lost in translation? inter-cultural exchange in art therapy

Chapter 2

LOST IN TRANSLATION: INTERCULTURAL EXCHANGE IN ART THERAPY

SUSAN HOGAN

T his chapter will explore what art therapists have said about art therapy across cultures. Art therapy is diverse and open to embracing a range of

perspectives from a Gestalt psychotherapy model, which is very verbal, to studio approaches which may focus on the individual's engagement with art making, and her "conversation" with herself via the art making, with little intervention. In-between, in this spectrum of activity, are group art therapy models: some of these are psychoanalytic with an emphasis on transference and use psychoanalytic concepts; some of these group approaches are more interactive and have a broader theoretical perspective (Waller's GroupInteractive model being particularly prominent); other group approaches are "Person Centered" and are not psychodynamic at all, but are rooted in the tradition of Humanistic psychology. In the U.S., the range of art therapy approaches, which is commonly available, is even broader, with some orientations being located within cognitive behavioral models of psychology (Hogan & Coulter, 2013). To fully represent this diversity of practice and opinion in one short chapter is not possible, but this chapter will attempt to provide a view of some of the debates taking place within art therapy on the subject of cultural diversity and intercultural exchange.

What Is Culture Anyway?

Culture, in the sense of a conglomeration of signifying or symbolic systems of meaning, is what we inhabit; it constitutes our habitus. This is an idea from the French sociologist Pierre Bourdieu. Habitus is concerned with the

11

12 Therapists Creating a Cultural Tapestry

way that social classifications can appear "natural" and "given," but habitus is more than an unconscious assimilation of classificatory norms and ways of being; it is: "a set of dispositions which generates practices and perceptions" Qohnson, 1995, p. 5). The habitus is described by Bourdieu as an "embodied history, internalized aS a second nature and so forgotten as history- is the active presence of the whole part of which it is the product" {Bourdieu, 1990, p. 56). All of our understandings about the world are in this sense cultural. McNiff suggested that we might "view all therapeutic relationships as meetings between cultures" {McNiff, 1984, p. 128). The circumspect position generated by this stance is a useful one for art and creative therapists to adopt, in my opinion, for reasons this chapter will elaborate.

What is considered abnormal or disturbed is actually constantly shifting (with a few notable exceptions- murder and incest taboos being relatively widespread across cultures). Deviancy is socially and historically located, rather than biologically determined. Explanations vary across cultures, including concepts about what is actually occurring and what is required to alleviate mental aberration. For example, in some cultures, a more community-based response is involved in alleviating mental distres~. Art therapists working in a particular cultural context may find themselves out of their depth, both in terms of understanding the cultural norms being expressed and in being able to decipher the symbolism being employed in the artwork, as I will elaborate in this chapter {Bird, 2012; Landes, 2012; Lofgren, 1981).

Western medical norms may be increasingly penetrating all corners of the globe, but there are potentially inherent tensions between different "thought styles" regarding conceptualizations of health and illness {Douglas, 1996). Furthermore, culture invariably mediates the expression of distress. For example, as I have pointed out in previous work, what is considered to be "normal" and "natural" in terms of acceptable grieving is culturally determined and specific {Hogan, 2012b, p. 80). A woman beating her chest and wailing aloud in one context is demonstrating her sorrow about the death of a loved one; whereas, exactly the same behavior in Britain, might result in the woman being sedated, or worse, being labeled as psychotic. We need to be sensitive to these differences.

Some social norms may explicitly cause certain sorts of mental suffering. For example, the so-called "nuclear family" {a parent or both parents living with their children) does not seem to support new maternity well . It is interesting to note that in extended family structures, reported incidence of postnatal depression is much lower because of higher levels of community support available. Likewise, the protocols around technocratic hospital births and dominant discourses around bonding and attachment in Britain, appear to cause considerable distress to large numbers of women, with iatrogenic

Lost in Translation 13

practices embedded as unquestioned norms in birthing procedures (Hogan, 2003, 2012b). "Dis-ease" may be culture-driven, and the therapist encountering the individual must be able to see this while not viewing or treating the distress as purely individual and neurotic. A culturally aware art therapist can challenge dominant discourses. Indeed, art therapy can act as a space in which to rehearse and explore strategies of resistance, as well as to explore and reconcile contradictory discourses-contradictions that create stress and 'dis-ease' (Hogan, 1997).

