Multicultural/Diversity Archives

Narrative Therapy in a Cross-Cultural Conversation with Someone Approaching Death

Posted on September 12, 2023February 11, 2026 by Psychotherapy.net Team

Acknowledgements

T?na koutou, t?na koutou, t?na koutou k?toa

Ko Ben Lomond t?ku maunga

Ko Loch Lomond t?ku moana

Ko McAllum t?ku iwi

No Kotorana ?ku t?puna, engari I haere mai ?ku t?puna ki Aotearoa nei

No reira ka mihi hoki au ki te iwi M?ori

Ko James Copeland t?ku t?puna

Ko Hamish McAllum t?ku p?pa

Ko Jan Hutchison t?ku m?ma

Ko Gavin Pilkington t?ku tane purotu

E rua ?ku tamariki ko Tim r?ua ko Ella

Ko Sasha McAllum Pilkington t?ku ingoa

No reira t?na koutou, t?na koutou

Kia ora t?tou k?toa

Thank you, Huia Swann, for your encouragement and feedback through the many iterations of this story.

An Unexpected Beginning (1)

It was a busy morning at the hospice. I made my way into the community team’s office and was greeted with a buzz of activity. One of the nurses called me and I turned to greet her. In her hand was a referral letter.

“Sasha, I was wondering if you would see this woman for counselling? Her name is Louise, and she has advanced lung cancer. (2) Louise is refusing all treatment. It seems someone thought she was ‘in denial’ but I saw Louise yesterday and she told me she’s ‘not having any chemo’ because she doesn’t think she’s worth it. Louise is M?ori, but she’s refused cultural support. Could you see her?” she repeated, as she handed me the letter (3).

“Of course,” I replied, disturbed by the thought that Louise didn’t feel she was worth treatment, but grateful the nurse had looked beyond the judgement that Louise was “in denial.” Before I could say any more, the nurse was summoned to the phone and with a smile, I left to call Louise.

A few days later I pulled up in a beautiful driveway. Plants nourished by an attentive hand surrounded the house in front of me. As I got out of the car, I saw a slight woman emerge into the sunlight. Her dark hair gleamed as the rays of sun caught it and, as I came closer, I saw she was smiling. Louise welcomed me warmly and, after I had removed my shoes, guided me into the house. We sat down at the kitchen table. Nearby stood a large kete (4) filled with driftwood, each piece carefully placed to reveal a story. Woven mats hung on the walls and outside I could see clusters of red berries hanging below the fronds of a nikau palm. Artistry was evident in creating this home and I looked around with admiration.

After some further introductions, Louise eased herself back in her chair and looked at me expectantly. Tentatively I responded to her silent invitation with, “People are so much more than the illness they are living with and their current situation. Would it be OK to begin, maybe, with me asking you a bit about yourself…so that I might learn a little about who and what matters to you?” (5) I didn’t name the illness as I didn’t know what language she preferred to use or how she might wish to speak about her experience.

Louise responded immediately. “Sure! I’m married to Pete and we have three children. They’re all really supportive, in and out of the house every day…”

Louise continued to share stories of her day-to-day life and I listened attentively, occasionally asking her questions so that I could learn more of what was important to her. I quickly learnt Louise was a hard worker and a committed parent. She made no mention of where she was from or her t?puna (6).

After a time, Louise paused and reached across the table to pick up a piece of paper. “Well, it’s lucky you’ve come to see me on your own.

I don’t like groups because I lie in them. I’m a liar,” she stated in a forthright tone, waving what I now realised was a support-group invitation from the hospice.

Struck by her honesty and trust in me, a stranger, I replied, “Would it be OK to ask what you mean when you say you lie?” (7) In my mind was an awareness that some truths are more easily spoken than others, and for some people it was unsafe to voice or live their truth.

Louise responded, speaking in rapid buoyant tones, “Oh, I say what I think I should in groups…but then later I discover it would have been all right if I’d said what I really thought.”

With all the respect I could convey, I replied, “What is your understanding of why you say what you think you should?”

Immediately Louise explained, “Oh, I tell a story to fit in.”

I reflected that people usually have good reasons for what they do. “What is important to you about fitting in, do you think?”

Louise sat back in her chair looking thoughtful. “I like to fit in. When I’m in a community I’m proud of it. I like belonging to clubs. I wasn’t brought up to do any sport or anything, so it means I can choose. I’m not tied to one thing.”

Curious, I responded, “Would you mind me asking… how do you go about this fitting in?”

Louise paused. “I don’t know, but I’m really good at it,” she finally said.

“Are you a flexible kind of a person?” I offered.

“Sure am.” Louise nodded.

“Which kinds of communities or clubs do you like to fit in with?” I continued.

“I take the best of what’s around. People are good to me, kind,” Louise answered, as if she couldn’t quite believe her good fortune.

“Would you say you are someone who both accepts and appreciates the generosity and care of others?” I asked, noticing her gratitude. (8)

Louise began to tell me how she appreciated homemade gifts as opposed to bought ones. She elaborated on the care and effort in the presents people made and gave to her. Homemade fudge was so much better than a box of chocolates, she explained.

“Do you see the intention behind the gift, the love maybe?” I asked. Louise nodded as if this was obvious to her.

“What do you give to people in return when you accept their gifts, noticing the care and effort that has gone into making them?” I asked, highlighting the reciprocity in the way she received gifts. (9)

“They must feel the magic, because I do,” Louise answered matter-of-factly. “People are kind,” she reiterated. “I have lung cancer. It’s an ugly cancer. I was so happy when they included me in the make-up day for women with cancer. I didn’t think they would, what with me having a dirty cancer and them all having the pretty pink kind.”

Taken aback, I responded, “Would it be OK to ask what you mean when you talk about your cancer as being dirty and theirs as a pretty pink kind?”

Louise lowered her head as she answered me. “My cancer is dirty because it’s a smoker’s cancer. It’s my own fault.”

Infusing as much respect into my voice as I could, I asked her in a quieter tone, “Would you mind me asking you some questions about how you began to smoke?” I reflected on how hard it would be to be a smoker with cancer and not afforded the support that other people living with cancer are offered. I tried to imagine being shamed at one of the worst moments in life, not allowed to feel sad or angry but being repeatedly blamed both vocally and silently.

“It was the ‘in thing’ to smoke,” Louise explained. I nodded. Louise and I both came from a time when many people smoked.

“When I was 10, 11, 12 years old, I pinched my mother’s cigarettes for a naughty puff,” she told me with a mischievous glint in her eye, evoking glimpses of childhood fun away from the surveillance of adult eyes.

“When you were 10, 11, 12 years old, do you think it was possible for you to realise the full implications of the naughty puffs?” I inquired, hoping to lessen the harsh judgement she extended towards herself alone.

“No. I didn’t realise in my teens either. It wasn’t ‘till much later when I came to live around people who didn’t smoke,” she told me.

“How do 10-, 11-, 12-year-olds come to smoke, do you think? How do they come to think it’s a good thing?” I responded.

“It’s the way I was brought up. It was a hard life. It wasn’t ‘till I started playing sport that I realised there were different ways of living, that some kids had a bed each and enough to eat. (10) My parents were hard people. They smoked and drank,” Louise conveyed with a frown.

In my head I did a few calculations. Louise would have been growing up after the Second World War when many M?ori were living in poverty. I thought about her family and wondered if Louise had a grandfather who fought in World War One. I knew of P?keh? returning servicemen who had been allocated a farm in the ballot after fighting in World War One, while my friend’s t?puna (11) who fought in the M?ori Battalion returned to discover his ancestral lands had been confiscated. There were many possible reasons for why Louise’s family experienced hardship.

“What is your understanding of how they came to be like that?” I asked.

“Maybe it’s ’cos they grew up in the Depression. (12) It was a hard life, and they worked hard and partied hard. Yeah, they were hard people,” she repeated.

“Hard lives can have people turning to cigarettes and drink to ease things, especially when there is trauma and hurt that comes with it,” I commented. “What do you make of there being cigarettes for sale when we all know they kill people?”

We pursued this line of questioning for a bit longer, with me seeking to broaden the responsibility for smoking into our societal context so that Louise wasn’t left to shoulder it entirely on her own.

However, I noticed myself beginning to labour a little in the conversation and started to wonder if I might be more interested in taking such a direction than Louise was.

So, I listened harder for what was important to her.

“Yeah, well…” Louise pondered. “I left home at 13 to get away from it all. I knew I had to get out. The beatings, the life… My fault I smoked… Miracle I survived this far. The shame of it has been with me since I’ve had children.”

“What was important to you that you knew you had to get out?” I wondered.

“I wanted to get away from the cigarettes and the booze…” Louise elaborated.

“Do you know what it was that was important to you that you wanted more from life, that you didn’t just accept the cigarettes and booze?”

“I wanted a better life and to live it,” Louise explained.

“May I ask, what sort of better life did you want?” (13)

Louise told me how she wanted a home and security. “I wanted a bed of my own and to know where I was sleeping each night,” she explained.

“What steps did you take towards getting a better life?” I inquired.

“I went white.”

The words hung in the air, heightening my awareness that I, a privileged P?keh?, sat at her table. I wondered how I was selling her short.

Louise continued, “I knew I had to leave if I was to survive, so I hung around with my white friends. When I left, I got away from a lot. Not just the cigarettes. I made sure I fitted in, and it was my ticket out.”

“Would you say fitting in saved your life?” I asked her.

“Definitely, I had to get away from the other lot.”

She watched me, seeming to wait to see how I would respond. I reflected on Louise calling her own people “the other lot.” I could hear the racist discourse ringing in my ears, inviting the harshness to be because they were M?ori, rather than taking into account the devastating effects of colonisation on generations of M?ori people.

“Could you help me understand a little more of what you mean when you say ‘the other lot?’” I inquired. (14)

“M?ori,” she replied, sounding like she was repeating something rather than truly believing it.

Louise waited, her body tense and alert.

“Colonisation has been very hard on the M?ori people,” I ventured, thinking of the decades of injustices M?ori had endured. “Do you think that the drinking and smoking and what you went through was because they were M?ori, or do you think it could have been because of the hardness of life and what it did to the family?” (15)

Louise’s shoulders dropped and she was quiet for a moment. “I’ve forgotten who I am,” she rasped sadly. (16)

Before I could respond, she ploughed on, seeming to contradict herself with what could have been growing pride in her voice. “I do all the old stuff: knitting, cooking, sewing, carpet-making. I paint.”

“Are you a creative person?” I asked her, smiling. “And the garden?”

Louise enthused about her garden.

“Are there threads of who you are in the old arts?” I asked her.

Louise considered. “Yes, I think there are.” She seemed to meditate on this for a moment, then looked me in the eye. The corners of her mouth crinkled up as a smile formed briefly. “But then I forget,” she added, looking shamefaced again.

“Colonisation can do that to people…get in the way of being connected to who you are… Not surprising when there were laws trying to do just that,” I said sadly. (17) I reflected on the children who had been beaten in school because of laws that forbade them to speak Te Reo M?ori and the efforts to suppress M?ori cultural practices. “There can be a heavy cost when you are forced to turn ‘white’ to survive. Would it be OK to ask if there has been a cost for you?” (18) I thought about what it might be like to forget who I was. Emotion stirred in my belly.

“I don’t have a belonging,” Louise confided. “I feel I’m a betrayer.”

Deep sadness leaked into the air around us. It hovered, seeming to draw us together. We sat in silence.

After a time, Louise gradually seemed to recover, and in a bright voice she said, “You know I’m Scottish. I identify as Scottish.” I looked into her beautiful brown face, with its broad nose and dark brown eyes, framed by the sweep of almost-black hair.

I responded then, not as I would to a P?keh? with a question, but in the way of M?ori who connect through the people and the land they come from, whanaungatanga (19). I adjusted my phrasing according to shades of tikanga M?ori (20) and said, “The people I come from are Scottish. They belong to the clan of Callum. They come from the highlands of Scotland.” My intention was to tell her we were connected, and in telling her this and in the way I phrased it, I wanted to say, “I also acknowledge your M?ori side and it is beautiful,” though this was implicit.

My disclosure resonated with Louise immediately. Laughing, she jumped out of her chair and rushed off to gather photos of all her grandparents who had died long ago. She introduced me to her Scottish grandmother, whom she loved dearly. “She taught me the old arts,” Louise explained.

“Were you a willing learner?” I asked her.

“Yes, I took in what I wanted and spat out what I didn’t.”

“May I ask what you value about your M?ori side?” I inquired, appreciating that the photos were of both sides of her family.

“M?ori love fully and unconditionally, no questions asked, no grudges.”

“How do you love?” (21) I asked, hoping to make visible a thread of whakapapa. (22)

Louise proudly announced, “I love like a M?ori!”

Warmly, I responded, “Can you tell me some stories of how you show that knowledge of loving?” I wanted to strengthen Louise’s description of herself as having the ability to love fully. It stood out in contrast to her sense of not being worth chemotherapy.

Louise was off, taking centre stage. I listened, grinning, delighted by her rich and lengthy stories of such loving. I then asked her questions of how she came to learn such loving and we tracked knowledge of love through the generations in some long-overlooked stories.

“Who in your life knows that you have this knowledge and way of expressing yourself?” I asked.

“All my friends!” Louise responded enthusiastically.

“Could it be that you have captured aspects you value from both worlds with your fitting-in ability?” I asked, after a moment’s reflection. Louise embraced this possibility seemingly for the first time. Her enthusiasm bubbled. We went over her mothering and loving of her children, with Louise adding details such as “…but the car is warranted.”

“Could it be you are not a betrayer if you’ve made the best of both your M?ori and P?keh? sides?” I slipped in the word P?keh?, the M?ori word for non-M?ori, to give weight to M?ori knowledge. “You’re right, I’m not,” she told me. Then, as she thought about it, her voice firmed. “No. I have been clever; I haven’t got off-side with anyone. I have danced on both sides of the fence.” Louise smiled fully at me. It was a beautiful sight.

Smiling back, I continued, “If you were to think of yourself as a person who can dance on both sides of the fence, what difference might that make to how you are living your life?”

“Well, just everything,” she exclaimed exuberantly. Idea after idea quickly followed.

“If this ability you have to dance in two worlds was one that you kept in your mind, what might it keep you in touch with that is important to you?”

“That I’m OK. Sasha, it’s going to change my life!” Louise’s joy once again spilled over. I was overwhelmed. How generous she is, I thought.

“Do you think it will make a difference to how you live with cancer?” I asked.

A little later, I started to draw the conversation to an end, mindful that we still had more to talk about.

“Sasha, I like this talking,” Louise exclaimed, with bouncing joy. “Today I discovered I’m not a liar!” (23)

I drove back to the hospice with sadness stuck to me rather than her happiness. All I could think of was Louise…a M?ori in a sea of P?keh?. I thought of the times when I have felt apart, out of step, disconnected and the only one. I tried to take myself there, but I knew it was not the same. When I arrived back at the hospice, I wondered what I might have missed, what I didn’t ask. Later, as I reflected with Niwa, my M?ori colleague and friend, I was reminded of the bridges that friendship, love, and respect can provide.

A few days later, I heard from the nurses that Louise had decided to have treatment for her cancer. Louise later explained to me, “I felt worth it after we talked.”

When Niwa and I met with Louise and her family a few weeks later, we heard the good news she was improving. A short time of respite from the cancer beckoned.

Postscript

This story illustrates one way a counsellor might go about such a conversation. It is not the only way to respond. I carry the knowledge that I have many blind spots, especially in conversations that are cross-cultural. I am also aware that I am the recipient of the kindness and generosity of the people with whom I meet. This story does not represent a “right way” to practice but rather is written in response to a question I ask myself: “What does my commitment to the principles of Te Tiriti O Waitangi (24) look like in practice?”

Notes

(1) For those readers interested in the use of stories to learn or teach narrative therapy see Carlson et al (2018) and Heath et al (2022). For additional examples of stories illustrating narrative therapy see Epston, 1989; Heath, 2015; Ingamells, 2014, Ingamells & Epston, 2016; Pilkington, 2014; 2016; 2021; 2022.

(2) This story was written with the permission of the person in it. All identifying information has been changed.

(3) In Aotearoa New Zealand, M?ori have a higher incidence of lung cancer and poorer survival rates than P?keh? (non-M?ori. A number of barriers to early diagnosis and treatment have been identified including access to care, engagement with specialists, communication with specialist services, and lack of culturally appropriate services (Kidd et al, 2021). Even though Louise’s lung cancer was incurable, chemotherapy would offer her the chance of improved quality of life and an extended life span.

When someone responds in ways that others don’t understand, it is common for judgements to be made from a position of “knowing best” what is right for that person. I find it more helpful to be curious about another person’s world and to try and understand what is important to them. I also want to learn what they are taking into consideration that matters to them and is restraining them from taking a particular course of action. For example, what was Louise concerned about or prioritising that she had chosen not to accept chemotherapy? Often, when I have fully inquired into what matters to a person and what they are weighing up, their decision-making process and reasons becomes clear. At other times, the questions I ask can lead them to reconsider their decision and take another path. (See Chochinov, 2022)

(4) A kete is a basket usually woven from flax. M?ori words are in common usage in Aotearoa New Zealand. I have chosen to leave such words in this text out of respect for the person in the story, and to uphold the mana of Te Reo M?ori (the M?ori language).

(5) My intention in asking this question is twofold. I wanted to get to know Louise aside from the difficulties she was living with in ways that dignified her and brought forward her preferred stories of who she was. I also wanted to create space for culturally respectful ways of getting to know each other without assuming how she might wish to go about that. A broad question such as this one creates space for Louise to answer in ways that fit for her. In some instances, I may ask a person if there is a particular way they wish to begin, in order to create space for karakia (a ritual chant or prayer) or any other ritual that may be meaningful to them. Louise’s talk and refusal of cultural support led me to think such an invitation might be uncomfortable for her. I therefore held back on this occasion knowing I could raise it another time.

Building a relationship in ways that honour and create space for possible cultural identities a person may hold is important, especially if that culture has been oppressed. Such respect has effects on what kinds of conversations are made possible and can open areas that are often overlooked. For example, acknowledgement of tikanga M?ori (M?ori cultural processes) can underpin the engagement of M?ori in treatment (Kidd et al, 2021) and can be significant in generating a relationship in which stories of suffering can be told.

It was unusual for me to have this first meeting with Louise on her own. (It was Louise’s decision to do so.) I usually meet with many different constellations of families and most often see someone who is unwell with at least one other member of their family/wh?nau. Louise introduced me to her family after this conversation and later brought different members of her wider wh?nau/family in to see me when they visited from other parts of the country.

(6) The people Louise was descended from. For some M?ori, this is an important part of forming a connection and getting to know each other.

(7) This was a significant deconstructive question in our conversation. Deconstructive questions pull apart the threads of an idea so that a person can examine them. When we take up a stance of curiosity and ask a person about the particular meaning of common words and ideas to them, new therapeutic directions can open up.

(8) As I learn more about Louise’s life, I am listening for how she goes about what is important to her and whether that way of living expresses Aristotelian “virtues” that she values, such as for example; generosity, compassion, kindness, courage and love. I gather more stories of these expressions of goodness that are valued by Louise and these stories make up the backbone of the re-authoring process (White, 2007). I am mindful that ideas of what is important and considered virtuous sit inside cultural frameworks. Such themes of what people are engaged with in their life, and the virtuous ways they go about what engages them, are called “narrative values” by the philosopher Todd May (p. 73, 2015). May says it is these stories that can give a person a sense of living meaningfully. Such identity stories that describe valued qualities of a person are very helpful at the end of life. Not only do they lend meaning to a person’s life, but they offer a way of responding to illness, treatment and dying that is not reliant on a well body. They can give a person a sense of agency at a time when they may be experiencing a lack of influence over their life (see also Pilkington, 2022).

(9) Ideas that position a person who is unwell as “only receiving” can lead them to feel a burden on others. I often inquire in detail into how a person receives the care of others and the experience they generate in the carer with the intention of highlighting the reciprocity in the relationship. The way we receive can give another person an experience of themselves as generous, kind, significant, and worthy for example.

(10) Moana Jackson vividly describes the processes of how colonisation robbed M?ori of a sense of home in their own land and what was lost. “When you take away the whenua from a people who regard themselves as tangata whenua; when you take away their ability literally to touch the mountains; if you limit their ability to dream their own dreams; if you take away the earth upon which they stood with love; then you render them homeless in the most complete sense (Jackson, 2022, para 25).” (Whenua means land and tangata whenua means people of the land.)

(11) T?puna means ancestor in the M?ori language.

(12) During the depression M?ori were harder hit than P?keh?. M?ori were often the first to lose work and were paid lower unemployment benefits than P?keh?. The situation with benefits was only rectified in 1936 (Waitangi Tribunal, 2004, p. 659).

(13) I cannot assume I know what “a better life” means to another person.

(14) My intention in asking this question was to make the racist discourse visible so that we could examine it together.

(15) Note the way I scaffold my question with a statement. Louise immediately recognised how I was positioning myself and responded. Consider the harmful impact if I had let the moment pass without addressing such an idea and one that included Louise in its judgements. We could ask, what was made possible in the conversation following these moments when I sided with her and her wh?nau against racist discourses?

