Pratyusha Tummala-Narra: On Psychoanalysis & Cultural Competence

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.

usha tummala-narra photo

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.

Casey Taft: On Non-Violence

This is the latest in a series of interviews with APA Books authors and editors. For this interview, Andrew Gifford, Development Editor at APA Books, interviewed Casey T. Taft of the National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine.

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.

Casey Taft

Casey T. Taft, Ph.D. is a staff psychologist at the National Center for PTSD in the VA Boston Healthcare System, and Professor of Psychiatry at Boston University School of Medicine. Dr. Taft was the 2006 Young Professional Award winner from the International Society for Traumatic Stress Studies, and the 2009 Linda Saltzman Memorial Intimate Partner Violence Researcher Award winner. He has served or is currently serving as Principal Investigator on funded grants focusing on understanding and preventing intimate partner violence through the National Institute of Mental Health, the Department of Veterans Affairs, the Centers for Disease Control, the Department of Defense, and the Blue Shield of California Foundation. Dr. Taft has published over 100 empirical papers and book chapters, chaired an American Psychological Association task force on trauma in the military, and consulted with the United Nations on preventing violence and abuse globally.

In addition to the book discussed in this interview, Dr. Taft is also the guest host of Intimate Partner Violence, a Psychotherapy Training Video available on DVD.

In your work with veterans suffering from PTSD, you managed to create something unique, as far as I know:  a model for treating interpersonal violence (IPV) that addresses both perpetrators and victims. How did you come up with this idea?  Could you tell us about the development of this model?  

Our model is trauma-informed in that we account for and discuss the role of trauma throughout the entire assessment and therapy process. What we’ve found is that when we give space for the perpetrator to discuss prior traumatic events, not only does this help set the stage for developing a positive therapeutic alliance and enhance motivation, but it can be healing in and of itself. While our program is not a trauma treatment per se, we do have some evidence that those who receive the program are themselves healing from trauma while they’re also much less likely to inflict trauma upon others. The goal of our program is to stop the cycle of trauma, and we do that be increasing an understanding of trauma and its impacts, and really focusing on how our prior experiences influence how we interpret various situations and our relationship partners.

You’ve noted that many models of IPV treatment do not take trauma into consideration at all. What inspired you to change that, with your model?

 Trauma-informed intervention is increasingly the standard of care for all kinds of problems that might lead someone to treatment, and it stands to reason that we should be doing the same with those who use violence in their relationships. In fact, trauma-informed intervention may be even more important with this population since more than half of those who engage in partner abuse have been abused themselves growing up or observed their parents abusing each other. While almost everyone in the partner violence field acknowledges high rates of trauma in this population, and there seems to be a growing belief that we should be educated about trauma, this hasn’t necessarily translated into specific evidence-based trauma-informed approaches. Especially when we consider that interventions to prevent and end intimate partner violence have not been particularly effective, and other research showing that trauma and PTSD are associated with violence through their influence on how we interpret our social worlds, this seemed like an obvious direction to go.

In your new book Trauma-Informed Treatment and Prevention of Intimate Partner Violence, you and co-authors Christopher M. Murphy and Suzannah K. Creech discuss the importance of a positive therapeutic process. Could you elaborate on what you mean by that phrase? What are some ways that practitioners can adopt a positive approach?

By positive therapeutic process, we’re referring to facilitating positive therapist-client relationships, motivation for ending the abuse, and engagement in the treatment process in general. Historically in partner violence intervention, there has been a tendency to downplay the importance of these factors, with intervention strategies that may be

considered overly confrontational and shaming. This is unfortunate because when we’re working with a trauma-exposed population, they may have difficulty trusting and joining with providers. Therefore, taking a more alliance-enhancing and motivational approach may go a long way towards enhancing our ability to reach violent individuals and help them end their violence. In fact, my dissertation research from long ago showed that when we are able to build a positive working alliance and facilitate group cohesion, those who are in partner violence intervention are less violent and abusive to their partners after program completion.

The programs you’ve developed to end domestic violence in military service members have seen terrific successes and have been adopted by many hospitals and clinics. How do you feel, seeing your work take root in so many places?

It feels amazing, to be honest. So many people have worked really hard to get us to this point. We spent over eight years running randomized controlled trials where we developed our violence prevention programs and evaluated them. Ours are the first programs shown to be effective for this population through controlled trials so we truly believe we are onto something important with this work. To be able to then help with implementing these programs across the VA healthcare system and within the military is exactly what we were hoping for when we began this endeavor. Our vision for the next phase of our clinical research program is to do the same thing with a civilian population. We have every reason to believe that a trauma-informed violence prevention intervention would similarly work for a civilian population.

As a vegan, you’ve written about how you want to promote non-violence towards animals, and echo a similar message of positivity when it comes to our treatment of all living creatures. Do you see violence as a systemic problem in our society?  Are there things we can do in our own lives to help prevent violence, whether on an interpersonal level or more broadly?

We know that when children are violent to animals, it’s a warning sign for problems with interpersonal violence down the road. Similarly, when we sanction unnecessary violence towards other sentient beings in any form, it promotes the view that violence is acceptable. I do see violence as a systemic problem in our society. Violence in many forms towards both human and nonhuman animals is all around us, and I believe that a pro-intersectional framework is required to understand that various forms of violence and injustice are all inter-connected, and all violence stems from the idea that some lives matter less than others, or that some are lesser. It’s quite amazing that all three of the authors for this book are vegan and share this pro-intersectional worldview.