Fernandez dissertation by ICSW

The Institute for Clinical Social Work

Subjective Experiences of Immigrant Psychotherapists of Color

A Dissertation Submitted to the Faculty of the The Institute for Clinical Social Work in Partial Fulfillment For the Degree of Doctor of Philosophy

Merari E. Fernandez Castro

Chicago, Illinois April, 2022

Abstract

This mixed-method phenomenological study explored the experiences of Immigrant Psychotherapists of Color (IPC) practicing psychotherapy in the United States. The purpose of the study was to explore the experiences of psychotherapists in relation to race and immigration and their sense of self, their clients and the psychotherapy community. A total of 50 psychotherapists answered a survey and the Demands of Immigration Scale. Eight psychotherapists participated in an in-depth interview. Findings suggested a negative directional correlation between discrimination in the host country and inclusion in the psychotherapy community. These results indicated that feelings of discrimination were prevalent. Qualitative data analysis included the following themes: (a) The impact of trauma and loss in the immigrant and person of color identity; (b) Struggling with racism in the psychotherapy community; (c) The impact of race and immigration on transference and countertransference; (d) Positive engagement with the psychotherapy community; (e) Having a sense of advocacy for minority clients and colleagues; (f) Absent discussions on race and racism in the therapeutic relationship; and (g) Feeling comfortable educating White people. This study calls for the psychotherapy community to work toward making a non-hostile environment toward IPCs and to enhance training on race and immigration related issues on transference and countertransference.

I’m not given a second chance. I am overdetermined from the outside. I am a slave not to the “idea” others have of me, but to my appearance. I arrive slowly in the world; sudden emergences are no longer my habit. I crawl along. The white gaze, the only valid one, is already dissecting me. I am fixed. Once their microtomes are sharpened, the Whites objectively cut sections of my reality. I have been betrayed. I sense, I see in this white gaze that it’s the arrival not of a new man, but of a new type of man, a new species. A Negro, in fact! Frantz Fanon

iii

Acknowledgements

I want to thank all who have invested time in thinking with me about this project, including my dissertation committee: Ida Roldan, Michelle Piotrowski, Mead Goedert, Patricia A. Seghers and Gabriel Ruiz. I also want to thank the participants who willingly shared their experiences, risking vulnerability hoping to contribute to make the psychotherapy community and society a better place for minorities. It was a meaningful experience for which I will always remain indebted to all who, when learning about my dissertation topic, encouraged and supported me along this journey. MEFC

Table of Contents Page Abstract……………………..……………………………………………………………ii Acknowledgements……...……………………...……………………………………….iv List of Tables……...……………………………………………………………………viii List of Figures....................................................................................................................ix Chapter I. Introduction…………………………………………………………………...……..1 General Statement of Purpose Significance of the Study for Clinical Social Work Statement of the Problem Theoretical problem Brief Literature Review Research Questions Hypothesis and question Theoretical and Operational Definitions of Major Concepts Statement of Assumptions Epistemological Foundation of Project Foregrounding

Table of Contents−Continued Chapter

Page

II. Literature Review…………………………………………………….…….……….24 Sociological Literature on Immigration and Race Historical Overview on Psychoanalysis and Immigration Current Psychoanalytic Literature on Immigration and Psychotherapy The Immigrant Psychotherapist and the Psychodynamic Encounter Current Psychoanalytic Literature on Race and Psychotherapy The Psychotherapist of Color and the Psychodynamic Encounter Theoretical Framework Relevant Studies III. Methods………………………………………………………………...………72 Hypotheses and Questions Rationale for a Mixed Method Research Design Rationale for Specific Methodology Research Sample Research Plan Data Collection Plan for Data Analysis Linguistic Considerations Ethical Considerations Limitations and Delimitations Changes to methodology

Table of Contents−Continued Chapter

Page

The Role and Background of the Researcher IV. Quantitative and Qualitative Results……………………………………..…102 Participants Demographics Quantitative Results Qualitative Results V. Quantitative and Qualitative Findings …………………………………..........181 Quantitative Findings and Discussion Qualitative Findings and Discussion Blended Findings and Discussion Clinical Implications Subjective Experience of the Researcher Appendices A. Screening Interview/Instrument/Survey/Qualitative Interview………….…241 B. Recruitment Flyer……………...………………………………………….…...252 C. Consent Forms………………………………………………………………...254 D. IRB Authorization Forms……………...……………….……………………...261 E. Qualitative Analysis Tools…..……………………..………………………….264 References…………………………………………………………………….…...268

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List of Tables

Tables

Page

Race…………………………………………..…………………………………103

Native Country …………………………………………………………………104

Time in Country of Origin…………………………...…………………………105

Years in the US…………………………………………………………………105

Correlations Discrimination and Inclusion……………………………………..119

Case Processing Summary Discrimination and Inclusion………………….…..120

Crosstabulation Discrimination and Inclusion………………………………….120

Chi-Square Tests Discrimination and Inclusion………..………………………120

Correlations Not Feeling at Home and Inclusion………………………………122

10.

Case Processing Summary Not Feeling at Home and Inclusion……………..…123

11.

Crosstabulation Not Feeling at Home and Inclusion………………...…………123

12.

Chi-Square Tests Not Feeling at Home and Inclusion………………………….124

viii

List of Figures

Figures

Page

Clinical Orientation………………………………………………………….….107

How would you identify the racial identity of your clients……….……………108

Immigrants Psychotherapist of Color Approach………………………………..109

Immigrants Psychotherapist of Color Relate……..…………………………….110

Immigrants Psychotherapist of Color Experience…..………………………….111

Immigrants Psychotherapist of Color Feeling……………...…………………..112

Immigrants Psychotherapist of Color Experience of the Community………….113

Community experience of the Immigrants Psychotherapist of Color……….….114

Inclusion…………………………..…………………………………………….115

10.

Percentage of Respondents Who Endorsed Each “Distress Level” Category for Loss Subscale….………………………………………………………………..116

11.

Percentage of “Distress Level” Discrimination Subscale……………..………..117

12.

