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From Psycho-Analysis to Culture-Analysis Also by Marwan Dwairy COUNSELING AND PSYCHOTHERAPY WITH ARABS AND MUSLIMS: A Culturally Sensitive Approach CROSS-CULTURAL COUNSELLING: The Arab Palestinian Case From Psycho-Analysis to Culture-Analysis A Within-Culture Psychotherapy Marwan Dwairy Oranim Academic College, Israel palgrave macmillan © Marwan Dwairy 2015 Softcover reprint of the hardcover 1st edition 2015 978-1-137-40792-4 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No portion of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The author has asserted his right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2015 by PALGRAVE MACMILLAN Palgrave Macmillan in the UK is an imprint of Macmillan Publishers Limited, registered in England, company number 785998, of Houndmills, Basingstoke, Hampshire RG21 6XS. Palgrave Macmillan in the US is a division of St Martin’s Press LLC, 175 Fifth Avenue, New York, NY 10010. Palgrave Macmillan is the global academic imprint of the above companies and has companies and representatives throughout the world. Palgrave® and Macmillan® are registered trademarks in the United States, the United Kingdom, Europe and other countries. ISBN 978-1-349-68109-9 ISBN 978-1-137-40793-1()eBook DOI 10.1057/9781137407931 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. Logging, pulping and manufacturing processes are expected to conform to the environmental regulations of the country of origin. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Dwairy, Marwan Adeeb. From psycho-analysis to culture-analysis : a within-culture psychotherapy / Marwan Dwairy. pages cm 1. Psychoanalysis. 2. Cross-cultural counseling. 3. Cultural psychiatry. I. Title. BF173.D93 2015 150.195—dc23 2015012362 Contents List of Tables, Figures, and Boxes viii Introduction 1 1 Culture and Psychology 4 Collectivistic culture 7 Psychological development 10 Personality theories 11 Psychopathology 14 Conclusion 16 2 Fitness of Psychoanalysis and Psychotherapy Across Cultures 18 Psychotherapy misses the main social domain and becomes entrenched in the intra-psychic one 19 The objectives of psychotherapy may be counter-productive 19 Transference and resistance in therapy 20 Non-directive therapy 21 Disputation of irrational thoughts 22 Conclusion 24 3 Contradictions and Inconsistencies in a Culture 26 Diversity and personal selection within individualistic and collectivistic cultures 28 Contradictions and inconsistency in the Bible 29 Contradictions and inconsistency in the Qura’an 32 Contradictions and inconsistency in proverbs 35 How do people deal with contradictions? 38 Conclusion 40 4 Culture Analysis 42 Resistance 42 External resistance 43 Case example 44 v vi Contents Culture analysis 47 Stages of culture analysis 50 A comparison of culture analysis and psychoanalysis 52 When is culture analysis considered? 53 Culture analysis with Ahmad and his father 55 Conclusion 60 5 Using Metaphors in Culture Analysis 62 Metaphors in cultures 62 Metaphors in culture analysis 64 Metaphor therapy 64 A case of metaphor therapy: “Swimming against the stream” 66 How does metaphor therapy work? 69 Metaphors and images are a true reality 70 A two-layer bio-psycho-social model 71 How do these two layers interact? 72 Psychotherapy and the bio-psycho-social system 74 Metaphoric psychotherapies 74 Treatment via dreams 75 Art therapy 76 Symptoms as metaphors 77 Conclusion 79 6 Culture Analysis and Memories 81 Memories in psychotherapy 82 Memories as a resource for detecting inconsistencies 83 Adler’s early recollection 85 Dana’s case 87 Personality types based on memories 91 Affect bridge to significant memories 96 Lafi’s case 97 Lamia’s case 101 Conclusion 105 7 Physical Environment and Culture Analysis 107 Talking about a significant object (TASO) 109 Yaser’s case 110 Conclusion 114 Contents vii 8 Cases 116 Integrative case 1: Samer: God does not love me 116 Integrative case 2: Badera: Turning the other cheek 132 Integrative case 3: Kamel: A life of charity 142 Therapeutic vignette 1: Moderating extreme Islamic values to treat anxiety and nervousness 153 Therapeutic vignette 2: Culture analysis within a friendship to treat anxiety and nightmares 159 Therapeutic vignette 3: Employing “Trust in God” in treatment of anxiety disorders 163 References 167 Index 172 Tables, Figures, and Boxes Tables 1.1 Characteristics of individualistic versus collectivistic cultures 8 4.1 Comparison of psychoanalysis and culture analysis 53 Figures 1.1 A continuum of individualism (circles) and collectivism (squares) 6 3.1 Cultural directives of “Yes” and “No” toward certain topics indicated by numbers 27 3.2 Two people select directives from the same culture to which they affiliate themselves 38 3.3 