On Therapy with Asian Patients

ACCOUNTING FOR CULTURE IN the psychodynamic formulation of our patients and ourselves is a challenge for several reasons. We are accustomed to attend with loving relish to almost every detail of a person's presentation, from the broad strokes of his or her lifestyle and interpersonal behavior, to the minutiae of his or her speech patterns, nuances of tone and eye movement, details of dress, and preferences for everything. It is striking, then, that the cultural matrix from which a person's history was likely to have been shaped or at least colored is, if often not ignored, then summarily acknowledged and then forgotten.

If such blindness or blind spot exists in a formulation, it is not without excellent cause. "Culture" is too broad a construct to capture in a single paper, or even many. However we know that an essential quality of it is its diversity: just as each person we meet is endlessly different than the last, so each culture has its own character, and there are many of them. However, when Sullivan (1953) pointed out that "we are more human than other vise", the truism may also apply to culture: human phenomena may take different shapes but is still human phenomena. The essential challenge in bringing together psychotherapy and culture is the challenge to balance the knowledge of similarity and the knowledge of difference. Overemphasis on difference and reductionism based on those differences can lead to the crime of bigotry and stereotype. It is principally to avoid that pitfall that I believe we tend more to shy from investigation along cultural lines among the lines we usually pursue. It is perhaps the subliminal protest against the distastefulness and hazard of cultural stereotype that restrain us in tacit politeness from subjecting ourselves to its possibility.

Writing about the psyche and psychotherapy of Asians requires a daunting chutzpah, the appreciation of which should never be far away. "Asian" does not and cannot signify a homogenous