Patient questions and therapeutic answers
The therapist says to the client, “tell me about your dreams” and the client shakes their head slowly and says “I had this dream …”. A therapist says to a teenager, “who are you?” The teenager answers, “I don’t know”. The therapist says to the teenager, “that’s normal at your age”. A client tells their therapist, “ I am very angry at my father”. The therapist says, “let’s do a role play. You be your father and I’ll be you. I’ll show you how to do it.” A client says they are sick of their job but they stay because the money and benefits are good. They want to get into another field. The cognitive therapist says, “let’s brainstorm the different fields you want to get into. We can look at the Occupational Handbook for the skills and pay scale for the different kinds of jobs. Then we can set some goals and seasonal objectives so we make sure you follow through with your goals”. The client feels overwhelmed but agrees. A mother expresses great sadness when her thirty-three-year-old son is getting ready to move out. The therapist says to the client, “it’s long overdue for your son to leave.” After the patient leaves the therapist adds “dependent personality” to her diagnosis.
If you are an individualist living in an industrial capitalist society, both the problems and the therapeutic responses probably sound familiar and the therapeutic interventions sound reasonable. But how good are these interventions with people whose home culture is collectivists outside Yankeedom, specifically India, China or Japan?
What are collectivist and individualist selves?
Roughly 80% of the world’s population is “collectivist”, consisting of most parts of the world with the exception of the United States and Western Europe. The latter country and part of a continent have been characterized as “individualist.” For collectivists, the group is prior to the individual in two senses. The caste group is prior to the family, and the family is prior to the individual. For individualists, the importance of the individual is prior to that of the family and the family is prior to one’s membership in a social class. In the history of human societies, there have been two kinds of collectivists, horizontal and vertical. Horizontal collectivists have been hunter-gatherers, simple horticultural societies who do not have castes or classes. This is why they are called “horizontal” collectivists. Agricultural states are vertical collectivists because they have social castes. We will be using the agriculturalist states of India, China and Japan for our case studies for collectivists. Industrial capitalist societies will be the type of societies we will characterize as individualist.
For collectivists, society is like an organism and extension of nature. Different castes within that society are pictured as being like the organs of a body. Individuals are like different cells in the body. For individualists, society is autonomous from nature and is governed by its own laws. Social institutions are built up by individuals via a social contract. Individuals are independent of society and social relations appear to them as being voluntary, contractual and accidental. Lastly, collectivists value stability. What is old is revered and what is new is looked upon with suspicion. For individualists it is the reverse. There are many other interesting differences, please see Table A for the full list. The question we will seek to address is how well will Western theories of personality work with collectivists?
Six western theories of personality
There are six western theories of personality: Psychoanalysis; Behaviorism; Humanistic; Biological Physiological; Biological Evolutionary and Cognitive. Each of these theories can be broken down into sub-schools which have various kinds of quarrels and emphasis, but for our purpose the six original theories are plenty.
Unit of analysis
The basic unit of analysis for psychoanalysis is dreams, fantasies and drives. For behaviorism the basic unit is habits – what people do, over and over again. For humanistic psychology the most important focus is curiosity and peak experiences. For the biological-physiological school, what matters most are hormones, genes and brain chemistry. For the biological evolutionary school what drives individuals is survival and reproduction. For the cognitive school the main focus are the qualities of reasoning.
Structure of the psyche
The structure of the psyche for psychoanalysis is the id, ego, superego and the unconscious, the conscious and the preconscious. For behaviorism, the structure surrounding the habit it is what happens just before the habit (associations, Pavlov) and what happens after (consequences, Skinner). Maslow’s hierarchy of needs focuses on where to place the individual for humanistic psychology. For the biological physiological theory, one major topic is temperament theory. For biological evolutionary school adaptation and sexual selection strategies is where the action is at. For the cognitive school automatic thoughts, cognitive interpretations , explanatory styles and assumptions is the focus.
Sources of conflict
For psychoanalysis there are two conflicts: between the conscious and the subconscious; and between id and the superego. For behaviorists the conflict is between he unconscious acquisition of associations and consequences which reinforce bad habits. For humanistic psychology the conflict is between the false self which is acquired from what they call a “a materialistic“society and the real self. For the biological physiological school, conflicts arise when people don’t know their own temperament and find themselves in work or educational setting that are mismatches with their temperament. The use of drugs to stabilize hormonal balances can cause problems due to overuse and side effects. For evolutionary psychologists many psychological problems stem from “evolutionary mismatches” between the predispositions we acquired as hunter-gatherers where we formed our human nature and our existence in industrial capitalist societies, which are far from our human nature. For cognitive psychologists, conflicts come from far-fetched automatic thoughts, cognitive interpretation distortions, pessimistic explanatory styles, and irrational assumptions.
