, J.G. (in press). A proposal for internationalizing counseling psychology: Rationale, recommendations and challenges. The Counseling Psychologist.

Lincoln, Y., & Guba, E. (1985). Naturalistic Inquiry. Beverly Hills, CA: Sage.

122 Lincoln, Y., & Guba, E. (2000). Paradigmatic controversies, contradictions, and emerging confluences. In N.K. Denzin, & Y.S. Lincoln (Eds.), Handbook of Qualitative Research (2nd ed.) (pp. 163-188). Thousand Oaks, CA: Sage Publications.

Lonner, W.J., & Ibrahim, F.A. (2000). Appraisal and assessment in cross-cultural counseling. In P.B. Pedersen, J.G. Draguns, W.J. Lonner & J.E. Trimble (Eds.), Counseling across cultures (5th ed., pp.3-27). Thousand Oaks, CA: Sage Publications.

Mauritius Alliance of Women, & Southern African research and Documentation-Women in Development Southern African Awareness (1997). Beyond Inequalities: Women in Mauritius. Quatre-Bornes, Mauritius: SCE Printing Ltd.

Mauritius Research Council (1998). Social fabric in Mauritius, Phase I. Rose-Hill, Mauritius: Mauritius Research Council.

Morrow, S.L., & Smith, M.L. (2000). Qualitative research for counseling psychology. In S.D. Brown & R.W. Lent (Eds.), Handbook of counseling psychology (3rd ed., pp.199-230). New York: John Wiley.

Mostern, K. (1994). Decolonization as learning: Practice and pedagogy in Frantz Fanon’s revolutionary narrative. In H.A. Giroux & P. McLaren (Eds.), Between borders: Pedagogy and the politics of cultural studies (pp.252-271). New York: Routledge.

Mpofu, E. (2002). Psychology in sub-Saharan Africa: Challenges, prospects and promises. International Journal of Psychology, 37, 179-186.

Nandy, A. (1983). The intimate enemy: Loss and recovery of self under colonialism. Delhi: Oxford University Press.

Park, K.B., Upshaw, H.S., Koh, S.D. (1988). East Asians’ responses to western health items. Journal of Cross-Cultural Psychology, 19, 51-64.

Patton, M. (1990). Qualitative evaluation and research methods(2nd ed.). Newbury park: Sage.

Pedersen, P.B. (1987). Ten frequent assumptions of cultural bias in counseling. Journal of Multicultural Counseling and Development, 1, 16-24.

Pedersen, P.B. (2002). Ethics, competence, and other professional issues in culture- centered counseling. In P.B. Pedersen, J.G. Draguns, W.J. Lonner & J.E. Trimble (Eds.), Counseling across cultures (5th ed., pp.3-27). Thousand Oaks, CA: Sage Publications.

123 Polkinghorne, D.E. (1984). Further extensions of methodological diversity for counseling psychology. Journal of Counseling Psychology, 31, 416-429.

Polkinghorne, D.E. (1994). Reaction to special section on qualitative research in counseling process and outcome. Journal of Counseling Psychology, 41, 510- 512.

Ponterotto, J.G., Casas, J.M. Suzuki, L.A. & Alexander, C.M. (Eds.). (1995). Handbook of multicultural counseling. Thousand Oaks, CA: Sage Publications, Inc.

Ponterotto, J.G., Fuertes, J.N., & Chen, E.C. (2000). Models of multicultural counseling. In S.D. Brown & R.W. Lent (Eds.), Handbook of counseling psychology (3rd ed., pp.639-669). New York: John Wiley.

Ponterotto, J.G., Rieger, B.P., Barrett, A., & Sparks, R. (1996). Development and initial validation of the Multicultural Counseling Awareness Scale. In G.R. Sodowsky & J.C. Impara (Eds.), Multicultural assessment in counseling and clinical psychology (pp.247-282). Lincoln, NE: Buros Institute of Mental Measurements.