(16) This is an example of how meaning can be lost in translation (Mutu, 2004). When Louise referred to who she was, she was not speaking of an individual internal construct of self but a relational self. Included in who she understood herself to be were her connections to her t?puna, her wh?nau, the whenua (land), and moana (sea). In this conversation, Louise is considering the elements of whanaungatanga that she wishes to be connected to and that have been disrupted by colonisation. I, in turn, am referring to a relational self when I reflect on what has gotten in the way of her connecting to who she is. When I asked my colleague Barbara O’Loughlin of Marut??hu and Ng?ti Hau?, to describe her understanding of who she was, she answered me, “I whakapapa to the maunga (mountains), to the moana (sea), the awa (river), to my t?puna, to my whanau and to te ao M?ori (the M?oriworld), (personal communication, November 24th, 2022)”. There is no “I” or “self” t

Using the Filipino Practice of Shared Inner Perception in Psychotherapy

Posted on August 14, 2023February 11, 2026 by Psychotherapy.net Team

Pakikiramdam (Shared Inner Perception)

Shared Inner Perception is the essence of the Filipino core value of Pakikiramdam. It is the sensing and attunement that occurs when people interact. Although I speak of it within a Filipino cultural context, many other collectivistic cultures share a similar value. And from an ancestral anthropological viewpoint, we were all collectivistic at one point in our histories.

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Pakikiramdam is a Filipino core value that is antithetical to the Western philosophy of directly stating what one feels or needs. The word “stating,” makes all the difference. Through Pakikiramdam, the Filipino — usually the immigrant or in the first-wave generation — is able to state or communicate far more without words than is typical or even comfortable for those solely dependent on the literal word for communicaion.

In mixed-generational or mixed-racial families, these two styles of communication often clash, leading to instances where the intent of the speaker becomes lost on the listener, while the listener feels out of touch with the speaker. In my clinical experience, this scenario often plays out in therapy with Filipino clients, leaving members of the family feeling unheard, mis-heard, or unvalued. If the therapist is not keenly attuned to the client, whether Filipino or not, the potential for miscommunication multiplies.

Shared inner perception in the therapy room starts with deep listening. It is using the therapist’s gift of intuition, attunement, collaborative projection, and co-transference. When the intuition channel of the therapist is clear, it’s like a light shone on a map that the client possesses. When the intuitive channels are unclear, ridden with ideologies and blind spots that belong to the therapist, intuition is instead like a broken compass, taking the client somewhere he intends not to be.

Pakikiramdam’s language relies on watching, listening for, and sensing non-verbal cues; paying attention to what is not said as much as to what is said. This includes paying attention to changes in vocal inflections, subtle facial and bodily movement, breathing patterns, and subvocal sounds, such as tsk, tsk, tsk.

This is not an uncommon scenario:

Ricky, a Filipino American son asked his elderly mother, “Do you want me to pass by your house before I head straight to work?” “His mother replied, “Oh no, just go right ahead.” And so the son did. A few days later, he realized that his mother experienced Tampo (having her feelings hurt, although not completely angry or upset, by someone they care about). Why?

Here’s the other part of the conversation from the mother’s perspective:

“No, just go right ahead. Oh, by the way, I remembered I have to call the plumber because I can’t flush my toilet. I had a stomachache yesterday, I guess I used too many toilet papers. Now, I don’t have a single roll. Gosh, I need to go because my neck is starting to ache holding onto the phone. Bye.”

It would’ve been more useful for the son if the mother had clearly and directly articulated her needs, even though he did repeat his request to her to stop by. Let’s explore this scenario.

Self-Soothing Versus Collective Coregulation

The “rules” for communication in individualistic and collectivistic cultures differ widely. Individuals and family members in cross-generational, or mixed cultural/racial families often experience scenarios similar to that of Ricky and his mother.

Systems of care in a particular culture are influenced, in large part, by the self-soothing strategies that are part of that culture’s value system. In America, grandparents can babysit their grandchildren but more formal out-of-home, out-of-family care, like daycare or school, provides American families with the stability and consistency of care that the parents need to manage their livelihood and parenting responsibilities.

In non-Western, collectivistic societies, cooperative care is the social norm, through which children are raised by non-family “trusted-others.” These informal resources allow primary caregivers to pursue much of the same goals parents have across cultures, that is, to pursue economic opportunities and navigate parenting with ease. In these collectivistic cultures, Filipino included, parents emphasize the importance of being part of a system, which includes relying on others and being someone to rely on.

In the Filipino culture (in the Philippines), preparing and rehearsing children to read non-verbal cues are taught almost instinctively by adults from birth. The words, iyak-iyakan (pretend crying), galit-galitan (pretend being mad), sakit-sakitan (pretend being hurt), may be used in a playful, teasing way with young children so they can read real situations when they arise.

I had the interesting experience of a being a kindergarten teacher both in the Philippines and in America. The stark difference in the use of teasing as part of the group dynamics with children and the adults was notable.

Teasing is defined as making fun of someone in the English language. While I am neither proposing or advocating for teasing, I am referring to a type of teasing where someone who is teased can tease back. In fact, this is not an uncommon strategy of parents in the Philippines to teach their children to tease back playfully when teased. In this instance, the teasing becomes a communal act, as does the soothing.

It’s also not uncommon that such teasing can be used to lighten up an embarrassing moment. For example, if a child trips in front of his friends, his friends might start laughing, not as a way to ridicule him entirely but to elicit laughter so that child does not feel embarassed. Again, rather than burdening the fallen child with soothing themself, that burden is shared by the group and soothing becomes an act of community based on that groups ability to sense or intuit that child’s distress.

Shared Inner Perception in Parenting

In the following illustration, I contrast the Filipino and American orientations to the goals of parenting.

The American parent’s goal is to teach their child to self-regulate, to be independent, and to be self-sufficient. In the individualistic, nuclear family system, there simply aren’t as many helpers that can assist in informally raising the child. A good child is one that can self-soothe, articulate their needs, and do things on their own.

The Filipino parent’s goal is to teach their child to enter group settings successfully. This means teaching children to read non-verbal cues, including watching for subtle changes in facial and bodily movement, as well as tone of breathing and voice. A good child is one who can collectively receive and give coregulation, can share their space, and do things with others.

To contrast self-regulation, coregulation, and collective coregulation (a term I made up to explain this phenomenon), I’ll use the umbrella metaphor:

In individualistic culture, it’s essential that an individual learns to build and toughen their own umbrella so that when rain comes, they won’t be drenched. This is self-regulation. When the rain turns into a storm that surpasses the umbrella’s protective capacity, the individual may seek the company of other umbrellas. After all, two umbrellas are better than one. This is coregulation.

In the therapy room, when trauma, or a client’s deepest hurt, is akin to the rain that turns to storm, deep attunement to that client’s need for the protective umbrella, so to speak, of the therapist becomes crucial. Self-regulation yields to coregulation.

Shared Inner Perception in the Therapy Room

Returning to Pakikiramdam, shared inner perception values the following for the purpose of connecting with others: Pangangapa (to grope), Pagtatantiya (to estimate), Tiyempuhan (to wait for the right time), Tiyakin (to ascertain), Pagsusuri (to investigate), Pakikibagay (to deal with), Pakikisakay (to catch/ride on), Timplahin (to blend or season to the right taste), Singhot (to smell or sniff).

It would be daunting to rely on the therapist’s intuition as a treatment plan. Intuition without a framework can put that therapist in a position of a guru who must rationalize that they were only following their intuition when they have led a client to themselves.

A useful tool is a sense of wonderment which gives way to collaborative projection. In that, the therapist’s projection is likened to a doctor who is giving an intravenous injection. The doctor has seen many veins, good and unsuitable candidates for a shot; they project based on their professional experience. When they finally choose a vein, that projection is essential, and yet they watch for a slight twitch and nuance because only the client can tell that a good vein is actually good.

The therapist who diligently engages in the practice of observing their clients can begin to wonder about the subtle unspoken reactions and changes in their client that serve as guiding cues for therapeutic involvement and intervention. This process of wonderment is not the same as interpreting, since the therapist must constantly check that their projections are in agreement with the client’s and not the other way around.

Shared inner perception is an openness to co-suffering, not just as a mere strategy for treatment but as a human experience that the suffering and the witness (therapist) are both touched by what was shared in the therapeutic relationship. As the client grows in therapy, so does the therapist and vice versa. It is a thread where the beginning and the end are indistinguishable.

It is a dance to take the experience of the client at face value, leaving space that there may or may not be more. In other words, that a no response from a client may be a camouflaged yes and a yes, a polite way of saying no. The therapist who hones their shared inner perception skills doesn’t read their clients like an x-ray, but understands that the x-ray may reveal very different results depending on how it is held.

Final Thoughts

Marco Iacaboni’s research on mirror neurons and the process of co-internalization distinguishes between the self and the other, suggesting that our neurobiology puts us “within each other.” In this vein, interpreting facial expressions and social exchanges becomes a mirroring process, a thread that connects both the therapists and the client, and not merely a strategy “done to” a client.

Although the concept of Pakikiramdam in this article was introduced through the Filipino cultural lens, its tenets are not exclusive to this culture. In addition, its therapeutic use is not reserved for this population. There are modalities in the Western culture that purport a similar framework to healing.

For example, J.L.Moreno’s work on psychodrama encourages therapist spontaneity and flexibility. The other characters in the drama can utter words that the protagonist (client) dare not speak, giving timely voice and necessary silence when appropriate.

Various other modalities rely on creative expression — the sand tray, movement, art, and music — all become powerful mediums through which to explore healing without tripping into the trappings of language that often mean different things to different people. Language in all its forms, spoken and otherwise, is at the heart of the therapeutic communication.

****

The therapist, therefore, listens deeply like a dancer listening to the rhythm of a tune for the first time, aligning her moves to the serenade of the music. Every beat counts and every beat missed becomes an opportunity to recalibrate the dancer to waltz back to the therapeutic relationship.

Makungu Akinyela on Testimony and the Mattering of Black Therapy

Posted on August 1, 2023February 11, 2026 by Psychotherapy.net Team

Lawrence Rubin: Hello, Makungu. I first became aware of your work through conversations with Drs. David Epston and Travis Heath, both of whom have worked clinically and written within the Narrative Therapy sphere. However, they've also made me aware of different approaches to narrative storytelling, including the oral tradition of West Africa, and your work. And that led me to an interest in Testimony Therapy. With that said, what is testimony therapy and what is testifying?

Testifying and Testimony Therapy

Makungu Akinyela: Testimony Therapy is a discursive therapy, related to Solution-Focused Narrative Therapy, and any of those therapies that we think about that focus on privileging people's stories about their lives. I tell people that testimony is a narrative therapy with a small “n” because testimony and testifying come from my tradition — the Black cultural tradition, to testify. The way Black folk use it is to tell your story but also to tell the story that you want told about you, to give your testimony. It has some roots in the Black church experience. Folks who are from the South or have been to the South and maybe to a Black church, might have witnessed a testimony service or folks testifying in church where they get up and tell a story. There are parts to testifying it. Usually, a testimony starts out with what I call a doom-and-gloom story. For folks who are into Narrative Therapy, Michael White and David Epston used to call it a thin telling of the story.

testimony therapy is a discursive therapy, related to Solution-Focused Narrative Therapy, and any of those therapies that we think about that focus on privileging people's stories about their lives

So, it starts off with this real doom-and-gloom narrative that goes something like, “Well, I woke up, and the doctors told me that I had cancer and I was going to die. And I've been sick ever since and in bed and I couldn’t get up. And that’s what my life is about.” That's the doom-and-gloom telling. But then usually a testimony begins to sound like, “But if it had not been for my friend or my neighbor, who came to give me support and help…” The important thing about that testifying process — the dialogue — is in Black orality, which is that orality that we are grounded in, the oral telling of stories.

And that call and response becomes a community telling of the story. It's not just the storyteller telling the story

There's also call-and-response. As the “testifier” begins to tell that doom-and-gloom story, there is a response to the call. The “witnesses” let them know that they're listening. “Wow! Really? Well, okay. Amen. I get you.” And that call and response becomes a community telling of the story. It's not just the storyteller telling the story. The witness to the story, by engaging with the story, also helps to shape where the story goes. The testifying usually goes from doom-and-gloom to the call-and-response, and then all in the “community” begin to identify what I call the “victorious moments” in the story.

Narrative Therapy might say those victorious moments contradict the thin telling of the story. And as you get to those victorious moments — if it were in a church ceremony, as people begin to give that feedback, that response to the call — they begin to say things like, “Yeah, it wasn't so bad. It was good.” And then people might start seeing the blessings in their lives in the middle of the doom-and-gloom.

The story begins to become a little stronger and a little more positive. By the time the story finishes and all have experienced victorious moments, transformation has happened, and the testimony becomes, “This is the story that I want people to have of me. This is the story that I want.” It uses narrative ideas, and for folks who are familiar with Narrative Therapy, the preferred outcomes have replaced the doom-and-gloom, thin story.

the critique that testimony gives to narrative therapy is that all storytelling and all ways of telling stories are not grounded in the metaphor of literacy

The important thing about testimony therapy is that it is a discursive therapy. I consider it a narrative therapy in the sense that it's a storytelling therapy. I agree with the narrative therapist, that people use stories to constitute their lives, to describe and explain the meaning of their lives. The critique that testimony gives to narrative therapy is that all storytelling and all ways of telling stories are not grounded in the metaphor of literacy. Narrative therapy, the therapy that was developed by Michael White, David Epston, and that is contributed to so strongly by all those other great people — you know, Steve Madigan, Jill Combs, and Gene Freedman – all those ways of doing narrative therapy are particularly grounded in the metaphor of literacy.

LR: Storytelling in a linear kind of way.

Oral Culture: A Different Kind of Listening

MA: Exactly, in very linear ways, even the metaphors that are used such as “Turning over a new page, re-authoring our lives.” So, the metaphors reflect the culture that it comes out of, which is primarily a culture whose consciousness is developed through literacy. What testimony therapy says is, “What about those people who come from cultures that are predominantly oral cultures, grounded in orality?” Like the culture of Africans from West Africa, where my folk come from, the culture of so-called African Americans who, basically, trace our lineage and heritage back to West Africa?

Our cultures are primarily oral. So, the thing that shapes our thinking, the way we talk about and think about relationships is grounded in that orality. Storytelling will look different, and the meaning that's given to the story is different. And so, within testimony therapy, rather than being grounded in the metaphor of literacy, I ground it in the metaphor of orality and musicality. Does that make sense?

LR: As a narrative therapist but also as a client-centered therapist, I would be validating. I would be using nonverbal gestures. I'd be highlighting unique outcomes. I would be listening to elements of the client’s story, which are doom-and-gloom-centered, and asking for counter-stories. What would I be doing differently if you were my therapist in this interaction and coming from that oral tradition? Now, what would we be adding as therapists in this moment?

MA:

I'm paying attention to the rhythm and the beat of a conversation

I'm paying attention to the rhythm and the beat of a conversation. So, it's not just the words of a conversation that are important, right? It's not just listening to the words that are coming out of your mouth. It's how the words are coming out of your mouth. I'm paying particular attention to things like the relationship between bodily space and the words, the rhythm that's created through bodily space. I'm paying attention to things like the expression on your face because those are all things that also begin to define orality.

In other words, people from oral cultures don't just use the words out of their mouth. It's the tone of the word. You know, where there might be three or four ways that I can use the same word, depending on the tone, it means something different. Also, it might be even the way I might use my body. You know, sometimes people make jokes about Black women. You know, if a Black woman is talking to you and she starts snaking her neck…what's the meaning of that? So, no matter what the words are that she's using, that body motion, the way she takes up space, begins to define the rhythm of the conversation –

LR: So, what feedback would you be giving me in the moment?

MA: I would be getting in rhythm with you, right?

LR: You would be mirroring?

MA: I might be mirroring, or I might be thinking, “Wow, he's really agitated here. And I might even slow down my rhythm, and I might begin to speak more slowly. And I might even become a little more reserved, again, because I'm believing that the rhythm and the beat of our conversation is just as important as what you're saying. I might be taking note of and become curious about what the emotional content of your speech might be at that moment, and I’d bring that out.

I'm a testimony therapist whoever I'm working with, just like narrative therapists

I was talking to a couple just the other day. Now, this couple happened to be White, but I'm a testimony therapist whoever I'm working with, just like narrative therapists. A narrative therapist, whoever they work with, they're simply using their cultural understanding to engage the work. And that's what I talk about with this. I don't believe that “techniques” in themselves fix things or do things.

But with that couple, there was a conversation going on. In this case, it's a heterosexual couple. The husband listened to the wife say something, and it felt as if she was saying he was the problem. But he was his usual calm demeanor, almost a flat effect. But he began to describe how he was resentful that she was making him into the problem. Sometimes, not always but sometimes therapists are really afraid to engage emotion, particularly “negative” emotion, right?

LR: I'm on the edge of my seat. So, how did you manage yourself with that White couple?

MA:

one of the things I point out is that oftentimes, particularly for Black people, we're encouraged to suppress our emotions

First of all, I validated what he had to say. And then I said, “You know — ” Let's call him George. Not his name. “George, I get the feeling that you are real pissed off about right now. And I'm really appreciating that. I'm really glad that you got pissed off enough to say that.” In other words, rather than running away from the emotion, to name the emotion — because I also believe that all our emotions are important. You may have read one of my articles, and one of the things I point out is that oftentimes, particularly for Black people, we're encouraged to suppress our emotions.

LR: Especially anger. Especially anger.

MA: Right, especially anger! You're not supposed to do that. I believe that my work as a therapist is creating a space where all emotions are safe, and all emotions can be validated and understood and experienced. Because one of the things that I'm trying to do when I'm working with my clients is — and again, these are my philosophical understanding of this work — that, under conditions of oppression or suppression, people are alienated from their emotions.

A lot of the ideas that I work with come from the psychiatrist, Frantz Fanon. And Fanon talks about alienation, which comes with colonization. And when people are alienated from their emotions, they don't feel their emotions. They don't experience their emotions. So, the emotions control them rather than them being in control of their lives. And so, a lot of the work that I do is about helping people to feel their feelings, to experience their feelings, and to dis-alienate themselves from that.

LR: So, going back to George and his wife, you highlighted what you surmised to be George's emotional reaction, his alienation from his emotions. And you helped encourage a conversation around that. How is that different from what a good Rogerian therapist or a linear narrative therapist might do?

MA:

one of the big complaints that I often get if I am referred a Black client, who maybe has previously had a White therapist, is the cultural uncomfortability that they felt in those relationships

That's a good question. And one of the emphases that I make is that this is not about trying to find something that on the front looks like a radically different practice. It's about worldview and understanding. One of the big complaints that I often get if I am referred a Black client, who maybe has previously had a White therapist, is the cultural uncomfortability that they felt in those relationships. It's like that person just didn't seem to get them. They say, “Well, they just sat there and listened. They didn't say anything.” You know, they didn't say anything.” Sometimes they'll even say, “They didn't tell me what to do.” And I'll say, “Well, you know, I'm not going to tell you what to do either.”

But again, it's just that interaction, that responding in those conversations in oral ways as opposed to this kind of a linear conversation. I ask you a question, and then I quietly wait for a response. And then I assess that response. “Okay.” And then I ask another question. And then I wait for a response. That's that linear conversation. Even when I'm doing supervision, I don't want therapists to try to be like me. In this field, that's what a lot of people do, particularly from our generation. You know, we used to go to those demonstrations, and we would be mesmerized by the experts.

LR: Nobody could be Albert Ellis, regardless of how hard they tried.

MA: Yeah. But, again, when I talk about Testimony Therapy, I'm talking about a conceptualization of the work that we're doing, which is grounded in a philosophy. In a very similar way, when Michael and David began to develop Narrative Therapy, for the most part, they were grounding their therapeutic work in the philosophies of Michel Foucault, in other words, a conceptualization of the meaning of the word. Does that make sense, what I'm saying?

So, you know, human interaction is human interaction whatever the culture, but there are conceptualizations that define the meaning of the interaction. There's a difference between people who come from oral cultures and, again, how stories get told and the meaning of those stories, and people who come from literary cultures.

LR: What about when you're working with a Black client, a Black couple, a Black family who don't identify with their ancestral roots, who have no connection to the oral tradition of West Africa? Does that make a difference?

MA:

I believe that when Black people say, “Hey, I know I'm Black. I'm Black,” that's not about having some deep sense of West African culture, because culture doesn't work like that. You see, the culture of African American people is African, I believe

I think you're asking a philosophical question. Just off the top, I say, okay, probably that couple that you're describing in that way wouldn't even be coming to see me, right? But also, I think this is about a perception of what culture is and what culture means. I believe that when Black people say, “Hey, I know I'm Black. I'm Black,” that's not about having some deep sense of West African culture, because culture doesn't work like that. You see, the culture of African American people is African, I believe.

It's African in the context of 300 years of colonization, but it's still African. And that doesn't mean that people go around every day thinking, “I'm African. I'm African.” They just are. They're being what they're being. Using Frantz Fanon once again, he once said, “A tiger doesn't have to proclaim its tiger-tude. It just is what it is.”

I described the whole idea of a Black church testimony service, right? That's African. Those are African ways of engaging. People don't name it that, but that's what it is. You know, the way that we talk, right? When we talk about Black ways of speech that we call Ebonics. I guess the more professional way is AAVE, African American Vernacular English. I'm speaking to you right now in pretty standard English. But if it wasn't you and it was somewhere else, I would be talking in Ebonics. But the thing about the way that I speak — I call it my grandmother's language — is that it’s grounded in a mixture of African and English vocabulary, but primarily West African syntax and grammar. It comes from there.

And this gets far beyond therapy, but we've got tons of research that shows the continuities, the continuations, the relationships between the cultures of African people in the western hemisphere, who are here because of enslavement and other things, and Africans on the west coast of Africa. So, when I'm talking about culture, I'm not talking about something that's this kind of mechanical thing that is easily identifiable. I'm talking about what we understand about the nature of culture, which is constantly moving, changing, and growing. Does that make sense?

Double Consciousness

LR: It does. Is there an implicit assumption or a presumption that an African American client, a Black client, has experienced or has internalized colonization and is living a story that really is one of adapting to those colonializing practices, whether or not they acknowledge it or feel it or resent White people?

