Mental Health, Uncategorized

Pride Month (Pride Week in Kitchener-Waterloo just wrapped) often gets me thinking about intersectionality:

Intersectionality is a concept often used in critical theories to describe the ways in which oppressive institutions (racism, sexism, homophobia, transphobia, ableism, xenophobia, classism, etc.) are interconnected and cannot be examined separately from one another.

Intersectionality is a concept that has developed from feminist theory (specifically exploring the lived experiences of women of colour), but now provides a lens through which to look at the power dynamics inherent to, but often invisible within, ANY kind of relational system. “The personal becomes the political” when we amalgamate those individual lived experiences into a narrative that can then influence–hopefully for the better, though the road is long–both cultural thought on the broad spectrum, and political agendas that often interfere with movement towards balance and equality.

Intersectionality also gives us a framework for exploring all of the many factors exerting influence on our day-to-day relationships with ourselves, partners, family, coworkers. It’s the language of systems theory, shifted a little to consider the oppressive nature of some, often many, of these factors. Family Systems looks at the function of the family actors and values on the individual; intersectionality gives us a broader perspective in which to observe and change the oppressive impacts of racism, ableism, patriarchy, classism, etc. on the individual within those relationships. In short, the personal became the political… became the personal again, providing us with better tools to re-examine the relational from clearer perspectives.

Many psychotherapists, and certainly anyone operating from a feminist-informed perspective, has likely already been working from some degree of intersectional understanding. This is a perspective that goes beyond the therapist speak of having “an eclectic practice”, which usually means we draw from any number of intervention strategies or therapeutic modalities to help alleviate client issues. This gets into the heart of truly seeing the vast array of impacting factors on any one individual trying to function in a relationship… and doubling or trebling that with every other relational partner we add in the room.

Depending on the kind of practice we work in, we’re somewhat hampered by a variety of cultural blindspots:

  • Access to psychotherapy is often a privilege tied to income, making it a very classist resource; agencies that can offer sliding-scale fees are often hamstrung by funding to limited, severely-short-termed services. Private practitioners who can offer scaled fees, especially geared to those on low- or welfare-based income levels, are few and far between.
  • The overwhelming majority of our clients are white, even in a plausibly-multicultural urban environment, introducing a (sometimes only subtle) degree of implicit racial bias, whether we are aware of, or admit to it, or not.
  • “Middle-class black women and men were about 30% and 60% less likely, respectively, than their white middle-class counterparts to hear back from a therapist agreeing to see them. Working-class individuals fared even worse: Women and men, regardless of race, were about 70% and 80% less likely, respectively, to get an appointment, compared with white middle-class individuals.
    “Psychotherapists are not immune to the same stereotypes that we all have, and I think they could become even more relevant for psychotherapists than for other professions [both medical and nonmedical], because they are embarking on this intimate, potentially long-term relationship with these [clients],” said Heather Kugelmass, a doctoral student in sociology at Princeton University. Kugelmass is the author of the study (PDF), which was published Wednesday in the Journal of Health and Social Behavior.” — “Therapists often discriminate against black and poor patients, study finds”, Carina Storr for CNN

  • Not every office space is handicap accessible for a variety of reasons–creating a very ableist environment even when we don’t mean to. (Point of disclosure: both my home office space and the Bliss office space uptown can only be accessed by means of stairs, and for a variety of reasons, not all of us can/will offer video sessions as a means of alternate access.)

Part of the ethical training to become a therapist deals with uncovering what we can about our own internal biases, but often we can only see where those biases reside by looking at what we’re NOT doing, those areas of the population we can see we’re NOT adequately addressing. Gender bias and transphobia, xenophobia and racism–some aspects of a therapist’s personal aversion may become clear during their training. It becomes the work of the training institute and supervisors to ensure that potential therapists explore those aversions and biases, pushing comfort boundaries where they can, but at the very least working to assure the therapist will Do No Harm to clientele out in the field.

The dark side of working to identify our own blind spots is the unfortunate side effect of being equally blind to how these factors potentially impact our clients, not just in terms of the therapeutic relationship (though this can become a strong tool in session; more on this in a minute) but in the broader systemic perspective. Becoming aware of therapeutic blind spot can then lead to some interesting conversations with the client about their experience of these biases on the micro and the macro levels; if the therapeutic relationship is deemed “safe enough” by the client for the conversation to happen, it opens up a level of insight to the therapist and client alike about how classism, racism, ableism, etc., impacts their ability to function in their relational contexts, their narratives about themselves, their values, their perception of their roles, their expectations for themselves and others.

Most white therapists I’ve known over the past decade don’t willingly bring these questions into the therapeutic conversation unless the client introduces the topics first. I don’t know how often I’ve heard a white therapist trot out the phrase, “I don’t see colour,” when speaking with or about clients of colour, but if racism is a system factor impacting the clients in question, then the therapist may be at fault for not being open to that discussion as it potentially affects the client. I still encounter therapists who refuse to work with queer or trans clients, or the well-meaning ones who claim that orientation or gender are no issue for THEM, and don’t know what to do with clients for whom orientation or gender identity clearly *IS* an issue.