Percentage of “Distress Level” Not Feeling at Home Subscale………………..118

Chapter I

Introduction

General Statement of Purpose

This mixed-method phenomenological study intended to understand the subjective experience of the immigrant psychotherapist of color (IPC). The IPC experience included a set of experiences that occur between IPCs and (a) themselves, (b) their clients, and (c) the broader psychotherapy community, while living and practicing psychotherapy in the United States. The study intended to look at the prevalence of loss and to examine the relationship between discrimination and experiences of not feeling at home, and their sense of inclusion in the psychotherapy community. This research generally defines the IPC as a person of color who was born and socialized in a foreign country or a United States territory, and later relocated to the mainland United States undergoing a process of acculturation. The IPC in this study could also include those who (a) came to mainland United States as students, dependents of relatives, spouses, or in any other capacity, (b) trained as therapists in the United States or elsewhere, and (c) may or may not have become residents or citizens of the United States (Kissil, K. Niño, A. & Davey, M., 2013). Therefore, this study provided accounts of psychotherapists of color who were born

2 outside the United States or in a United States territory, and who have established their psychotherapy practice in the mainland United States. These accounts entailed the multiple experiences mentioned above, in addition to an examination of how subjective experiences are shaped by immigration and racial identities.

Significance of the Study for Clinical Social Work This study acknowledged a group of psychotherapists in the field of social work whose experiences have not been widely acknowledged in writings or professional discussions. This exclusion might call into question the depth of those theories and clinical interventions that have consistently ignored the work and experience of IPCs. In addition, this exclusion can negatively affect IPCs because by not seeing their experiences reflected in the literature, they might feel that their voices have been silenced, and that they themselves are invisible. This in turn could possibly exacerbate feelings of (a) loss, (b) not feeling at home, and (c) being the target of discrimination. Increasingly, minorities and IPCs need to recognize themselves both in the literature they study in academia and in their professional experiences. All professional discussions—whether in trainings, writings, conferences, or case consultations—should be relevant to everyone in the psychotherapeutic community. This study helped fill the gap for minority clinicians, particularly IPCs who may have regarded their experiences as not worthy of discussion because the literature did not reflect their experiences. This study helped mainstream psychotherapists by facilitating an awareness and understanding of the IPC experience. This is important because social work strives to

3 adhere to values of diversity. Indeed, an inherent part of social work ethical practice is the development of awareness of people who differ from oneself. I recognize the fields of social work, psychotherapy, and psychoanalysis have had discussions about the importance of cultural sensitivity when working with clients from different (a) backgrounds, (b) ethnic and racial identities, and (c) lifestyles. However, the prevailing emphasis has focused on two things: recognizing biases and power struggles while treating clients from minority groups, and exploring how psychotherapists position themselves in relation to clients’ identities in the therapeutic dyad while being a White psychotherapist (Fallenbaum, 2018; Chang & Berk, 2009). However, the same exploration has not been as abundant when it relates to how immigrant psychotherapists of color position themselves with clients. Indeed, those few existing accounts have been written primarily by IPCs with a focus on immigration and race. It is understandable that minority psychotherapists have generated most of this literature. Issues of race and immigration shape personal identity and have a deep personal impact. However, where mainstream psychotherapists form the majority, the issue of immigration rarely comes up, even among White psychotherapists whose ancestors emigrated to the United States. As such, there is a missing, forgotten, and unspoken experience in the collective unconscious of the psychotherapy field: the history of immigration among psychotherapists. Historically, psychotherapists and psychoanalysts have often remained silent about their immigration history, but that is changing. More immigrants are joining the field, and at the same time, political realities are prompting psychotherapists to move around the globe. Given that forgotten and

4 unspoken background in psychoanalysis, it is important to be curious about the experience of the IPC. Many questions about IPCs still remain unanswered, including (a) What happens in the clinical encounter when the psychotherapist is an immigrant of color, (b) How does the IPC experience professional growth and relate to the broader psychotherapeutic community, in terms of the IPC’s identity as an immigrant and as a person of color, and (c) What is the immigrant psychotherapist experience of their clients, and vice versa? This study will explore these questions by considering traditional psychodynamic psychotherapy and psychoanalytic literature on race and immigration. This study also intended to contribute to the growing research by including a full minority-group sample, given that research literature has neglected including minority groups in research samples (Case & Smith, 2000).

Statement of the Problem The challenges faced by IPCs have profound implications in terms of their (a) sense of self, (b) clinical encounters, and (c) interaction with and one’s experience of the psychotherapy community. The psychoanalytic literature has included few discussions of these external challenges and their subjective implications. However, much has been written about the subjective experience of the mainstream psychotherapist and analyst. Psychoanalytic literature and presentations, for example, are devoted to the role of the subjective experience of the analyst and psychotherapist and how it manifests via countertransference (Ogden, 1997; Benjamin, 1993; Aaron, 1991). However, these discussions have almost entirely excluded the subjective experience of the IPC, who

5 seems to be invisible to the leaders of mainstream psychotherapy and psychoanalytic discourse. In rare instances that the literature addresses immigration and the immigrant therapist, I saw descriptions of the following feelings: 1.

Dislocation,

Not belonging,

Homesickness,

A multiplicity of loss experiences, related to family and country of origin (Akhtar, 1999c, 2006 & 2007),

An unwelcoming, hostile environment (Pérez-Foster, 2001), and

As a result of all the above, the dissociation of the foreign and immigrant self (Hazel, 2013 & Lobban, 2013).

One of the main issues addressed in the immigration literature is the immigrant experience of loss that can occur after leaving (a) a familiar geographical location, (b) a professional community, and (c) family and friends. This loss might have an impact on the IPC’s countertransference in their clinical encounters with clients. This difficulty would be minimized if the IPC’s colleagues were to clinically recognize such an impact and offer support to the IPC (Akhtar, 1995). Conversely, practices of exclusion in the psychotherapy community might exacerbate the same sense of loss and of not belonging that psychotherapists of color often experience (Winograd, 2014). Professional success is particularly difficult for IPCs, who work in a field that does not seem to understand that their subjective experiences are unique and important to explore. This demonstrates the psychotherapy community’s lack of awareness of its exclusion of these particular

6 members of their community (Akhtar, 2006; Leary, 2000; Tummala-Narra, 2004; Winograd, 2014). The discussion of the impact of immigration and race on the psychotherapist’s personal experience has been minimally discussed in comparison to other subjective psychotherapist experiences; thus, there is a need to advocate for an understanding of the IPC’s experience through research, training, and writing. The research that comes nearest to addressing the experiences of the IPC focused generally on immigration in general, or specifically on either the immigrant psychotherapist or therapist of color. The literature on each of these areas seemed compartmentalized. As such, we knew very little of IPCs and their subjective experiences of immigrating to the United States. Other studies (Barreto, 2013) in this area discussed the following: (a) the experience of the immigrant psychotherapist after arriving in the United States, (b) how these psychotherapists bring their own education and experiences from their countries of origin, and (c) the need to adapt to new professional values, expectations, and theories (in addition to a new culture and language)—all in an effort to fit into a new psychotherapy culture in the United States. However, no research addressed (a) how immigrant psychotherapists experience loss while emigrating to a foreign country, and how that experience factors into their work with clients, (b) how the identity as an immigrant and person of color enriches or brings unique challenges in the psychotherapist’s clinical work, and (c) how this unique identity and difference creates issues of exclusion and discrimination in the psychotherapy community.