A person’s change in values in two different contexts 40 4.1 Two persons from the same culture select different values and they each alter their values according to the context 48 5.1 A two-layer bio-psycho-social model 72 Boxes 1.1 Dependent personality disorder 301.6 16 viii Introduction After finishing my studies in psychology in 1978, I opened the first psychological services center to be situated among the Arab- Palestinian population in Israel. It was located in Nazareth, and I worked with Muslim and Christian clients. It did not take me long to realize that the tools, techniques, and theories I had learned at university were not effective. The reasons for this were many: talk therapy disappointed most of the clients, who wanted something concrete, such as medication; addressing personal or intimate issues was embarrassing and was resisted; clients were not able to express or talk about their feelings; many issues that were discussed were determined by the clients’ unconditional acceptance of norms and customs, which also limited these discussions; clients always pro- jected the responsibility for what was happening onto others without taking personal responsibility; and many terms related to the self, such as self-fulfillment, self-awareness, or self-responsibility, were foreign to them. At that time, I felt that the theories I had learned did not fit the people of Nazareth. I was convinced that psychotherapy could not succeed as long as these people still held traditional norms and atti- tudes that dismissed the individual’s rights, needs, and freedom of choice. I invested a lot of energy and became active in many social organizations in the community in order to bring about social and cultural change. Only in 1994, after I had moved to live and work in the US, could I gain a new perspective on my culture and I then realized that the theories I had learned and adopted are not universal, but rather need to be revised or changed in order to fit people who 1 2 From Psycho-Analysis to Culture-Analysis live in collectivistic and traditional cultures. I became convinced that psychotherapy should not be used as a tool for changing the client’s culture, but rather it should be used to find ways to help the client feel better within her culture. Since then I have become active in develop- ing and adapting therapeutic techniques for clients from collectivistic cultures, including African, South American, and Asian cultures. The idea of working within the client’s culture is not new and has been adopted by many scholars who work with collectivistic cultures. Culture analysis is an approach and technique that directs therapists in how to use the client’s culture to facilitate change. According to this approach, culture is not a static barrier that hinders psychother- apy, but rather is dynamic and can be employed to facilitate it. This attitude is based on the fact that every culture has internal conflicts and inconsistencies and that each member of each culture selectively adopts some aspects of the culture and neglects others. When such a client reaches an impasse in coping with a certain psychological prob- lem or symptom, the values and attitudes that the client has selected during the course of his life need to be revised. I coin the term “culture analysis” in order to orchestrate it together with psychoanalysis to indicate that for people from collectivistic cul- tures who adopt collective selves, the main analysis should be in the cultural realm before the psychological realm, and to indicate the similarity between the two approaches where both look for contents that are remote from the client’s consciousness or awareness: psy- choanalysis looks for repressed drives, needs, and wishes within the client’s psyche, and culture analysis looks for neglected, overseen, or rejected values and attitudes within the client’s culture. In both cases, bringing new content to consciousness initiates a process of change. One major difference between the two approaches is that in psycho- analysis the new content typically causes resistance within the client and conflicts with her family, while in culture analysis no resistance takes place and no confrontations with the family are expected. In the first chapter of this book, I explain the relationship between psychological theories and culture and how psychology emerged as a byproduct of individualism as a means of understanding the individual entity in the West. In Chapter 2, I focus on psychother- apy in order to show the discrepancy between the objectives of psychotherapy and the norms and values of clients who belong to a collectivistic culture and demonstrate that, as a result of this Introduction 3 discrepancy, psychotherapy with these clients may sometimes be counterproductive.