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Therapy Today, February 2024

When I work with clients who have left their homelands to escape persecution or conflict situations I am struck by their complex attachments to their home of origin. Although they may have experienced abuse and now appreciate the stability of living in a safer country, their emotional bonds to their homeland are often undiminished.

I see my work with these clients as journeys which are often challenging but also inspirational and transformational. In this article I have tried to capture the sense of disjuncture created by cross-cultural predicaments that I have identified in my own practice.

My mixed cultural background and experience as a woman of colour growing up in Britain in the 1960s^1,2 inform my interest in this area, and have helped me build therapeutic bonds and relate to what clients are going through. Nevertheless, there has still been much to learn. Although I draw on the growing body of research and writing that focus on racism, prejudice and cultural differences, little has been written that adequately captures the complexity of my clients’ lives or how to work with their predicaments. 

I have worked in person and online with clients who have fled to various countries in Europe to escape homophobia, female genital mutilation, the subjugation of self-esteem and self-worth, financial insecurity, fierce patriarchy, religious indoctrination or insistence, violation of human rights and denial of their experience by their families. Many feel guilty about their escapes, especially if family members are left behind. They have also left behind a sense of belonging – although they may value the sense of autonomy, freedom and individualism they have gained, they are often still deeply attached to their families and communities. This struggle lies at the heart of their being and experience of living. 

Perspectives

To illustrate some of the turmoil that my clients express I have shared below selected excerpts from my counselling notes, with names and identifiable details changed to protect client confidentiality. By being introduced through their stories to their families and communities I have learned that unexpected movement can occur in these more ‘traditional’ family worlds. Attachment exists both ways. Family bonds, love and compassion can at times be relied on despite initial hostility, fear, defiance and confusion being expressed. Yet there is no room for romanticism – as one client says: ‘You don’t find many homeless families in the Arab world. But this form of “stronger together” leads to guilt when one becomes independent. [The family can express] passive-aggressive ways of uttering shared collective disappointment.’  

Client stories

The following excerpts from my notes have been shared with the clients’ permission, although names and identifiable details have been changed. 

● Hala talks of the need to sleep near a wall, of seeing a black mountain in her dreams and feeling haunted and terrified with night sweats, fear of the dark and claustrophobia.  

● Zaineb still has nightmares after being strip-searched at Heathrow on arrival from Somalia. She talks of her terror at being trapped in the UK in an arranged marriage, where her husband was violent and controlling. She also talks about being forced into protecting her abuser by not telling her family what is happening otherwise her brothers would kill him. Nonetheless, she takes pride in having a Somali identity and expressed anger about the hypocrisy of white Western judgments about human rights issues in the Global South.  

● Thomas was bullied and abused as a child for five years because of his effeminate behaviour. His parents told him to ‘toughen up’, which resulted in years of severe loneliness and fear of socialising while living in his homeland. Despite his determination and strength of character, his social phobia is only just decreasing after 15 months of therapy in the UK. 

● Raj felt trapped by his childhood upbringing. He was distressed and angry in one session, ripping up bits of paper. He said his work in the UK was affecting him spiritually. He went to work feeling ‘hollow’, and described a childlike feeling, a sense that he is being punished and his spirit broken. Our work explored how his family’s ambition and judgments were informing his emotional response to his work.

Emerging themes

When contacting my clients to gain permission to use parts of my notes, I also asked them for responses by email to three questions that could also be shared. Here is a selection of responses to the questions, and the themes that emerged:

Question 1: ‘What are your feelings in relation to your parents/family?’
Themes:

● Mixed feelings – connection but a sense of guilt and distress at the impact their family’s behaviour can have on them: ‘It’s a complex mess – I do love her [my mother] and there is a sense of responsibility – she sacrificed a lot, I admire her, but I also blame her [for what happened to me]. I won’t go back to live in Somalia [yet] my family keeps me connected to Somalia. I am Somali and that is important to me as it gives me a sense of identity.’ 

● Loving their family and feeling guilt for leaving, but also feeling misunderstood by them: ‘The way to describe this best is a mix of love and caring but also frustration and guilt. I feel like I should be looking out for them as I made the decision to leave. But I also feel misunderstood by them – they love me but also act in a way that makes me feel guilt and not appreciated for what I achieved and sacrificed.’ 

● Feeling infantilised by parents: ‘My mother is one pillar, metaphorically speaking, on which the foundations of my life have been built, yet living at home would mean lack of independence. [They would behave as if ] they are still looking after a child.’ 

● Depth of shared experience: ‘The attachment I share with my family is a multifaceted bond woven through the tapestry of our collective experiences, including the scars of trauma.’  