7 As a result of this lack of attention in the literature and research, the psychotherapy and psychoanalytic community may be unconsciously prone to bias and discrimination, which interferes with the IPC’s full inclusion into their communities. This bias and discrimination contain racial implications, which adds complexity to the situation. For example, the racial implications and biases against the IPC also come into play during (a) supervision, (b) consultation group meetings, and (c) trainings (Tummala-Narra, 2004). At times, these dynamics hinder the IPC’s success and full participation as a member of the psychotherapy community. It is my understanding that support for this group of clinicians—regarding the challenges they face in the psychotherapy and psychoanalytic community—is minimal. Given the current political climate in the United States, we needed to understand the IPC experience within the context of the immigration debate, which has taken centerstage in United States politics. The social and political debate and discourse about immigration has often targeted immigrants by blaming them for the country’s problems. Indeed, after the 2016 presidential election, the immigration debate intensified (Thompson, 2018) and social-justice organizations documented an escalation of racist acts and behavior against ethnic minorities (Southern Poverty Law Center, 2018). Immigrant psychotherapists found themselves thrust into this context, which raised questions such as: How does the United States political climate impact the immigrant psychotherapist of color, and what role does the psychotherapy community play in the intensification of racial and ethnocentric dynamics? This study aimed to address the unspoken experiences of the IPC, as well as related challenges and achievements. I explored unique realities that many IPC face,

8 thereby bringing together the current literature on the experience of the immigrant psychotherapist and the psychotherapist of color. This study has helped in closing the gap between both literature topics helping in the understanding of the IPC’s experience as an immigrant and a person of color, while also highlighting the subjective reality of the therapist in a new foreign country, and what those different ways of being mean. This study also aimed to explore how the psychotherapy community may be complicit via its relative silence. Such complicity can obscure and overlook issues related to (a) race, (b) culture, and (c) immigration, particularly the experiences of the IPC. However, politics and the clinical encounter are inextricable. The psychoanalytic and psychotherapy community should no longer ignore the political implications of immigration and race; such omissions signal an unconscious and conscious disavowal of the importance of the immigrant and person of color experience. Furthermore, the tendency to ignore these issues has reflected the prerogative of a socially privileged group. Jennifer Tolleson (2009) suggested that while psychoanalysts often discuss unconscious processes of disavowal in relation to their clinical work, these same psychoanalysts enact the same processes when it comes to social justice. “According to the psychoanalytic template,” Tolleson writes, “we are fundamentally composed, not simply by what we cannot know, see, imagine or represent. We are, in short, constituted by the missing” (p. 196). A missing component in psychoanalysis has been the discussion of immigration, ethnicity, and race. The mainstream community has often relegated this discussion to minority psychoanalysts and those for whom it would be a special interest. Leary (2000) described this silence in psychoanalysis as a racial enactment, writing, “. . . the most

9 common racial enactment has been our relative silence about racial issues” (p. 647). This study aims to emphasize the role of psychoanalytic thinking, namely, to discover what is absent or what appears invisible, particularly in the case of the experience of the IPC.

Theoretical problem. Scholars have undertheorized the IPC experience, but some contemporary authors have discussed the immigration experience using psychoanalytic concepts. Others have discussed race and racism. Those who have theorized the immigrant experience include Salma Akhtar (1995), Tummala-Narra (2004), Hazel (2013), and Lobban (2013). Akhtar (1995) discussed the immigration experience and the related psychological processes that immigrants undergo as they begin, struggle with, and come to terms intrapsychically with their immigration—in addition to countertransference challenges that the immigrant psychotherapist might encounter. Hazel (2013) and Lobban (2013) emphasized the possibility that IPCs have a sense of inner diversity, and that they dissociate from their foreign selves when facing ostracism or discrimination. Some who have written about race elaborated on their understanding of the unique challenges the psychotherapist of color encounters (Winograd, 2014). Discussing racial identity, Layton (2002) said that identity is constituted in relation to cultural norms, and norms are generally embodied “in those whose love and approval we most want and desperately need” (p. 202). Layton (2002) explained that to live a race or gender or sexed identity “properly”—that is, in accordance with dominant cultural norms—one must discard those parts of oneself that lack approval. The author understood the term dynamic unconscious as a gendered, raced, sexed and class-specific entity and, therefore,

10 deeply rooted in our social context. The author proposed the concept of the normative unconscious, in which the subject lives through a racialized unconscious, assuming and following socially established norms. The previous concepts and theorizing on race allow for a comprehension of the racial dynamics in the psychotherapy community and the IPC subjective experience.

Brief Literature Review A few studies focusing on the immigrant psychotherapist helped in the understanding of the experience of the IPC by focusing on specific areas such as (a) language, (b) training, and (c) becoming a therapist in a foreign culture (Barreto, K., 2013; Gulina & Dobrolioubova, 2018). These studies were interesting, but we needed to study the overall IPC experience through a psychoanalytic lens. Gulina and Dobrolioubova’s 2018 research, for example, focused on language in the consulting room, but not on overall subjective IPC experiences with themselves, clients, and the psychotherapy community. Language plays an important role in the experience of the immigrant psychotherapist, but this study had a broader perspective, as it will discuss the overall IPC experience, as it related to being both an individual and a clinician. In addition, Gulina and Dobrolioubova’s main setting was the U.K., not the United States, and they focused on the experiences of mostly white European immigrants, which we can assume was the nationality of the sample. Race was not discussed, but perhaps that is only because the researchers did not prioritize race as a subject. My study, however, prioritized race because the experience of an IPC could be quite different from the experience of a White immigrant (Tummala-Narra, 2020).

11 In addition, my study aimed to bring together the aspects mentioned above in previous studies from a psychoanalytic perspective. However, I sought a deeper understanding of what emerged psychologically for IPCs and how their experiences played into the clinical dyad as well as the psychotherapy community. Using the concepts initially described by Akhtar (1999b) such as idealization, splitting, nostalgia, transference and countertransference, among others, to explore the IPC’s experience of loss, inclusion and discrimination in a psychoanalytically-oriented research set this study apart from others. In sum, this study aimed to expand and deepen a discussion of the unspoken experience of the IPC. This discussion was important for several reasons: 1.

