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AEDP West Sunday Seminar
with AEDP Faculty Member ANNE COOPER, Psy.D.
MAY 23, 2010 | San Anselmo, CA
AEDP and the Culturally Diverse: Working with Cultural Diversity In an Attachment-Driven Experiential Psychotherapy

This event was co-sponsored by R. Cassidy Seminars

REVIEW - Excepts taken from a review written by Steve Kanofsky, Ph.D. & Lynnette Bealle, Ph.D.

One of the central challenges we all struggle with as therapists and teachers facing the shifting multicultural landscape we live in is how to effectively integrate a broader perspective that acknowledges the reality of culturally specific factors along with the more universal issues of attachment and emotion so central to AEDP. What a rare and welcome opportunity it was for about 75 of us at AEDP West, including a number of our Wright Institute faculty and graduates, to hear Anne Cooper, present her integration of these perspectives and help us delve deeply into the experience of emotion and attachment while making room for the cultural variants that have a huge impact on how we see the world.

To help us become centered she took us through a meditation focused on our own internal experience.  She then gave a brief summary of ‘AEDP in a Nutshell’ and the ‘Many Facets of Culture” as preparation for showing the first Video Vignette of her work with a Chinese man. Since you already know about AEDP, we focus more on her overview of culture.

THE ‘MANY FACES OF CULTURE’:
Anne reminded us that culture is much more than ethnicity and race. She offered a more comprehensive view of culture as “The unique behavior patterns and lifestyle that encompass a set of views, beliefs, values, and attitudes shared by a group of people that distinguish it from other groups.” Among other factors, cultures may vary in migration/acculturation, geography, religion and spirituality, occupational emphases, gender norms, sexual orientation differences, and differences in social class. Within this broader systemic view of culture, culture and individuals influence each other reciprocally on conscious and unconscious levels so culture is always “dynamic and changing.”

Anne talked about how each and every one of our clients has a culture, that each and every therapist has a culture and that these two cultures mutually interact. For example, white middle class therapists are inevitably influenced by a broader cultural emphasis upon individualism and educational and financial aspirations that are often very different from the values of more collectivist cultures where family and group well-being take precedence over individual preferences. In order to provide the most culturally sensitive treatment we must start with an experiential appreciation of our own cultural influences and our “cultural selves.” As we fully appreciate our own cultured selves we can more effectively attune to and be curious about the nuances of our clients’ cultural selves without pathologizing or invalidating their experiences.

To ground this integration of AEDP and culture, Anne showed some of her profoundly moving work with a client whose movement within a difficult therapy was truly amazing. She had seen him for only 19 sessions: 4 months every other week, then after a year and a half break he returned for a second period of sessions once a month.

Anne alerted us to cultural themes that helped account for his feeling so pressured and emotionally constrained: the high expectations to fulfill his parents’ dreams so important in his Chinese culture of origin, the responsibilities of the eldest son to carry on the family name, and the cultural and gender pressures to avoid emotion at all cost, especially emotional pain and anger at parents.

‘MOVING TOWARD A CULTURALLY RESPONSIVE PARADIGM’
Anne emphasized that cultural responsiveness is more about process (how do I enter into a relationship and take into consideration the multifaceted identities the person is bringing) than content (specific skills or techniques for particular cultural groups). Prior models of cultural responsiveness have emphasized between group differences while ignoring within group differences (e.g., “here’s what Asian clients are like.”) In more contemporary culturally sensitive models, we are each seen as having unique, culturally specific, and shared universal qualities and therapists can respond most effectively based on the client’s individual needs for emphasis upon one or more of these factors. In this process oriented model, the therapist’s cultural responsiveness is life-long and ever evolving, and our cultural openness and curiosity (versus cultural neutrality and “expert cultural knowledge”) leads the way. Anne then shared research about “what heals across cultures.”

“COMMON FACTORS”
Research reminds us that the therapeutic relationship serves as a base for therapeutic interventions across cultures;  that relatedness is the most effective way to promote well-being; that successful therapy includes a shared view (between client and therapist) for explaining symptoms; that clients’ expectation in the form of faith or hope in the process of healing are crucial; and that culturally diverse clients consider the therapist’s cultural responsiveness and understanding of their worldview more important than cultural matching.

“ATTACHMENT AND CULTURAL VALIDITY”
Anne then reviewed further research on attachment and emotions. 1) Cross cultural studies support the idea that Attachment is a universal phenomenon. (The presence of multiple caretakers doesn’t interfere with a unique attachment relationship between parent and child.)  2) Cross cultural research on Emotions reveals certain universal themes: that Emotions are universal (we all seem to feel the same emotions underneath); that Culture shapes what emotions we display when (display rules); and that facial expression of emotion (the particular configuration of muscle movements) appear to be fixed.