Pope-Davis, D.B.; Toporek, R.L.; Ortega-Villalobos, L., Ligiero, D.P, Brittan-Powell, C.S., Liu, W.M., Bashshur, M., Codrington, J.N., Liang, C.T.H. (2002). Client perspectives of multicultural counseling competence: A qualitative examination. The Counseling Psychologist. 30, 355-393.

Proctor, R.W., & Capaldi, E.J. (2001). Empirical evaluation and justification of methodologies in psychological science. Psychological Bulletin, 127, 759-772.

Richardson, L. (2000). Writing: A method of inquiry. In N.K. Denzin, & Y.S. Lincoln (Eds.), Handbook of Qualitative Research (2nd ed.) (pp. 923-948). Thousand Oaks, CA: Sage Publications.

Richie, P.L.J., & Sabourin, M. (2001). Contributing to world development: Research activities of the International Union of Psychological Science. International Journal of Psychology, 36, 71-75.

Root, M.P.P. (1998). Facilitating psychotherapy with Asian American clients. In D.R. Atkinson, G. Morten, & D.W. Sue (Eds.) Counseling American minorities (5th ed., pp.214-234). New York: McGraw-Hill.

Sanchez, L.M. (1999). Psychology in Venezuela: Perceptions and opinions of research psychologists. Applied Psychology: An International Review, 48, 481-496.

Selvon, S. (2001). A Comprehensive History of Mauritius. Mauritius: Mauritius Printing Specialists.

Sinha, D. (1990). Appropriate indigenous psychology in India: A search for new identity. In S. Iwawaki, Y. Kashima, & K. Leung (Eds.), Innovations in cross- 124 cultural psychology: Selected papers from the tenth international conference of the International Association for Cross-Cultural Psychology held at Nara, (pp.38-48).

Smith, L.T. (1999). Decolonizing methodologies: Research and Indigenous peoples. New York: Zed Books.

Smith, M.L., & Glass, G.V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32, 752-760.

Sodowsky, G.R., Kuo-Jackson, P.Y., Richardson, M.F., & Corey, A.T. (1998). Correlates of self-reported multicultural competencies: Counselor multicultural social desirability, race, social inadequacy, locus of control racial etiology, and multicultural training. Journal of Counseling Psychology, 45, 256-264.

Sodowsky, G.R., Taffe, R.C., Gutkin, T.B., & Wise, S.L. (1994). Development of the Multicultural Counseling Inventory: A self-report measure of multicultural counseling competencies. Journal of Counseling Psychology, 41, 137-148.

Speight, S.L., Myers, L.J., Cox, C.I., & Highlen, P.S. (1991). A redefinition of multicultural counseling. Journal of Counseling and Development, 70, 29-36.

Sue, D., & Sundberg, N.D. (1996). Research and research hypotheses about effectiveness in intercultural counseling. In P.B. Pedersen, J.G. Draguns, W.J. Lonner, & J.E. Trimble (Eds.), Counseling across cultures (4th ed., pp. 323-352). Thousand Oaks, CA: Sage.

Sue, D.W., Bernier, J.E., Durran, A., Feinberg, L., Pedersen, P., Smith, E.J., & Vasquez- Nuttall, E. (1982). Position paper: Cross-cultural counseling competencies. The Counseling Psychologist, 10, 45-52

Sue, D.W., Carter, R.T., Casas, J.M., Fouad, N.A., Ivey, A.E., Jensen, M., et al. (1998). Multicultural Counseling Competencies: Individual and organizational development. Thousand Oaks, CA: Sage Publications.

Sue, D.W., Ivey, A.E., & Pedersen, P.B. (1996). A Theory of multicultural counseling and therapy. Cincinnati, OH: Brooks/Cole Publishing Company.

Sue, S., & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy: A critique and reformulation. American Psychologist, 42, 37-45.

Torrey, E.F. (1972). The mind game: Witchdoctors and psychiatrists. New York: Emerson Hall Publishers.

Walsh, W.B. (2001). The changing nature of the science of vocational psychology. Journal of Vocational Behavior, 59, 262-274.