MA:

every Black person has two souls in one dark body, an American soul, meaning White, and a Negro soul. And they're constantly fighting and struggling against each other

Absolutely. And, again, I ground my ideas in, like I said, Frantz Fanon and W. E. B. Du Bois, who was probably one of the greatest minds of the 20th Century — from the whole 20th Century because he wrote his first book in 1903, and he died in 1964. But he wrote a book called The Souls of Black Folk. In there, he defines this idea that's called double consciousness. Basically, he calls us Negros, but he says every Black person has two souls in one dark body, an American soul, meaning White, and a Negro soul. And they're constantly fighting and struggling against each other.

That's something that I could never explain probably to you because you've never been through that. But to be a Black person who is constantly doubting their Blackness but also affirming their Blackness at the same time, right? If I told you, as a little boy — we're about the same age — one of my favorite shows used to be Dennis the Menace. Remember Dennis the Menace?

LR: I remember Dennis the Menace.

MA: And wanting to be Dennis the Menace but also saying, “Wow. I wish I had hair like Dennis,” or, you know, “Wow. How come my mom doesn't stay home and bake cookies all the time? My mom is up working,” right? You know, “My dad doesn't wear a tie except on Sundays,” right? But it's also giving meaning to that. Or growing up — again, we're in the same age group – remember Tarzan on Sunday afternoon, the Tarzan movies?

LR: I do. Johnny Weissmuller, yep.

MA: – and identifying with Tarzan more than the so-called natives? And, as a matter of fact, not wanting to be the native. That's the double consciousness that Du Bois talks about. Fanon calls it the zone of nonbeing.

LR: The zone of nonbeing?

MA: And Fanon, going from Hegel's master-slave hypothesis. I don't know if you're familiar with that.

LR: Familiar only by name.

MA: Fanon says that's about the idea of recognition and consciousness, that we become conscious of ourselves by being recognized by others. Now, that's fine, but Fanon says, in a colonial situation, the colonizer never recognizes the colonized as human, right?

LR: And the colonized don't recognize necessarily that they have been colonized.

MA:

In the colonized relationship, the third person is always in the middle of the relationship

Sometimes. Exactly. But also, what he says, in the zone of nonbeing, the colonized is never able to have a “normal” relationship.” Because a normal relationship is this, Larry: I and thou. I see you. You see me. We recognize each other. We are conscious of each other. In the colonized relationship, the third person is always in the middle of the relationship.

So, in describing another person, and this is using me hypothetically, I might say, “You know that guy over there? He's dark-skinned, but he's handsome.” So, in other words, there's another measuring stick to that person to help me describe that person. “You know that guy? He is really dumb for light-skinned dude.” So, there's always these relationships that are in the middle of our relationships. These are the things that affect relationships.

I'm a family therapist, right? These are the things that begin to affect relationships even when they're unspoken. And if you're not aware of the nature of those things, that's what testimony therapy brings to the forefront, that these are also things that are important to think about in these situations. When I've got a husband and wife come in, it's not just the problems they have. It's the problems they have that have been exasperated (sic) in the everyday lived experience of just being a Black person growing up in America.

LR: Is there a presumption that all Blacks, all African Americans have this double consciousness whether they're aware of it or not?

MA: Absolutely. Can you be Black in America and not always have this small voice in the back of your head? For Black women, the decisions about how they fix their hair is a political decision and not just a daily decision. The choice. How they do that. Decisions about how we speak and how we are heard, right? If we speak and our speech sounds too Black, or if we speak and our speech sounds too White, right?

LR: Or not white enough.

MA: The clothes that we might choose to wear. All of those are decisions which are grounded in, “How will I be perceived?” And it's not just how I will be perceived. Also, I'm concerned about how other Black people are perceived because I'm afraid that how they're perceived also may have some effect on how I'm perceived.

LR: So, the Black person is always being evaluated. And if they're not receiving overt criticism, there is this other consciousness in which they're either comparing themselves unfavorably to other Blacks or unfavorably to Whites. So, your clients, to the one, your Black clients experience oppression whether they are conscious of it?

MA: Even if it is not named that. There's always this question of… For instance, I was at a conference last week. And my wife and I were about to open our hotel door. I was kind of casually dressed, had a nice little jacket on. You know, my wife is super colorful and flamboyant. So, she had some colorful clothes on. There was a White family about three doors down, and I think they were locked out of their space. And we went to our door, and we opened it up, and one of the women said, “Oh, it's down here." She's telling us, “It's down here.” And we kind of looked confused. And she says, “Oh, never mind.” [laughs]

LR: They thought you were the help opening –

MA: They thought we were the help. [laughs] You know, I wasn't dressed in any kind of uniform or anything like that. And so, now, the part of that is, you know, my wife kind of got a little… She's like, "Argh.” I said, “Look.” As I thought about it, I was like, “Wow. Why?” What was that about? Why would they assume that I was the help? What is there about me that looked like the help? I wasn't dressed like the help or anything else. But there was that quick assumption. That's what the young people call everyday microaggressions. It's like those things that make you wonder. Now, you're not quite sure, but it's, again, to always have those thoughts. It is not an unusual thing for me to have conversations with my clients, and in some way experiences like that come up in the conversation. Or ideas like that come up. And, again, this is not about people being hyper-politicized or understanding. This is the everydayness of life.

LR: Black life.

MA: What testimony therapy is about is about having a framework to understand that and to understand the meanings of that and a framework that allows us to engage those conversations in ways that feel safe and also are not committed to having you just basically fit in. You know, our traditional training as therapists is to help people fit in. Do we really want people to fit in to that experience of life, or do we want to give them ways of challenging that and seeing themselves in more powerful ways?

Therapy Embraces Culture

LR: Is psychotherapy with Blacks/African Americans diminished if the therapist does not take a testimony-oriented approach or that does not focus on that double consciousness?

MA:

I don't get into the wars about what approach to therapy is best

No. The reason I'm not going to say that is because I don't think just taking a testimony approach, even though I think that the things that I talk about are valid and should be dealt with, is critical because I don't get into the wars about what approach to therapy is best. But I do think that the dominant Eurocentric approaches to therapy are oppressive in that they try to force people to fit into a cultural context that is not their home. That is the subject of the book that I'm working on which is about decolonizing therapy, and that idea of decolonizing and dis-alienating the work that we do away from that kind of therapy which basically assumes Western ideas and cultural values. Eurocentric ideas are the norm and, in that context, the best way to help people's mental health is to help them better be able to fit into those norms. And so, we use those Eurocentric approaches to fit people in.

LR: I appreciate this and am very excited by this conversation, and I see how animated you’ve become — your gestures, your tone, your body movements. And I guess, if I was doing a testimony-type therapy, we would be talking about this experience between the two of us.

MA: This is what I do in my therapy room.

LR: So, if you believe that all Black America has double consciousness, is therapy with Black folks less than good enough therapy if we don't touch on the issues of double consciousness and colonialization? Is it incomplete therapy by definition?

MA: If we are not aware of that reality, yes! I believe that the reality of double consciousness, the zone of nonbeing, as Fanon calls it. But there has to be a consciousness of the lived experience of Blackness in the West.

LR: Living in a Black body.

MA: – and how, as a family therapist and systemic therapist, that impacts relationships. That's always the undercurrent of relationships. Even when it's not spoken, even when it's not something that people are consciously aware of in sophisticated ways, it's impacting the way they think.

There's always this comparison. When we talk about Black male and female gender relationships, there's always that under thing. You know, it's always racialized. When you have Black men who don't like Black women, they say specifically, “Black women ain't shit.” Black women may be thinking, “You know what? I can't stand Black men. I'm thinking about dating out of my race because these men…”

It's all of them, right? And the thing that defines them is their Blackness. That's what makes them Black. So, it defines those relationships. When people are afraid of how their kids look. “I don't want you braiding your hair like that. People are going to think you're a gangbanger or something.”

LR: Or have “the talk” with them.

MA: So, this lived experience shapes relationships. And, again, so th

Spitting Truth from My Soul: A Case Story of Rapping, Probation, and the Narrative Practices- Part II

Posted on February 2, 2023February 11, 2026 by Psychotherapy.net Team

Recapitulation

This is the second part of a two-part case story that focuses on a 24-year-old African American client named Ray who was referred to me (TH) by probation services. In this brief introduction I will try to summarize what transpired in Part I. Whenever possible, I will attempt to provide phrases or “pieces” of Ray’s language so the reader can begin to get a “feel” for him and our work.

Rap music was introduced as an entry point to our work. After our first session Ray could probably best be described as equal parts skeptical and intrigued. He enjoyed sharing rap songs that were meaningful to him as well as having the opportunity to create rhymes of his own.

We rather quickly discussed ways in which rap music was misunderstood (“Adults throughout my whole life telling me it’s violent and the music of the devil . . .”) and how others could not or were not willing to hear the important messages that can be contained within certain songs. We proposed a pair of magic headphones (“Magic Beats”) as a way to help those who would not listen begin to hear rap’s message. This idea will prove particularly important as our conversation progresses in Part II.

As our first conversation continued, we started exploring the sociopolitical implications of rap music and hip-hop culture. We framed rap as a kind of philosophy (“But without all the white cats . . .”) that served as a voice for the voiceless. We also stumbled across a connection between Ray’s grandmother and rap music (“I’m rapping about the same s**t she’s saying but in my own way . . .”). This struck him as perplexing (“That’s crazy bro . . .”) and also enlightening (“I never thought of it like that . . .”) given the disdain she had expressed for rap music throughout his youth. Our first meeting came to a close by having a conversation about our conversation.

We explored the difference between just talking and rapping, to which Ray responded, “It’s like when I rhyme . . . I spit truth from my soul.” We both agreed that inviting rap to our future meetings would be of benefit. More specifically, we discovered that rapping might serve as a pathway to liberation (“Remove the shackles from my soul . . .”). I invited Ray to consider composing a rhyme that paints the part of the picture that probation services doesn’t see. He responded enthusiastically but seemingly nervous that probation services would discover the way we were working and somehow veto it (“You’re the weirdest shrink they have ever sent me to. Not weird like bad, not bad at all, but does probation know you do this?”). We then decided that calling our work together a “studio session” was a better fit than therapy.

Ray picked up in our second meeting directly where he left off in the first. He came prepared with a rhyme that would be the foundation of a counter-story. He noted in that rhyme the importance of challenging rules (“Just because these are the rules you play the game by doesn’t mean these are the only rules . . .”). The conversation evolved into looking at whether or not Ray had found some ways of challenging rules more effectively than others. He then traced the relationship between rap and anger (“It’s like my anger would leave my mouth through my rhymes . . .”). Part I concluded with a pensive Ray searching for a rhyme that captured this most important function of rap music as an antidote to anger and aggression. The following rhyme picks up where our original story concluded.

An Antidote to Anger

Judicial system mad puzzling

DA presents two options
Jail cell or rat on my cousin
Death sentence if I’m released
Seen on the streets
All free
They’ll be like “who you dropped a dime on g’”
Obscene language make them ends
So I’m squeezing my pen
That’s mightier than the blade
Not trying to see death
Strategize and not be so impulsive
Quiet cats survive
Bullets for the ones boasting
Friday night drive on Colfax
Enjoying the madness
That was created by fascists
Reagan-nomics took our tools away it’s so savage
Regardless of politics
This my Mile High life
Shout out to my bail bonds-man.

Travis (T): What speaks to you in this verse?

Ray (R): The line, ‘So I’m squeezing my pen, that’s mightier than the blade,’ is the main one. I mean, the rhyme talks about the stress, the penitentiary, but then boom (begins rapping) So I’m squeezing my pen, that’s mightier than the blade.

T: Did you fight with your pen instead of your blade before you ended up on probation?

R: Usually, yes. But there are these times where I just lost it.

T: The pen was knocked out of your hand?

R: Yeah, you could say that.

T: What happens when the pen gets knocked out of your hand?

R: It’s like I’m a different person. I do these things I know are stupid, but I just do them, anyway. It makes no damn sense.

T: But when you have the pen?

R: I can do anything.

T: Would it be accurate to say that when you have the pen you can spit truth like you said in our last meeting and that’s when Ray The Philosopher comes out (I uttered the term Ray The Philosopher without giving it much thought and certainly without an understanding of how it would later be adopted in our work together)?

R: For sure. That’s kind of a dope name right there, brother… Ray The Philosopher (said with gusto)

T: Do many people in your life know Ray The philosopher?

R: My homies do.

T: Is there anyone else you can think of?

R: No, not really.

T: What do you think would happen if we introduced more people in your life to Ray The Philosopher and his rhymes?

R: I think it would be good, but like I said last time, nobody wants to listen. They think rap is corrupt.

T: What if we were to inform them that when you can think ahead and fight with your pen through rap it helps you avoid anger and thus probation? Do you think they know this about you?

R: Nah, they don’t know that. I still don’t know if they would hear me.

T: Even if they knew that it would help you avoid future relationships with probation, they still wouldn’t hear you?

R: (silence for 15-20 seconds) Maybe. I mean, I hope so.

T: What do you think your grandmother would think about rap as a way to fight with your pen instead of your fists? Have you spoken with her about how you and rap have this kind of relationship?

R: No. I’ve never spoken much about my rhymes at all with my grandmother. I’ve just always known how much she hates rap. Like if I bring it up, I know she’s going to roll her eyes at me.

T: Do you think the kind of rap she hates and the kind of rap you’re tight with when you’re fighting with your pen are different?

R: Oh, yeah! She thinks rap music is just about cursing, talking about hoes and drugs and shit like that.

T: If she truly knew how rap music unshackled your soul do you think she might begin to have a change of heart?

R: Yeah, I still just don’t know if she would listen, though.

T: What if we created a space in here where you could perform for her, and we constructed a marquee (points upward) that lights up and says Ray The Philosopher!?!

R: (Laughs)

T: If you rapped for her and she could feel the words instead of just hearing them, what do you think might happen?

R: I really don’t know.

T: Would you say that your grandmother’s wisdom finds its way into your rhymes?

R: Oh yeah, I know it’s in there a lot.

T: Can you think of an example in the rhyme that you shared with me at the beginning of our conversation today?

R: My grandmother has always wanted the best for me. That’s why I started out that first line with her. You know, (begins rapping) Grandma said I should reconsider law school. I was sampling from another rhyme that starts with mama instead of grandma, but it’s because I know she wants the best for me and that’s why she’s always bothering me about school.

The thing is, she also taught me to be street smart, which is why I like to challenge the whole foundation that student loans and shit are built upon. It’s like a scam for poor people. You know what I mean? I would have never thought about shit in these terms if it weren’t for her. I would have never looked deeper. And that’s what that second verse is about, too, with people on TV commercials acting like they can save your life and shit. You ever watched TV at like 2:00am?

T: I have a few times, yes.

R: Then you know what I mean, right? There’s these cats trying to sell hocus-pocus. They are saying shit like, (changes voice to that of a highly embellished television salesperson) “For 20 years now I’ve been helping people change their lives. For only three easy payments of $99.95 you can get the 7 secrets that will make you rich. Order now!”

(Both bellowing with laughter)

T: I didn’t know you were an actor, too, Ray?!

R: (Laughs)

T: In all seriousness, if I’m hearing you right, Ray, your grandmother’s wisdom is everywhere in your rhymes, and she doesn’t even know it?

R: Yeah, I guess you’re right.

T: Do you think we might be able to invite your grandmother to see, hear, and feel that rap can be a philosophy of street smarts and wisdom and not just a form of music that young people like to listen to?

R: I think so.

T: If we are successful do you think this would be sort of like putting the Magic Beats we talked about on your grandmother’s ears?

R: Yeah, but the rhymes will need to be just right.

T: Perhaps we should take some time in here to get them where you want them?

R: For sure.

Turn Up the Sound

Ray and I spent our next two conversations focused on taking the various rhymes rapped during our first two meetings and worked on creating a mega-anthology. It was a scintillating process that saw KRS-ONE, Tupac Shakur, and other artists rapping in unison through Ray’s mouth. I brought in my laptop computer to help with the process, and Ray made it do things I did not know it was capable of.

He turned my computer, and my office along with it, into a fully functioning recording studio. I even created a marquee (clearly the work of a second-rate artist) that read “Ray The Philosopher,” which always led to a hearty chuckle from Ray every time I hung it up at the beginning of our meetings.

“Yo, Travis. Turn up the sound a little bit,” Ray said as I scurried over to the computer. “Yeah, that’s good right there,” he reassured me making an ‘a-ok’ sign with the finger and thumb on his right hand. I watched, often in awe, as Ray meticulously perfected his craft. He was locked in his element, and I was an enthusiastic fellow traveler.

“Nah, we need to change up that baseline a little bit,” he said shaking his head and taking a swig of water. “It doesn’t quite pop. I need more time.”

I have had the great fortune of working on similar projects with people who had sought my counsel in the past, but this was among the most ambitious ventures I had encountered. As we started to make our way toward the end of our fourth session together, I started to wonder if perhaps we had bitten off more than we could chew. Now I knew that Ray had similar feelings. It wasn’t as though we hadn’t been aware of time but more like we had lost ourselves in it.

T: Ray, the last thing I want to do is rush you through this process.

R: But I only get to come here one more time.

T: Well, I know that’s the initial agreement you had with probation, but I can see you as many times as we think would be best.

R: What about you, though? I don’t want to be a leach?

T: What do you mean?

R: You’ve got to get paid, man. This ain’t no charity. This is your livelihood, bro.

T: I really appreciate you thinking of me, Ray. Tell you what, how about I give probation a call and tell them a bit about the situation and see if we can get some more time? In the past this is something they have often been willing to do.

R: What if they’re not?

T: Then we will see the work through to its completion anyway, Ray. As long as it takes. This is just too important. Don’t you agree? Besides, I have been thinking about something. Would it be okay if I shared it with you?

R: Of course.

T: I know your grandmother is going to come in at the conclusion of our work to celebrate with us. I was wondering what you thought about perhaps inviting other people to meet Ray The Philosopher? Is there anyone else you who you think it might be good to invite to wear the Magic Beats?

R: Hmm… I haven’t really though about it too much.

T: I’m just thinking out loud here, Ray, so stop me if this doesn’t make sense, okay?

R: Okay.

T: What do you think would happen if your probation officer were introduced to this idea of you fighting with your pen instead of your fists?

R: I mean, I’m sure he would like it. He just wants me to keep my hands clean for the next year.

T: What do you think would be the consequences of us not bringing him up to speed on this?

R: I don’t know.

T: As it stands now, do you think your PO views you as someone who is going to fight with his fists and get into trouble again or someone who is going to keep his hands clean?

R: (Laughs cynically) I damn sure don’t think he trusts me. I think he believes I’m going to be out gang-banging (a hip-hop term for engaging in violent acts as a member of a street gang), and I don’t even do that shit.

T: How has it come to be that you don’t even do that shit and yet your PO thinks you do? Do you think we should try and set the record straight and let him know how rap allows you to fight with your pen instead of your fists?

R: But he’s going to give me that same old bullshit about how I don’t take responsibility and blah, blah, blah (uses his right hand to imitate a talking mouth).

T: Do you think if you rapped for him and let him know how rap can strangle the advances of anger and aggression, he would look at you as more likely to keep your hands clean or less likely?

R: (Pauses for 10-15 seconds) More likely to keep my hands clean.

T: What do you think the consequences would be if we weren’t to set the record straight?

R: Yeah, I get what you’re saying now.

T: How do you mean?

R: Like, it’s not enough for just me to come up with this plan if he still thinks about me a certain way… like I’m a criminal.

T: Do you believe this is an opportunity for Ray The Philosopher to replace the other names that have been placed on you in the past like criminal?

R: Now that you mention it, yeah, I guess so.

T: Would you say that sometimes your PO is a tough nut to crack?

R: C’mon, now! That dude is like impossible to crack.

T: Do you think then that we might have to prove to him just how effective fighting with your pen can be?

R: Sure, but how the hell are we going to do that?

T: How long have you seen me for now, Ray?

R: (Pauses to think) Like about a month.

T: I know this is a tricky question because I’m asking you to guess what another person might be feeling, but do you have any sense for how your PO would say this last month has been for you.

R: I actually talked to him about this last week. I’ve been squeaky clean. Not one single issue, homie.

T: What do you think he would have told me about how things were going if I had talked to him prior to you coming to see me?

R: Man, he was always in my grill about shit saying I was defiant, I was going to go to jail, and this and that.

T: Fair to say then that he believes things are going better now?

R: No doubt.

T: Has one month been enough to convince him that you are on the right track?

R: Hell no! It’s like he’s just waiting for me to fuck up.

T: How many months do you think it might take to convince him that you are on the right track and ready to end your relationship with probation?

R: I mean, I still have over a year of this.

T: Do you think it will take all of that time to show him just how effective fighting with your pen can be?

R: Probably so.

T: What if we were to invite him in here, bring him up to speed on your philosophy of fighting with your pen and not your fists, and then make a commitment to this going forward?

R: I don’t know if he’ll believe it.

T: You make a good point. Like you’ve told me, he can be a bit stubborn and so can your grandmother! Even as tough as it is going to be, are you willing to fight with your pen and prove to your grandmother, your family, and your PO the true character of Ray The Philosopher? You already have one-month under your belt!

Ray paused after my question. I started to wonder if perhaps my query had pushed him a bit too far. His face remained stoic as the silence continued beyond 30 seconds. Just as I started to ponder my next move fearing I had lost him, he replied, “I’m down (a hip-hop term voicing agreement).”