The United States psychoanalytic community was immersed in a social reality where immigration factors prominently, and we could not ignore its influence on clinical practice.

There was a current gap in the literature about the IPC experience, compared to that of the immigrant client.

A psychoanalytic lens was mostly absent from the literature that addresses perspectives and issues of interest of the IPC.

There was a need to discuss racial enactments in the therapeutic dyad and in the psychotherapy community, but issues pertinent to this group of psychotherapists was barely discussed in psychoanalytic research literature and professional psychoanalytic training.

12 Research Questions The main research question was: What is the subjective experience of the immigrant psychotherapist of color? From this main question, several additional questions follow, including: 1.

How does the IPC describe their immigration experience?

How does the IPC describe their sense of self as it pertains to their immigrant and racial identities?

How does the immigrant and racial identity of the psychotherapist of color emerge as part of the dynamic between the immigrant psychotherapist and the client?

How does the IPC describe the experience of being an immigrant therapist?

How would the IPC describe their subjective experience with the psychotherapy community in relation to the IPC’s immigrant and racial identity?

Hypothesis and question. The main variables of the quantitative portion of the study are: 1.

Loss,

Not feeling at home,

Inclusion, and

Discrimination. The variable of loss was incorporated in the following question: What are the

range and variation of scores for the experience of loss recorded by immigrant psychotherapists of color who complete the Demands of Immigration Scale? The

13 variables of not feeling at home, inclusion, and discrimination were incorporated in the following two hypotheses: (a) There is an inverse relationship between the experience of discrimination (as measured by the DIS) in the host country and how included the immigrant psychotherapist of color feels in the psychotherapy community, and (b) There is an inverse relationship between the experience of not feeling at home (as measured by the DIS) in the host country and how included the immigrant psychotherapist of color feels in the psychotherapy community.

Theoretical and Operational Definitions of Major Concepts This study utilized the following operational definitions and major concepts: 1.

Acculturation: The general processes and outcomes (both cultural and

psychological) of cultural contact. Immigrants contact a dominant culture and adapt by using a set of strategies that include (a) assimilation, (b) separation, and (c) integration and / or marginalization. The availability of these options depends on how welcoming the new environment is towards foreigners (Berry, 1997, pp. 294, 297). 2.

Client: The person who is, or has been, in psychotherapy treatment.

Psychoanalysts may use the term “patient” instead. 3.

Color-blind Racism: Racial ideology based on the superficial extension of the

principles of liberalism to racial matters that result in raceless explanations for all sort of race-related affairs. The central frames of color-blind racism are “minimization of racism,” “cultural racism,” “naturalization,” and “abstract liberalism” (Bonilla-Silva, 2015). 4.

Country of Origin: The country in which the immigrant was born and raised.

14 5.

Discrimination: There are active and subtle varieties of discrimination, such as

the notion that immigrants do not belong in the United States nor deserve the same rights as the native born (Aroian, 2003, p. 128). 6.

Exile: An individual who left the home country with little or no time to prepare

due to one or more of the following: (a) fear of persecution, (b) war, and (c) political and/or natural dangers. Given the circumstances of the exile’s flight, the individual might not retain the possibility to revisit their home country, possibly resulting in the exile’s rejection of the home country (Akhtar, 1999a, p. 124). 7.

Geographical Dislocation: Leaving a country or region for another country or

region in the same country. This involves a disturbing loss of familiar topography and the loss of physical objects (Akhtar, 2007, p. 168). 8.

Host Country: The country to which immigrants relocate after leaving their

country of origin. 9.

Immigrant: A person who has left her or his country voluntarily. As opposed to

the exiled, this person (a) had time to prepare for departure, (b) experienced fewer traumatic events associated with the departure, and (c) went on to enjoy greater possibilities to revisit the home country. In all, these factors lend themselves to feelings of nostalgia toward the country of origin (Akhtar, 1999a, p. 124). 10.

Immigrant’s Nostalgia: This mechanism results in an idealization of the

immigrant’s past. Powerful affects might be associated with houses, cafes, street corners, hills, the countryside. Such affects can create an “if only” fantasy in which the immigrant’s life would have been wonderful, if only they had remained in their home country. This nostalgia is bittersweet and can arise when the immigrant (a) contemplates

15 artifacts from back home, (b) listens to native music, or (c) reads poetry, allowing a fantasized reunion with the home country via maudlin reminiscences (Akhtar, 1999a, p. 125). 11.

Immigrant Psychotherapist: An individual who was born and socialized in a

foreign country and later relocated to the United States for a long enough period to go through acculturation. This definition includes therapists who came to the United States as (a) students, (b) dependents of relatives, or (c) spouses—or indeed in any other capacity. These therapists trained in the United States or elsewhere, and may or may not become residents or citizens of the United States (Kissil, Niño, & Davey, 2013). 12.

Inclusion: The degree to which an employee feels like an esteemed member of

the workplace. This perception is based on the degree to which the employee experiences treatment that satisfies his or her needs for belonging and uniqueness (Shore, Lynn, et al. 2011). 13.

Language: The medium in which inner experiences become concretized or given

symbolic meaning. Also, defined by Ding and others (2011) as concerning immigrants’ perceived barriers in communication, due to accent and difficulty in speaking a new language. 14.

Loss: The feeling that pertains to the emotional attachment to people, places, and

experiences in the home country—insofar as the immigrant lost this attachment after emigrating (Ding, Hofstetter, Norman, Irvin, Chhay, & Hovell, 2011). This definition is according to the Demands on Immigration Scale (DIS). 15.

Mainstream Psychotherapists: Individuals raised, born, socialized, and trained

as psychotherapists in the mainland United States of any race.

16 16.

Mourning: A reaction to a real loss of a loved object. The painful yearning to

recover what was lost, which is reminiscent, affectively and adaptively, of earlier infantile object loss or separations. When object loss is significant enough to bring about a reaction of mourning, it represents a threatening, transforming, and remodeling force to the identification systems of the mourner (Garza-Guerrero, 1974, p. 414). 17.

Normative Unconscious: A range of clinical theories that replicate rather than

challenge the splits demanded by dominant identity categories, by the racism, sexism, classism, and homophobia in which these categories are forged (Layton, 2002, p. 202). 18.

Not Feeling at Home: Feeling like a stranger or a foreigner who is not part of the

receiving country (Aroian, 2003, p. 129) as measured by the Demands of Immigration Scale (DIS). 19.

Person of Color: A non-white person as defined by the participant. This concept

has been utilized to categorize individual subjects to the social construct of blackness or brownness. For the purpose of the sample, participants are asked to define this based on the color of their skin and physical traits. 20.

