Race, Identity and the Transference/ Countertransference: A Mixed-Race Patient and a Mixed-Race Psychotherapist- A Single Case Study Tennyson E. Millar Jnr. A thesis submitted in partial fulfilment of the requirements of the University of East London in collaboration with the Tavistock and Portman NHS Foundation Trust Doctorate in Child Psychoanalytic Psychotherapy (M80). October 2014 Word Count: 63,233 i This thesis represents my own research and original work. It cannot be attributed to any other person or persons. ii Abstract This thesis is a single case-study of a child and adolescent psychotherapist working with a fourteen year old female adolescent patient of similar mixed ethnic background. The thesis presents the completed two year therapeutic work which included periods of intensive therapy (3-4 times-a-week work) following less intensive work. The patient’s early life was marked by witnessing parental domestic violence and parents who divorced. She subsequently struggled with maintaining relationships and presented race and gender identity ambiguity. She had consistently self-harmed and overdosed since the age of thirteen. The psychotherapist relied heavily on his countertransference in order to better understand and make sense of the patient’s inner world, particularly regarding issues of identity, race, gender and attachment. The primary research method used to analyse processed clinical session notes was Grounded Theory Method. iii Table of Contents Acknowledgements Introduction to the Research 1 1 My Personal Interest in Race and the Mixed-Race Experience 3 1.1 Mix-Race /Half-caste? Black, White or Brown? 3 1.2 Autobiographical Issues 3 1.3 Ethnicities 9 1.4 Mixed-Race in the Public Eye 10 1.5 The Demographics of Mixed-Race in the UK 14 2 Theoretical Issues concerning Psychotherapy, Ethnicity and 16 Adolescence 2.1 Contemporary Literature on Psychotherapy and Race 16 2.2 Race and Psychoanalysis 18 2.3 New Ethnicities 29 2.4 Autobiographical Accounts 32 2.5 Unique Research 37 2.6 Mixed-Race and Psychotherapy 40 2.7 The Relevance of these Literatures on Race and Ethnicity to this 43 Research 2.8 Psychoanalytic Themes: Countertransference and Projective Identification 45 2.9 Psychoanalytic Themes: Adolescence 50 2.l0 Relevance of the Psychoanalytic Study of Adolescence to this Case 55 Study 3 The Single Case Study – ‘Yasmin’ 58 3.1 Referrals and Allocation within a Tier 3 CAMHS team 58 3.2 Yasmin 59 3.3 History 60 3.4 Themes in the Work 61 3.5 Grounded Theory Analysis 62 3.6 First Impressions 63 3.7 Half-Caste 68 3.8 Disturbing Countertransference 74 iv 3.9 Countertransference Explored 91 3.10 Adolescent Extremes 99 3.11 In Search of Father 103 3.12 Gender and Identity 108 3.13 Erotic Transference ‘example 1’ 110 3.14 Erotic Transference ‘example 2’ 113 4 Methodology 120 4.1 Intensive and Extensive Methods 120 4.2 Case Studies 121 4.3 Strengths and Limitations of the Single Case Study 122 4.4 Psychotherapy and Single Case Studies 123 4.5 Grounded Theory Method 128 4.6 Grounded Theory in this Case Study 130 5 Conclusion 133 5.1 Evolution of the Research and Discoveries 133 5.2 Grounded Theory Analysis and the Clinical Data 136 5.3 Issues of Race in Therapeutic Practice 139 5.4 Internal or External Racism? 142 5.5 Complexities of the Mix Race Experience 145 5.6 The Future of Psychotherapy in Multi-Racial Cities 148 5.7 What can be learnt from this therapy? 153 Bibliography 160-164 v Acknowledgements To ‘Yasmin’, to whom I owe a debt of gratitude. To Margot Waddell and Margaret Rustin; two kind faces that introduced me to the Tavistock and Child Psychotherapy. To Caroline Gluckman and Trudy Kluber, service supervisor and M80 tutor/supervisor respectively. They provided two generous and contrasting supervisions throughout my four year training. To Gill Ingall and Michael Rustin, my research supervisors. A special mention for Michael and the advice, thought and time he gave me. To my sons, born at the beginning and end of my training. To my wife, without her love, support and understanding this would not have been possible. vi Introduction to the Research This investigation aims to present the psychoanalytical psychotherapeutic work undertaken by a mixed-race psychotherapist and mixed-race patient and explores the complexities of identity (both internal and external), race (both internal and external) and the transference/countertransference which were central to it. I returned to the original clinical material of a completed case, now as a researcher, with the desire to study and present a greater understanding of the complexity of the mixed- race experience. This allowed for exploration of experiences and issues of mixed-race identity which were relevant to my patient but also of personal and professional