After the conclusion of our fourth session Ray and I agreed that it would be good to check in with his PO together. We decided that in addition to talking about the need for more sessions, we would also let his PO know (a signed release was already in place) about how Ray had been fighting with his pen instead of his fists. The PO acknowledged that things were going better the past month, but he remained skeptical. He agreed to get payment covered for half of every session for the next month. The way the following month was structured it would afford us five more weekly meetings.

Two Different Stories

Ray seemed somewhat relieved that more sessions had been granted but also a little bit ticked that his PO was still unconvinced. He felt his PO was “playing games” and “testing me.”

Our next three meetings were spent wrestling with these feelings. Ray began discovering that restoring his reputation burned nearly as many calories as he was taking in. Instead of being consumed by anger towards his PO, Ray stayed true to his word to fight with his pen. He remixed a song by the artist Common:

We should name the block poverty
That rock stole our humanity
You hear that glock pop?
For dough we perform beastiality
“Fucking each other over
What you expect they animals”
Then act like they the ones offended
When TMZ release the audio
If life’s a game
They withhold that playbook
But playas make that scratch
We get the itch
Run your shit
This a jook
Or a lick
See that’s a stick-up if you down with my click
We starving in the darkness
Force upon us they man made eclipse
Is it a curse?
Mad poisons in our blood?
My pops tried to disinfect it
Chugging that rum
And I do the same (word?)
Like father like son.

Ray no longer waited for me to inquire about the lyrics. He would deconstruct them now almost as a natural part of our process. “See, this is what he (probation officer) doesn’t understand. I was born behind the god damn eight-ball. No father. Poor. I’ve always had to hustle to survive. He doesn’t know my pain. Does he even care to know it? But that don’t even matter. Is he testing me? I’m going to pass that test.”

Ray began rapping the second verse from this song:

To my reflection I scribed
What I be feeling inside
Can’t leave it buried in the dirt
Gotta breathe it and give it life
My neighborhood taught us no self-control
That boom-bap made us feel like it’s our right to explode
No positive role-model
The hustlers were our fathers
Rappers instructed us to spit rhymes
And don’t bother
With the life of an outlaw
It’s a trick to keep us blind
And deny our title as God
Preventing our rise
They been doing this for centuries
Stolen lands from our North and South American fam
Jews burnt
Japanese thrown in determent camps
Hatred can hide
Right in front of our eyes
But I flipped that same hate
Used it as fuel to survive
I’m of a mind that believes love will conquer hate
They be seeing black and white
While my crew is dazed by all the gray
So gather around the fire
Light it up
Continue the cipher
Cause in the darkness of nights
Our stars still shine brighter
This is my dream!

T: Ray, are there two different stories in the two beats you have shared with me today?

R: Yeah, the first one is the pain and strife. The second is what happens when I look ahead and fight with my pen.

T: Pain and strife and fighting with your pen… both of those are rhymes that you brought into our work earlier, right?

R: Yep.

T: Would it be right to say then that these last two verses are a sort of remix of all of the beats we’ve heard in here so far?

R: Pretty much.

T: Would these verses be good to share with the folks who join us for our final celebration of the work you’ve accomplished in here?

R: Yeah, but I might tweak them throw in a couple of other verses from different rhymes to get it just where I want it.

Our second to last session was a dress rehearsal. Ray came with the beats he wanted to perform and refined them. We also talked about how he wanted our final celebration to commence, what would happen, and who to invite.

He joked that it “would be kind of like a block party, but where a therapist lives in the house on the corner.” We also decided that those in attendance would have an opportunity to voice their support of Ray’s efforts over the past two months as well as hopes and dreams for the future. As this session came to a close I could detect a nervousness that was following Ray.

T: Ray, I could be wrong here, but I am wondering if some nervousness is hanging with us right now.

R: Yeah, I guess so.

T: Do you mind if I ask you what kind of nervousness it is? People I’ve worked with before have taught me that there are different kinds? Do you know what I mean?

R: You know, I’m not like a professional rapper or anything like that, but I’ve performed in my neighborhood before. It feels like that. Like, you think you have a good rhyme, but you never know for sure until you get on stage and the crowd is feelin’ it.

T: What gives you confidence that the rhyme you have created in our work together will deliver just the message you hoped it would?

R: I put my whole heart and soul into it. I didn’t leave one drop.

T: Do you think the people who are here with us next time will feel your heart and soul coming out through your lyrics?

R: (Pauses for 10 seconds or so) I really think so.

T: Do you remember when I first asked you about what would happen if you rapped for your grandmother or your probation officer?

R: Yeah, I said they wouldn’t hear it.

T: Are you saying that you feel differently about that now?

R: Yeah, I guess so.

T: What would you say has shifted?

R: These rhymes are me but just in lyrical form.

T: And you don't believe your grandmother or those who love and care about you would reject this gift that is a lyrical manifestation of you?

R: No, my grandmother always tells me that she’ll never run out of love for me.

T: Hey, something just struck me, Ray. Would it be okay if I share it with you?

R: For sure.

T: I wonder if you just discovered the Magic Beats?

R: What do you mean?

T: Do you believe that when you create a rhyme that fully represents you and comes from the deepest depths of your soul that even those who don’t prefer rap music could still hear it?

R: (A smile overwhelmed the now dwindling doubt on his face as he nodded affirmatively)

T: Ray! This is great! What an incredible discovery you have made!

Ray often tried to minimize any expressions of emotion, but even he smiled loudly at this development. In our excitement we almost instinctively exchanged daps (gesture similar to a handshake) with our right hands before giving one another a quick hug. With this we had established an unspoken agreement that we were ready for Ray’s performance and celebration next week.

A Celebration of Hope

Ray and I agreed to meet about a half an hour before everyone else to prepare the room for the celebration. As we moved tables and chairs and geared up the laptop computer everything was coming together. “Alright, I think we’ve got it,” I said looking in Ray’s direction. He then shook his head ‘no’ and looked upward to indicate to me to direct my gaze towards the ceiling. “What?” I said with a perplexed look.

He nodded upward once more. I stared skyward still trying to decipher what Ray was communicating. Then I realized that in my haste to make sure there were enough chairs for everyone I had forgotten to hang up the marquee. Like a dog with his tail between his legs I went back to my desk in the back room and removed from the top drawer the “Ray The Philosopher” marquee. I dashed back out to the main office and hung it up in its customary location. “Now we got it,” Ray asserted.

Soon, Ray’s grandmother, his sister, and a few other people from his neighborhood began making their way into the office. There was a sort of nervous excitement that filled the room. Lost in conversation, time had escaped me. I

reached into my pocket and pulled out my phone to take a quick look at the time. In doing so I noticed a message was waiting for me from Ray’s probation officer. Oh no, I thought to myself. He had left me a message stating that something had come up and he wasn’t going to be able to make it. Just as I was about to hold the phone to my ear to listen to it, he lumbered through the front door. “Sorry I’m late,” he said. “Did you get my message? I got caught up with a few things at the office.”

Relieved that everyone was now here, I looked at Ray to see if he was ready to go. Ray had asked that I start by saying a few words to give folks a sense of what today’s meeting was all about. After welcoming everyone and thanking them for attending, I began discussing a bit about Ray’s journey.

“During our two months together, Ray has reaffirmed how rap music can be an ally in helping him be the person he wants to be. He has composed a series of beats he would like to perform for you today. Ray suggested that

Spitting Truth from My Soul: A Case Story of Rapping, Probation, and the Narrative Practices- Part I

Posted on January 10, 2023February 11, 2026 by Psychotherapy.net Team

The Rap That Binds

“This kid really doesn’t get it,” a clearly frustrated voice blared so loudly that I moved the phone’s speaker a couple of inches from my ear to avoid any future hearing loss.

“He just won’t take any responsibility for his actions, and he doesn't give a shit…and he has 16 more months until he’s off probation! I just don’t think he’s going to make it. I don’t even think you want this one!” I recognized this voice as that of a probation supervisor I had worked with a number of times over the years, but never had I heard frustration get the better of him in such an obvious way. “I’d be happy to see him,” I said. “Send him my way.”

When I put the phone down, I wondered if my enthusiasm might have been misplaced and I would have been wiser to tell him I was overloaded and couldn't take on any more work at this moment. No more than 24 hours later I received a phone call from Ray, a 24-year-old young man who told me his probation officer had passed on my phone number to him. I was intrigued by how polite and soft-spoken he sounded over the phone, and we set up an appointment for later in the week.

My work with people involved with the justice system, whether on probation or otherwise, began nearly 13 years ago when I was just a 22-year-old graduate student in Los Angeles, California. After years of agency work, I now operate a small private practice where probation officers, schools, and word of mouth drive young people like Ray to my door.

In community agencies I had worked in the past, I met with people twice a week as mandated by their sentences. More recently, I have started getting short-term referrals, which often allow for between 4-8 meetings with people. In the case of Ray, we ended up seeing each other 9 times. Probation assumed responsibility for payment for 5 meetings only.

After that, our time was up. However, Ray indicated that he wanted to continue to attend on his own volition. This is something that happens with a surprising number of cases. I have learned that if we call the probation officer on the case, the Department of Justice will usually pick up at least half of the cost for the remaining number of sessions, something they were willing to do for Ray.

Three days after first talking to Ray on the phone, he walked into the office wearing blue jeans, a red hoodie, and had headphones dangling around his neck. As he sat down across from me, I had an intuition that he was not a stranger to this process often called “therapy,” a fact he would confirm as we began talking.

It was as if he was bracing himself for what was to come. He sat back in his chair, both of his hands tightly grabbing on to an arm almost as if he was at the mercy of a neophyte airline pilot preparing to practice landing a massive 747 for the first time. Perhaps he was expecting a barrage of advice disguised as “psychoeducation?” Or was he steeling himself for inquiries about what might be neurochemically “wrong” with him? Everything about how he was composing himself suggested to me that this young man had heard it all before.

My first query was clearly not one he was expecting. “Do you mind if I ask what you are listening to?” gesturing to his headphones. Ray raised his head up to look me in the eyes for the first time since walking into the room, his gaze a blend of skepticism and curiosity. “Styles P and Pharoahe Monch,” he replied.

“How old are you again?” I said as a smile crept on to my face.

“Why?” he inquired.

“It’s just that most 24-year-olds I have spoken with aren’t keen to the ways of Styles P and Pharoahe Monch,” I said still smiling knowing the album he was referencing was over a decade old and was not one many young men of his age were typically in step with.

“A lot of this new shit ain’t real. I can feel what Styles and Pharoahe are saying,” Ray declared.

And with this, we were off. I had been granted the great privilege of riding shotgun in Ray’s lyrical journey. For the next forty-five minutes we listened to music on his phone and critically examined the verses he found most meaningful. What follows is an example of one such verse:

I Supreme Lord and Master (ISLAM)
But at times,
The words ring empty
When I see another homie blood splattered
Dreams get shattered
Family fractured
Ugly reputations is what give television ratings
Problem story plastered
Learn the science of our plight
These depictions keep penitentiaries packed tight
But only God can judge me
Once I fade away from life.

Yet another example:

How many Super Bowls passed
My mind’s eye showing possibility so I grasp
Of a hood block,
With no patrolling cops
No empty baggies once holding rocks
Shells from a glock
But the wisdom I've acquired allows us to question what was taught
Pause in the moment
The impulse can be stopped.

During the conversation that followed I learned that not only did Ray have an affinity for rap music, but he also wrote some rhymes of his own.

A Voice to the Voiceless

Travis: Listening to you today, Ray, I have a hunch that you and rap music have been homeboys for a long time and you both share a long and storied history together. Am I right or wrong?

Ray: Yeah, I mean, I can’t remember my life without rap. It’s like it was with me from the moment I came out of the womb. You know, I’m sure that’s not true, but that’s what it feels like.

T: Wow! Are you telling me that no one has been a friend to you longer than rap has? (He nods his assent) This seems like a really important relationship. Would it be okay with you if I tried to understand the relationship you and rap share a bit better?

R: Sure, go for it.

T: I’m curious to know if anyone has ever asked you about your relationship with rap before?

R: (pauses 10 seconds or so) I mean, not really. My homies and I cypher back-and-forth about it, but… you know… I haven’t really broken down my relationship with it if that makes any sense.

T: It does make sense. Thank you. Other than your homies, does anyone else ask you about your relationship with rap?

R: No, except for like teachers and probation and other adults throughout my whole life trying to tell me it’s violent and the music of the devil (takes his index fingers and makes horns over his head) and shit like that (laughs).

T: So, if I’m hearing you correctly, Ray, those adults don’t really ask you about your relationship with rap, but rather tell you the sort of relationship you should have with it?

R: Exactly! It’s like they don’t know shit about it but want to tell you it’s the root of all evil.

T: This is really remarkable to me, Ray! Would it be okay if I asked you a few more questions about it?

R: Oh yeah, no problem.

T: If it gets boring to you or you would rather go in another direction just tell me, okay?

R: Word (a hip-hop phrase that in this context verbalizes agreement).

T: What do you think the adults you just mentioned, like former teachers or people involved with probation, could stand to learn from your relationship with rap?

R: They would never learn anything because they won’t listen. Their minds are already done made up.

T: Do you mind if I ask what kind of headphones those are, Ray? (pointing to his neck).

R: These? Oh, man, these are Beats (a popular brand of headphones).

T: Now I heard you say that those folks wouldn’t listen, and I want you to know that I absolutely believe you. Even still, I want to invite you to imagine for a second that we could take a pair of Beats, maybe even magic Beats, and slip them on to the people that can’t or won’t hear while they were sleeping, and the message would sneak through their ears and permeate their minds whether they wanted it to or not. Imagine now that they have woken up. What education would rap have given them?

R: Man, I wish you could pick me up some of those headphones (said laughing)!

T: That would be pretty cool, right? Maybe that’s a project we can work on later (both of us laughing).

R: For real! What I think they would learn is that there are a lot of people in the world who don’t have a voice. If you are someone in the world who does have a voice, you know, that’s great. Good for you. And by voice I mean, you know, we all have like a voice box that works. What I mean when I say voice is a voice that others can hear or will really listen to. My whole life I’ve never really had that voice because I’m poor and black… except when I rap. This is true, you know, for like pretty much my whole crew in my neighborhood, too. Rap is our voice.

T: Are you of the opinion that the people who won’t listen that you referenced earlier would learn from the “magic Beats” that rap could serve as a voice for the voiceless?

R: Exactly. I mean, if everyone listens to everything you say anyway, then fine, you don’t need something like rap. (Begins rapping):

The more I wild out
Allows me to achieve that street clout
While lives are turned into tools
Did dominant narratives actually raise a bunch of fools?
Our escape from a jumpshot or a hip-hop plate?
While theirs is school?
But either one of us can lose
Trying to chase what Lupe articulated as The Cool,
White men in suits don’t have to jump
Still a thousand and one ways to lose with his shoes

R: You know, that line, “White men in suits don’t have to jump,” that’s what I’m talking about.

T: Right, there’s that old saying, “White men can’t jump,” when it comes to basketball. Did those lyrics do something clever with it?

R: For sure. White men don’t have to jump to make money and white men don’t have to rap to be heard. Don’t get me wrong, I write rhymes because I love to. Sometimes when I write it’s just about partying or females or something light. But I also write because it allows me to have a voice. You know, it’s like rap says to the world I’m going to say shit how it is whether you like it or not.

Of Protest and Freedom

It was becoming increasingly clear that Ray’s relationship with rap, and the hip-hop culture in which it resided, was one of protest, freedom, and inspiration. As our conversation continued to traverse the electrifying and winding roads of rap music, we alternated between listening to songs on Ray’s phone and discussing, almost philosophizing, at the conclusion of each. That served as inspiration for the following exchange:

T: Do you think rappers are philosophers?

R: No doubt. Rap is philosophy but without all the old white cats (said laughing).

T: Socrates is not the father or first philosopher of rap?

R: No! (Laughs harder)

T: Who do you think is?

R: Probably KRS-ONE.

T: What in your opinion is the job of a philosopher?

R: To make people think, like hold a mirror up to the world so they can see how foolish they are. (Begins rapping):

Peep the crucifix
Comes across mysterious
With I(j)ehova hanging from the partisan nails of politics
The origins
Governing men of Romans
Did agree to its means justifying capital punishment
For the minds
They despised
To keep all the sheep in line
While revolution sparked divine
Christ
But check the rhyme
What if they lynched him hanging from the branch of a tree
Then burned him half alive
Peep manipulation B
We would pray to a tree
Then human torching eventually
Fire associated with hell
Overstand irony
When a bullet burns its way into your brother's physical
Laid to rest in a wooden casket
Damned its cyclical.

T: What do you hear in these rhymes?

R: It’s like it exposes hypocrisy, you know what I mean? People believe things about God or religion or whatever without even opening up a book or thinking. They just accept a history they like or feel comfortable about or that some cat on TV tells them is right.

T: Are you of the opinion that there are multiple histories?

R: Oh yeah, no doubt. The history that you get in history books is the only one most people read, though.

T: Where do these histories come from?

R: Usually from your teacher and books in school.

T: Where does the information in those books come from?

R: I mean, that mostly comes from white people and their ancestors. You know, I took a philosophy class in college like 4 years ago and I don’t think we talked about one brother the whole time. That’s part of the reason I never fit in there.

T: And the fact that the only history that was discussed was from a white perspective, what does that mean for the other histories?

R: You see them in like Roots (a television mini-series from the 1970’s depicting the life of a black slave in the United States) and shit (laughing). We had to watch that in high school. That shit is so weak.

T: What would be a stronger portrayal?

R: You just heard one (in the previous rap). But it’s like I told you earlier, people don’t want to listen to those.

T: Do you believe you are a philosopher?

R: I never really thought about it like that. I know I’m a writer. But I guess that means I am a philosopher.

T: Do you mind if I tap into your own philosophical expertise?

R: Sure. I know what you’re go to say next (said with a wry smile). You are going to ask me about my philosophy on shit.

T: You know me too well already, Ray!

R: My philosophy is simple. It’s to see the truth even when they try and obscure it. It’s to go deeper. If you don’t, you’ll believe a lie.

T: How do you see deeper?

R: You have to do what my grandmother says: ignore the noise. You can’t believe everything you hear. You can’t even believe everything you think you see.

T: Is your grandmother a wise philosopher, too?

R: She’s the wisest person I know.

T: What has her philosophy taught you about the person you want to be?

R: She always says I didn’t raise no fool.

T: Would you say that your grandmother’s philosophy and the philosophy of KRS-ONE are similar?

R: Hmm… (pauses for 10-15 seconds) that’s crazy, bro. I never thought of it like that, but I guess so.

T: In what ways would you say they are similar?

R: Both of them are encouraging me to think in my own way. To be my own person. Basically, just be wise to the ways of the world.

T: Do you think that it would be helpful in our work to call on the ideas of great philosophers like your grandmother and also KRS-ONE as we try to navigate the situation that brought you to see me?

R: Yeah, it’s just crazy though because my grandmother hates rap. Like she thinks it “corrupts the youth” (fingers on both hands raised to make air quotes).

T: If only we had those “Magic Beats.” Do you think she would be more open to it then?

R: (Smiles and then laughs) Yeah, and maybe she would see that I’m rapping about like the same shit she’s saying but in my own way.

T: Have you ever thought that maybe the spirit of your ancestors and their struggles can be channeled through your raps? Maybe rap is like your history book?

R: I mean… that’s deep! I ain’t never thought of it quite like that, but yeah, my raps are about me, where I came from, and where my people came from.

T: Would it be okay if we cracked open your rap’s history book in our work together?

R: Yeah.

T: Do you think it might provide us with some stories that the regular history books miss?

R: Oh, no question! Stories that regular history books wouldn’t even touch!

So engrossed did we both become in the progression of this conversation that time itself seemed to melt away. Ray continued writing his own history through various rhymes and interpretations of them.

Removing the Shackles

At one point Ray could not conceal his enthusiasm for a verse he located on his phone. He said he had been listening to it for a few weeks with a great deal of frequency. It moved him so much that he immediately stopped the music after it had played and rapped the verse himself again.

With these I see
Crimson stains on this project concrete
Yellow tape barricade
Homie wrapped in white sheets
It's a struggle just to eat
So how the fuck do they rationalize judging me or my deeds
Grab a pen
Clear the phlegm
Then commence to bless the beat
Give ya'll a tour of my life
Without walking on my streets
It's my life!
Being scribbled on they college ruled pages
Escape when we cipher up
That type of freedom is amazing
My life!

I watched him intently and took a few deep breaths before breaking the silence we had both fallen into by my first query.

T: Ray, I noticed that you listened to this verse and then stopped the music and rapped it. Were you, by any chance, deepening your relationship with the lyrics by rapping it yourself?

R: I do this all the time. What I like to do is take a verse that someone else wrote and then just add my own flavor, kind of like sampling (a hip-hop term for taking an older song and mixing it with a new one) or remixing.

T: Do you mean that you take the original rhyme and add your own story?

R: Exactly.

Ray was so engaged that by the end of our conversation it was as if he were a different person than the one who walked through the door an hour before. Certainly he was a poor match for the description of the detached and uncaring young man who lacked any semblance of motivation that the probation officer had provided for me earlier in the week.

The fact there wasn’t much sand left in the hourglass of our first meeting had sneaked up on both of us. My mind was left spinning with possibilities for where our future conversations could go. With just five minutes remaining, I invited Ray to reflect with me on what had transpired which broke us both out of our enthrallment.

Travis: Would it be all right if I asked you a little bit about how our meeting today is going?

Ray: That’s cool.

T: Thank you, as I know I have asked you a lot of questions today. I appreciate you hanging in there with me. I’ve noticed that it’s very different when we are just speaking as opposed to when we invite rap to the party. Have you noticed this?

R: Yeah, for sure.

T: How do you understand this?