On the surface it appears that western psychotherapy theories are very different from each other and they are –relatively. But when we consider the whole world, 80% of whom are collectivists,Western personality theories have more in common than they are different. Western psychotherapy is oozing with individualism as it falls under individualism in the last twelve categories under Table A. Because of this, Western psychotherapy has major liabilities as a therapy for collectivists. The “three strikes you’re out” in the title of this article stands for the average length of time some researchers have estimated that collectivists will stay in therapy with Western psychotherapists. My sources for this article will be the Sue’s book Counseling the Culturally Diverse; Harry Triandis’ book Individualism and Collectivism and John Berry’s Cross-Cultural Psychology.
What I will present covers a thirty-year period from 1970 to 2000. Perhaps in the past twenty years things have changed. I remain skeptical because cross-cultural psychology is the black sheep of the field and the field of psychology has historically resisted social and cultural explanations for psychological process, whether it be class, race, gender or religion. I would be happy to know that Western psychotherapy has become more cross-culturally sensitive in the past 20 years.
Where are we going?
The heart of the article will be to cite:
- instances of problems that collectivists may raise in therapy;
- Western psychotherapists’ interventions with a particular interpretation or suggestion, and;
- why the intervention won’t work.
I will strive to have at least two examples for each school of Western psychotherapies interventions. As you will see, some Western theories are worse than others when it comes to alienating collectivists. After these examples are given I will state my five qualifications and then draw conclusions.
Ways in Which Western Psychotherapy Fail Collectivists
Since moving to Yankeedom four years ago, a collectivist son has begun to see a counselor who his friend recommended because he feels worthless. He claims it is because he is not able to keep up with the other kids in terms of dating and partying. After many sessions, the psychoanalytic therapist suggests to the son that his parents may be trying to keep their son dependent because it makes their lives more meaningful. How will the collectivist respond? Not well. The collectivist would be horrified to think that his parents, to whom he owes his life, would be capable of these machinations. He was raised in a Confucian culture where the family comes first.
A collectivist woman expresses dissatisfaction with her marriage. The therapist suggests the collectivist take out a sheet of paper and list all the virtues and vices of her husband. Then on the back sheet of a paper, list the virtues and vices of her father. The therapist then asks the client to compare the characteristics of her husband and her father. They are very similar. The therapist announces that their client is going through the Electra complex – a girl’s psychosexual competition with her mother for possession of her father. How good an interpretation is this? It is out to lunch. Even if Freud’s theory was right, in order for it to work you would need to live in a nuclear family. The collectivist woman lives in an extended family with her grandfather and mother’s brother helping to raise the child. This diffusion of male responsibility will undermine Freud’s Electra complex.
A collectivist teenage boy has been feeling anxious in the presence of his older brother. An Adlerian therapist suggests that as the second born in the birth order, what he might be feeling is repressed competitiveness. “Competitiveness with the older brother is how middle children behave.” How will that go over with the collectivist? It won’t make much sense. Adler’s birth order assumes that there is that the primary relationship is between the parents and each of the children taken separately. This ignores the fact that in collectivist societies older children take care of younger ones. Brother-sister dynamics are strong enough to throw a monkey wrench into the birth order theory. The job of the middle child is to take care of the younger child, not compete with the eldest.
A collectivist parent comes to therapy and says his son does not display the proper respect for them or towards his elders. The son talks back to them, questions their authority and complains that he can’t stay out as late as the other kids. The therapist suspects the problem is that the parent is raising the child in an authoritarian way. Will it be helpful to tell the parent this? No, it will not. With rare exceptions, collectivists of all castes raise their children to be obedient. What this parent is doing is not pathological. They are raising their children in the way in which the entire culture operates.
A collectivist female teenager comes to a school counselor because they are tired of taking care of their younger brothers and sisters. The Eriksonian therapist asks the teenager what they would like to do with their time. The teenager says they don’t know. The therapist announces that teenager id going through a developmental crisis called “identity vs role confusion”. During this stage, adolescents explore their independence and develop a sense of self. How well would this interpretation work for this teenager. Not well. Typically, collectivist teenagers do not have a time as teenagers where they go to school and not work. They begin helping their parents, working as early as seven years old. They are also expected to do the same work their parents did. There is no asking “who am I? “There are no “rebels without a cause” in collectivism.