interest to me, and the significance of race and identity to the psychotherapy process. The plan of work was to gather and utilise data concerning a 14 year old adolescent girl who had attachment and identity difficulties. The data was drawn from two years of psychotherapy work; one year of twice weekly work followed by one year of intensive three/four times a week work. The setting for the research was the consulting room at the hospital. This investigation explored and analysed the therapist–patient transference/ countertransference relationship of an adolescent and psychotherapist that were both of a similar dual racial configuration. Fundamental to this research are several distinct yet related inquiries: • An in-depth analysis and investigation of a mixed-race adolescent girl’s understanding of her race and identity. • An assessment of psychoanalysis’s relationship and attitude to race and in particular mixed race. The analysis of the complexities of the psychotherapeutic process when the therapeutic dyad is made of a similar multi-ethnic configuration. • Examining the psychotherapist’s own preoccupations and countertransference experiences. A question was whether a focus on these terms in the therapy and the contrasting way in which the therapist and patient title or view themselves could be understood and worked on using the transference and countertransference? I wished to explore whether this 1 dimension of ethnic identity influenced other areas of the therapeutic work and if so how it had done so? This investigation extended its scope as it developed. Race and identity were the main focuses of my exploration yet as my analysis deepened I found other areas of interest that were initially hidden from me. The ethnic preoccupations which were brought into the consulting room at certain points both by the therapist and the patient were shown in the research to have brought some perturbation to the psychotherapeutic process, as at times did the adolescent acting- out of the patient and the therapist’s response to this. However examination of the clinical material during the research revealed that a psychotherapeutic process was nevertheless sustained, and that the patient had been able to find in the therapist an object in which she could have some trust. The therapy provided space in which the dilemmas of identity faced by the patient were able to be reflected on, and some development take place. 2 Chapter 1 My Personal Interest in Race and the Mixed Race Experience Mixed-Race / Half-Caste? Black, White or Brown? I grew up in West London in the 1970’s and 80’s the son of a black father from Barbados and a white mother from London. I believe things were much simpler back then than they are today. That is not suggesting they were better, but without doubt simpler. I was a ‘half-caste child’. My mother called me this as did my father, my friends, extended family, teachers, -everyone did. It was a name so widely used and accepted that it held a similar place in the minds and dialects of people as ‘mixed race’ does today. As I have implied beforehand the subject of race classification was rather simplified or undervalued or neglected in the 70’s and 80’s and in fact the 1971 and 1981 UK censuses did not even have a category to record the complex and varying ethnicities living in the UK. The 1991 census included some of these categories and this was broadened out in the 2001 and recent 2011 censuses. Today there are many recognised categories for ethnicities and races so that a title such as mixed-race does not fully suffice. The 2001 United Kingdom census provided categories and sub-categories for the ever increase diversity of the UK’s population. ‘Mixed’ was further broken down into (White and Black Caribbean, White and Black African, White and Asian and Other Mixed). However, half-caste is a term that is still employed in certain geographical areas around the UK. My patient upon whom this thesis is based often referred to herself as half-caste. Political correctness has deemed this title offensive so it is rarely heard these days but as I suggested, it has not completely disappeared. Looking back now on my childhood, half-caste was not the nicest way to categorise a person of mixed racial ethnicity but it was a lot better than half-breed and mongrel (other names I was called as a child). Autobiographical Issues In the distant past I have been at the receiving end of racially motivated attacks, verbal abuse and police harassment. The latter was more insidious and institutional, the former 3 two more blatant and explicit. These incidents mostly occurred in teenage-hood where I started to perceive and understand racism, but some occurred when I was much younger. I have been called nigger, wog, coffee, coon, Paki, Arab etc.