Question 2: ‘What have you found challenging about living away from your family and homeland – for example, have you experienced racism?’
Themes: 

● Carrying guilt: ‘We always carry this sense that we are not doing enough for our country, any act that resembles a normal life gets portrayed within yourself as an act of “treason”, as if we are abandoning our sole purpose for existence. We carry our cause with us wherever we go.’ 

● Experiencing prejudice: ‘I feel this built-in prejudice that they, “the West”, view us as violent, vicious and uneducated, everything that I am not. Sometimes I want to stand my ground and say I am proudly Palestinian, and prove my point and argument over and over. Other days I am just tired, and hide behind my ambiguous looks.’  

● Feeling isolated: ‘Lack of family over here in the UK is a problem. I also can’t visit my family at home. Getting citizenship and having a passport would give me the power to move across borders.’ 

● Not belonging and feeling misunderstood: ‘I push myself to always make sure I act and speak in the right way so as to not offend anyone. There is the feeling that I am a somewhat second category citizen. I feel like I am on guard to the outside world in the UK, as if revealing my true self would be embarrassing. 

Question 3: ‘What do you think counsellors need to know to work effectively with clients from the Global South or less prosperous countries, who are now living in the Global North or a country with Western values?’
Themes: 

● Clients may need reassurance that their therapist can empathise with them: ‘If you haven’t feared for your life as a child, if you haven’t feared for your safety as a woman, and if you haven’t felt bias due to your origins, then it might be hard to comprehend where other people are coming from. In my case, for years we woke up to death and blood, we live in constant fear of losing our freedom, our identities, our rights JEDI NOORDEGRAAF/IKON IMAGES as human beings. Every day is a battle.’  

● Awareness of cultural differences: ‘There is an assumption that Western values are global values. For example, I can’t just “walk away” from my family – I am connected to them.’ Another client said: ‘This belief that there is something superior about Western values can mean it feels shameful to speak up about our experiences.’ 

● Allowing time for trust to build: ‘When you are an emigrant, you create around yourself a safety net which can be very limiting at times, and it really takes a while to build trust with another person.’ 

Working effectively 

In my experience, the following considerations are important for helping my clients to feel confident to work through their material: 

● Being curious – asking early on about their journey to the UK or leaving their homelands, and wanting to know what their families are like, what has happened and is still happening. This view is endorsed by Charura and Lago.³ Zahid also notes that broaching the subject of culture and ethnicity with clients validates them.⁴ 

● Respecting difference – understanding the different values communities may have in respect to family structure,⁵ and respecting that difference by being open and aware of cultural assumptions you may hold, is also important. The expectations and values common in individualistic societies and their contrast with those held in collectivist communities can be difficult to negotiate, and so it is important to introduce cultural diversity and identity early on in sessions.^6,7,8 

● Being politically aware – awareness of racism and cultural assumptions needs to be integrated into transcultural counselling.⁴ Counsellors working in cross-cultural counselling must educate themselves about the political, social contexts and histories that affect clients (rather than expecting clients to educate them).⁹ Charura and Lago also recommend knowledge of decolonialisation that exposes historical studies of eugenics and forced sterilisation, and the imbalance of power at a theoretical and cultural level that Eurocentric therapy can represent. A self-reflective approach along with political awareness are essential.⁹  

● Remaining open-minded – recognising what clients’ family members may struggle with, noticing attachment, and that expressions of distress and suspicion can also reflect concern and engagement. Connections between individuals and families can be remarkably resilient, even when complex.

● Being patient – allowing plenty of time for clients to feel safe. Building trust is vital so that clients can expose their issues with their families, knowing that their families will not be judged. Trust is also necessary so that they can question their own feelings and attachment without fear of judgment. 

Personal development 

I have learned much from my work with clients from other cultures. Working with a Palestinian client brought home how violence in society infiltrates personal lives. And through my work with a Polish client I began to examine the disjuncture in religion between spirituality and dogma. Ultimately, I have become more aware of the extent to which Western, Global North values and perspectives can inhibit or cloud insight into other perspectives.  

My clients’ insights have been essential to my understanding of my own experiences and my own development as a counsellor. Through this work I have become aware of the extent to which I have absorbed society’s prejudice towards people who look like me, and my experience of being an outsider. I have had to find my own sense of value, independent of the preconceptions and racism in the wider society.  

Working with this client group is a privilege, and I have witnessed courage, wisdom and ingenuity – a reminder of who is the real expert in the room. I am humbled by the resilience clients develop and have learned that people can discover an inner strength that enables them to transcend the conflicts their experiences have presented, no matter how profound.