Poisoning of Nostalgia: When negative experiences prevent the exiled from

idealizing the country of origin, instead directing aggression toward memories of the past. Nostalgia seems like a psychic luxury to the exiled (Akhtar, 1999b, p. 126). 21.

Psychotherapy Community: The environment, training and workspaces in

which psychotherapists, including IPCs, nourish their psychotherapy and clinical skills. These environments consist of (a) training institutes, (b) organizations, and (c) academia or consultation groups, in which psychotherapists interact with other likeminded professionals in the fields of social work, psychotherapy, and / or psychoanalysis.

17 22.

Race or Races: Invented social categories that are nonetheless socially real and

reenacted in everyday life via encounters in numerous situations and spaces (BonillaSilva, 2015). 23.

Racism: Anything—a thought, feeling, or action—that uses the notion of race as

an activating and organizing principle (Dalal, 2006, p. 57). Racism is a construct that implies a subordination of ethnic-group differences of many kinds to an ideology of essential racial difference based on non-essential matters like skin color and hair texture, with the purpose of power and resource negotiation and the maintenance and justification of hierarchy (Hamer, 2014, pp. 217, 226). Racism is . . . a network of social relations at social, political, economic, and ideological levels that shapes the life chances of the various races as well as the product of racial domination projects (e.g., colonialism, slavery, labor migration, etc.) . . . embedded in societies (Bonilla-Silva, 2015). 24.

Traumatic Immigration: Trauma in the context of immigration can take place

via numerous channels, including: a. Experiences in the country of origin. b. Traumatic events during transit to the host country. c. Continual rejection in the host country. d. Substandard living conditions in the new country (Pérez-Foster, 2001, p. 155). 25.

Trauma of Dislocation: When pain, regret, and feelings of unbelonging (of

oneself to the external world, and of the external world to oneself) emerge and cause great distress. One simply does not feel "at home" (Akhtar, 2007).

18 Statement of Assumptions This study included several assumptions. The first assumption was that the immigration experience was inherently traumatic and stressful, and that it required an extraordinary amount of inner resources to acclimate and survive in a new environment. Several immigration scholars asserted this claim (Akhtar, 1999a; Tummala-Narra, 2014; Pérez-Foster, 2001). Akhtar (1999a) stated that the immigration process was more traumatic to those who were forced to leave the country of origin due to violence or natural disasters, but that all immigration experiences were inherently traumatic. Ainslie and others (2013) assumed the same position and advocated for more inclusion of trauma studies within the context of immigration in psychoanalytic writing. Similarly, PérezFoster (2001) delineated four specific periods in which trauma permeated the immigration experience. The second assumption in this study was that IPCs might face more difficulties in acculturating and succeeding professionally than their White immigrant counterparts due to racism in the United States as a whole and, as an extension, in the psychotherapy community. This assumption stemmed from two things: the political climate in the United States, in which race permeates all areas of people’s life, and accounts from psychoanalysts and psychotherapists of color about race-related encounters with their clients and the psychotherapy community. Several authors have described learning to manage racially related questions from clients as well as the existence of racially charged dynamics with White colleagues—for example, White colleagues not referring White clients to IPCs, as if IPCs lacked the

19 ability to serve anyone other than their own people (Akhtar, 1999c; Leary, 2000 & Winograd, 2014). The study’s third assumption was that topics of immigration and race had been neglected by the psychoanalytic and psychotherapy community. Several authors mentioned the lack of sufficient discussion of race and immigration in psychoanalytic literature (Akhtar, 1999c; Hazel, 2013). Also, I had presented on this topic, and attendees—most of them psychotherapists of color—requested a list of readings used in the presentation, as well as the creation of more presentations and groups in which they could safely discuss such topics. The study’s fourth assumption considered that IPCs’ subjectivity and identity played a significant role in therapeutic treatment; therefore, it was not only the client’s subjectivity that counted, but also the therapist’s. The blank-screen conception—in which the therapist or analyst’s subjectivity needed to be removed from the process to allow for a clear stream of associations—might not work best in this context, or even be possible when race and immigration created constant alarms that were unconscious, and thus unprocessed. This study recognized associations as being interconnected with reality; for instance, the psychotherapist’s apparent and obvious racial identity existed in relation to the client’s inner reality and conflicts. In this way, there was a co-creation of meaning of two unconscious processes in which inner and outer reality—from the internal intrapsychic to the external social reality—continually met and engaged. Many researchers, particularly relational psychoanalytic theorists, have assumed the importance of the psychotherapist’s subjectivity in transference and countertransference processes (Benjamin, 1990; Hoffman, 1983).

20 Epistemological Foundation of Project This study located itself within the social-constructivist tradition and considered four important assumptions, the first of which Gergen (2009) stated as follows: “The way we all understand the world is not required by what there is” (p.5). In terms of this study, we should not take for granted simple explanations about immigration and IPCs; I did not assume only one explanation of reality but considered multiple analyses. Therefore, as Gergen (2009) mentioned, my ideas about reality could shift at any time during the course of this project. The second stance, according to Gergen (2009), implied that everyone’s understanding of the world was not the truth but a construction based on the relationships sustained with others. Most ideas and thoughts brought forward in this study were the result of my personal relationships and experiences, as I have identified with most of the literature written on the immigrant psychotherapist and psychotherapist of color. My interpretation of reality was based on my experiences as a woman, immigrant, person of color, and psychodynamic psychotherapist. Gergen’s (2009) third stance stated, “Constructions gain their significance from their social utility . . . When we say that a certain description is ‘accurate’ . . . or ‘true’. . . we are not judging it according to how well it pictures the world” (p. 10). In other words, I could not affirm that my assertions were a clear picture of reality because I was judging the issue of immigration in this study according to how well it represents my reality and the subjects’ reality. However, regarding immigration, only a few dominant voices had ascribed to themselves the telling of truth and shaping of reality. Other voices, such as the subjects of this study, told an alternative story that emerged during the subsequent

21 chapters. This alternative story matters because members of the psychotherapy community could take their perceived reality for granted, without considering that their perceptions were embedded in social constructs that, when left unexamined, favor racism, exclusion, silence on important social issues, and lack of ownership of whiteness. Gergen’s fourth assumption stated, “If we long for change, we should shake up our traditional ways of constructing the world and set out to generate new ways of making sense” (Gergen, 2009, p. 12). This implied that there existed (a) a standard way of thinking within psychoanalysis, (b) different factions in psychoanalysis, and (c) groups who speak on behalf of people of color and immigrants. This study’s approach to the IPC’s unspoken reality allowed for transformation of common ideas and assumptions. This transformation situated us within a new perceived reality, which included the possible ways in which I participated in the oppression of others.