R: It’s like when I rhyme… I spit truth from my soul.

T: How is rapping with your soul different than talking with your mouth?

R: When I talk, I think. I thought that’s what we’re supposed to do in therapy, anyway. That’s what all those other fucking shrinks did.

T: Would it be all right if we made up our own therapy and put aside other kinds of therapy you have been through or heard about?

R: Yeah (said with a chuckle and skeptical eyes).

T: What can your soul rhyme that your mouth sometimes might have trouble saying?

R: Freedom. It’s like when I’m rapping I can feel the words come through my body. It’s natural, like I don’t have to think about it.

T: By that do you mean to say that rhymes remove the shackles that are attached to your soul?

R: Right (said turning his head to one side as if in deliberation and then nodding).

T: I saw your face light up. I wonder if inspiration is brewing in your soul this very moment? I know I am guessing so I could very well be wrong.

R: No, it’s just that I thought of a verse. (Begins rapping):

It's like we being played
When they say
Strive for a slice
Of they cake
They filthy hands holding hate
Choke out fate
But the rhyme melts the shackles
Oppression disintegrates
Even just for one moment
When we flowing on stage
It goes on and on and on…

T: Have you had shackles on your soul that rap music helps you break free from?

R: Yeah, sometimes it feels like rap is my only way to break free.

T: I notice when you rap that your whole body changes. For example, when we were just talking earlier you were kind of slumped down in your chair. But when you rap, your back straightens up, your face lights up, and your hands are active. It’s almost like I can see you breaking free right in front of me. What do you think would happen if rap made more frequent visits to your life?

R: I would feel more alive and like I have a voice, you know what I mean? Like being on probation it feels like I have no voice. I just get told what to do and it’s like they tell everyone the same thing and don’t really care what really makes someone tick. It’s like we are cattle just being pushed through the gates.

T: Do you think Rap music could be a great way for us to understand what makes you tick?

R: The best way!

T: I get the sense you have many important stories to rap about. Would you be willing to write a song between now and next time that paints the part of the picture that probation and maybe other people in your life don’t get about you?

R: (Nods affirmatively)

T: Do you know what I mean?

R: Oh yeah, for sure. I already feel a couple of ideas (pointing to his head). Like people automatically assume I’m stupid and like I’m some kind of bad person or criminal or something. They don’t even know me.

T: Might writing a rhyme about the parts they don’t know release the shackles from your soul?

R: Yeah, but not all the way.

T: It might take more than one rhyme to release them all the way?

R: Yeah.

T: Do you have many stories to tell?

R: Oh yeah!

T: I want you to know that I will support you in writing as many rhymes as it takes.

R: You’re the weirdest shrink they have ever sent me to. Not weird like bad, not bad at all, but does probation know you do this?

T: Do what? Ask people to rap?

R: Yeah!

T: They know I help people find the kinds of therapies that best work for them. Do you think this one we’ve come up with today might work for you?

R: Oh yeah, but I don’t even know if this is really therapy.

T: What would you call it?

R: It’s like a studio session where I’m making beats with my homies or something.

T: Should we have a studio session once a week together?

R: (Smiles and laughs) For sure.

Spitting From My Soul

Ray returned for our second conversation with his black New York Yankees hat turned to the side looking somewhat, but perhaps not yet completely relaxed as he sat down. He reached into his pocket and pulled out a folded piece of paper as his right leg bounced up and down. He quickly unfolded it and scanned over its content. “Here are a few lyrics,” he said quietly but with conviction as he handed the document to me. I was feeling a bit caught off guard that Ray had picked up so quickly where we left off in our last conversation.

T: Ray, I have to be honest, I feel so privileged to hold this is my hand right now. I wonder if I am holding a gift from your soul?

R: You could say that (kindly smiling at me).

T: I just had an idea and I’m curious if it would be okay if I shared it with you? (Ray nodded in the affirmative). Last week you told me that rhymes come from your soul when they are rapped. I could be wrong here, but I’m just wondering if I read the rhyme on the paper if it might lose some of its soulfulness? And the last thing I want to do is strip the rhyme of its soulfulness.

R: I’ve got a baseline for this (pointing to his phone). It’s dope (a hip-hop term that means good or of high quality) You want to hear it?

T: I would be honored, Ray.

As the music percolated through the small speakers on his phone I noticed I couldn’t help but bob my head. I looked up and Ray was doing the same. Our eyes caught and Ray smiled slightly with the left side of his mouth. In this moment I pondered whether or not I should invite him to rap, but I hesitated not wanting to make him feel uncomfortable in our second conversation. A few seconds later, Ray reached his hand out indicating he wanted the document with the lyrics on it back from me. I obliged. Ray bobbed his head a few more times and said, “This still needs a little more time in the lab, but…”

What happened next as Ray began to “spit truth” was almost like a detonation. The words rhythmically rolled off his tongue with an intensity that made me suspect something important was transpiring. I didn’t just listen to what he said, I felt it. Ray’s passion was palpable, and I could feel its infusion through my body. We now bobbed our heads in unison and for a brief time it was as if the world had shrunk and we were the only two people that now could fit in it. It was the kind of attunement and connection with another person that was equal parts mysterious and exhilarating.

Grandma said I should reconsider law school
That means I wear a suit and bend the truth and feel awful
Hell no, got a degree but what that cost you
You make a good salary just to pay Sallie Mae
That's real as ever
Ducking bill collectors like a Jehovah's witness
When they showed up at your door at Christmas
Praise God it's hard to stay spiritual
How they got these people on the TV selling miracles
You mean to tell me everything gonna be fine
If I call your hotline and pay 29.99
Well damn, why didn’t you say so
Take this check and ask God to multiply all my pesos

T: I am so captivated by what just happened, Ray! Would it be alright if I tried to understand your rhyming genius a little better?

R: For sure.

T: May I ask what is it about this rhyme that reveals a part of yourself that other people often fail to get?

R: People think that because I don’t have a college degree I’m stupid. They make that judgment up front. Now I’m not trying to say that college is always a bad thing (said looking at me knowing that I’m also a college professor), but, you know, sometimes it’s like a scam. Like, I'm a poor kid. Think about how much debt I would rack up by going to college. Dude, it’s astronomical. I tried community college for a year. Is that even a good investment? You know, I think a really good rhyme exposes the way people think. So that first part is just like a challenge. You know, just because these are the rules you play the game by doesn’t mean they are the only rules.

T: Do you think rhyming helps you create your own rules while also challenging the rules people tell you that you should follow?

R: No doubt. And sometimes you challenge rules in rhymes just to make people think.

T: Is that like what you were saying last week about rap as a philosophy (I asked Ray this very much hoping the conversation meant as much to him as it had to me).

R: Exactly, like KRS-One!

T: (Feeling relieved that we seemed to be catching up right where we left off last week, I continued) Can I tap a bit further into your rhyming knowledge here, Ray?

R: Sure.

T: Are you of the opinion that challenging rules is a good thing? (Ray nods in the affirmative) And why do you think it’s a good thing to challenge rules?

R: If no one challenges rules, shit gets stale. You know what I mean? Like people start to take things for granted. Sometimes a good rhyme is just like grabbing someone and going (pretends like he’s physically shaking someone). It’s like, wake up, yo!

T: Do you believe there are different ways to challenge rules?

R: A lot of different ways.

T: Are some ways of challenging rules more effective than others in your experience?

R: Yeah, I mean, look how I ended up here on probation.

T: How do you mean?

R: Ever since I was a kid, I would find myself in certain situations where I would get angry and step (a hip-hop term that means to challenge someone physically, often to a fight) to someone. Yeah, and it’s stupid, I know. I’ve been getting that lecture my whole life.

T: How do you understand the relationship between rap and anger?

R: When I would write rhymes, they would keep me out of trouble. Like if someone was pissing me off, I would just go home and make a beat about it. It’s like my anger would leave my mouth through my rhymes.

T: Let me see if I’m hearing you correctly, Ray, because I don’t want to get this wrong. Are you saying that rap is able to put anger in its place?

R: Yeah, I don’t end up doing something stupid.

T: Maybe this is a long shot, Ray, but do any rhymes come to mind that capture what we are talking about here?

R: No, not really… (pauses in a pensive fashion for 30 seconds or so)…actually, yeah, one does (he composes himself and then begins rapping):

References

Travis Heath on Psychotherapy as an Act of Rebellion

Posted on December 8, 2022February 25, 2026 by rezendevknowfully.com

An Act of Rebellion

Lawrence Rubin: Hi Travis, thanks for joining me today. I first became aware of you and your work after reading “Reimagining Narrative Therapy” that you co-edited with Tom Carlson and David Epston. There you said that therapy is, or at least should be, an act of rebellion?

Travis Heath: I wrote that, huh? It’s always interesting to reflect on one’s own words. Should it be an act of rebellion? Maybe it shouldn’t be in every case. Yet, I think there could be therapeutic advantages to therapy being an act of rebellion. What I mean is that sometimes, usually unwittingly, therapy can become an act of reinforcing normative ways of being. What we might describe as “mentally healthy” may actually be a normative societal way of behaving. So then, an act of rebellion is when people move against the norm, right? To go against the status quo. And there could be — whether it be in therapy or elsewhere — immense therapeutic value when that rebellious act is consistent with who the person most knows themselves to be. Now, I’ll say that an act of rebellion for the sake of rebellion, like a contrarian act of rebellion around every turn, may not always useful. But one that is truly consistent with who a person is can have a positive impact on one’s mental health.

LR: And sometimes people come to therapy not sure of who they are, or which story is the one that is the healthiest for them to live by. Are you suggesting that for some people a therapeutic relationship allows them to rebel against norms that are oppressing them or holding them down?

TH: I think a therapeutic relationship can help with that, although I don’t know if that is enough alone. As someone who is informed by narrative ways of working, therapeutic questions are very important to me. Most of my questions are average at best and probably don’t lead to much change in people’s lives. But all I need is one really good question. Not one that I’ve conjured up, but one that just comes up quickly in the moment from the relationship I am having with the person that I just throw out there. A good question can open up a way of living that a person hadn’t articulated in a particular way before. Maybe they felt it somewhere or tried to imagine it, but now they’ve put words to a particular direction.

LR: This may be a tough one to pull out of your hat, but can you give me an example of a client that you recently worked with, or that stands out in memory, where you came up with the right question at the right time?

TH: Yeah, that’s a good question. I was working with a women-identified person in her 40s. In our culture, there are certain ideas about bodies — how they should look, and how bodies should and shouldn’t be shaped. I think this is especially so for women. That pressure seems to be increasing for those of us who are male-identified as well, but it’s been very tough for women for some time. She was really distressed when she came to me and was talking about eating peanut butter. Like, “I’m really distressed because I’m eating peanut butter.” And I remember saying to her, “Okay, I hear you and I want to understand what’s distressing about this?”

I remember saying to her, “Can I share something with you? I eat peanut butter too sometimes.” And she kind of smiled, but added, “No, I mean I eat too much peanut butter.” And I said, “Okay, again, I hear you. Help me understand. What’s too much peanut butter?” She said, “Well, I might eat a spoonful or two spoonfuls of peanut butter.” And I said, “Hey, I won’t want to tell you how to eat or what you should or shouldn’t be eating. I’m just really trying to understand. And I wonder, is it possible that you could eat a spoonful or two spoonfuls of peanut butter and that might in some way be okay? Now, if you told me you ate the whole jar or something and you were doing this nightly, I would understand how that would be distressing. But do you suppose it might be okay that you eat a spoonful or two of peanut butter?”

With that question, she burst into tears. It was a simple question, not something you’d see in a textbook as an exemplar. But it was really just a question that in some small way, maybe larger than I initially realized, invited her to think about how she came to understand what’s too much peanut butter and what’s not enough peanut butter. The question was asking her to consider how she came to understand that eating peanut butter might begin to define her as not a good person. How did she come to understand that process? And we really had a session just about peanut butter, which sounds sort of wild, but it wasn’t initially an act of rebellion. It became an act of rebellion for her because she was resisting some of these discourses about food and about her body.

I remember asking her, “Okay, so how often do you do this?” She said once or twice a month, so I said, “All right. Let’s just say that you stopped doing that. Do you then think your body would, over time, or maybe quickly, begin to conform to this body that you’ve been told you should have?” She really thought about that and said, “No, it probably wouldn’t.” “Well, what kind of acts of torture or anything else could you put your body through to make it look like these bodies you’re telling me would make you a good person?” In that moment, with that question and the questions and answers that followed, it was essentially about, “If I looked this way, I’d be a good person.” But she couldn’t initially articulate that. It was the question about “peanut butter” which enabled her to communicate those feelings of insecurity that she constantly experienced yet couldn’t ever explain. In that way, our conversation about eating, and even just existing in her body, became an act of rebellion against normative prescriptions of what society tells women is a good body.

LR: You know, Travis, I would imagine at one level you were very aware that you weren’t really talking about a spoonful of peanut butter. Instead, you were creating a space in which she could really question the legitimacy of her rigid thinking, and maybe even dive more deeply into a conversation about self-worth, body image, and perhaps gender with its discontents.

TH: Lawrence, I might say it just a little bit differently. Not so much her own self-talk, but the talk of the culture that she had adopted and the cultural meaning of “self-talk.”. Because when people say “self” in front of anything — self-talk, self-esteem — I get skeptical. Self-talk isn’t really her talk, although it may feel like her talk because Lord knows how long that talk has been kicking around. But she didn’t come out of the womb with that talk. That talk came from someplace, and now it’s become a part of her. So, I think that this act of rebellion you’re talking about, when it is really shining, can help people see that and say, “Oh gosh, I didn’t come out of the womb with this. Actually, these aren’t my ideas.” Then that can lead to, “And I don’t even have to subscribe to these ideas,” which can be very liberating.

Confessions of an Anti-Manualist

LR: So, you created a space in which she was given permission to rebel against certain language that has been forced on her or force-fed to her. Shifting gears a bit, has traditional therapy’s search for the grail of evidence-based techniques enhanced or diminished the craft of psychotherapy?

TH: I like the question, and I think it’s an important one. Without trying to be too long-winded, I do think that historically the idea of “evidence-based techniques” came from a good place. By that, I mean hey, there was a time when psychotherapy was viewed in a certain kind of way—the work of charlatans. Hell, there were psychologists, not clinical psychologists, but there were psychologists — I think Cattell and some of those other folks — that weren’t necessarily huge fans of psychotherapy. And so, I think there was a time when it was important to show that there was some kind of scientific evidence base, that therapy wasn’t just akin to palm-reading. Maybe I shouldn’t dismiss that out of hand, but that’s a different conversation. The point being, there was a real reason for attempting to create psychotherapeutic techniques with evidence as their primary foundation.

At some point, this idea of evidence-based practice got tangled up with late capitalist ideas, and people discovered that you could sell a hell of a lot of workbooks. You could also bring a hell of a lot of legitimacy to what you were doing, and it helped your personal brand that was tangled up with the brand of your therapy. That’s where I think it started to become problematic. So, the idea of having evidence is not necessarily bad. But when it’s done for these sorts of capitalist reasons, I become concerned about it.

Now to your question of the art, if you will, of psychotherapy. I’ll share a quick story from a class I was teaching probably 10 years ago. It was an undergraduate intro to clinical and counseling class, and as we discussed I have never been too keen on these evidence-based models. So, I started the class by bringing in treatment manuals and handing them to everyone. “All right class let’s look these over. What do you think about them?” Most of the students, and I think this says a lot, were comforted by this. “Oh, great. I could do this. I could follow this script.”

Then one intrepid young woman who sat in the front of the class asked, “Well, what happens if you’re using this and it doesn’t work with someone?” And I said, “Well, okay, that leaves us at a bit of an impasse, doesn’t it? I personally don’t believe there are just two ways to do therapy. But let’s just look at two possibilities. So, one possibility is we use this manualized approach that we’re looking at. And it works to a certain degree for some people, maybe even most people. And you do a mediocre, good enough job, your whole career. And then, every now and again, you find someone it really doesn’t work for, and I guess you just abort mission. Or another option — it’s not the only other option — is that we learn how to do this on sort of a moment-to-moment basis. We’re really being in touch with the other person.” I said some other shit, too, but the students almost universally agreed that one sounds better, but it also sounds scarier. It sounds like a lot more work. And how do I know if I’m doing it right? They had all these questions, which were all very fair.

My worry is that somewhere, usually early on in people’s formal training, without even realizing, without even really being presented it, they’re nudged to make the choice of one manualized treatment over another. They’re nudged to go down one of these pre-determined roads — and they’re sort of nudged often. And then if you’re trained in that way, it’s hard to put the genie back in the bottle. It’s not really that one way of doing therapy is superior, but if you’ve worked with enough people, you come to understand that you aren’t going to be able to take the same damn thing and apply it to everyone who walks through the door, or even most people.

LR: So, would you say that you are an anti-manualist, or that you practice an anti-manualized form of therapy? I know Narrative Therapy is, by definition, an anti-manualized intervention.

TH: I have never heard it put that way. I like the term. I accept the term. I don’t know if I always live up to that as much as I could. I mean look, there are certainly patterns to my work. And people who know my work well and who have watched it behind mirrors or whatever they’ve done over the years, could point to patterns in my work. I don’t know if patterns are manuals because I’m not necessarily adhering to a prescriptive one, two, three, four, this is the order of how you do things. But there’s a certain soul to the way that I work. And there are patterns in how I work. I won’t deny that. At one point, however many years ago, I said, “Well, I never do the same therapy twice.” That feels a little self-aggrandizing. Like why am I saying that? Yes, there are elements that overlap. So, to be an anti-manualist, yes. I like that idea. And, I have to acknowledge that not everything I do with every single person is completely new and creative. There are some patterns that you see.

De-Colonializing Therapy

LR: There are likely many clinicians in our audience who are really into manuals. It seems that once a therapy has an acronym, a workbook, and a “seal of approval” by some credentialing body, it becomes the stuff of grail. In this vein, and based on our conversation and my reading of your work, are we speaking about detraditionalizing therapy practice?

TH: Thanks for asking these questions. To detraditionalize, for me, is something that if it doesn’t happen, then a therapy dies. But let’s get outside of therapy for a moment. I think almost anything dies. Maybe some of the folks who would frequent this interview may not be sports fans, so excuse the sports analogy, but I’m a big basketball fan — played basketball my whole life. And people will watch the modern NBA and they’ll say, “these guys shoot too many three-point shots. Back in my day, we never shot 30-foot shots.

That may be true enough, but the game has to evolve. It must evolve. It cannot stay stagnant. Now, did it have to evolve in the way it did? Maybe not. But it must evolve, or it dies. And I think it’s the same with therapy. So, to detraditionalize, it’s not that we can’t do it with intention, we can. But I think for an approach to therapy to remain viable over the years, it must change and evolve. A lot of psychoanalytic psychodynamic approaches are probably misunderstood in the modern world. But the best practitioners I know who appreciate and look through that lens, they’re not doing the same shit Freud was doing. They might have taken some of those ideas and some of those cues, but they’ve detraditionalized them. In a way, they’ve modernized them. So, that’s the first thing I want to say.

The second is, like in my work, I think traditionally there is a healer and a person to be healed. And then the person that’s the healer is somehow supposed to have the answers or write the prescription. And to me — I’ll take a line from my mentor friend and colleague David Epston — a lot of Narrative Therapy is about elevating the knowledge of the other. And so much of my practice, and a part of it that I think is maybe detraditionalized, is not to rely on psychological knowledges, or psychiatric knowledges or descriptions, but to try to elevate the knowledge of the other.

And the other doesn’t just include the person who’s in front of you. There’s a whole ancestral presence that often comes with that person who sits in front of you. Whether they realize it or not, it travels with them, it informs them with insider knowledge about how they may approach distress or problems that they’re up against in the world. And even so with therapists that would make the claim, “Well, I’m client-centered, I focus on the client.” Yes, but if you actually watch it unfold, it’s still based on a counseling prescription or a psychiatric or psychological prescription about how the session should go. It isn’t necessarily elevating the knowledge of the other.

LR: You said something earlier, and I don’t necessarily want to skip around too much, but it seems like we’re entering a cross-conversation about multiculturalism. When we talk about “elevating the other,”, are we getting at your ideas about working with “the other,” and what you have referred to as “decolonializing” psychotherapy?

TH: The phrase I’ve liked most recently is “anti-colonialize.” De-colonialize is fine, but I don’t like post-colonial, because post-colonial implies that somehow, we’ve moved past colonial logic, which we haven’t. Anti-colonial to me just seems like a little bit of a stricter stance against past, present, and future colonial logic and colonial attempts at living. So, I’ll start with that. But de-colonial is fine. I like that word, too.

You’ve heard me use the phrase “colonial logic,” but I’d like to weave in yet another term here: “multicultural.” If we look at the term “multicultural,” and a multicultural approach to therapy or counseling, often what that is saying is, “Hey, those of you from non-European descent, you can come, we welcome you. You can come and heal in these Eurocentric mediums of healing.” On the surface of it, that’s a nice offer. But it doesn’t make a ton of sense. And really what it’s doing is replicating colonial logic in that, “Hey, these European ways of being, behaving, and these European standards of living, these are the right standards. And we’re going to help you through therapy live up to these standards and these ways of being.”

To me, an anti-colonial approach would seek to first try to find the colonial logic that’s at play. And nobody bats a thousand at that, I would argue. But because it’s so embedded in the culture, we don’t think to critique it, although that has been happening more in the last couple of years. Anti-colonial, then, talks about culturally democratic approaches to therapy. A friend of mine, Makungu Akinyela in Georgia, has a type of therapy called “Testimony Therapy” which he equates to being next of kin to narrative therapy and African-centered therapy approaches. He says that a culturally democratic approach is to invite people to speak on behalf of their own healing.