Art therapists work in a variety of contexts, but for those who work in psychiatric services, there is also another important layer of cultural discourse, and that is the diagnostic. For example, diagnostic categories are instrumental in the therapeutic encounter. These categories rest on suppositions about "normality" and appropriate sex-role behavior (Hogan, 1997). A further dimension involved is that some practitioners believe that differences between people are biologically determined. Biological determinism is the idea that shared behavioral norms, and the social and economic differences between groups (primarily "races," classes, and sexes), arise from inherited inborn distinctions. Certain sets of social relations have existed and evolutionary theory was (and is) used to justify them.

In the 19th century, the application of evolutionary theories was simply a matter of analogy. Equated through supposed likeness were women, criminals, children,beggars, the Irish, and the insane-as they were lacking in social power and were likened to "primitives" or to "savages." Biological determinism has changed shape over time, but is still evident in psychiatric discourses, especially in relation to gender (Hogan, 2013). Even when ideas about normality and appropriate sex-role behavior are not theorized through biological explanations, they are still potentially oppressive.

In art therapy, we deal with pictorial symbols, metaphors, and analogies in addition to the spoken word, and these may have a particular cultural resonance. Images are fundamentally polysemous, and therefore, inherently open to multiple interpretations. The timbre of a metaphor may easily be lost. Furthermore, there can be a disjunction between what is depicted and what is said, or what is enacted with the body in relation to the work. This dislocation may be a meaningful disjunction, not simply a matter of the difficulty of verbal expression. The art therapist can be alert to this.

Cultural Issues and Interpretation

Issues of interpretation are always important, and some acknowledgement of cultural issues have been made in the art therapy literature to date, most notably Burt (2012); Campbell, Liebmann, Brooks, Jones, and Ward


(1999); Dokter (1998); Hiscox and Calisch (1998); Hogan (1997, 2003, 2012a, 21012b). The importance of greater acknowledging "issues of culture" more broadly in art therapy has been highlighted as crucially important, if we are not inadvertently to oppress others (Hogan 1997; Hogan 2013; Talwar, Iyer, & Doby-Copeland, 2004). ,

Hogan's (1997a) edited volume looked broadly at women's issues and art therapy, and especially at negative discourses surrounding definitions of femininity with reference to the negative positioning of women within psychiatric discourses (Burt, 1997; Hogan, 1997b; Joyce, 1997). Women's bodies, especially the experience of pregnancy and childbirth, received attention (Fabre-Lewin, 1997; Hogan, 1997c; Malchiodi, 1997; Skaife, 1997). Cultural misogyny and violence against women were also emphasized, as well as lesbian concerns Oones, 1997; Martin, 1997). The book also contained an exploration of blackness in the art therapeutic encounter, and a groundbreaking essay on internalized racism (Campbell & Gaga, 1997). This work has been reissued (Hogan, 2012a) in a new edition called Revisiting Feminist Approaches, which more fully addresses the issue of domestic violence Oones, 2012) and includes other new voices.

Burt's (2011) substantial edited volume, Art Therapy & Postmodernism, addresses cultural interpretation and the implication for therapy in a varied selection of essays. Further work on women's issues includes an examination of women's changed sense of self-identity and sexuality as a result of pregnancy and childbirth, and a trenchant critique of the reductive application of object-relations theory, as well as a critical appraisal of frankly misogynist theories about "too good" mothering. Maternal guilt, depression, and anger are reappraised in the light of negative psychological theories about mothers (Hogan, 2012b).

Hiscox and Calish (1998) and Campbell et al.'s (1999) edited collections examined cultural diversity and highlighted problems of institutionalized racism, as well as the experience of being a member of a "visible minority" and an art therapist (Annoual, 1998, p. 14). The "racial identity" of the therapist in relation to clinical practice was also considered. Hiscox and Calish emphasized an acknowledgement of cultural context.

All human behavior is influenced by, and is a reflection of, the cultural context within which it is nurtured. Culture includes such features as attitudes, forms of emotional expression, patterns of relating to others and ways of thought. It is a patterned, organized and integrated collection of characteristics and traits like a weaving or tapestry. Members of a culture share common threads with the group as a whole while also retaining some individuality. (p. 9)


Skaife (2007), summarizing Blackwell (1994), suggested that issues of racism in group work can get lost when there is just one "other" in the white group: "The single black person will be absorbed into the group in a beneficent denial of their difference: (p. 146). It is important to point out that some people of color will collude with this experience. Skaife suggests such "colour blindness" can obscure the particularity of the individual. Dokter ( 1998) also noted a reluctance to acknowledge difference in art therapy group work, but sees this arising out of "deep-seated fears about labels" (Hiscox & Calish, p. 148).