A female therapist has been seeing a single collectivist male patient once a week for the past two years. The male patient asks his therapist if she would go out with him.
The female therapist thinks to herself that the transference is going very well. How right is her interpretation? She is off. Transference is based on the idea that in order to become healthy, the patient must temporarily transfer their loyalties from the family of origin to the therapist. This theory will not work with collectivists because the family is too important to the client to ever allow any transference to occur.
A collectivist is court-referred to attend therapy because of a drinking problem. A behaviorist therapist begins asking his patient what were his associations right before he began to drink. Then he asks him what were the consequences (positive or negative reinforcement) right after he has a drink. The therapist explains the patient must change the associations and consequences in order to stop drinking. How will this work for the collectivist? Not well. Behaviorists are very optimistic about getting people to change because mostly they think of people as blank slates. The collectivist is much more conservative and thinks of himself as a certain “type” (temperament) and there isn’t much that can be done.
When this technique doesn’t work well, the behaviorist refers the collectivist to an AA meeting. The collectivist is a Muslim and it is difficult to find an AA meeting with a Muslim higher power. Eventually he finds one. At the first meeting, in front of complete strangers, he is asked to admit he is an alcoholic. He is very uncomfortable and leaves after one meeting.
A collectivist man is violent with his partner. A social behaviorist following Bandura is interested in the relationship between watching television violence and committing real violence. The therapist suspects that the models he is following are attractive and competent and are not punished for their violence. The collectivist wife doesn’t think much of the intervention. She says men have always been violent with their wives and it goes back generations in her family. “That’s just how men are.”
The medical doctor notices a collectivist female patient seems to have extreme mood swings and refers her to a psychiatrist at the hospital the doctor works for. The collectivist is embarrassed to see a psychiatrist because that means they are “crazy”. They go anyway and the psychiatrist diagnoses them as bi-polar and gives them medication. He explains to his patient that the drugs will “even out” their hormonal imbalances. The collectivist takes the medication but does not understand how temperament can be changed with medication. She thought temperament was something you were born with and doesn’t change.
The collectivist woman’s mood stabilizes and she feels much better. She would like to continue to see the psychiatrist and in fact she invites him over to meet her family.
The psychiatrist tells the patient the hospital does not provide for ongoing therapy. The patient says ok, but still wants the psychiatrist to come over once to meet her family. The psychiatrist explains that would be very unprofessional. The collectivist is hurt that the psychiatrist rejects her offer.
A collectivist female patient complains to the therapist that her daughter is being selfish. She wants to go away to medical school to become a doctor. The collectivist patient says she should be helping out with the family business so they can pass their business to the next generation. The humanistic psychologist sides with the daughter and tells the patient her daughter is striving to be self-actualized as an individual and she should make room to let her grow. How does the collectivist react? Negatively. Collectivists have no models for self-actualization, and especially not for women.
A collectivist arrives at a therapy session and wants to report on a dream. The therapist is a follower of the Gestalt psychologist, Fritz Perls (image at the front of the article). Perls believed that all the different parts of the dream were fragmented parts of their client’s personality. Perls wanted the patient to act out the different parts of the dream. So if part of a dream was a spewing fire hydrant you acted that out. If a spinning house were part of the dream, you acted out the spinning house. Then the different parts of the dream talked to each other. Perls believed the parts of the dream talking to each other were ways to integrate the personality. How would that work for collectivists? It would be a disaster.
In the first place, collectivists do not think they are the authors of their dreams. They do not say, as individualists might, “I had a dream”. Rather they say “A dream came to me.” Secondly, collectivists do not think the dream is about their personal life. All dreams are about the group. Thirdly, collectivists dreams are not random firings of the brain or fragmented parts of their identity. Collectivists think that dreams are prophetic. They predict some future event that will happen to the group. Imagine the Gestalt therapist’s surprise when he learns his patient has travelled to Chinatown in another city to warn his people about a coming flood!
A collectivist has recently been widowed and claims that the house she has lived in with her husband is haunted by him. She claimed he is haranguing her for not showing respect to their grandparents. The therapist asks the client what she thinks is really going on here. Expecting his client to realize this is a projection of her own feelings, the therapist is disappointed that the collectivist lacks insight. This humanist psychologist thinks that insight and understanding are a necessary foundation for action. The collectivist is also disappointed. She came in expecting advice about what to do, not to play mind games.