And so, if we hope to practice an anti-colonial approach, which to me is like the big umbrella term, then a culturally democratic practice seems important because people are allowed to speak on behalf of their own healing. Speak in their mother tongues. Speak through the cultural knowledges that they have come up with.

One thing about psychiatry and psychology, if we’re not careful, is we can get a little too big for our britches. We can think that healing’s only taken place in the last century-and-a-half, or whatever it’s been. No, it’s like, hey, come on, you think just because we’ve now labeled these things as depression or anxiety or PTSD, people haven’t been up against these things throughout time?

LR: Like we invented these afflictions.

TH: Right. And did these people with depression and anxiety all just curl up in a ball and not live their lives? No, people have experience with healing. And they have knowledge about healing. It doesn’t have to exist in a Eurocentric way. And often what therapists are doing — almost always unwittingly — when they’re reproducing colonial logics in their practice is recolonizing people. And often the therapist doesn’t realize this is happening, nor does the client. And yet, this process is playing out. It’s assimilation. We talk about, should people assimilate when coming to a new country…Well, really that’s what therapy has often been doing, again unwittingly. I don’t think this has been done with malice.

LR: This is psychiatric assimilation.

TH: Right, exactly. And so traditional therapy reproduces this colonial logic, which then sometimes — again, completely unwittingly almost always — is reproducing internalized racism where people might already experience feelings of inferiority. It doesn’t always have to be around race, of course. It could be any number of other factors. So, I hope that there’s some justice to your question.

LR: So, traditional multicultural counseling, if I’m hearing you right, is, “Sure, come into my session, wear your native garb, let me learn a couple of buzzwords that are unique to your culture. And sure, tell me your story. But in the end, I’m going to lay some ACT on you.”

TH: Yeah. And again, almost never is this done with malice. But that’s some of the demanding work I think we have to do. And another thing is like, okay, I am of mixed racial background. I have the blood of the colonizer and the colonized that runs through me, which is a complicated place.

One of my colleagues out here in San Diego now, Vid Zamani, he was the first one I heard say that if we are reproducing traditional Eurocentric ways of doing therapy, then we are a de facto White. And I really appreciated that, because it was like, well, just because of my own background, that doesn’t make me immune from practicing colonial logic. And he said, of course, that makes total sense.

But if we’re not careful, then what happens is in the field’s attempt to diversify—sure, we might look diversified on the surface, but our practices aren’t that diversified—we’re still practicing the same colonial logics. The practice really isn’t changing, even if superficially the people doing the practice look different.

LR: So, until the psychotherapist recognizes that they are colonializing their clients, until the traditional colonializing psychotherapist rebels against their own inherited narratives of what psychotherapy is, they will continue to colonialize their clients. And colonialize the psyches of their clients.

TH: Yes. And this is, I’ve found, a largely unpopular idea. Especially among folks who have been doing this for a while. I’ll share this story that I think drives home your point. I was doing a job interview. Not for the institution I’m currently at, but for a past institution. I was doing a presentation that talked about some of this stuff that we’re talking about now. And when I got to the end of it, a dude says to me — an older white man in his 60s, “Hey, I’m going to throw you a softball question.” And right away I was like, okay, yeah, what’s this guy up to? And then he says, “Well, what am I supposed to do when you tell my students that I am practicing a therapy that’s colonizing folks?” And I thought about it for about five seconds, and then respectfully I said, “Well, if I can share something with you, I can guarantee you I’m practicing in colonizing ways. And in fact, I can guarantee you I’m doing it in ways I’m not yet aware of. So, in that sense, I wouldn’t be asking you to do anything that I am not practicing myself.” But I found that there are folks that are resistant to the fact that their work could be colonizing at all.

Communities of Care

LR: In the context of this thing called multicultural practice and colonization, what do you mean when you talk about the dignification of the client? I think that was your word.

TH: No, it’s David Epston’s word, although I might have used it. What’s interesting about that, Lawrence, is that I met David in 2015, so that’s seven or so years ago. I had been out of graduate school a good six, seven years at that point. I had been practicing in the community for the same amount of time. I had been a university professor for seven or eight years. I had been around this a minute, and I had never — and I mean literally never — heard a person use the word “dignity” regarding clients in therapy. I was taken aback by the word the first time I heard it in this context. Dignification is even a little better than dignity.

When someone’s up against something, some kind of distress — I’ve worked with a decent number of people in the criminal legal system — they are often stripped of their dignity. And so, dignification is really an effort to afford the person that dignity within the conversation. And when we engage in dignification and people can feel that they have dignity, that helps to open additional stories in their lives. And maybe those stories were already there, but if they don’t feel as though they have dignity, then those stories are inaccessible to us. Even if they’re there someplace.

I noticed this with people in the penal system—it doesn’t happen after one meeting and could actually take months — but when they really started to feel dignity, and that they were living a life with dignity, and respected as a person with dignity, we would start to see a turning point in what we were doing. Because there aren’t many systems that are practicing un-dignification more than the criminal legal system. And so, it was actually a great place for me to see that juxtaposition of when people are afforded dignity. And these probation officers would ask me, “Hey, how did you get this young man to take responsibility for his actions?” And I said, “Well, first by never mentioning the term ‘personal responsibility.’ That’s probably not a great way to go, even if that’s what you’re hoping for. And secondarily, by taking them seriously. Treating them with dignity. Listening to their ideas. Taking that insider knowledge they have and really using it as something that could move us forward in a way that would make sense in their lives.

LR: Your dislike of the notion of “personal responsibility” brings me to something you said about the difference between self-care and communities of care. What is that difference?

TH: Well, it depends. What’s the goal? If the goal is to make money and sell lots of products, then we’re not moving in the wrong direction at all. I think Ronald Purser is the dude’s name, he wrote the book “McMindfulness.” He articulates this as well as anybody I’ve heard. It’s worth the read.

Look, self-care is another one of those things I feel like came from a good place. And when I talk about my issues with self-care, I preface it by saying, if you want to take a bubble bath, that could be lovely. If you want to watch a movie or do whatever, great. I’m not against that. Where I find this to be problematic, and our field has done this as much as any that I’ve seen, is a student, for example, in a master’s or doctoral training program in our field starts struggling. And often the response by those in charge has been, “Well, are you doing your self-care? What are you doing to take care of yourself?” But then you look at a PhD student. They come here, work 18 hours a day, doing all their school stuff. We don’t pay them enough to survive, we give them a small stipend. Now they have to go work another job. But we remind them “please don’t forget to take care of yourself.”

Essentially and systemically, we outsource the responsibility for the oppressiveness of the system and then turn around and say, “It’s your responsibility.” As opposed to a community of care — and this is something I try to think about in my role as chair now of an academic department — which is, “Okay, if we have faculty that are drowning or students that are drowning, what are we doing to do to help, rather than lay the responsibility on the student to adapt to a system that is rather oppressive?” So, do we need to scale back some of what we’re requiring? Do we need to change the ways that the system operates? What can we be doing, other than once a school year bringing puppies in? “Hey, that’s lovely.” Or they’ll have a little massage chair set up. Fine.

I was talking to someone this morning, and the language that she used was so passive. We say, “I’m experiencing burnout.” And my thought about that is, no, you’re being burned out. That’s not the same thing. It’s about experiencing burnout versus being burned out. Our systems are burning us out. And so, if our systems are burning us out and we’re asking people to handle this individually while the system that’s doing this for its own gain takes no responsibility, well, then this is just going to keep repeating.

And I’ll come full circle to say that I think, not individual people, necessarily, but folks with something to sell don’t mind that. Because if the person is continually being burned out, guess what? They’re going to consume more of the product that we want. So, the system is actually set up beautifully for making money. I don’t necessarily think it’s set up good for quote-unquote “mental health.”

LR: So, in a sense, graduate trainees, like therapy clients, are typically colonized and oppressed by structures of authority. What do you mean when you say that therapy — and graduate education in the context of this conversation — should be an act of shared humanness?

TH: Yeah, I think again, the culture that we’re in is so ruggedly individualist, that often the human experience gets defined solely within the individual. And I worry about that. And to me, therapy at its best is shared humanness. I used to do this early on when I was a therapist. I came up for my first master’s class in 2002 with all these journals under my arm. I was going to save the world by going into these communities in South Los Angeles. And it didn’t take me long to figure out that shit wasn’t going to work, and I had to do something else. I learned that quickly.

The way I think about the shared humanness now is, we can’t be doing what we’re doing right now in this conversation without shared humanness. The same goes for a therapeutic conversation. When there is shared humanness and it comes together, something exponential is possible. But I would not be able to say everything I’m saying today during our time together without your questions. Your question takes me somewhere that I couldn’t have gone just by myself. Maybe I could have generally gone there, but something about your questions and the give–and-take transports us there. And the shared humanness in therapy is exactly the same. You bring these two people together. And what we could each accomplish on our own could be fine, or even good. But what we can accomplish in this shared human way is exponential.

Wholehearted Therapy

LR: Very similar to what Irvin Yalom refers to as the here–and–now—that the therapeutic relationship is lived in the moment — the fruits of psychotherapy grow from the back and forth. Is this related to what you describe as “wholehearted therapy practice?” And what does a therapist look like when they’re practicing halfhearted therapy?

TH: I think halfhearted therapy, or quarterhearted, or two-thirdshearted could happen for a lot of different reasons. But to me, wholehearted therapy is bringing all of yourself to the practice. One of our students asked a fair question just a couple of weeks ago; “How do I know how to be in therapy relative to how and who I am out in the world?” They asked it a little differently, but basically what they were asking was based on their feeling, “I don’t know how to not bring all of who I am into the room.”

And so, I think halfhearted therapy can happen when we think that there are parts of us that somehow can’t come into the room. Now, what I’m not saying is that there are certain topics we might not talk about in the room. Now, I would even question some of those and whether they are truly off limits, and I do frequently. But obviously there would be some topics that would be off-limits for us. Therapists could decide that. But I’m not so much talking about the topics of discussion. I’m talking about how much of themselves that they’re bringing. And I fear that therapists are often taught not to bring important parts of themselves.

With regard to halfhearted therapy, they could be doing therapy in a system in which they’re chronically underpaid and overworked, and their spirits are just really sucked dry. And then they just don’t have that spirit to bring. In no way would I blame the therapist for that. But if I think about the times when I’ve engaged in halfhearted or quarterhearted, or however much hearted therapy practice, it’s often been for those reasons. Now, earlier on in my career, it was because I was asking myself, well, can I be this in the room? And of course, that’s a ludicrous question, because I am this. So, one way or another, the person that I’m in conversation with starts to deduce that anyway.

LR: In the recently released “Reimagining Narrative Therapy Through Practice, Stories, and Autoethnography,” you wrote a chapter entitled, “Maybe We Are Okay: Contemporary Narrative Therapy in the Time of Trump,” in which you narrated the therapeutic interaction you had with a person whose political views, specifically, their Republican views, clashed very dramatically with your Democratic views. So much so that the conversations about who you voted for 2016 became part of the therapeutic relationship. And in that relationship, you nicely demonstrated how you can disagree with someone’s political views, but still respect them as a person. Was that an example of wholehearted practice?

TH: It was interesting how that chapter came about. You know how therapists can get together and start talking in between seeing clients. Well, I noticed a lot of my colleagues saying something like, “Well, if Trump came to therapy, would you work with him?” I didn’t say anything when my colleagues were saying, “NO, I would never do that! Who could do that?” But then, I thought about it, and I was like, yeah, I think I’d work with him. I don’t know if he’d want to work with me. Maybe he’d tell me to get lost, but I think I’d try.

I just remember how outraged they were. And when they asked the question of how I would do that, I would say, “Well, I haven’t worked with Trump, but I’ve worked with plenty of people who have views that are very different than mine.” So, that was the inspiration for this, to try to explain shit to myself. Even after writing the chapter, I’m not sure I understand how I always engage in this work. But, to go back to bringing one’s full self into the room, we didn’t get deeper into the party politics in that chapter. But if we happened to in our sessions, I wasn’t super-enthused about voting for Hillary. I felt like a lot of people — like I have to decide between two people that I’m not really enthused about. Okay, I’ll take the one that I’m a little more enthused about. I’ll engage in a minimization-of-harm vote, is kind of how I felt.

But clearly, in the chapter you’re describing, my client and I voted for different people. When that moment came up, the question was, “Do I talk about it or do I not?” And the thing about that is, okay, I could decide not to talk about it. I could decide to do the thing as, “Oh, that’s an interesting question. I wonder why you’re asking?” But she knew. She had a sense of this, of who I voted for. And I’ve heard people say this kind of thing who haven’t read the chapter, but have said, “Well, you know, you’ve got to be careful. You’re pressing your political views on them.” But I disagree. What I’m doing in therapy is I’m simply showing up as I am, and she can show up as she is. And then we have to figure out how that meshes, and how we do the work together that we’ve been charged with doing with one another.

And that doesn’t require me being neutral. And by the way, I’m not neutral. It’s just a matter of whether I admit I’m not. I’ve seen a lot of discourse around this lately about neutrality and people debating what it means and all this kind of stuff. But to me, it’s an impossibility. We are not neutral. And so rather than try and pretend as though I am — not unsolicited would I share such a thing, but when it works its way into the session — when she brings this up, it’s like okay, let’s talk about the shit that we’re not supposed to talk about. Let’s talk about religion. Let’s talk about politics. To me, therapy seems like a great place to do that. And not just in the sense of me just passively listening or looking for pathology in the patient and how they talk about this. But rather, let’s have an actual conversation with two wholehearted human beings about the thing that we’re not supposed to have a conversation.

LR: In a sense, you are co-rebelling against the mandates of traditional therapy with a client by self-disclosing and by being fully present.

TH: And neither of us has to change our political party. Although for me, I’m not that enamored with the Democratic Party, either. But I’m not sure I have a party that represents my interests, to be honest. I certainly wouldn’t say I’m an Independent. That has its own set of connotations. But I don’t feel like I have a party that represents my interests. And I didn’t say that explicitly. At least I don’t recall saying that in my work with her. But perhaps it came out. Perhaps this is more complicated than we give it credit for.

And to me, probably these last two or three years, I’ve constantly been on the lookout in my therapeutic work for people with binaries. Because our culture relies so heavily on them. And I often find that when people bring those up, that’s at the root of something that they’re really struggling with. And it’s built into our language, Lawrence. We say, “Well, I need to hear both sides of the story.” And to me I’m like, I’d like to hear all the sides of the story that I could hear. I’d like to hear many sides of the story. I found that often people are thrust into these binaries, and it almost feels like there’s not another option. So part of my job is to have these discussions and then look outside of those binaries for what could be there. And I don’t think therapists do this on purpose, or clients do it on purpose. It seems to be a real cultural thing.

LR: I used to joke with my classes — sorta — by saying, “There are two types of people in the world. Those who believe there are two types of people in the world, and those who don’t.” Does this wholeheartedness, the kind you described in your work with this particular client involve what you refer to as “radical respect?”

TH: I can tell you the story about where that term came from. I don’t know if we mentioned it in the book, but it came from Art Frank, a brilliant writer. He’s not a therapist but when he would read transcripts of sessions or watched sessions, he said, “When I see David [Epston] practicing, Tom [Stone Carlson] practicing, what I see is radical respect.” And so that term actually came from someone outside of the therapeutic community altogether, which I think is worth noting.

I think part of what he’s getting at is there is that no matter where the person moves, no matter where they might take the conversation, no matter what the stories are that they might wish to live through, or that are living through them, that narrative therapy endeavors — it isn’t always successful — but endeavors to hold this deep respect for people and why they are behaving the way they are. Why they’re living through the stories that they are. Why they’re feeling the way they are. And that radical respect then to me promotes curiosity.

So, in the chapter that you were referencing, the Trump chapter as it’s getting to be called, I hope there were some examples of radical respect in there. I’ll give you an example from the chapter of my attempt at it. When I came to realize that by completely dismissing her perspective — which I don’t think I did, but I could have because I found a lot of things Trump did objectionable — I might have been engaging in some sort of erasure of her family. And that would have been highly disrespectful. And so even when it was something that I fundamentally disagree with, there was still a way I could practice respect. This was opposed to going, “Well, but you’re on the wrong side of history.” I also think radical respect is a feeling that both the therapist and client experience, sometimes without words.

Art Bochner talks about “evocative autoethnography” which is not about the therapist simply being a fly on the wall, but instead being moved by the client’s story, their narrative. Let’s say you were reading that chapter about me and the woman, and you had never seen either of us before, and then you see us walk out of a room. You’d know it was us. But the point is, that’s what we’re endeavoring with autoethnography. We get out of the world of jargon so both partners in the therapeutic moment can feel and experience it.

LR: As we near the end of our time, Travis, I want you to know that I’ve had a lot of fun in this interview. Do you have any questions for me?

TH: No, but I will say one thing quickly, though. If therapy is really an act of rebellion, then there has to be something at stake, there has to be risk involved. It has to mean that you could be out of compliance in some way — with tradition, with certification standards, with accreditation expectations. And if we’re not doing anything, if what we’re doing is completely devoid of risk, or we’re afraid to take any of that, then we won’t move any of these things forward. And I know plenty of people who are, in their own ways, challenging these different systems. And this is not to knock the accrediting bodies. They have their role. But we have to take some of these risks. To detraditionalize, as we were talking about earlier. Risk is inevitable, right?

LR: On that note, I think I’m going to say goodbye. I thoroughly enjoyed this conversation, Travis. It reignites me.

TH: Stay in touch. Holler at me with whatever.

QUESTIONS FOR CLINICAL THOUGHT

How does Dr. Heath’s description of his work resonate with your own therapeutic approach?
Which of his concepts strikes a particular chord with you and why?
How might you have worked with the client who struggled with peanut butter consumption?
How do you engage in radical respect with your own clients? Do you have difficulty doing so with a particular type of client?
Can you think of a client with whom you have worked, or continue to work, wholeheartedly or halfheartedly?
What about Narrative Therapy interests you and challenges you to learn more about the model?

How to Successfully Navigate Cultural Challenges with Filipino Clients

Posted on October 19, 2022February 19, 2026 by Psychotherapy.net Team

Linda came into the office with an anguished look on her face, lamenting that her mother had given her the “cold shoulder.” The reason: Linda hadn’t taken her children to see their lola (grandmother in Filipino) for weeks. Through a wrinkled brow she continued, “my mom thinks I owe her a visit even though we’re trying not to catch COVID. I know she took care of the kids when they were younger, but she makes me feel like my obligation is a string that is never to be broken. I’m grateful to her, but…”

In Filipino culture, the sense that a past or recent good deed or favor must be remembered (and repaid) is called utang na loob. Utang is “debt” and loob is “inner self.” Filipinos are collectivistic in nature. The physical proximity that exists (the bubble) between two people is so much closer than is customary in American culture. The young American child is taught to articulate her needs and to orient herself within her own space. That child is taught to say, “Johnny, I got this toy first. Wait your turn.” On the other hand, the Filipinx child’s orientation is to empathize, which may or may not result in her sharing the toy with Johnny. But if sharing takes place (“Here’s the toy, Johnny”), positive reinforcement is given. The adult smiles approvingly at the behavior of the mabait na bata (kind kid). Often, the adult in Filipino culture also teaches the child empathy by narrating non-verbal cues and gestures: “Look at Johnny, he’s very sad. He wants to play with the toy too.”

The Filipino American in Session

One of the challenges to the Filipinx American is to reconcile cultural opposites. I remember when I first immigrated to America, I saw a popular Filipina student from my school soften her otherwise deep, bright, red lipstick in the school bus each time we were on our way home. I later realized that she was struggling to bridge the cultural divide, attempting to appear American to the outside world and Filipina inside her home—a daunting task, especially for a young adult who is trying to make her way in the social realm.

It might be easy to assume that a Filipino has assimilated into the American culture once they have learned the language—most are bilingual. However, this bilingualism also creates myriad possibilities for miscommunication, not just in the therapy room but in the Filipino home. While a born-and-raised Filipinx American client may be more comfortable with English, their older relatives may not. Such was the case with Linda’s mother, her grandmother and her uncle. To help Linda in her familial struggles around utang na loob in the therapy room, I had to make space for the conflicted familial energy that came with the linguistic and cultural divide separating the generations.

A Westen-trained therapist might immediately focus on supporting a client like Linda by assisting her in setting boundaries and helping her to assert herself in the face of what she regarded as her mother’s unrealistic demands. While doing so might be a reasonable route to take later in therapy with her, it could very well backfire while working within her collectivistic familial system. Borrowing from Emotional-Focused Therapy, discovering our loved ones’ emotional longing can transform how we respond to them. However, this can be tricky because it’s important not to put your clients in a position where they carry the burden of changing the familial system by accommodating and flexing their emotional muscle at the expense of their own psychological well-being. I didn’t want to do that with Linda and her family.

The Linearity of the English Language

To help Linda set boundaries with her mother and other family members, it was important for me to further explore the concept of utang na loob with her. As a debt, utang is typically a quantifiable exchange, such as a defined amount of money that both parties agree upon. In contrast, although it is inextricably linked to external exchange, or debt, loob describes the inner workings of the Filipinx psyche, an unquantifiable. The phrase lakas ng loob roughly translates as “persistence on the inside.” But the word “inside” gets lost in translation. Sensing (pakiramdam in Filipino) is a core value rarely explored in Filipino American psychology. Pakiramdam is to sense someone beyond their verbal assertion and articulation.