Anne described her integration of AEDP and the above research on cultural factors as “A Beautiful Blend: AEDP, Universal Healing, and Cultural Responsiveness.” In this blend culturally sensitive AEDP therapists emphasize 1) Connectedness and forming secure attachments 2) The healing power of emotions; and 3) Creating a new and different healing experience from the beginning to establish hope in the healing process.

AEDP as a process model overlaps with the process model of Cultural Responsiveness. It is self-correcting through tracking red signal and green signal affects (where red signals may indicate a need to reassess our cultural approach). It honors silence and non-verbal communication as important cultural tools. Eye contact can be considered inappropriate or disrespectful in some cultures; non verbal-expressions (gestures, body posture, personal space) are often culturally based; somatic complaints may be important ways to communicate emotion, especially in more collective and less verbal cultures.

With her client in mind, Anne summarized some of the Chinese Cultural themes most relevant to her work: The influence of Confucianism, the crucial importance of filial piety (respect for parents and elders), the importance of education in social status, the crucial role of sons in a patriarchal culture where the oldest son has great power and responsibility to the family. Given the emphasis upon emotional restraint within Chinese (and other) cultures, she suggests the following: 1) Meet the patient where they are and get curious (“What is the worst thing that could happen if we explore your feelings?”); 2) Use gentle but persistent redirection back to emotion; 3) Use abundant affirmation; 4) Provide psycho-education about emotions and the importance of emotional experiencing; 5) If the patient wants advice or concrete information offer this while also exploring feelings that get triggered; 6) Recognize that emotional display may be more subtle or subdued; 7) Use delight, laughter and play to further attachment and emotion.

She described further useful guidelines for building relationships with clients culturally different from ourselves, referring to some of Pam Hays work (2001): 1) Developing trust by placing   more time and focus on relationship building; 2) Finding areas of cultural intersections and capitalize on them; 3) Using self-disclosure to join and create safety; and 4) Being humble in the face of what we don’t know.

Anne mentioned still other ways for therapists to be culturally connected: 1) Create an environment that is non-judging and accepting (where spiritual beliefs, practices, cultural idiosyncrasies are given plenty of room); 2) Understand the client’s cultural strengths and resources (as well as the constraints); 3) Become aware of the history of the client and his/her culture; 4) Remember that the client’s self-report supersedes any learned knowledge about the culture.

In terms of particular challenges this culturally informed AEDP model may invite, Anne emphasized how some of us may have difficulty moving into a more active and directive stance that may be useful for members of some cultures, that we may need to tolerate less eye contact, that our own vulnerability in working with culturally different clients may be more pronounced, and that self-disclosure about our own cultural backgrounds may be indicated.

Summary: Anne’s clear articulation of the crucial importance of cultural sensitivity in our work, including the necessity that we do our own cultural self-exploration in order to most effectively understand and contextualize our clients’ cultural selves, is an important reminder that we can’t simply focus on accessing emotional experience, expression, and meta-processing as the entire story in our AEDP work.  In a case specific and culture specific way, we must be open to different cultural specifications about the validity of emotional expression and the particular ways that emotion may be expressed. We often need to become more aware of our own cultural selves (and biases) and may need to become more self-disclosing about how our own cultural biases might either overlap with or contradict the biases of our clients. We may need to work even harder to develop the relationship, be very open to exploring and accepting differing cultural beliefs, use psycho-education and advice giving more often, and do more affirming of personal and cultural strengths than we’re accustomed to.

The good news is that, to do culturally informed AEDP, we need not“throw out the baby with the bathwater.” As Anne’s model reminds us and her amazing clinical work showed us, AEDP’s process focus is compatible with current models of sensitive multicultural practice. The 4 state  3 state transformation model of AEDP is completely relevant and helpful to clients from all cultural backgrounds since attachment and emotions are universal across cultures, even as we may need to adapt our approaches to most successfully do this transformative work. We are extremely grateful to Anne for having the courage to show us the real struggles involved in the work and for providing such a wise and useful integration as we struggle in our field and the broader society to successfully transition to a changing multicultural landscape.



Anne Cooper, Psy.D.
Faculty member of the AEDP Institute and adjunct faculty of the Wright Institute. As a Filipina-American who has recently lived in the Philippines and adopted two orphans from the Philippines, Dr. Cooper has a strong interest in culture and what it means to be multiracial in America. She has given workshops on AEDP in the Bay Area and has taught AEDP in Manila. She also has given workshops to parents on creating stronger attachment bonds with their children as well as presenting on the interplay between diet, neurochemicals, and mood. Dr. Cooper is in private practice in Menlo Park, California.

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