A collectivist, after much reluctance, admits he is upset with his father for not doing more work on the family business. The Gestalt therapist says to the client, “let’s bring your father into the room”. The frightened collectivist agrees. Then the therapist says “let’s make believe your father is right here. In fact, let’s make believe he is this pillow. What I want you to do is punch the pillow are hard as you can and tell him how you really feel”. The collectivist grows silent and says he can’t do it. There are long awkward silences. Mercifully the session ends. The collectivist never returns. The humanistic psychologist thinks that his patient needs assertiveness training.
Humanistic psychologists are the enemies of formality and structure. They prefer their clients (they refuse to call them patients) call them by their first name and they dress more causally than other professionals. Furthermore, they set no agenda for the session because they want to “be in the present”. Lastly, they want to sessions to be led by the client, rather than the therapist because the client must take the initiative in their own self-healing. How will this work? Badly. Collectivists expect their therapist to play a professional role, including dressing for the occasion and referring to themselves as “doctor”. The collectivist expects the therapist to take the lead in what they will talk about and there needs to be procedures that are explicit in how their problem will be solved. All this lack of structure will raise the anxiety level of the collectivist. The humanist psychologist thinks the anxiety is good for them because it teaches them to handle anxiety in real life. It never dawns on the therapist that the collectivist’s home and work-life might be very structured.
Why are we attracted to fat and sugar when we know it is no good for us? Evolutionary psychology says because they are quick sources of energy and they are adaptative if taken in small quantities. In the era in which we formed our human nature, neither fat nor sugar was readily available. Prior to the Industrial Revolution, for upper-class collectivists in agricultural states, being overweight was a status symbol because it showed that you were more important and were less likely to be a victim of famines.
However, in the past 300 years sugar and fat are readily available. At the same time, over the same time period, life has been more sedentary – at least for the upper classes. These factors combine to make more people obese. What this meant for collectivist is that being overweight no longer had high status because even the lower classes now carried extra weight.
This upper class collectivist is told by a bio-evolutionary psychiatrist that they need to lose twenty-five pounds. The collectivist is upset because they are proud of their weight and losing weight will affect their perceived status. The collectivist asks the hospital if they are able to transfer them to an Indian doctor who understands these things.
A collectivist has lived in a temperate zone where the sun sets between six and nine PM, depending on whether it is winter or summer. The collectivist works as a middle manager for a transnational corporation and he is reassigned to work in Fairbanks, Alaska. The collectivist notices he has become depressed in the winter. His bio-evolutionary psychiatrist explains to his client he has seasonal affective disorder (SAD)and needs light therapy. The collectivist thinks that remedy is weird and does not want to buy any “magical” light box. He thinks he is depressed because he misses the people in his country of origin.
Collectivist parents come to therapy because they are unhappy with their daughter’s choice of a partner. The boy lacks broad shoulders and he appears scrawny. In addition, the boy has no interest in introducing his parents to her parents. The evolutionary psychologist explains to the collectivist that times have changed. He tells the collectivist that broad shoulders and physical strength were adaptive when men pulled plows. However, with the development of tractors, it became less necessary for a farmer to have physical strength to be an attractive mate. What matters in industrial capitalist society is these teenagers have common interests and are emotionally compatible. Further, he says that these days people marry for love and not for economic reasons.
This is incomprehensive to the collectivist. Their daughter’s boyfriend seems more likely to become sick and not provide for their daughter. Furthermore, their daughter is in no position to know what she wants in a partner. Sexual attraction is a very unstable reason to marry. Both their parents know more about what it takes to make a successful marriage. How can the therapist think that two people barely twenty years old are in any position to decide their future? The collectivist parents leave therapy because they think the therapist is incompetent.
A collectivist mom is upset with her six-year-old daughter for not making a list of all the groceries they need when they go to the store. The cognitive psychologist explains that it’s a lot to expect of a six-year-old to make lists of food and drinks and anticipate when they might run out before next week’s shopping. The therapist explains that her daughter has not mastered Piaget’s concrete operational stage and she is not likely to do this well. The collectivist does not know about western stages of development and treats children as little adults.
A collectivist man is required to attend a 40-week program for domestic violence. His partner is seeing a priest for help and as a result she is getting stronger. This makes the collectivist man very depressed and sad. The cognitive psychologist in the group program suggests they work on a writing a five-part radial message to his wife. A radial message consists of sense data, emotions, interpretations, intention and consequences. For the next three sessions the collectivist man disappears. When he returns, the cognitive therapist asks “where were you?” The collectivist confesses that he travelled to another city to confer with a shaman for help. They did a ritual together and the shaman claims to have expelled the evil spirit that has possessed his wife.
