Psychotherapy of Arab Patients in the West: Uniqueness, Empathy, and "Otherness"

Article excerpt

The study of Arab patients seeking treatment for their psychological problems in the West has previously been underrepresented in mainstream American journals. Notwithstanding various attempts that deal with Arab Americans as a minority group, there has been a paucity of scholarship dealing with Arab patients' unique characteristics related to sociopolitical, cultural, and other factors that impact the therapeutic process for those individuals who are not acculturated to the American way of life. These patients present challenges to their therapists owing to the contrasting cultural understanding and conceptualization of mental illness and therapeutic process.

Therapists need to fully appreciate the relationship between culture and psychotherapy. Patients' and clinicians' awareness of differences may contribute to the ability of both sides of the therapeutic dyad to overcome some of the differences encountered when Arab patients are treated outside their cultural domain. A case vignette serves to illuminate how issues of cultural transference and countertransference can be managed for the benefit of the patient and the enlightenment of the therapist.

Would that I could be the peacemaker in your soul, that I might turn the discord and the rivalry of your elements into oneness and melody? But how shall I unless, yourselve be also the peacemaker, nay, the lover of all your elements'?

Khalil Gibran

The Prophet

INTRODUCTION & LITERATURE REVIEW

The vast majority of research that focuses on the treatment and counseling of Arab clients in the West has approached the subject from a narrow perspective, in line with issues pertinent to Arab Americans as a minority group living in the United States and elsewhere (1-6). This trend follows an emphasis on using explanatory factors for intergroup differences in psychological phenomena (7). Although helpful in enumerating relevant perspectives that hold central places in cultural psychology, there is an increased need to re-examine those cultural issues specific to some Arab patients. Some of these issues are sufficiently demonstrable in therapeutic relationships when these patients, living outside of the mainstream of United States culture, seek treatment for their psychological problems in the West. Despite the rich contribution that was made during the last few decades on the question "how to understand the Arab mind," there is still a paucity of scholarship on therapeutic aspects and issues relevant to people of Arabic origin (8) who are increasingly finding their way into mental health institutions in the West.

This increase may be attributed to either inadequacy of the mental health system in their countries of origin, or to the prevailing perception that Western therapeutic interventions have a better outcome, especially by the burgeoning educated middle class of people in the Middle East, many with advanced degrees, who may have had some prior Western contact. Of particular importance are the potential differences exhibited by individuals who only come for treatment when contrasted with others who were either partially or fully acculturated to the Western culture.

As a result, these patients face a double quandary, being foreign to the culture to which they came seeking treatment, and being subjected to conceptualization of mental illness prevailing in the Western culture that is not only foreign to them, but may do them a disservice. This situation calls for a deeper examination of the issues beyond the minority status and hybrid identity emphasized in previous studies. In recent years, however, several studies have focused on these patients (8-10), their special needs, given the fact that they were at best only partially acculturated to their host countries, as mentioned previously. It is, therefore, equally meaningful to highlight the challenges this group of patients presents to their therapists in the West owing to differences in mental-illness conceptualizations, as well as other closely intertwined factors related to sociopolitical, ethnic, and cultural ethos, and understanding. …