This is the latest in a series of interviews with APA Books authors. For this interview, Andrew Gifford, Developmental Editor at APA Books, spoke with Pratyusha Tummala-Narra, professor of psychology at Boston College. Her book Psychoanalytic Theory and Cultural Competence in Psychotherapy won Honorable Mention at the 2017 PROSE Awards.
Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.
Pratyusha (Usha) Tummala-Narra received her Ph.D. in Clinical Psychology at Michigan State University. She is an Associate Professor in the Department of Counseling, Developmental and Educational Psychology at Boston College; a Teaching Associate in Psychiatry at the Cambridge Health Alliance/Harvard Medical School; and in Independent Practice in Cambridge, Massachusetts. Her research interests focus on the intersections of culture, race, gender, immigration, and trauma, and culturally informed psychotherapy practice. Her clinical scholarship has focused on psychoanalytic perspectives on the relationship between sociocultural context and identity and its influence on the therapeutic process.
AG: Congratulations on winning a PROSE Award! Tell us a little bit about your inspiration for writing this title, and what you hope the book will achieve.
PT-N: Thank you! The book is a culmination of my clinical experience and research over the course of twenty years. I have worked with clients in psychotherapy who have taught me a great deal about the complexity of sociocultural context in their lives. They are the inspiration for me writing this book. Over the years, I had the opportunity to learn from mentors and scholars from psychoanalytic, multicultural, and feminist perspectives, all of which have influenced my understanding of cultural competence in practice. My hope in writing the book was to expand the ways in which cultural competence has been discussed in psychology. In particular, I wanted to bring to the foreground psychoanalytic concepts that are especially helpful in examining and addressing the depth of how sociocultural realities shape people’s experiences of themselves and their relationships, and conflict and distress. I hope that the book draws attention to an understanding of sociocultural issues in psychotherapy that underscores both the realities of context and the individual’s experience of this context as dynamic, fluid, and powerful.
AG: In 2012, in an article written for the Division 39 newsletter, you pointed out the “absence of dialogue” about race and called for psychoanalysts to offer insight into this neglected discussion. What role do you see for psychoanalytic theory in helping generate this dialogue?
PT-N: There is indeed an absence of constructive dialogue on race in psychology and in broader society. Race, unlike some other aspects of social context, evokes anxiety and grief for people of all racial backgrounds. Psychoanalytic theory can help us understand why it is so difficult for us to engage in honest dialogue about race, especially with people whom we perceive as racially and/or culturally different from us. A major area of interest within psychoanalytic theory concerns trauma and traumatic stress. The challenges we face in discussing race in the United
States at least in part stem from the fact that race and racism are traumatic both in the past and in the present, and much of how racism operates lies in the unconscious. Even when we perceive ourselves to be open-minded, we are socialized with messages regarding race from an early age, which then impact the ways we perceive our own social locations and those of others. Psychoanalytic theory helps us to recognize that we all have biases, stereotypes, and prejudice that lie outside of our conscious awareness, and that we struggle to hold tension with regard to our privilege and our marginalization. The theory can also help us begin to have more authentic dialogue about race through an understanding of individual and collective defenses, such as denial and projection, which serve to protect us from anxiety produced from talking about race and racism. Psychoanalytic theory also suggests that such dialogue requires witnessing and mourning the loss and trauma incurred through racism, which means that as a profession, we need to create spaces where people with different experiences with race can engage with each other by listening attentively to each other. Interestingly, although it is assumed that psychologists are good listeners, we sometimes are limited in the ways that we listen when we become defensive despite our good intentions. Psychoanalytic theory helps us to think more about our own role as listeners in the context of race.
AG: Psychoanalysis has become old-fashioned in many people’s eyes, perhaps due in part to its origins within the European, doctor-patient tradition. What does psychoanalysis offer—both generally and for multicultural populations specifically —that other, younger approaches do not?
Psychoanalysis does have a history of neglecting issues of sociocultural context. However, over the past twenty years, psychoanalytic scholars have moved away from an understanding of intrapsychic life as unaffected by sociocultural context. Increasingly, psychoanalytic psychologists and psychoanalysts have been concerned with how sociocultural issues and social oppression influence people’s intrapsychic and relational life. These scholars are also interested in how early experiences within one’s family and community can shape later experiences with their social contexts and relationships with others. Contemporary psychoanalytic perspectives assume that there is a bidirectional influence between the context and the individual. For example, two people of the same ethnicity may have different feelings about a similar cultural context, even though they may also have some shared experiences. Psychoanalysis offers an important lens into why people experience a particular aspect of diversity in certain ways by considering the influence of unique life experiences and unconscious processes associated with these experiences. These developments within psychoanalysis have a great deal to offer our understanding of cultural competence in psychotherapy. It is important that psychologists consider that cultural competence involves a process of understanding various dimensions of a person’s life, including his/her unconscious life (e.g., wishes, conflicts, defenses, fantasies, dreams), as they have tremendous impact on how he/she experiences the self and others and how he/she responds to stress and conflict.
AG: What advice do you have for psychology students today who are interested in pursuing psychoanalytic training?
My hope is that psychology students are open and excited to learn about psychoanalytic theory and its contributions to understandings of cultural competence in psychotherapy. Unfortunately, in many training programs in psychology, students are not exposed to psychoanalytic theory. I encourage students to advocate for more exposure to psychoanalytic ideas in their training. Students are typically working with clients who are coping with multiple forms of stress, often situated within systemic oppression (e.g., poverty, racism, sexism, homophobia, transphobia, ableism). The opportunity to learn about how clients experience and cope with oppression both intrapsychically and interpersonally would benefit students as they develop formulations and techniques to engage effectively with their clients. The dynamics of issues of diversity are also evident in students’ relationships with their supervisors and faculty, and psychoanalytic theory can offer a lens into understanding impasses that may occur in these relationships as well.