In Filipino culture child-rearing, there is rehearsing that occurs between caregiver and child, which teaches the child that communication relies not solely on explicit language, but also, and deeply, on bodily movements such as the motion of the eyebrows, the breathing pattern, and bodily posture. Trained in Western notions of communication, a therapist might initially be curious as to why their client can’t just speak directly to mitigate misunderstanding—in this case, Linda with her mother. The assumption that verbal assertion trumps all other types of communication is the equivalent of seeing the world from a particular cultural perspective that in this case does not represent the Filipinx worldview or practice.

The history of the Philippines is complex. It ancestral roots were embedded in the rites of animism prior to colonization by the Spaniards. I believe that a history of oppression teaches the colonized to communicate implicitly with each other to maintain freedom of expression and to avoid imprisonment, both literal and emotional. Jose Rizal, the national hero of the Philippines spoke in codes through his literary manuscripts because it was safer to do so during its colonialization by Spain. Executed at 35 by firing squad, his work is studied to date by students who learn to decode his writings for their true underlying meanings. Speaking in code was a functional way to adapt to psychological threats, real and perceived. But it’s also a way to speak when people are in closer proximity. Despite Filipinxs’ bilingualism, concepts that aim to be translatable into English—in this case, utang na loob—can, and very often do, lose their meaning.

Lost in Translation

A debt can be paid with a simple, explicit transaction, often, at least from a Western perspective, by a transfer of money. While utang literally translates to “debt” in Filipino, the word used in the native language rarely means “to pay” but to tanaw. Tanaw in Filipino means “to glimpse back on, to look back and not forget.” Regarding the immigrant who leaves the motherland in search of greener pastures, the young Filipinx American often carries a sense of obligation or burden to repay favors done for them by their elders. And because loob is the unquantifiable sense of the otherwise measurable utang, immigrants often bring with them and carry the unsettling feeling of not knowing the extent of the debt—how much and how long they need to pay for it, or what the repayment was—when they didn’t ask for or agree to the loan in the first place. They are simply expected to remember that they are in debt, and despite their gratitude and wish to honor their parents, struggle with the indeterminate nature of that debt.

It is as if upon leaving the motherland, the immigrant is given a rope with which they can metaphorically climb the steep mountain ahead of them. The rope is securely tied to the parent, who hopes their child will use it to the best of their abilities in the new land by striving for the highest goals, perhaps in the form of receiving straight A’s in their new schools. This rope is the bond between parent and child, and in essence ties the child to the parent in debt, utang na loob. This binding translates, so to speak, into an honoring through appreciation; a thank you and even a showcasing and sharing of one’s financial accomplishments.

This can be a deeply unsettling experience for the immigrant or Filipinx American who views this material—and sometimes immaterial and unmeasurable—tabulation as superficial. However, it’s important to remember what the material transaction represents. It allows the immigrant to satisfy their emotional needs (the sense of honoring the debt to the parent) and to feel like a hero in the parent’s eyes. When, on the other hand, the parent, who is still holding tightly to the rope feels forgotten or their generosity or sacrifice diminished, they often become sour, passively resentful, and pull out a lengthy list of all they’ve done for their child who is now successful in their new life and the new world because of what they provided. In turn, the now-grown child feels confused and attacked.

The Shadow Side of Utang Na Loob

I’ve found that there are many reasons for the giving of favors. While kagandahang-loob (a Filipino core value of inner goodness shared with others) stands out, it is not always the case that favors are altruistic. I have seen generosity through giving favors used as emotional and financial investment (“You owe me money or gratitude for what I have given you or sacrificed for you”), a means of controlling the recipient, and as an ensnaring that keeps someone close at all costs. When the recipient of a favor is perceived by the giver (usually a parent or other close relative) as being successful in navigating the American culture by virtue of a stable job or possessions, including home ownership, that “giver” may expect something in return, either materially/financially or emotionally, such as in dependence or a never-ending thanks and the return of favors or satisfaction of demands or expectations.

In general, Filipino immigrants learn to self-soothe through connection, as opposed to Americans, who seem to do so through independence and materiality. When an immigrant learns to navigate the American culture through self-care and self-soothing strategies, they can, in turn, better assist their own children in exploring their own worlds, rather than fostering in those children a sense of indebtedness or a thirsting for parental attention and affection. When, however, that parent begins to experience disconnection from their now independent-thinking child, they may invoke utang na loob to counter that sense of emotional distancing. They may, in turn, come to rely on their children to define their own happiness, in essence putting all their emotional eggs in one basket, and fear that the independence of their children may mean an empty emotional basket.

In Linda’s case, any “sensed” or “felt” lack of appreciation by her mother was experienced as resentment, typically passive in nature. In all likelihood, Linda’s mother felt forgotten when COVID separated her from her child and grandchildren. For the mother, Linda’s disconnection (actually because of COVID) was felt as a personal rejection, and she reacted with resentment toward her daughter for a lack of gratitude. Verbally appreciating her mother and telling her how much her help meant went a long way in bridging the gap that had developed between Linda and her mother. Repetition of and consistency in communicating her appreciation became that much more important in shoring the rift. In a culture where politeness and kindness towards the debt holder supersede directness and self-assertion, repetition is critical and interpreted as sincerity.

Because Linda hadn’t shown this “gratitude with sincerity” in a while, she decided to give it a shot, although she knew it was not likely that her mother would readily or eagerly accept it. She was more likely to give Linda a hard time following the first few attempts. It was also likely that when she called home, her mother would sound aloof and even sarcastic, so it was up to Linda to reach out with consistency to give her mother and the relationship the chance to pivot. Oftentimes, this is all that is necessary for Filipinx clients in a comparable situation.

It’s possible that despite her consistency and expression of affection, Linda and her mother had become trapped in a negative emotional cycle from which it became difficult to escape. At the point when Linda came to see me, I believed that it was important to give her a gentle nudge in the direction of exploring the setting of healthy boundaries while discussing utang na loob with her.

Final Thoughts

The concept and evocation of utang na loob has evolved over time; however, Filipinos may continue to use it in attempt to reel someone in or collect an explicit or implicit material or emotional debt in the name of a cultural or familial norm. However, from the depths of its ancestral roots and its connection to the culturally derived, deep unspoken sensing of “the other” (pakiramdam), it has also served the purpose of helping to maintain the integrity and survival of the Filipinx cultural ecosystem across the diaspora. In the process, this deeply-rooted belief and practice, despite the familial tension it can engender (as it did in Linda’s case), also encourages the child to give without concern about exchange or debt—with the faith that doing so will be remembered in one form or another today or into the future, keeping family members connected.

Author Note: Articulating the nuances of utang na loob for a clinical audience has been a feat. I tried to provide service to my fellow-practitioners/healers but am also mindful that my description of this dynamic concept continues to breathe and change with and for each Filipinx American client and their family.

Us Versus It: Racism, Family Treatment, and Eco-Systemic Considerations

Posted on September 23, 2020February 25, 2026 by Psychotherapy.net Team

As an Eco-Systemic Structural Family Therapist (ESFT), I help families establish and learn new patterns of interactions both within and outside of their homes by creating a contextual frame in the form of “Us versus It.” Using this frame, which refers to the family (Us) versus the impacts of racism (It), I attempt to help each member of the family to view their problems and possible solutions in the context of broader issues related to race and racism. Hence, here I will reflect on my work in the therapy room from the perspective of my child client, their caregivers, the therapists, and the ESFT model.

The Child

“It should not be like this; it should not be like, this Miss Paula.” I sat quietly as I listened to my 14-year-old Hispanic client Valentina express her agony over the recent killing of George Floyd, the racially charged incidents surrounding police brutality, and the global protests in support of the Black Lives Matter movement. As I sat quietly, listening to Valentina’s innocence being diminished at this sensitive stage of development where her sense of self, identity, and beliefs about herself and the world are being shaped by the horrific reality of what she described as “not normal,” I began reflecting on my role as a therapist of color. Identifying the truth of Valentina’s distress did not bring me comfort as I realized uncomfortable conversations about race and racism needed to be had.

Not knowing what response I was expecting from this 8th grader who wants to live in a world where she does not have to be “the adult” in her father’s household and where her mother does not have to devote all her time to working multiple jobs in order to take care of her and her younger brother, I asked Valentina, “What do you understand about what is going on in the world today?”

As we discussed the differential treatment of people of color, Valentina began to identify that she herself belongs to a marginalized group. Drawn to tears, I felt empathetic as I heard Valentina describe her hurt over possibly being racially profiled or being told to “go back to her country” because she speaks fluent Spanish. With the decades of individual and systemic racial injustice and inequality that people of color, specifically black people, have experienced in the United States, a significant negative impact on the mental health and wellbeing of the members of this racial outgroup has occurred as well.

From differences in socioeconomic status, to impoverished conditions of living, to discrimination within organizations where there are limited opportunities and resources for African Americans to grow professionally, racism is very much still prevalent today, as affected families are still disproportionately disadvantaged in their access to opportunities for wealth, education, employment, and housing.

As a black female myself, as I reflected on this not-so-surprising inequality and injustice black people are subjected to, I thought about the families who come each week to my therapy office looking to change systems and patterns within their family and establish better attachments with their children. A significant portion of these families are African American, and in one form or another are a representation of the experience of all black people in America. Early in his life, my 10-year-old African American male client learned social cues signaling to him that he was different from his classmates from other racial groups simply because he looked different from them. My 6-year-old female client refers to her mixed-raced skin color as “ugly” and her white mother’s skin and hair as “pretty.”

The Caregiver

The more I have felt challenged to create the space to conceptualize my clients from a broader sociocultural perspective, the more I have acknowledged the “hard truths” that my African American family clients bring into the therapy room every week. Some of these hard truths include my 12-year-old African American male client Andre’s grandmother/legal guardian, who has been raising him since he was a toddler, sharing her fears about raising two African American men from different decades. She experienced the same fears for Andre’s father when she was raising him that she now experiences while raising Andre.

I recall feeling cold as I listened to Andre’s grandmother narrate her feelings as she recalled watching and re-watching the video recording of the killing of George Floyd. I personally could not bring myself to watch the complete video, as I was overwhelmed with sadness and hurt from the injustice and perpetration of violence against black people—especially black men—by the police and criminal justice system. However, I sat in the session hearing my client as she narrated the events that occurred in this video as if it were Andre’s father or Andre. As I heard her, I saw her “hard truth” that she saw Andre’s father and Andre in George Floyd.

Discussing her feelings about raising a young African American male in a world where racism is not only prevalent but inescapable because it is being recorded, she expressed how much effort she has put into raising a “kind, caring, intelligent” young black boy, but also how that is not enough to guarantee his safety or access to the best opportunities. It appears that Andre’s grandmother may have some regret around how she raised Andre’s father, as she recalled “sheltering” him out of fear, which contributed to his not being responsible or self-sufficient.

To understand why Andre’s grandmother felt that it was safer to “shelter” his father when raising him helped me to better understand the connection between impoverishment and segregation, and the high levels of crime, substance abuse, mental illness, and violence that she had attempted to protect Andre’s father from and was now trying so desperately to protect Andre from.

When I think about impoverished neighborhoods, I also think about my 13-year-old African American female client Tracy’s biological mother, who lost her son in a “suspicious” car accident a few years back about which my client reports, “There is more to the story we will never know.” Tracy’s mother, who since losing her son became very active in seeking justice for him and other young black males like him, has also acknowledged that her son often got into trouble and that their “unsafe” neighborhood had a significant impact on how he lived his life.

Although well aware of the effect one’s environment and upbringing can have on them, I still found it difficult hearing Tracy’s mother express the disadvantaged conditions of living she and her family have experienced, and how they cost her the life of her son. Tracy’s mother’s grief sits with her every day, as this was not only her child, but a child whose life she continues to prove to anyone who will listen…mattered!

The Therapist

As the recent racially charged incidents in the country made me reflect, perhaps anew, on what role I am currently playing as a therapist of color in and outside of the therapy room, I went back to the ACA Ethics Code, which says, “The primary responsibility of counselors is to respect the dignity and promote the welfare of clients.” It also directs counselors to actively understand the diverse cultural backgrounds of the clients they serve, and to explore their own cultural identities and how these affect their values and beliefs about the counseling process. These words are the core of competent and compassionate multicultural practice.

In the context of these ethics, “it is even more important for me to see my clients not how I want to see them, but rather how they want to be seen”. If I have a African American single mother of two who is managing two jobs and unable to remember session times, my first conceptualization of that client should not be of her as “lazy” or “forgetful,” because it may just be she is a mother trying to provide for her family and may need a little extra support from me, such as a twice-weekly rather than weekly session reminder.

Former NFL player, motivational speaker, and pastor Miles McPherson believes that every consultation should be a race consultation. The problem comes when you have assumptions based on a social narrative stemming from your own beliefs and upbringing. Putting them aside and having a race consultation allows us to let our clients tell us who they are. I view McPherson’s ideology as a positive and useful one in that it allows me to enter the therapy room viewing it as a “race consultation” with the goal of setting aside my preconceived race-related notions about my clients. This orientation also frees me of the fear of acknowledging my “blind spots” because it gives me room to learn as well as see where I may be falling short. Not acknowledging the racial elephant in the room is like being comfortable doing the wrong thing.

I have come to realize the importance for therapists who belong to non-black racial groups, specifically white racial groups, to be more knowledgeable around the historic and systemic disadvantage African Americans have experienced for decades and how that plays a role on their mental and physical health. Culturally competent therapists who are knowledgeable around the impact of systemic and intergenerational racism may be in a better position to “buy-in” with their clients, that is, to recognize their own privilege and take the extra step, like making an extra phone call to a client when needed, advocating for a client who needs extra resources from the community, or exploring their own cultural identities beliefs as they help their client identify their own.

The Model

The Eco-Systemic Structural Family Therapy (ESFT) framework identifies certain overlapping and interacting individual, systemic, and societal patterns that contribute to the interactions, hardships, and coping strategies of the African American families with whom I frequently work. This framework posits that the symptomatic child is reflective of the breakdown of family life as an adaptive response to hardship. Using this collaborative, strength-based, and trauma-informed model, my work with families applies the four pillars of ESFT—attachment, co-caregiver alliance, executive functioning, and self -regulation—to help develop caregiver-to-child attachment, strengthen the level of functioning and skills caregivers have in order to perform day-to-day tasks for managing their lives and the lives of their child, identify social support systems that help the family build caring and stable environments, and observe how the family makes meaning of and copes with emotional and affective experiences.

Take, for example, my 9-year-old African American male client Tyree, whose “Core Negative Interactional Pattern” (CNIP) includes Tyree’s getting “easily frustrated” and instigating fights with his sister, which leads to Mom yelling, Tyree being punished, and then Tyree’s “shutting down” or engaging in emotional outbursts such as yelling, crying, or screaming.

When I think about what hardship, tragedy, and trauma that may contribute to these presenting problems Tyree exhibits, I think about his witnessing domestic violence between his father and mother on several occasions. Additionally, his father is currently incarcerated, and his mother now occupies the single-parent role and is busy ensuring that she is able to financially provide for Tyree and his siblings. Given these changes in Tyree’s family system, it is useful for me to recognize his interactional pattern within the family as a reaction to the loss of having his father in the home and the burdens on the entire family unit against the racial/cultural backdrop of their lives.

In such cases where caregivers may suddenly take up the role of single parent or have been upholding the role for a very long time, ESFT promotes executive functioning and caregiver-to-child attachment with concepts like “Ennoblement,” where caregivers are able to view themselves as competent, caring, and able to keep their child safe. For instance, my work with my 11-year-old African American male client George’s mother included a consistent level of “Ennoblement,” as she needed a reminder and affirmation that she was competent, caring and able to keep George safe even though she did not currently have the support from his father. Because of the hardships experienced by George and his mother, many sessions with this family included George’s mother expressing the difficulties of being a single mother and lacking a support system.

I have learned that it is essential for African American mothers and their families in particular to be empowered, as research indicates that most African American homes are female-headed homes helmed by mothers, grandmothers, and aunts. According to the United States Census Bureau, the percentage of White children under 18 who live with both parents almost doubles that of Black children. This data is very reflective in my therapy room, as a large proportion of the African American families I see are single-parent families which are female-headed.

***

In thinking about the various children and family members with whom I have and will work and reflecting on my role as a therapist of color using the ESFT model, I aspire to bring deeper and more meaningful racially-informed conversations into the therapy room. I hope to do so by creating a safe space for more racially-sensitive and race-oriented conversations between caregivers and their children. In doing so, I also hope to join more authentically and empathetically with African American families while together we construct more adaptive narratives.

Barriers and the Black Experience in Mental Health Care

Posted on August 5, 2020February 11, 2026 by Psychotherapy.net Team

Initially, I struggled with writing this piece. After a couple of weeks of writing, rewriting and tossing, I finally locked in on my block. The issue is this: it is nearly impossible to write a short blog piece about the black experience in mental health. This goes for both my perspective as a black physician and the perspective of the black patient. I worried about being reductionistic with an incredibly important and deeply layered topic.

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There is no simple way to condense the experience of being black in any context. As I considered the different factors that influence the black experience in mental health care, I realized that the histories of discriminatory practices, unethical research, denial of care, racially biased diagnosis and treatment, and poor representation among mental health care providers each deserve volumes of exploration.

That being said, I know that discussing the foundation of racism and discrimination in mental health care is a start. This is the legacy upon which many black patients sit when they come to our offices each day. Three issues in particular have been substantial barriers to my own patients’ seeking care: lack of resources, distrust, and mental illness stigma.

Lack of resources

Jared, a 20-year-old black male, arrived at my office with his mom. Jared, who was living with his mom and younger sister, was unemployed and spent most of his time in his room. They had traveled nearly an hour to see me, as there were limited mental health resources in their community. Jared wanted to see a black psychiatrist but struggled to find any in his city.

Low-income communities and communities of color typically have the fewest mental health resources. To find care, residents often travel far outside of their communities, creating an unnecessary burden. For those with limited finances, arranging transportation, time off from work, and childcare can make access difficult.

When resources aren’t available, information and education aren’t brought into these communities. Mental health practices and clinics not only provide clinical services, but often are the center of knowledge about mental illness and support for those dealing with these conditions. When those resources are absent, members of a local community may not understand their conditions or their options for care and support.

Also absent from the black community are black mental health professionals with a similar lived experience and background. Many black individuals are interested in working with a black therapist or psychiatrist. However, only 4% of psychologists and less than 4% of psychiatrists are black. Non-black mental healthcare providers are less likely to provide racially sensitive and culturally competent care. Black providers are more likely to understand how blackness has impacted the black mental healthcare experience. There’s no need to explore the racial differences between the provider and patient. The focus can be on the reason the individual is seeking care. More importantly, black providers are more likely to understand and be sensitive to the problems black clients experience accessing mental health services.

For some patients and clients, there is a sense of pride in seeing one’s own people successfully navigate the training and career pathway involved in becoming a therapist or psychiatrist. Many black patients feel strongly connected to the success and accomplishments of other members of the black community.

Distrust

Dustin, a 24-year-old black male, had recently moved to Austin. He had dealt with anxiety since childhood. Now living with his aunt, he struggled to go to work each day and rarely socialized. After a long discussion, we agreed to start a low dose SSRI. He missed his first follow-up appointment. He came to his next appointment only to disclose that he had not started his medication and didn’t believe that it would help.

The history of medicine in the United States is fraught with racially discriminatory practices against black people. From non-consensual sterilization to the syphilis experiments, black people have been dehumanized and harmed by unethical medical practices. On the flipside, more recent medical research often fails to include representative black populations and often underrepresents the impact of disease and treatment in the black community.

In mental health, studies have consistently shown bias in diagnosis in black patients. Black patients are more frequently diagnosed with schizophrenia rather than mood disorders when compared with white patients presenting with the same symptoms. Even when a correct diagnosis is made, black patients are less likely to receive evidence-based care than their white counterparts.

These deeply embedded practices and history have cultivated a mistrust, and at times a fear of health care and mental health care institutions in the black community. There is legitimacy in the black community’s concern about misdiagnosis and inappropriate care. Unfortunately, some have chosen not to seek care when needed.

Mental Health Stigma

Erica, a mid-30’s black woman, presented with depression for most of the past year. Raised by two loving parents, she had attended graduate school after college and now worked as an assistant professor at a local university. She had never sought professional help for her mood symptoms, but worried that they were interfering with her work and home life.

Stigma surrounding mental illness is pervasive in the black community. When Erica opened up to her mother about her mood concerns, her mother advised her to talk to her pastor. She discouraged her from seeking professional help worried that people might think she was “crazy.”

Mental health stigma and misinformation has created a reluctance for many in the black community. Holding shame around mental illness means that individuals are less likely to seek appropriate care. When they do look for help, black individuals are more likely to seek counsel from places of worship or family and friends. Unfortunately, their help-seeking often stops there.

Culturally sensitive care recognizes these issues and makes space within the therapeutic relationship for these issues to be acknowledged honestly to the degree that each individual needs.

***

Consider all the spoken and unspoken concerns that accompany your clients or patients into your office. The basics of accessing care, trusting the intentions and guidance of care providers, and trusting the legitimacy of their own health concerns complicate the black experience in mental health care. Psychiatrists and therapists should examine their own beliefs about and around issues of race. Understand what influences your practice and informs how you bring cultural sensitivity into your patient or client interactions.

Usha Tummala-Narra on Living Multicultural Competence

Posted on February 21, 2020February 24, 2026 by Psychotherapy.net Team

Lawrence Rubin: I want to thank you very much, Usha, for being with us today and sharing your time and expertise with our audience of psychotherapists.

Usha Tummala-Narra: Thank you for inviting me.

Towards a Definition

LR: Multicultural competence seems to have become somewhat of a buzzword in the field of counseling and psychotherapy, defined differently by different clinicians; but since it’s the nexus of your own clinical and research work, can you tell our readers what you think it is and what you think it isn’t?