Kalmanowitz and Lloyd ( 1998) discussed the interaction of traditional forms of South African healing and Western therapy. One of their case examples is very instructive: two therapists were seeing a black woman concurrently-one black and the other white. Shamanism was recommended by the Black therapist, "who believed that the girl's anger needed to be addressed to the ancestors, through a medium, before it could be released" (Kalmanowitz & Lloyd, p. 122). Only after this process did she think therapy could be effective. The white therapist was willing to consider this, and then, "A third (black) member [of the therapeutic staff team] entered the debateresolute that she herself would stick with the therapy until the anger found expression. What had seemed a black-white issue transpired to be more subtle" (Kalmanowitz & Lloyd, p. 122). Kalmanowitz and Lloyd's point is that skin color was not the dividing issue; rather, different ideas about therapeutic efficacy in a particular cultural context were to the fore, as well as underlying tensions between "native" and "Western" treatment models (Hogan, 2013).

Lala (20 11) pointed to her work with a white woman who identified as black, for complex reasons. This reminds us that our clients are the experts on their own lives. It is those we work with who "must be seen as self-determining unique beings who are constantly composing and reconfiguring their own identity, experiences and struggles" (Lala, 2011, p. 33).

When running a varied group myself recently, diversity is precisely what came to the fore; the British Caribbean women were dissimilar to each other in their experience of being black women. Others, such as a British Yemeni Muslim woman, had had a very different life-experience, especially with reference to community expectations and restraints. Explication of different cultural perspectives was intrinsic to the group process (Hogan 2013).

McNiff ( 1984/2009) noted a tendency towards greater and obvious acknowledgment of differences in "cross-cultural" art therapy relationships:

The process of intersubjectivity characterizes all human relations. Cross-cultural communications simply make the perception of differences more explicit. Within cross-cultural therapeutic relationships and art therapy training groups differences tend to increase curiosity and interest. (p. 104)


Lala (2011) also emphasizes the recognition of heterogeneity, using the term ethnically diverse to describe her work with women from several different countries. She wrote, "It was important for me as a clinician to recognize that individuals who embrace the same ethnicity do not always share the same race, culture or religion" (Lala, 2011, p. 32). The phrase "embrace the same ethnicity" ends up rather ambiguous in this usage. Furthermore, her interest is in acknowledging women's complex self-identification in an attempt to avoid stereotyping (Lala, 2011, p. 33).

Rosa!, Tumer-Schikler, and Yurt (1989) advocated against separatism in their work with obese teenagers. They argued that the "diversity of membership enriched the group." Further, it brought together young people who did not normally socialize, allowing them to "find commonalities and gain respect for each other" (Rosal eta!., p. 131).

Dokter's (1998) edited book considered therapeutic work with refugees and migrants across a range of disciplines, including art therapy. She emphasized complexity and pointed out that ethnic groups tend to be composed of a number of different cultural groups with varying orientations. Her argument is that cultural differences between people (including people who look the same) are always important to self-identity.

Dokter's (1998) position is supported by Annoual (1998), who wrote, somewhat disconcertingly, about "Blacks" in the U.S. as a collective, but went on to assert that,

Black, as an identity, is highly contested and is by no means a static concept. In fact, it is to be understood as a highly individualistic process in the construction of identity. As with other elements of self-identification, one's blackness is something that may change depending on situation and context. (p. 20)

Indeed, cultural affiliation is key. Dokter (1998) warned that visible similarities can obscure heterogeneity. She suggested that the situation is further complicated because of intermarriage between different cultural groups.

However, Dokter (1998) pointed out specific stresses of migration concerned with cultural transition and potential conflicts of values. Lala (2011) was astute in summarizing the multiple issues at play in work with immigrant and refugee women:

While going through the immigration process, the constant reminders of traumatic material from the client's past, coupled with an ongoing imminent threat of deportation, pose a real and damaging deterrent to recovery and healing. For example, women without immigrant status have less access to services and resources but, at the same time, are dealing with the stress of

Lost in Translation

multiple settlement issues. Issues such as language, culture shock, financial constraints, housing security and isolation all impact the client directly and need to be considered during the therapeutic process. (p. 35)

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Chabaro ( 1998) also addressed immigration, stating art "helped me open the door between the life I left behind and the new one I was about to adopt. This travel in time (past life and present) was a part of the healing process which I needed to face in order to grieve the loss of my country of origin and accept my new foreign life" (p . 232).

Though most of the literature was very positive about the possibilities for intercultural art therapy, Chabaro ( 1998) warned against the possibility of misinterpretation and against the overgeneralization of symbolic material. She is particularly critical of pictorial diagnostic tests, which are more widespread in the U.S., than the U.K and Australia. She was also disdainful of the cultural stereotyping of Arabs that she encountered in the U.S., especially in schools.