125 Wampold, B.E. (1996). Designing a research study. In F.T.L. Leong & J.T. Austin (Eds.), The psychology research handbook: A guide for graduate students and research assistants (pp.59-72). Thousand Oaks, CA: Sage Publications.

Worthington, R.L., Mobley, M., Franks, R.P., & Tan, J.A. (2000). Multicultural counseling competencies: Verbal content, counselor attributions, and social desirability. Journal of Counseling Psychology, 47, 460-468.

Young, R.J.C. (2001). Postcolonialism: An historical introduction. Oxford: Blackwell.

de Zoysa, P., & Ismail, C. (2002). Psychology in an Asian country: A report from Sri Lanka. International Journal of Psychology, 37, 110-111.

126

APPENDIX A

SEMI-STRUCTURED INTERVIEW

• Topic: Participants’ university education in psychology

1. How would you describe your psychology training?

2. What theoretical orientation(s) were you trained in?

3. Did your graduate training teach one model of counseling, or did it account for

multicultural issues?

4. How much of your university training focused on classroom learning versus

practicums?

5. What type of supervision did you receive during your training?

• Topic: How their training is helpful to them in their current work

1. What helpful concepts & techniques did you learn during your training?

2. Can you give some examples of what you just described?

• How they bridged gaps in their training in order to adapt to Mauritian cultures and

realities

1. How did you practice psychology when you first started practicing in Mauritius?

2. When, if at all, did you start thinking that your training may not apply fully to the

Mauritian context and cultures?

3. Were there clients with whom you felt that what you had learned during your training

was not applicable? Please describe what became problematic for you.

127 4. How and why did you change how you practice psychology? (if needed, probe for

issues surrounding theory, cultural differences, and the process of change)

5. Make sure that the participant addressed the following areas:

-constructs and techniques they maintained

-constructs and techniques they kept and adapted

-constructs and techniques they no longer use

-in each case, make sure specific examples are provided

• Topic: Whether issues of colonization affect how they think about themselves and

their work

1. How would you describe the Mauritian culture?

2. In what ways has Mauritius’ history of colonization impacted our culture?

3. Are any of the issues you just described present in your work? If yes, please

elaborate and give examples.

• Topic: Whether language and translation are an issue in psychotherapy

1. What language(s) do you use in therapy?

2. Are there situations where you would switch language, or use words from other

languages?

3. How do you translate the psychology jargon so it is accessible to your clients?

• Topic: When working with clients from different ethnic, racial and/or religious

background than their own:

¾ the level of awareness of differences;

1. Do you act differently with clients who are from different ethnic, racial or

religious backgrounds than your own? If yes, please elaborate.

128 2. Can you give examples when you felt that your client was being rude,

disrespectful or disengaged?

3. How do you think your own culture impacts who you are as a therapist?

4. Have you ever felt you needed to consult with a therapist from your client’s

culture? Give specific example.

¾ the level of knowledge about the client’s culture; and

1. How much knowledge do you have about the culture(s) of your clients? Please

give specific examples.

2. What are ways in which the client’s culture affects therapy? Please give specific

examples.

¾ the different skills used

1. Do you address cultural differences during your sessions with the client? Please

give specific examples.

2. Have you ever sought consultation when working with a client from a different

culture? Please give specific examples.

129

APPENDIX B

QUESTIONNAIRE ABOUT SERVICES PROVIDED BY

MENTAL HEALTH PRACTITIONERS

To answer the following questions about the services you provided in 2002 (calendar year), we suggest that you take a typical month for your practice and look at the actual appointments you had. If asked to provide numbers, use this typical month and multiply by 12 to obtain an estimate for the year. 1. What type of services did you provide during 2002? (outreach (presentations, etc ٱ group therapy ٱ individual therapy ٱ family or couple’s therapy ٱ (consultation (to colleagues or organizations ٱ assessment ٱ

2. How many clients did you see in individual therapy during 2002? If providing an exact number of clients you served in 2002: ______If providing an estimate of the number of clients you served in 2002, please check one of the boxes below: 1000-801 ٱ 800-601 ٱ 600-401 ٱ 400-201 ٱ less than 200 ٱ more than 1401 ٱ 1400-1201 ٱ 1200-1001 ٱ