UT: Indeed, there’ve been many different definitions. I arrived at cultural competence from a psychoanalytic perspective. Given that, I think of multicultural competence as a way of understanding, a way of engaging with sociocultural context and how it shapes interpersonal processes as well as intrapsychic life and extending into the therapeutic relationship. How do the sociocultural context and dynamics that are evident in broader society get mirrored in the relationship between the therapist and the client? So, cultural competence to me looks at the various layers of an individual’s life, both intrapsychically and interpersonally.

LR: Irvin Yalom talks about the therapeutic relationship as a microcosm for the client’s interpersonal world, so I’m wondering if what you’re saying is that a multiculturally competent clinician strives to build a connection with the client’s broader contextualized experience.

UT: That’s certainly a part of it. I think the other piece is the person of the therapist in terms of their own socio-cultural history. This includes their own history of social oppression – what they find as positive and identify positively with in terms of their cultural background, their religious background or linguistic background. It’s about how all those sets of cultural and socio-cultural experiences shape the therapist and their subjectivity and how that in turn interacts with the subjectivity of the client. There’s this kind of interaction between multiple cultural worlds happening regardless of who we’re working with therapeutically. And this is not specific to working with clients from a particular socio-cultural background, but rather I see it as broader than that. It’s about engaging our broader context within the therapeutic relationship.

And so for me, cultural competence isn’t a specialty, it’s just part of professional competence. I just really see it as a regular part of psychotherapy.

LR: So, it’s more than just two people coming together, but it’s almost like two worlds coming together in the therapeutic encounter.

UT: Yes, that’s right.

Revealing Full Personhood

LR: Traditional therapeutic practice, particularly dynamically-informed practice, is built upon the premise of therapeutic neutrality; so how can a clinician bring their full contextual personhood into the relationship with a client and still be faithful to the ethics and the tenets of psychotherapy?

UT: That’s a great question. We should consider what neutrality actually looks like and feels like for the client. We’ve been socialized as therapists to put everything about ourselves to the side so that we’re not imposing our agenda onto the client. And so, therapists have this idea that “if I was to initiate a discussion about race or culture or gender, that it’s really my personal wish that’s being filled in some way, or my personal longing to engage in those discussions rather than the client’s needs and what might be actually helpful to the client.” But in fact, what I have found is that so many clients in fact need to talk about issues of race and culture and religion but have been told all their lives in one way or another that they shouldn’t. As a result, people’s experiences of racism are often kept hidden, are kept silent, and are more often spoken about within somebody’s home or with a circle of friends.

But, we should consider that psychotherapy is actually a place where we can talk about things that we have been told not to because therapy is not an ordinary conversation, as Freud himself pointed out. For me, then, we must think about what’s not being spoken about when we neglect to address issues of sociocultural context and background. If we’re not talking about something like social class and how it impacts our clients, then perhaps neither will our clients. I don’t see those particular issues as being separate from what may be going on internally for a person – what they might be struggling with. I just see the two as quite intertwined in terms of a person’s suffering and conflicts and relational issues. They’re very intertwined for me.

LR: It’s interesting how you’re saying that people who differ from the so-called mainstream are taught to be invisible, to homogenize themselves and hide the rich context of their life. And the same seems to go for therapists who are taught to blend into the background, to neutralize the rich cultural, racial, gendered, religious aspects of themselves so they may be fully available. But you’re also saying that both client and therapist need to step out of that invisibility and reveal themselves to each other.

UT: Yes. If we’re interested in exploring a full range of experience within our client’s lives, then we must actually explore all of those different aspects of our own life. And I don’t see how we can separate the individual from their context. One other thing that comes to my mind is how we might even from the very start think about developmental history. When we do an intake assessment and ask questions about a person’s development, we typically ask questions about their family, school experiences, work and health history – things of the like. But we tend not to ask more specific cultural, racial and contextual questions like, was the family struggling financially, did they have resources in the community, what was it like growing up in this particular family?

It can be so important to ask about the immigration history not only of the client and their immediate family, but of the extended family. Deep and culturally-informed questions can be so valuable like, was there any bullying related to racism or to sexism or homophobia? These are the kinds of questions I think that could extend what we already do, but into a realm that considers the fact that development is occurring in multiple contexts and that we ought to know and learn about what’s happening in those contexts, especially for kids. But also for adult patients, who have been internalizing all sorts of things as a function of being in and living through those contexts.

Becoming Culturally Competent

LR: It goes back to what we talked about before—the need to de-neutralize the relational encounter with our clients. What are some of the challenges that you’ve seen clinicians deal with, or that you want to caution clinicians to be careful of?

UT: Actually, something you said pointed to part of my response to this in that I don’t see cultural competence as necessarily an outcome, but as a process. It’s a journey, as you say. And I think one of the things that clinicians are challenged with is this idea that somehow cultural competence only relates to certain outcomes related to people of color, or people holding some kind of minority status, rather than this being relevant to all people of all backgrounds. And so, I think that an important challenge to overcome is the assumptions we make about what is cultural competence and who it is relevant for. If we don’t see it as relevant to all of us, then it becomes a situation for certain people at certain times rather than thinking more broadly. I also don’t see it as only a professional endeavor, but a personal endeavor as well, because if we are not learning to listen to issues of context and culture in our everyday lives, then it’s very difficult to know how to listen for that in our professional work. So, to think that we just need a set of competencies to apply in a technical way in the therapeutic relationship, that’s really not what I think of as cultural competence. To me that’s a mechanical way of being rather than investing the self into the work.

LR: A more fluid way of living multiculturally rather than simply turning on the multicultural switch when in therapy! What do you see as some of the blind spots clinicians may have in working with the “other,” basically someone who’s different from yourself in any regard?

UT: I think that’s a great way to phrase it because so much of the time, the assumption or presumption in our literature is that the clinician is white, and the client is the racial minority person or something like that. Whereas certainly in my case, it might be reversed or there are two racial minority people in the room. So, you can have any combination. I think one blind spot may have to do with our human tendency to overgeneralize about groups or our conceptions about certain, if not all, socio-cultural groups. It is the notion that if someone is affiliated with or identified with a particular group, then they carry certain characteristics or that they have this or that particular set of values. I do think it’s important to have some working knowledge about the history of different cultural groups and a good working sense of that. To me, those form just a beginning framework, a beginning sense, rather than a story or rather than really understanding what belonging to that particular cultural group means for and feels like to the person.

Everybody has a unique experience of their own culture or their own religion or belonging to a particular racial group or being multiracial. I think this is why for me, a psychoanalytic perspective is particularly well-suited to this line of inquiry, because it does allow us to think about experiences that are deeply embedded in relationships, within early life relationships, but also throughout one’s lifespan and one’s evolving relationship with the broader context as well.

Another blind spot that comes to mind has to do with working with somebody who is, in some way, of similar background and making an assumption of sameness, which can get in the way of differentiating ourselves from the other. This is the flip side of overgeneralizing about the other, sort of more about merging – two people whom you think might be similar in some dimension which may not necessarily be true.

LR: Overgeneralizing about the other and undergeneralizing about someone we perceive to be like ourselves or with whom we share certain demographics. Like me working with a white Jewish male and not inquiring into their whiteness, Judaism or their maleness and as a result, missing out on a lot of potentially good information about what it is like for them.

UT: And sometimes the clients are making assumptions about the therapist, too. So, you might hear a client say, “Oh, you know what it’s like to be Christian,” or biracial, or gay? And I could say, “Well, I know what it’s like for me, but I’m still learning about what it might be like for you and trying to understand that more.” And certainly, with some of my white clients, I routinely ask about their ethnic background. I will ask them to describe it. Some of these clients will say, “Well, I’m just white you know; that’s just who I am.” And to me it always reflects how we’re socialized around race, particularly in this country, to believe that some people don’t have a history beyond just being white. So any previous family history is really kind of disavowed, which people may actually have a lot of complicated feelings about.

LR: And if we don’t allow that into the conversation, then it just continues to be a force of oppression. Just out of…

UT: Disavowal of some kind.

Bearing Witness

LR: Along these lines, what have you learned about social oppression, racism and trauma in working with immigrants and refugees that could help our audience of therapists along their own journeys towards multicultural awareness and competence?

UT: The journey I’ve had has been an incredible one. I feel very grateful for the opportunity to have learned from the people I’ve worked with in therapy. They have been an incredible resource in transforming my understanding of immigration and trauma. One of the things that I have learned along the way is how incredibly complicated the process of immigration is psychologically.

Immigration is rife with hope and optimism and resilience, but also with deep separation and loss. And the ways that people reconcile this are unique to that individual and depend on so many different factors. It depends on their families, the quality of their relational life, their own personalities and what they bring to those relationships. It also very much depends on the traumatic experiences, the support they’ve received and the willingness of people to listen to them and to hear their perspectives. So much of what’s happened in more recent years, certainly since Trump’s election, is we have enormous anxiety among immigrants and refugees.

This anxiety is not only about status, the fear of deportation and separation from loved ones, but also related to the underlying anxiety that immigrants have always felt around not belonging and not being wanted. You know, feeling as though one must find other ways to sustain the self. And that’s been important for me to understand and bear witness to. So, listening to the stories of immigrants and refugees is not just about hearing what happened, but about witnessing and bearing what is happening now and what has happened in the past. There’s tremendous transformation that occurs across the lifespan for immigrants and refugees, as well as developmental points and junctures where their kids and their grandkids are also challenged. And that itself transforms one’s own experience of what it means to be an immigrant or refugee. So, there’s a lot that we still have to understand and learn and research. Actually, I think about these changes that occur as a function of time and cultural shifts and political context and social oppression – all those things.

LR: On a more personal level, if I may, how has or is being an Indian, Hindu female, informed your own multicultural journey as a clinician and a researcher?

UT: Well, certainly it informs a great deal of my whole self, which you know, I bring to my work as well. I immigrated to the United States when I was seven years old from India and grew up first in New York City and then in New Jersey and then moved to Michigan. And we traveled around quite a lot while growing up in the US as well. So, I think that one of the things that stood out to me in that process of adjusting to being in America was how incredibly resourceful my family as well as people in my community — my Indian community, the Hindu temple — were. We really found ways to take care of each other and be very present with each other in one sense. And yet in another way, people also have difficulty talking about painful losses and traumas, so there was this really interesting paradox within the community where I grew up.

I think it’s true for many communities that there’s this sense of cohesion and an incredible connection that feels positive that brings a great deal of strength for people. And yet at the same time, when there are issues of trauma such as violence in the home, racism, sexual abuse, or political oppression that people might have faced prior to immigrating, these things become much more complicated to talk about openly and become stigmatized. So, I became increasingly interested in figuring out what can we do about that and why is that the case? A lot of what I do in my research and in my practice has to do with trying to figure out those gaps and try to make mental health care more accessible to people who typically wouldn’t seek it out or who may not trust the typical mental health professional to understand their context, their values and their families.

I think anything that’s not considered mainstream American is not necessarily considered positive or normal in some cases or normative. People within immigrant communities have a lot of concerns. Racial minority communities as well.

I have concerns that if an immigrant sees a therapist, are they going to be seen as abnormal, or are their families going to be devalued? Is their culture going to be devalued in some way because of the very theories that we use to conduct psychotherapy? And so, there’s a lot of concern around that for people in addition to around providers’ not having awareness of the impact of trauma or the impact of emotional suffering on individuals and families. This is one way I think about my own journey interfacing with and guiding my professional life and is clearly very important to me.

A Different Worldview

LR: What are the elements of the Indian and Indian American worldview that psychotherapists need to understand?

UT: I think there are some common shared elements. But I think that it’s also important to point out that, as you say, there isn’t one worldview. Somebody may say something like, “what’s it like to be an Indian person?” Well, you can ask a million Indian people and you’ll hear different things about what that means. So, I would say that there’s no one thing that’s definitive. There are many things, but I will try to narrow it down to a Hindu Indian perspective — but again, it depends on how much a person identifies with a particular religion or a particular ethnicity, and even a region within India and language, all those things.

One of the things that comes to mind as a common or a shared element of Indian culture is the ways in which families interact with each other. There is traditionally a respect for older members of a family, in a way — a deference.

And this leads us to think about conflict within families. While there is the tradition of deference to older members of the family, younger members may want to do something that’s not approved of by the older members, but they may then go ahead and do it. But in this instance, they tend to avoid speaking about the conflict. So, there are ways of communicating that are more culturally accepted or valued.

From a Hindu perspective, there’s also a belief in Karma, or a belief in the inevitability of suffering in human life. This is very interesting to me because it parallels psychoanalysis in a particular kind of way in that there is an acceptance of the fact that suffering happens and that there’s value in bearing suffering, at least to a certain extent in service of others, in service of a greater good. So, this feeling of being a part of something greater than yourself or bigger than yourself is something that I think a lot of Indians more broadly, but certainly Hindus, tend to value as well.

These are a couple of more common types of shared elements. There’s also a third thing I could highlight, which is a different sense of ideology around parenting. Parents are typically pretty involved in their children’s lives throughout their lifespan. The Hindu Indian notions of parenting don’t necessarily follow the same developmental lines of being 18 and going to college or being 21 and experiencing a definitive separation from the family. And so, in a lot of Indian families the separation may happen later, or it may take a different form in some other way later in life. So, that can look a little bit different from Western notions of parent involvement. And sometimes it’s extended family too, like aunts and uncles who play a significant role in the attachment and separation experiences within families.

Sitting with Suffering

LR: Along these lines of differences in worldview, I understand that in Hinduism, as in some other religions, suffering for the greater good is seen as a virtue, as aspirational. Western psychotherapy, in contrast, seems bent on eliminating suffering, resolving irrational thoughts, helping the person to regulate themselves, helping the person to change their behaviors so they don’t suffer. And even though the third wave of cognitive behavior therapy incorporates mindfulness and acceptance, do you still see a tension between traditional Western psychotherapies that are designed to eliminate suffering and therapeutic orientations that embrace suffering for growth?

UT: To see some type of suffering as a normative part of life feels very aligned to me with the reality of what I see every day. But the idea that somehow to live a happy, fulfilled life you must eliminate all suffering, just doesn’t add up. I think it’s sort of a setup for people to actually feel even worse, and it creates more suffering because there’s a way in which this expectation creates the unrealistic expectation that one should never feel bad or one should never have negative experiences. And in fact, we all do and we all will and that’s sort of a foundational idea. So, I do see it as a problem of trying to eliminate the suffering as quickly as possible rather than trying to understand what’s happening. I do see that as a big tension.

LR: I wonder then if Western psychotherapists need to be aware of the intrinsic pressure of our models to sanitize living. An example, perhaps, is our seemingly uncomfortable relationship with death, dying and grieving. We remove people to facilities. We don’t talk about death. We have special grief counselors, which is okay, but what about conversations in families around loss and death? I worry that many therapists in our audience may be too caught up in that need to sanitize and cleanse the person of suffering.

UT: I think we probably feel some pressure to have to relieve people of how bad it feels. And I understand that. And of course, there are certain situations where that suffering is so overwhelming that we do need to help and relieve people. But if it’s something that is a natural part of a loss or separation that happens, we can help people to bear those and know that they will come through it. And so, you’re certainly instilling hope. But you’re not also giving this false hope that somehow everything will be fine after this. Because in fact, it often isn’t, you know?

LR: I wonder if therapists working with refugees and immigrants who have been trafficked, tormented or brutalized simply find it so hard to be in the presence of someone who’s suffered that they try purge them (and themselves by association) of their suffering? Or might some therapists simply not be cut out to work with these clients for reasons related to countertransference?

UT: I do think there are certainly some types of suffering that feel too much to bear for therapists, but that varies for each of us. Some things are going to just feel harder. And perhaps it’s because we’ve been through something similar or that we just don’t want to imagine, you know, and bear witness to that. And certainly, that happens. I’m thinking also of situations where a therapist may not know what to do with that suffering, so they minimize it or push it aside.

LR: Ignore it.

UT: Ignore it. I’m thinking of a situation where clients will talk about experiences of racism at the workplace or at school and wonder within themselves, was that racism? Was that why I feel so badly?

LR: It goes back to something we were talking about earlier in the conversation — core competencies of a clinician who is aspiring to cultural competence. So maybe we should add to this conversation the willingness and ability to sit in the presence of pain, someone else’s pain, our own pain, and bear witness to it — to embrace it, to allow it into the conversation. And in doing so, honor the client who has been oppressed, who’s been trafficked, who’s been marginalized, who’s been hunted.

UT: You’re right. You’re mentioning situations of extreme trauma like trafficking that feel, in some way, so foreign to so many people, as though it’s happening out there somewhere. And in fact, it’s happening in our own neighborhoods and in our own microcosms. I think that it speaks back to that earlier point we touched on which has to do with our own personal investment in these issues. If we don’t take the time to learn about what’s happening to people within our broader society, then it’s going to be very hard to listen for these experiences.

LR: You speak about our broader society. I worry that some psychotherapists consider our broader society maybe a few states away, or “all the way” out to the Coast. But when you expand the definition of “our broader society” to humanity beyond borders, then it’s really a commitment to considering that there but for the grace of Allah or Brahma or Yahweh, go I — that we are all potential sufferers.

UT: Yes.

LR: I wonder if certain therapists would actually benefit from working with such clients and to consider doing so to be a gift of enlightenment for them. A potential gift of the opportunity for awareness and growth.

UT: I think it’s so pivotal to growth as a human being and as a therapist. It’s transformative when you listen to people’s stories from various places and contexts; it is unbelievably transformative.

Final Thoughts

LR: Given that patriarchy and the masculine worldview have historically infused psychotherapy and religion, how does male privilege impact the practice of psychotherapy for you? What are some of the learning lessons we need to learn?

UT: It’s a big framework kind of question. When I think about male privilege more broadly, I see it in the context of our traditional theories that I think hold so much weight over how we think today. I don’t think, oh, well these were some of the older theories or theorists and that was a long time ago. But in fact, I think about how we’ve all been and continue to be socialized under certain models of thinking. In the research world, for example, there is still a valuing of a certain type of research which is quantitative and includes randomized clinical trials as the gold standard. Only certain types of methodologies fall under that umbrella, whereas qualitative research such as case studies are actually more feminized and seen as less valuable. Storytelling and listening and witnessing and participatory action research, which is not valued as highly as quantitative research, is really rooted in community psychology and feminist psychology.

So, I’ve been really interested in using the feminized methodologies and rethinking the issue of being privileged, how it applies to our research paradigms and ultimately to our clinical practices. You know, what narratives and whose narratives are being privileged, and why? Not to say that there isn’t value in all these different paradigms. I see great value and I learn a great deal from each of them, but I do think that the issue of male privilege brings up a broader question about privilege in terms of what therapies are available to different communities. I think about what research is considered to be gold standard and acceptable, and how that all translates to public welfare and people’s wellbeing. I think there are many ways to challenge the status quo in terms of that.

LR: A dichotomy between quantitative and qualitative as masculine and feminine. It seems that the newer therapies are much more relational, inter-psychic, narrative and contextual than the traditional therapies. This makes me wonder about you as a psychotherapist. When a client walks into a room with you, a Hindu, Indian female, what can they expect from you based on the intersectionality of you, of your Usha-hood?

UT: When someone comes to me for psychotherapy, I think they can expect someone who is really interested, curious about their life, about their perspective, how they make meaning of things in their life, and what’s important to them. And I want to hear their story. I want to know who they are as fully as I can know them and as they will let me know them. I want them to understand that we’re all vulnerable in some way or another, but also that being in psychotherapy itself can feel really precarious and that I understand that. I hope to make it a space where they can connect with as much of themselves as they can and make decisions that feel more fulfilling.

LR: So, you are curious, and you are caring, and you are contextual, and you are collaborative.

UT: I would say so, yeah. That’s what I try to be.

LR: Well, it’s about the journey, not about the destination. Right?

UT: True. Very true.

LR: Do you have any questions of me before we stop, Usha?

UT: I have one question. I am curious about how you’re finding this mode of interacting with your audience and what you’ve been learning from that.

LR: This mode of communication, the interviews I conduct, is the pinnacle of the work I do for Psychotherapy.net, because each interaction expands me as a teacher, clinician and as a person. Learning from some of the experts in the field, those who are passionate and committed has ignited my own passion and commitment to learn and grow. It has also made me painfully aware of my biases and limitations, but also of my gifts and strengths. It has made me all the more sensitive to stories, to context, and to the importance of deeply felt personal experiences. I hope that answered the question.

UT: It does and very much aligns with how I’m experiencing you. So, I just want to say that. It’s really been lovely to talk to you.

LR: Same here, Usha. I hope we can speak again.

UT: Me too.

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An Unexpected Beginning (1)

Postscript

Notes

Pakikiramdam (Shared Inner Perception)

Self-Soothing Versus Collective Coregulation

Shared Inner Perception in Parenting

Shared Inner Perception in the Therapy Room

Final Thoughts

Testifying and Testimony Therapy

Oral Culture: A Different Kind of Listening

Double Consciousness

Therapy Embraces Culture

Recapitulation

An Antidote to Anger

Turn Up the Sound

Two Different Stories

A Celebration of Hope

The Rap That Binds

A Voice to the Voiceless

Of Protest and Freedom

Removing the Shackles

Spitting From My Soul

An Act of Rebellion

Confessions of an Anti-Manualist

De-Colonializing Therapy

Communities of Care

Wholehearted Therapy

The Filipino American in Session

The Linearity of the English Language

Lost in Translation

The Shadow Side of Utang Na Loob

Final Thoughts

The Child

The Caregiver

The Therapist

The Model

Towards a Definition

Revealing Full Personhood

Becoming Culturally Competent

Bearing Witness

A Different Worldview

Sitting with Suffering

Final Thoughts