A collectivist lives in a city which has just had flooding as the result of a storm. One of his sons has been injured and there has been significant damage to their house. The cognitive psychologist, trying to be helpful, suggests the collectivist make a list of all the things that need to be done and set a time line for each task of the project. He further suggests that this may be a good opportunity to set some long-range goals for his children. How will this be received? Not well. The therapist is operating with an internal locus of control. That means how long something lasts, how much the event will affect other areas of a person’s life and whoever is responsible is largely under the person’s control. The collectivist won’t go for this. He thinks that the causes of things are either the will of the gods, luck or possibly due to sorcery. How long something lasts, as well as it how it affects the rest of his life are not under his control. He understands the therapist means well, but the therapist is naïve. Meanwhile the therapist is toying with a diagnosis that the collectivist is depressed.
Vertical collectivists are not the only kind of collectivist
As mentioned in the orientation section, I have only discussed collectivists in agricultural states. Horizontal collectivists at the tribal level of society are very different from vertical collectivists. However, we think Western psychotherapy would fare at least as bad with them
The degree of success or failure would depend on the acculturating group membership upon entering the country
There are six kinds of acculturating groups: immigrants, ethnic groups, refugees, sojourners, native peoples and slaves. Immigrants are migrating people who have come to new country intentionally, plan to stay permanently and have at least a modest savings upon entering the country. These folks have the highest probability of having limited success with western psychotherapy. Sojourners, who move from place to place, if they are students, might not do too badly if they had some extra money and would have become more familiar with western ways through courses taken. On the other hand, refugees are usually fleeing their country of origin because of economic, political or religious persecution or natural disasters. They have little money and no clear intention to stay. They are less likely to enter therapy voluntarily and more likely to be court-referred. Native Americans, given the genocide and persecution to which they have been subjected, would hardly come to therapy voluntarily.
There are collectivists in separate countries and subgroups within countries
My article has focused on collectivists as they exist in different countries. However, there are also collectivists who exist within a single country, even in Yankeedom.
There are predictable sociocultural factors that would make people more or less collectivist even within an individualist culture. For example:
Maximum Collectivist Maximum individualist
Working class Middle class, upper-middle class
Racial minorities Racial majority (72% white)
Older than 50 years of age Between 20-50 years of age
Catholic, Hindu, Muslim, Confucian Protestants, Jews
Rural Urban, suburbs
Deep south, farming Coastal cities, industry
Military service No military service
Children No children
Space does not permit me to explain this, but my point is there can be individualists within agricultural civilizations just as there are collectivists within industrial capitalist societies.
Pristine vs Hybrid Collectivist
In this article I have treated agricultural civilizations and industrial capitalist societies as if they existed in a pristine form with no interaction. But in the last two hundred years capitalism has traded with, colonialized and manipulated India, China and Japan so that they are no longer pure collectivist societies. China, despite the control of the Communist Party, has allowed forms of capitalism to come in so that the Chinese today are not the same as they were two hundred years ago. The same is true of India, thanks to British imperialism. While the Japanese industrialized themselves in the second half of the 19th century, they had their constitution dictated by the Yankee rulers after World War II. Despite this, both Chinese and Japanese capitalism still contain a collectivist core which has not been hollowed out.
I am not saying Western psychotherapy never works with collectivists
It is much more likely to work with people on the individualist side of the collectivist columns above. So a light-skinned collectivist, upper middle-class man between 20 and 50 living in a coastal city without children and no military experience might be very receptive.
I began my article with five psychological problems an individual in an industrial capitalist society might have, along with what seem to be good therapeutic interventions. The issue this article raises is two-fold:
- How helpful will these interventions be with people who live in collectivist societies such as India, China or Japan?
- Are the problems the client raises universal problems all people have or are the problems themselves not relevant for people living in collectivist societies?
My claim in this article are that therapeutic interventions fail to deal effectively with the problems that collectivists might face if are immigrants, sojourners or refugees.
I began by defining what it means to have a collectivist or individualist self. I provided a table which compares collectivists and individualists across nineteen categories. I then gave an overview of six western personality theories and compared them across three categories: the unit of analysis; the structure of the psyche and the sources of the conflict to lay a foundation for understanding Western psychotherapeutic interventions.
The heart of the article is to raise, on average, three psychological problems a collectivist might have in a Western psychotherapy session. Each school was faced on average with three problems the collectivist will present. Then their interventions were criticized for being cross-culturally insensitive. I closed my article with five qualifications.