After considerable reflection, it seems salient to bring awareness to the ways my perspective on therapy, training, and being a member of society has shifted over the past several months. I have been forced to confront my own privilege in ways I never have, needing to reflect on my own passivity and silence in the face of racism and injustice. These recent events have illuminated a heightened sense of inequality that runs deep through our culture, including access to care and adequate Internet connection. On the surface, it may seem that one’s ability to find meaning would be significantly obstructed during times of intense affect and dissociation; however, I have witnessed extraordinary resilience in this period of great uncertainty. Meaning has been unveiled with great intensity, and it has been a catalyst for creativity and interpersonal connection. I have yet to make sense out of these observations and insights, but I look forward to the continued search for meaning in the face of our current realities of unavoidable change.
The majority of my training experiences in Wisconsin have been serving African American and other non-white (e.g., Latinx and Asian American) populations within a lower socioeconomic class. This is not because that is what I "chose," but because those were the opportunities that were provided to me. I did, however, "choose" to continue working at these sites. Being given opportunities and choosing are two drastically different things. As I write my internship essays, why should I have to share my patients' demographic information (specifically, the number of African Americans, Hispanics/Latinos, etc.)? Why should I "use" my experiences with underrepresented populations to INCREASE my chances of getting an internship placement? It feels very wrong and unethical to do that. What seems more reasonable to me is to share THEIR stories, not my own. Why should it matter what experiences I have been given when the people with whom I work have not been given many, if any?
Let me share an example. I have been given the opportunity to work with recently-immigrated, non-English speaking refugees, primarily Rohingya Muslims from Myanmar and Southeast Asia. Never have I been confronted with more difference, both religiously and culturally, but despite those differences, the intensity of connection with these individuals has been life-altering. As a trainee, I initially felt the need to be the one containing the knowledge, the one who is capable of helping, the one possessing the resources. It took only a few sessions to realize that what I was experiencing was my own anxiety and inability to tolerate, internally, another’s experience and story; what these individuals and families needed was someone who can listen deeply, holding them (the Other) in mind.
Historically, psychoanalysis has had an underlying assumption that lower income, culturally diverse patients lack insight; thus, insight-, or depth-oriented interventions need to be avoided. I painfully fell into this reductionist, restrictive mindset. Much of my discomfort stemmed from not only my inability to truly see the Other, but also being the one with the “power” as an unlicensed, white, female clinician. As Carlos Padrón suggested, “When we invisibilize the Other, we make part of our own soul inaccessible […] creating a fantasy of self-privacy and of being unknowable to the Other.” I have been reflecting significantly on ways to change the frame of therapy to celebrate otherness and the subjective experience, rather than revert to the narrow foundational principles of Ego Psychology. I think that training programs need to start doing the same.
As trainees, we need to think about how we talk about our experiences. Even more importantly, I think that training programs need to rethink what they are looking for. My diversity statement for internship was very bold (perhaps too bold and in-your-face) but I don't really see any other option. Though I have to share the demographics of my patients on the application, I certainly discuss why this should not be the case and what they are asking from us is to minimize other's experiences to maximize our appeal and sense of "cultural competency."
- cg
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