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Recent civic explosions have impelled the author to ask: 'Do our clinical efforts merely help people to adjust to a sick society? Has our preoccupation with the inner turmoil of our patients made us neglect social forces that produce or at least exacerbate pathology? Are our therapeutic efforts too often geared to the upper levels of society, ignoring the multitudes crippled and thwarted by economic and social conditions?' Ethnic groups on the fringes of society, denied opportunities for self-fulfilment, endure much suffering. Traditional psychotherapy is irrelevant to their troubles; consequently as patients, they are demanding, suspicious, hostile, or—conversely—apatheic, hopeless, or overly dependent. Work with the poor demands a reassessment of our treatment goals; such work has been started in mental health centers. According to the author, not only people, but institutions should be changed.
Sager has pointed out that many therapists feel alienated when working with the poor who are the victims of repression and discrimination. The desperate inability of an individual to extricate himself from a crushing environment and the terrible realities of his existence make us feel impotent. Such a feeling alienates the therapist from his patient whom, consciously or not, he blames for his disquiet. This discomfort may be manifested by avoidance or overidentification, evidenced by benevolence and patronizing or infantalizing patterns, and is related to the therapist's own unresolved problems with authority. Countertransferences in this particular area have not been generally examined. The author recommends that therapists conscientiously set aside time for introspection. Here group participation can reveal to the therapist unsuspected attitudes, biases, guilts, value systems, intervention models, and goals. The indigenous nonprofessional can help bridge the gap between the client's culture and that of the therapist, interpret the therapist to the client, an