Foregrounding I became interested in this study for many reasons, some of which relate to my own experience and struggles with moving to the continental United States from Puerto Rico, and the psychic demands I experienced in this process. My immigration experience presented overwhelming feelings of homesickness and demands of assimilation; I resisted the latter in multiple ways. I was critical of how society expected me to assimilate without providing the necessary space and respect to mourn the loss of leaving Puerto Rico. My perception was that any expression of attachment to Puerto Rico was perceived by others as something questionable, a threat, or a lack of gratitude for what the host

22 country provided. Because of my attachment, I went through a process of idealizing the place where I was born and raised. As I tried to make peace with my decision to move to mainland United States, I entered the field of social work in Chicago. I had already earned a master’s degree in social work from the University of Puerto Rico. Studying in Puerto Rico before emigrating to the United States provided me with a clear perspective and exposure to theories, such as the pedagogy of the oppressed and Marxist theory, among other foundational sociological theories. These theories gave me the perspectives necessary to assume a political stance early in my counseling work with immigrant survivors of domestic violence. I encountered many challenges during my first years and in my later work as a clinical social worker. Some of these challenges involved having to explain to White social workers my perspective as a woman of color. I also advocated for more racially friendly spaces, administrative protocols, and decisions for minority clients. However, the experience that drove me the most to conduct this study pertained to my struggles in developing and succeeding as a psychotherapist in private practice. Some of my first obstacles in private practice related to cultural misunderstandings and structural resistance. Other contributing factors included a presumed incompetence about me as a woman of color. And finally, my struggles in asserting myself amid numerous structural challenges. I had experiences with White clients and psychotherapists that were profound, in that they made me aware of race-related biases in the clinical encounter and in the psychotherapeutic community. These biases would make success more difficult for a psychotherapist to achieve. I began asking other minority psychotherapists about race and

23 immigration in regard to their psychotherapy and psychoanalytic practices, and I started my own research by reading everything I could find on such topics. I found others had similar struggles, and I realized that some of the unspoken and unacknowledged realities that immigrant psychotherapists faced in their practice with clients require space to be named, spoken, and acknowledged.

Chapter II

Literature Review Introduction The following literature review was divided into sections addressing the following major topics: 1. Sociological literature on immigration and race. This section explores concepts such as: a. Race. b. Racial identity. c. Color-blind Racism. d. Immigration. e. Social inclusion and exclusion. f. Colonialism. g. Discrimination. 2.

Historical overview on psychoanalysis and immigration.

3. Current psychoanalytic literature on immigration and psychotherapy. This section explores concepts such as: a. The trauma of immigration. b. Loss and mourning. c. Not feeling at home.

25 d. Language. e. Acculturation. f. Geographical dislocation. g. Nostalgia. 4. Transference and countertransference as they relate to the immigrant psychotherapist and the psychodynamic encounter. 5. Historical overview on psychoanalysis and race. 6. Current psychoanalytic literature on race and psychotherapy. This section explores concepts such as normative unconscious and skin color. 7. The psychotherapist of color and the psychodynamic encounter regrading transference and countertransference. 8. The immigrant psychotherapist of color in community. 9. Theoretical framework. 10.

Relevant studies. I conducted literature research via several resources, including:

Psychoanalytic Electronic Publishing.

EBSCO host.

Google Scholar.

Local libraries.

The United States National Library of Medicine National Institute of Health. My search included the following key terms, some which I searched in Spanish,

e.g., “psicoanalista immigrante.” Therefore, my literature review includes Spanishlanguage sources on:

26 1.

Psychotherapist race composition.

Immigration.

Race.

Racism.

Racism history.

Psychotherapist of color.

Psychoanalyst of color.

Immigrant psychotherapist.

Immigrant psychoanalyst.

10.

Immigrant and host country. I also selected relevant articles assigned as doctoral coursework, as well as

readings recommended by my dissertation committee. My search produced some topics beyond the scope of this study, e.g., psychotherapeutic work with immigrants and related issues of cultural competency, which I excluded.

Sociological Literature on Immigration and Race The topics of immigration and race figured prominently social and political discourse in the United States. Both topics represented core historical parts of the formation and historical development of current US society. Sociologists, historians, educators, and philosophers including Diangelo (2018), Fredrickson (2015), hooks (1989), Lotto (2016), and West (1993), had addressed this development via topics including:

27 1.

The immigration and settlement of White colonizers.

Colonizers’ commandeering of Native American and Mexican land.

The genocide of Indigenous people.

The lynching and enslavement of forced African migrants who were condemned

to live in poverty and exploitation for many years. This history of domination created a White-oriented society in which White people devalued and prevented non-White people from integrating into current society. This exclusion found its roots in historic racism and colonization, the two structural pillars supporting inequality against people of color in the United States. The concept of race developed as the result of historic racism in the U.S. and Europe (Cobas, Duany, Feagin, 2016). Race was created with the purpose of attributing inferior qualities to minority groups based on biology, which White people used to justify inequality. The justification for unequal treatment was subsequently institutionalized (Diangelo, 2018). Bonilla-Silva (2015) described how we “. . . conceive ‘race’ . . . as primarily a biological or cultural category easy to read through marks in the body (phenotype) or the cultural practices of the groups” (p. 1359). Therefore, most expert sociologists regarded race as a social construction with no real biological utility or meaning, besides Othering and protecting White privilege. Racism as an ideology formed the basis of all institutional laws and policies against African Americans and minorities in the U.S. However, racism took new subtle shapes and forms. As a result of the Civil Rights movement, many White people recognized that overtly racist actions were morally inappropriate. Blatant racism

28 conflicted with White American’s proclaimed values of freedom (Diangelo, 2018). Therefore, racism became more subtle but still systematic. Bonilla-Silva (2015) described this subtle racism as “color-blind racism,” a variety that is “no longer overt, seems almost invisible, and seemingly nonracial” (p. 1363). Bonilla-Silva further characterized color-blind racism as a racial ideology that applies the principles of liberalism to “. . . racial matters that result in raceless explanations for all sorts of race-related affairs” (p. 1364). As a result, racism was not regarded as racism, but as a result of decisions that individuals willingly and freely made within the context of a free country that provided all citizens with equal opportunity. For example, fewer people of color have taught and studied at U.S. universities. Through the lens of color-blind racism, universities had fewer professors of color because universities received fewer applications from professors of color. Also, through this lens, universities understood they thoroughly evaluated all prospective students and simply chose the best applicants, which had nothing to do with students’ racial characteristics. For an institution, this reasoning was easier than looking at racial systemic barriers for professors and students of color (Diangelo, 2018; hooks, 1989). Race, as ascribed to different minority groups, might not have biological meaning. However, race justified racist practices in the U.S., and had thus become an important means of defining cultural and personal identities. Racial identity, therefore, was a symbolic internal representation of personal identity within the realm of society. BonillaSilva (2015) stated that as “. . . subjects face similar experiences, they develop a consciousness, a sense of ‘us’ versus ‘them,’” and that