Trans clients are often my best example of complex intersectionality; it’s never going to be “just a simple case” of depression or anxiety. The endemic issues of workplace or school bullying transfolk experience, for example, speaks to the trans/xenophobic and sexist issues that have enormous impact on self-esteem and self-image; they may not feel they can safely access support networks and services, even when those service are financially accessible to them. The entire transitional experience can be hugely impactful on a client’s social, familial, relational structures; it can threaten their employability, introducing the classism issues:

“The 2011 National Transgender Discrimination Survey found that trans people are four times more likely than the general population to have an annual income of less than $10,000.” — Lara Rutherford-Morrison, “8 Statistics That Prove Why Transgender Day Of Visibility Is So Crucial”, citing National Transgender Discrimination Survey: Full Report, SEPTEMBER 11, 2012

Women, especially women of colour, experience many similar intersectional issues; many struggle against gender roles projected by a male-dominated cultural narrative. They battle in the workplace against glass ceilings imposed by traditional male-biased evaluation systems (up to and including being outright penalized for things like mat leaves), limiting their upward mobility and earning potential. Working in the bromance-laden High Tech industry, for example, introduces some significant challenges for women. Single women, and single mothers in particular, face strongly-biased class/financial and racial stigmas, even in the 21st century.

These are NOT ISOLATED FACTORS that bear zero impact on the clients and the issues they bring into therapy. It’s therefore a huge disservice for therapists to be blind, however inadvertently, to the unknown impact of these systemic influences. Practicing intersectionality doesn’t mean we turn therapy into discussions ABOUT those issues, but it does mean we really need to learn to be fearless in asking about the client’s own experiences in these areas as potentially affecting the challenges they ARE bringing into the counselling room. Our job as therapists is to check our own biases, including our own well-intended willful attempts at non-bias, at the door.

Relationships

In the world of Contextual Therapy, the core principle of relationships is that we develop or dismiss/destroy relationships on the basis of merited trust, that being trust earned from having more positive transactions than negative ones on the relational ledger. Try though some might to deny it, all relationships have ledgers, because all individuals keep tallies, whether we do it consciously or not. If we don’t keep those tallies, how do we know who to trust and who not to trust? When someone says, “I trust a person on the basis of a gut instinct”, what they are responding to is often the prompting from a subconscious consultation with their internalized ledger of transactions. The decision may be based on minimal or comparative information only (this new person behaves or otherwise reminds me of some other person to whom I already assign a high degree of merited trust) and especially in early relational transactions, may be based predominantly on unconscious or non-verbal communications that we record, analyze, and respond to equally unconsciously.

The relational ledger is a huge component of relationships. People seek professional intervention (reparative counseling, personal development, legal proceedings) generally when the balance of the ledger has tipped to, and remains consistently tipped to, the negative side of that ledger. Merited trust is dented, eroded, or absent. The damage may be on both sides of the relationship, or it may be one party’s perception that the other party is just “bad”. frequently, both in and out of therapy, one or more participants in the relationship may become focused or fixated on the other party’s negative aspects – their contributions to the negative aspect of the relational ledger.

The fixation happens because, at our core, we are cellular organisms. as such, cellular organism learn faster and more strongly from negative stimuli than from positive stimuli. Self-protective aversion is a non-conscious reaction: even single-cell protozoa will unthinkingly flinch away from a negative stimulation; there is no analysis of the dangers or possible responses required. Movement towards positive stimulation is not, however, as fast, and learning to move into positive stimulation is something that higher life forms sometimes need to be trained to do. We all seek food when hungry and warmth when cold, but in both cases, there are scientific and psychological schools of thought that label those instinctive behaviours as reactions away from the negative stimulus of “cold”, or “hunger”. We instinctively move away from pain or discomfort; moving towards something is an entirely separate set of analytical functions.

In relationships, we often witness people responding to a relational stimulus in a largely unthinking fashion. We move away from pain. Sometimes we do this by relabeling the pain as anger and changing the direction to focus it on someone or something external to ourselves. Sometimes we seek to remove the thing we identify as the source of pain from our relational radius (up to and including removing people we perceive as causing us pain). Sometimes we look inwards to find what that pain is attached to, what other times in our lives we’ve felt pain, and how we have developed the response in which we’re currently engaged as a result of repeating patterns. the latter approach is common to several therapeutic models.

Where relational ledgers come in, is the fact that because we learn fastest and most efficiently from those protozoan aversion-responses, at an almost cellular level we are programmed to retain the negative far more strongly and for far longer than we do the positive transactions. This isn’t a justification to allow people to wallow in the pain, but it’s an explanation of why it’s such a common thing for people to fixate on the negative to the detriment of any focus on the positive, and why the experience of “depression” isn’t limited to the human species. So we store far more data on the negative ledger (or at least we tend to focus on it more) than we do on the positive ledger. when a relationship comes into trouble, often it’s because the negative focus has superseded any sense of accumulated merit, and that shift in focus is what erodes the trust; it’s not that the relational transactions themselves have changed, but rather that something in the participants themselves has (for whatever reasons) caused a shift in the focus.