3. How many clients did you see in group therapy during 2002? If providing an exact number of clients you served in 2002: ______If providing an estimate of the number of clients you served in 2002, please check one of the boxes below: 1000-801 ٱ 800-601 ٱ 600-401 ٱ 400-201 ٱ less than 200 ٱ more than 1401 ٱ 1400-1201 ٱ 1200-1001 ٱ

4. How many clients did you serve during outreaches during 2002? If providing an exact number of clients you served in 2002: ______If providing an estimate of the number of clients you served in 2002, please check one of the boxes below: 1000-801 ٱ 800-601 ٱ 600-401 ٱ 400-201 ٱ less than 200 ٱ more than 1401 ٱ 1400-1201 ٱ 1200-1001 ٱ

5. How many clients did you see in family or couple’s therapy during 2002? If providing an exact number of clients you served in 2002: ______If providing an estimate of the number of clients you served in 2002, please check one of the boxes below:

130 1000-801 ٱ 800-601 ٱ 600-401 ٱ 400-201 ٱ less than 200 ٱ more than 1401 ٱ 1400-1201 ٱ 1200-1001 ٱ

6. How many clients did you see for assessments only during 2002? If providing an exact number of clients you served in 2002: ______

If providing an estimate of the number of clients you served in 2002, please check one of the boxes below: 1000-801 ٱ 800-601 ٱ 600-401 ٱ 400-201 ٱ less than 200 ٱ more than 1401 ٱ 1400-1201 ٱ 1200-1001 ٱ

7. How many consultations did you provide during 2002? If providing an exact number of clients you served in 2002: ______If providing an estimate of the number of clients you served in 2002, please check one of the boxes below: 90-71 ٱ 70-51 ٱ 50-31 ٱ 30-11 ٱ less than 10 ٱ more than 130 ٱ 130-111 ٱ 110-91 ٱ

8. Please rank order the following sources from which your clients heard about your services: _____ word of mouth _____ family member recommendation _____ newspaper advertising _____ physician/nurse’s referral _____ school personnel (e.g., teachers, principals) _____ phone book _____ past and/or present clients _____ media coverage (television, radio and newspaper)

9. What is the ethnicity of the clients you served in 2002? Please provide percentages. ____% Hindu Indian Mauritian ____% Muslim Indian/Pakistani Mauritian ____% White Mauritian ____% Creole Mauritian ____% Chinese Mauritian ____% Other (please specify:______)

10. What is the gender of the clients you served in 2002? ____% female ____% males

11. Based on the occupation of your clients, or the occupation(s) of their family, what is the social class of the clients you served in 2002? Please provide percentages. ____% lower class ____% middle class ____% upper class

131 12. What were the presenting problems and diagnoses of the clients you served in 2002? Please provide percentages or number of cases for each category. _____ anxiety disorders _____ mood disorders _____ substance abuse disorders _____personality disorders _____ psychotic disorders _____ sexual disorders _____ eating disorders _____ adjustment disorders _____ learning disorders _____ cognitive disorders _____ developmental disorders _____ disruptive behavior disorders _____ other disorders (please specify: ______)

13. On average, how many sessions do you have with a client? If relevant, please provide a breakdown of number of sessions per diagnostic category. ______

14. How was your caseload in 2002 representative of your caseload over the course of your career as a psychologist here in Mauritius? ______

15. Please answer the questions regarding yourself: i. Please identify the ethnic group(s) to which you belong: ______ii. ______female ٱ male ٱ :iii. Please identify your sex iv. How would you define your social class while growing up? upper class ٱ middle class ٱ lower class ٱ .v vi. How many years have you been practicing in Mauritius? ______years vii. Which schools & universities did you attend for the following: viii. --primary school:______ix. --secondary school: ______x. --undergraduate university:______Country: ______xi. --graduate university (ies) ______Country: ______Doctoral ٱ Masters ٱ :xii. What was the highest level of education you attained xiii. Please indicate the years during which you received your psychology training: 19___ to ______

132