29 “. . . after the process of attaching meaning to a ‘people’ is instituted, race becomes a real category of group association and identity” (p. 1360). Racial identity has factored into the organization of oneself and others in relation to all social interactions and internal experiences. This organization would increase when society reminded citizens of their racial identifications. Cobas and others (2016) discussed how White people racialized U.S. Latinos as “brown people” following the incorporation of Mexican territory and the annexation of Puerto Rico. After the Spanish American War of 1898, White people began describing the inhabitants of Cuba, Puerto Rico, and the Philippines as dark-skinned, poor, and primitive. Due to this history, contemporary references to a Latino person in the U.S. could trigger assumptions regarding class and skin color that ultimately portray Latinos as less than White people. The literature connected race and racism to issues of immigration. This was particularly the case when immigrants had come to the U.S. from countries whose inhabitants were predominantly people of color. This group of immigrants usually came from developed countries that were negatively impacted by new eras of globalization (Suarez-Orozco, 2005). Immigration benefited wealthy host countries via an influx of workers, but host-country citizens often perceived immigrants as a threat, which inspired xenophobic and anti-immigrant sentiment. My literature review found that the majority of U.S. immigrants come from Latin America and Asia, and their experiences were heterogeneous. Some were low-skilled paid workers, while others held advanced degrees. The review also indicated the following reasons for immigration: family reunification, employment, upward mobility, lifestyle change, war, political conflict and natural disasters.

30 Race and immigration involved colonialism. The era of colonization might appear to belong to history, but the ideology that justified colonization influenced immigration and racial dynamics. Albert Memmi (2001) discussed colonizers and the colonized. He stated that in order to have a lower class of colonized people who could provide cheap labor for low-quality jobs, there must be powerful and affluent colonizers creating laws that reserved for themselves lucrative forms of employment. The legacy of White European colonization has informed racism in the United States and the U.S. preference for immigrants from predominantly White countries. In addition, regulatory and economic laws have primarily benefited those of high social class, i.e., White people (Bonilla-Silva, 2015). For Whites to preserve their high status, they needed a lower social class with low-paying jobs, primarily consisting of people of color. Race, immigration, and colonialism were often connected to the experience of exclusion. Twenge and Baumeister (2005) discussed belonging as fundamental to human life, and posit that rejected people react with anger, resentment, and retaliation. These reactions prompt conflict, thereby perpetuating a cycle of additional exclusion and conflict. Exclusion harms communities where excluded people live and work because exclusion increases mistrust and inequality. Major and Eccleston (2005) discussed exclusion as a means for majority groups to achieve (a) alleviation of discomfort, (b) system justification, and (c) status preservation. Also, people tend to respond to their exclusion by (a) finding alternative means for inclusion within the stigmatized group, (b) blaming the group’s prejudices directed at them, and (c) facilitating for excluded members a shield from negative evaluation, which protects self-esteem and ideological perspective.

31 The literature differentiated between racism and discrimination. Diangelo (2018) explains that because racism indicates systemic oppression and not isolated individual acts, a given act against a person of color constitutes discrimination, not racism. For an act to constitute racism, the individual who commits the act must have the support of a system of oppression. hooks (1989) highlights the difference between domination and prejudice, alluding to individual explanations of discrimination versus systemic oppression. Overall, discrimination entails actions against a person belonging to a societal group seen in unfavorable terms.

Historical Overview of Psychoanalysis and Immigration To discuss the subjective experience of the immigrant psychotherapist of color (IPC), we need to consider the centrality of the immigration experience to the development of psychoanalysis and to its founder. Sigmund Freud was Jewish, which positioned him within a marginalized societal group. Freud knew that his ethnicity might open his work to unfair scrutiny, and this awareness influenced some of his professional decisions. In addition, some writers, including Vispo and Podruzny (2002), attested to Freud’s ability to speak both Czech and German, in which case Freud’s foreign self would have remained present during his life. Freud emigrated from Freiburg to Vienna when he was three years old, and later emigrated from Vienna to London to escape the Nazis. After traveling by train, he often had no recollection of the journey. This may be due to the psychic disorganization of his early migrations. Such psychic pain could explain Freud’s resoluteness to remain in Vienna despite the approach of Nazis. Akhtar (2006) asserted that Freud’s childhood

32 migrations carried a psychological impact, as Freud never forgot about Freiburg’s forests and often criticized Vienna for its shortcomings, perhaps because Vienna was not Freiburg. It was not only Freud who lived this experience but also other European immigrant analysts who, according to Boulanger (2004) and Grinberg and Grinberg (1989), emigrated to safer European countries or to the United States in order to escape “. . . the Nazis and the ravages of World War II” (Ipp, 2013, p. 551). These immigrant analysts pioneered the emergence of psychoanalysis in the United States during the early 1940s. Despite the history and connection of psychoanalysis to immigration, psychoanalytic theorizing has not sufficiently addressed immigration (Ainslie, TummalaNarra, Harlem, Barbanel, and Ruth, 2013; Boulanger, 2004; Gringberg and Gringberg, 1989; Kuriloff, 2001), despite the fact that in any clinical encounter, the client or therapist (or both) might have been immigrants. Among early immigrant analysts, the topic of immigration might have evoked a fear of annihilation, as it evoked ostracized minority groups’ search for safety, particularly as relating to Jewish people. In order to survive in their new environments, these analysts had to acclimate, which in some cases meant that they “. . . abandoned social, cultural, and political traditions that have been part of psychoanalysis in Europe” (Jacoby, as cited in Ainslie et al., 2013, 664). Akhtar (2006) posited that analysts did not discuss immigration because they were exiles, as opposed to being immigrants. When one’s place of origin still exists and one can return, the immigrant is likely to fantasize about going back. When one is forced