Frequently, young relationships hit this point after the “honeymoon phase” ends, and the participants start looking past their own romantic projections to the other party with whom they interact. That’s a difficult transition in any relationship, and one that can often lead right into what Wong & McKeen refer to in The Relationship Garden as the cycle of power struggles, in which the participants try and change each other back into those early romantic projections, or fight internally to adjust themselves to the new perceptions. Change, particularly opaque internalized changes, often leads to external behavioural changes, which are a big factor in the tipping of the relational ledger. Our protozoan selves don’t like change, change means “Unknowns” and “Differences”, and on some level, change is generalized as a negative stimulus, so we try to avoid it. Aversion may take the form of ignoring the signals and actions of change and remaining rutted in our comfort zones; it may take the form of trying to force the source of those changes to stop whatever s/he is doing to upset the status quo; it may take the form of engaging change but only on our own terms as a means of micro-managing our own fears in and of the process. It may also take the form of embracing change for change’s sake, without having a goal for change to help inform the decisions we make as part of the change process (which leads in turn to all kinds of other tensions and issues within the relationship, and is equally culpable in the disruption of balance within the relational ledger).

In times of relational tension and crisis, many of us (me included) find ourselves tallying the internally-maintained “list of grievances”, or clinging to the hurts to justify retaliatory behaviours. This is how people most commonly respond to the balance tipping towards the negative side of the relational ledger. It’s a kind of psychological narcissism (making the hurt and pain all about ourselves as a means of justifying further responses to and on the negative ledger), and leads to something called “destructive entitlement”, in which we inefficiently attempt to rebalance the ledger by forcing another party to “pay for our hurts”. (The principle of “destructive entitlement” is, by the way, a whole other post or series of posts; it sometimes ties in with legacy values we inherit from others, particularly previous generations in our family of origin, or legacy values that we inherit from chosen family or social spheres, any or all of which we respond to in ways that come only at cost to someone else.) Equally often, by the time a relationship reaches the point of drastic rebalancing on account of pervasive negative focus, one or more participants are past the point of being willing or capable of considering, or even viewing, the positive aspects of the relational ledger.

At this point in time, the first step in diffusing the tensions is giving the emotional content (the personal grievances) safe space to be expressed and acknowledged, without judgment, but more importantly, without expectation of a reactive response. a grievance is not necessarily best interpreted as a signal requiring change. Sometimes a grievance just needs to be aired and heard in order to reduce the tensions associated with the grievance. At some point thereafter, a subsequent step (not necessarily the next step, but an important one to include somewhere in the investigative process) is to force a review of the positive ledger. It may something as simple as asking, “what is it that initially attracted me to this other person? What positive factors does s/he bring to the relationship, then and now? what do I like about him/her?” the positives may not be immediately accessible in a tense or conflicted relational period, but making any entry onto the positive ledger is crucial at this juncture, creating a foothold from which balance, or at least a less-critical angle of tippage, may be more easily restored. It also forces the perceived-aggrieved party to step outside the entrenched Self and consider, even if only briefly, the merits of Other. This is a huge step not only in relationship counseling, but in any kind of mediation scenario; “consider the other person’s perspective” is a hugely important tool for breaking tension, and increasing the potential for establishing a different kind of relational modality than the one which brought the parties to their current emotionally-laden impasse in the first place.

Working one’s way out of the aggrieved entrenchment is difficult; the fact that a lot of people can’t do that on their own can’t unhook from their own emotional aversion-responses, is part of why the field of family & relationship therapy is flourishing. Part of our job as therapists is to supply the multi-directional partiality that creates safe space for each party to explore the relational ledger, assisting them to collaboratively determine what they want to do about any perceived imbalance. it occurs to me that relationship therapy is best described as “psychological archeology”, because by the time people make it into counseling, the root issues are often lost. Individuals hit a negative stimulus, and react. People around them, perceiving the reaction as some kind of change in behaviour, will react themselves. Often this reaction/response is confrontational in nature. As soon as the original responsive party perceives confrontation, the response is often defensive, without necessarily explaining at all the original stimulus/reaction sequence (at least not in any rational way). The continuing opacity of behaviour may lead to further perceived challenges, which then cause the originator to justify the defensiveness – this is the stage at which the relational transactions are most likely to become externalized as anger and blame projected onto the other participant(s). so by the time the relationship arrives in the counsellor’s office, the participants are several stages away from the core issues, and the presenting problem – the only aspect of which many people coming into therapy are immediately conscious of – is at the tertiary level of justified anger, firmly entrenched on the negative side of the relational ledger. The archeology comes in by way of digging past the immediate hostilities or tensions, back past the defensive responses, and looking for the root sources of the current imbalances. Treating only the tertiary stage, and trying to reset the balance of the ledger or restore the merited trust on the basis of that level of transaction, is leaving the relationship participants wide open to ongoing problems as a result of not examining the foundations of those interactions for weakness, and bringing the unconscious protozoa reactions to the light of conscious evaluation within the ledger. We respond unthinkingly to the negative; we consciously condition ourselves to consider the positive.

Copyright 2008, 2011 KGrierson