Schaverien (1998) explored the transmission of grief and trauma across generations through collective memory, with reference to Jewish cultural identity. In this essay, she discussed how artworks allowed previously terrifying images to become assimilated. Schaverien ( 1987) also explored the positive aspects of the scapegoat transference, in which the artwork may

come to be e xperienced by its maker as the embodiment of the image it carries ... It may temporarily be experienced as ' live' and, so, if consciously handled, its disposal may have the effect of a cleansing ritual. (p. 167)

Case (1998) noted some cultural pressures and constraints in her work with members of the Chinese population in Hong Kong. They saw themselves as unrepressed and pragmatic, but also as very willing to engage ingroup work. This was coupled with a strong expectation that she would make authoritative interpretations (p. 255).

My second edited collection, Gender Issues in Art Therapy (Hogan, 2003), explored gay, lesbian, and transgendered identities, and particular symbolism and cultural understandings within these communities that are potentially open to misunderstanding. The gender and sexual otientation of the therapist was explored (Bichovsky 2003; Liebmann, 2003; Loureiro, 2003) and oppression and violence toward women (Hogan, 2003; Martin, 2003; Talwar, 2003). Specifically, Talwar (2003) pointed out that "our own sociopolitical choices and theoretical orientations determine our use of interpretation" and cautions that art therapists working with ' third-world' women may "lack the ability to apprehend [the] visual information" (pp. 191-192).

It was interesting that Dokter's ( 1985) comments about heterogeneity above echo in those of Modood (2005). How to capture the complexity of


cultural identities today is an interesting question, as "non-white immigrants ... do not form a separate socioeconomic class, nor are they distinctively located in one class" (Modood, 2005, p. 53). Class was a slippery concept anyway; it therefore seems more useful to consider more cultural information, but Modood was cautious about the term "ethnicity." A critique of the concept of "ethnicity" was that, like "race," it was:

an externally imposed identity on a group of people who may not have thought of themselves as a group . .. [Consequently] the categorizations of a dominant group can create a quasi-group out of those who share similar physical appearance, so an ethnic group is a quasi-group based on what are perceived by non-members to be distinctive cultural characteristics of a given population. (Modood, 2005, p. 55)

Clearly, this is problematic. More palatable was the idea of "ethnicity" as a form of group understanding. This was described thus: "An ethnic group is, theoretically, one in which the association with both a particular origin and specific customs is adopted by people themselves to establish a shared identity" (Platt, 2011, p . 69). However, Modood (2005) cautioned against the use of the concept, making this interesting analogy:

Racial categories may be like the artificial boundaries of some postcolonial independent states, reflecting colonial administrative divisions and great powers' geopolitics, forcing together those who do not belong together and separating those who do. (p. 58)

Even those who feel that the term "ethnicity" had promise were cautious about its use. Platt, (2007), for example, drawing on the work of Geertz ( 1993),

. stressed the contingent and fluid nature of ethnicity and suggested that the term is potentially useful in suggesting "flexible cultural bonds," but worried that the term could be abused to suggest fixed hereditary differences that can lead to a rigid and fixed essentialist view of culture, where "culture" becomes the preserve of "the other" and viewed as an "additional characteristic" of the ethnic groups, rather than the terrain "through and in which all people live, which is inherently relational and which gives meaning to the world and all social relations" (Platt, 2007, p. 18). Clearly, the very concept of "ethnicity" must be called into question, or at least used with great caution.

Farris-Dufrene and Garrett (1998) (with reference to work with the native North American population) went so far as to raise questions about the efficacy of art therapy across different cultures. Further, Farris-Dufrene and Garrett emphasized that sickness in a Shamanistic tradition was not seen as just


"located" in the individual in Native American culture, and emphasized that cultural sensitivity and insight were necessary for meaningful engagement:

The use of the arts in healing goes beyond sickness per se and encompasses a multilevel concern with the well-being of the individual and the community. Healing deals with psychological, social and spiritual crises. With its emphasis on prevention, traditional healing effectively addresses a wide range of physical and social ills. (Farris-Dufrene & Garrett, p. 244)

Another art therapy writer from North America, Lofgren (1981), highlighted how some of her assumptions were unhelpful to her understanding of images made by a Navajo Indian client in the United States. In the first image, Navajo symbolism is used to represent a guardian enclosing three sides of the paper, with the fourth side containing an opening to allow for the movement of the spirits; Lofgren was "dismayed" by the image and thought it was pathological and impoverished, because she was unacquainted with such symbolism.

