Feature – Embracing difference

The Nafsiyat Intercultural Therapy Centre provides support to clients from black, asian and minority ethnic communities. Baffour Ababio explains the concepts behind the centre.

Located in a quiet mews not far from Archway Station, North London, the Nafsiyat Intercultural Therapy

Centre feels bright and welcoming and the spectrum of diversity visually represented through clothes and ethnicities is striking.

The quiet hum of conversation in the work and reception areas reflects an array of languages including Tigrinya, Arabic, Turkish, Spanish, Swahili, Kurmanji, Somali, Farsi and English. The centre lists 20 available languages on its website. Individuals coming for their appointments mirror that richness of ethnic depth: Middle Eastern, East African, black British, Mediterranean, European and white English coalescing in the rainbow that is the Nafsiyat Intercultural Therapy Centre.

Adults living in the North London boroughs of Camden, Islington, Enfield and Haringey can access free short-term therapy with a GP or self referral. Demand often outstrips delivery, though.

The introduction of Nafsiyat’s Choice service fractionally mitigates this, making long-term intercultural therapy available to people living in all London boroughs, for a fee. Open-ended therapy is delivered to clients who pay £60 for the first 50-minute session, then between £40 and £60 per session, depending on individual financial situations.

Securing grants from trusts and mainstream healthcare sources is crucial for the centre’s work and, as a charity, it relies on the generosity of its supporters. Therapists – both volunteer and paid – are qualified or in the final stages of post-graduate training and come from different ethnic and cultural backgrounds.

Beginnings

Nafsiyat was set up in the early 1980s by psychotherapist Jafar Kareem and colleagues. Before the centre’s inception, people from black, Asian and minority ethnic (BAME) communities tended to have limited access to counselling and psychotherapy.

Back then, BAME individuals were, as they are now, overrepresented in psychiatric hospitals (particularly locked wards), probation services and prisons, in proportion to their numbers within the general population. Compared with the white British population, these communities had high rates of diagnosis of psychotic illness, prescriptions for pharmaceuticals and other physical treatments such as electro-convulsive therapy. There was also a sense that the psychotherapy offered to individuals with cultural heritages from all over the world was laden with Western cultural values and inherent biases. Intercultural therapy provided – then and now – a way to probe the universal application of Western psychotherapy and include non-Western concepts of mental illness and healing into the practice of psychotherapy.

A ‘decolonisation of psychotherapy’

Kareem’s theory of intercultural therapy draws on psychoanalysis, sociology and medical anthropology, and prioritises the recognition of the consulting room’s dynamics. Conscious and unconscious assumptions made when client and therapist are from different cultures are particularly important, and the therapy is more likely to be successful when they are understood and explored from the outset (Kareem and Littlewood, 2006).

Discomfort often emerges in the spaces between different cultures, and working through – rather than avoiding – any variance is integral. Differences are embraced in Kareem’s theory: the matching ethnicity of client and therapist is not considered necessary unless warranted by language differences. The belief is that the commonality of humanity will emerge alongside or after naming these differences.

Intercultural therapy also shines a light on the external political and socio-economic realities for clients – their inner worlds and practical needs.

This doesn’t just happen inside the consulting room: Nafsiyat employs community link workers (CLWs) who provide practical support for clients with issues such as housing, immigration and employment, arrange referrals and help signpost clients to access further support from different services during and after therapy. CLWs provide a link between the therapy and practical requirements.

‘Discomfort often emerges in the spaces between cultures… working through any variance is integral’

Addressing power inequity

Marginalisation in the external world can also lead to client distress. Therapists must name, explore and work through any power inequity between themselves and clients at the outset to avoid re-enacting marginalisation in the consulting room.

For example, several of Nafsiyat’s BAME clients describe previous treatment sessions with other therapists ‘steeped in Eurocentric theoretical models’ as ‘useful’ but with a caveat: the therapists missed issues arising from the clients’ experience as members of a BAME population. This wasn’t because the therapist was white, or even BAME (BAME therapists can also avoid tackling discrimination), but because they had avoided examining what impact oppression and difference in the consulting room had on the client. In other words, the clients’ external world experience of feeling diminished or of being dominant (in the case of a white client and a BAME therapist) was reinforced during therapy which then had an impact on their inner experience of oppression or domination.

External issues

Events outside the consulting room can have an impact on clients’ inner worlds, too. Therapists at Nafsiyat pay attention to local and global current affairs, to keep in mind during therapy.

For example, could an earthquake in Iran stir up something for the Iranian client currently in treatment in London? What bearing might the Grenfell Tower tragedy have on a client (not from Grenfell) who appears unusually depressed following the disaster? Intercultural therapists must entertain the possibility of old wounds being reopened (re-traumatisation) by shifting external events.

New identities

Globalisation has resulted in traditional notions of identity making way for fluid identities; intercultural therapists cannot surmise a client’s identity based on their name, appearance, dress, language, ethnicity or gender. The multiplicity of human interaction across and within borders has also changed expressions of self, reconfigured identities and cultures.

Religion, class, ethnicity, sexuality, language, dialect and accent, gender, disability, sexual orientation, race, age, education and ability form the constituent and cultural parts of these identities.

The founder of Nafsiyat, Jafar Kareem, chose the name Nafsiyat based on three different syllables from different ancient languages, which stand for mind, soul and body (Kareem and Littlewood, 2006). Clients from certain regions are also drawn to the centre because of the name – in Arabic, Urdu and Somali – Nafsiyat means ‘soul’.

Intercultural therapy takes a holistic approach – no matter the cultural make-up of the therapeutic relationship, the therapist must examine inter- and intra-relational discomfort, keep an eye on the impact of the external realities on the client and react to their needs.

This feature of the Nafsiyat Intercultural Therapy Centre was originally published in The New Psychotherapist, Issue 71, Summer 2019. To receive a free subscription to our flagship magazine, join UKCP today.