Figure 2.1. Navajo symbolism.


Figure 2.2. Life history.

A further example of her cultural assumptions, in direct response to the artwork, was described by Lofgren (1981) with reference to the introduction of a personal history time line, which she assumed would start on the left and work towards the right, illustrating a chronological sequence of events; however, a more global and less linear approach was taken, with the image divided into four quarters. This approach concorded with a Native American outlook about time, but could easily be misconstrued. Lofgren concluded that without more training towards cultural sensitivity in the analysis of behavior and symbolism, art therapists could unwittingly harm their clients. She asserted, "Everyone can cite examples of individual incompetence or insensitivity within the mental health field. What I wish to emphasize is that institutionalized forms of cultural bias affect the practice of even the most conscientious therapist" (Logfren, p. 29).

It is imperative that art therapists avoid interpreting art and work in a facilitative manner, especially so with those using unfamiliar symbolic schemas. To have an in-depth understanding of diverse literary and cultural perspectives is probably beyond the scope of basic art therapy training; but a conceptual understanding and sensitivity towards cultural diversity is imperative. "How can a white Australian art therapist work effectively in a plur-


al society without first having confronted the prejudices so seamlessly inherent in her upbringing and history?" demanded Megan Holloway rhetorically (2009). Certainly, creating some space in art therapy training to reflect on this feels imperative.

This chapter focused on intercultural or cross-cultural exchange in particular and some of the literature that touches upon intercultural art therapy. This chapter suggested that gender is also an important cultural dimension that structures our experience of the world and must not be overlooked (Hogan, 1997, 2003, 2012). Finally, as stated earlier, the safest stance for the art therapist to adopt may be that which views all therapeutic relationships as meetings between cultures.

Acknowledgments

Thanks to Gary Nash for alerting me to Denise Lofgren's frank and brave exploration of her difficulties and prejudices, in working with a woman with a very different cultural orientation. Thanks to Robert Kapadia's salutary critical appraisal of my work.

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working with new mothers. In H. Burt (Ed.), Art therapy and postmodernism: Creative healing through a prism (pp. 70-82). London: Jessica Kingsley.

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Rosa!, Turner-Schikler, & Yurt (1989). Art therapy with obese children: Racial, cultural, and therapeutic implications. In A. R. Hiscox & A. C. Calisch (Eds.), Tapestry of cultural issues in art therapy (pp. 109-133). London: Jessica Kingsley.

Schaverien,J. (1998). Inheritance: Jewish identity, art psychotherapy workshops and the legacy of the holocaust. In D. Dokter (Ed.), Art therapists, refugees and migrants: Reaching across borders (pp. 155- 174). London: Jessica Kingsley.

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Working with Black and White: An art therapy supervision group, S. (2007). Working with Black and White: An art therapy supervision group. In J. Schaverien & C. Case (Eds.), Supervision of art psychotherapy: A theoretical and practical handbook (pp. 139-152). London : Routledge.

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Biography

Susan Hogan, Ph.D. is qualified as an art therapist in 1985. She has a particular interest in group-work and experiential learning, following early


employment with Peter Edwards M.D., an exceptional psychiatrist who had worked with Maxwell Jones. She is currently Professor in Cultural Studies and Art Therapy at the University of Derby. Hogan has also conducted work with pregnant women and women who have recently given birth, offering art therapy groups to give support to women, and an opportunity for them to explore their changed sense of self-identity and sexuality as a result of pregnancy and motherhood.

Professor Hogan's major intellectual work is Healing Arts: The History of Art Therapy (2001), described by the late Professor of Psychiatry, Roy Porter, as "sure to be the definitive monograph on this subject for the foreseeable future." Her other books are Feminist Approaches to Art Therapy (as editor, 1997); Gender Issues in Art Therapy (as editor, 2003); Conception Diary: Thinking About Pregnancy & Motherhood (2006); Revisiting Feminist Approaches to Art Therapy (as editor, 2012); The Introductory Guide to Art Therapy (with Coulter, 2013). She is currently cowriting on women's experience of ageing with sociologists from the University of Sheffield. In addition to all of the above, she has also published a number of both scholarly and polemical papers on women and theories of insanity.

Particularly influenced by the anthropological work of her late motherin-law, Professor Dame Mary Douglas, Hogan's work has been innovative in its application of social anthropological and sociological ideas .to art therapy, as well as in her unwavering challenge to reductive psychological theorizing.

lost in translation? inter-cultural exchange in art therapy

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