33 to migrate due to war or human tragedy, however, there is no hope of return or opportunity to fantasize. To forget a traumatic past, the exiled analyst might deny cultural differences between themselves and their clients. It took a considerable amount of time for psychoanalysts to speak about their exodus and their transformation into “. . . othered selves in a new land” (Ipp, 2013, p. 551). Regarding early immigrant analysts, we should highlight how being the Other has been traumatic for some, as the self needs to adjust to a newly imposed identity. Another reason the psychoanalytic community might have ignored the immigrant experience involves the focus on analytic theory regarding intrapsychic reality. The idea that immigration exists outside the intrapsychic experience explains immigrant psychoanalysts’ silence regarding their immigration history. Moskowitz (Winograd, 2014) discussed how psychoanalysis has prioritized drives and internal objects, thereby overlooking the profound traumas sustained by experiences with racism, culture, immigration, and marginalization. Psychoanalysts are taught that clients discuss the outside world as a means of defense against their internal world. Immigration falls into the “outside world” category. Psychoanalysis distinguishes itself from other theoretical fields by emphasizing the importance of the internal human experience in helping people take responsibility for their lives and the world “out there” (Kuriloff, 2001). This perspective makes it difficult to address the external world while remaining within this particular psychoanalytic perspective. However, the discussion of these topics becomes more relevant for the psychoanalytic community when considering (a) sociopolitical and demographic

34 changes, (b) how those changes impact worldviews, and (c) the diversity of clients in the clinical encounter (Ainsle et al., 2013).

Current Psychoanalytic Literature on Immigration and Psychotherapy The trauma of immigration. Several authors have discussed the psychic impact of the immigrant experience. Some have considered the immigrant self as a new form of identity that is foreign to the individual. This identity arrives suddenly and without warning (Ainslie, 2017), intruding upon the existing identity, which was nurtured, held, and sustained by a community of people in the individual’s early life. Ainslie (2017) described the immigrant’s previous holding community as “psychic entities” (p. 695) that served powerful psychological functions. The holding function also sustains the idea of “play” in ways akin to Winnicott's formulations. Ainslie added other important functions such as (a) the “use” of the me-not-me zone of experience, which separates the desire for fusion and fear of disintegrating abandonment, (b) the potential space created by the gap between symbiotic engagement, and (c) the maternal object. For Boulanger (2004), the disruption of the immigrant’s facilitating environment is traumatic. Once the individual comes to the host country, a psychic disorganization takes place, due to ruptured continuity between the self and its surroundings. This demands a reorganization, which might go unattained (Grinberg & Grinberg, 1989). The immigrant attempts to reconcile a double version of the self, which places intense demands on the psyche. Harlem (2010) stated that immigration includes an inner reality

35 in which parts of the self are left behind and others never arrive, getting lost in transit, without the possibility for reconciliation, mourning, or even acknowledgement. Ainslie and others (2013) discussed some of the common vicissitudes present in the immigrant experience: loss and mourning, language adaptation, ethnic identification and racism, trauma, and generational issues. These factors are present due to the process of losing a holding environment, and the hostile reception that usually accompanies the arrival to a new country. In this regard, Tummala-Narra (2014) mentioned how the traumatic immigrant experience can be compounded by issues including: discrimination, racism, interpersonal violence, lack of access to mental-health services, and the stigma within the immigrant community about looking for help. Akhtar (1999a) considered all migratory transitions inherently traumatic, whether for immigrants or exiles. However, he listed five differences between exiles and immigrants, and argued that the exile experience is more traumatic. This is because their movement between places usually occurs in response to a sociopolitical crisis or catastrophic event. The exile / immigrant distinction might extend to different processes of mourning and adaptation. Akhtar also enumerated the processes taking place in the immigrant psyche post-immigration: 1. Pain evoked by the awareness of separation. 2. Joy of a fantasized reunion with the motherland, which idealizes the future and robs the present of its full commitment. 3. A lifelong attempt of symbolic restitution. 4. Aggression in the memories of the exile toward the country of origin which contaminates positive memories of the motherland.

36 5. Assimilation complicated by a disappointing welcome from the new country. 6. Guilt over success and affluence, in addition to survivor’s guilt. 7. Not being able to fantasize about returning because there will be no return. Unlike other psychoanalytic authors, Pérez-Foster (2001) focused on external factors, or outer realities, related to the trauma of immigration. These factors occur before, during, and after immigration via the following stages: 1. Premigration trauma. 2. Traumatic events during transit to the new country. 3. Continuing traumatogenic experiences during the process of asylum-seeking and resettlement. 4. Substandard living conditions in the host country. Perez-Foster explained that premigration traumatic experiences prompt emigration, and that the trauma will resurface for years after arrival to the new country. While waiting for asylum and resettlement, immigrants are placed in a state of limbo inside camps or detention centers. If abuse or violence occurred in the country of origin, the negative atmosphere at these centers can elicit memories of previous trauma and emotional arousal. After settling in the new country, many immigrants live in poor communities without access to resources that might better their disadvantaged situations. Many immigrants encounter exploitation and substandard living conditions, which compound their psychological stress. Grinberg and Grinberg (1989) discussed internal processes in the psyche and life of the immigrant. The authors referred to Sigmund Freud’s definition of trauma in relation to the experience of migration. According to Freud, trauma results from the ego’s

37 inability to protect itself from an external threat (external stimuli) or internal threat (anxiety signal). This process leaves the ego defenseless. Freud also mentioned that trauma should not be considered in isolation but in conjunction with the individual’s history and previous personality traits. Grinberg and Grinberg (1989) stated the following: . . . migration as a traumatic experience comes under the heading of what have been called

cumulative traumas and tension traumas, in which the subject’s

reactions are not always expressed or visible, but the effects of such trauma run deep and last long (p. 12). Under this definition, immigration would prove especially difficult for those who, prior to emigrating, suffered adverse childhood experiences and / or the sustained loss of reliable objects while in their country of origin, as compared to immigrants who have reorganized in the face of a past crisis. These past experiences set the stage for either mental or physical illness, or creativity and reinvention.

Loss, mourning and nostalgia.

Akhtar was one of the first to write psychoanalytically about the process involved with moving from one country to another. In a short article titled, “The Immigrant, the Exile and the Experience of Nostalgia” (1999a), Akhtar described immigrant loss as manifested within homesickness related to familiar places, corners and cafes, landscapes, native music and food, in addition to people and family. The mechanism of nostalgia protected the individual from the rigors of mourning. Nostalgic people become acutely aware of cultural artifacts, which they hold in high

38 regard. Attachments to memories and artifacts sustain a sense of identity and of belonging to the country of origin. The immigrant’s loss of the homeland entails a continual fantasy to return. This robs immigrants of their ability to fully experience the present. Exiles experience loss to an opposite extreme. They have left behind their homelands due to war or natural disaster. Their sense of loss expresses itself via rapid integration into the new culture. The transition is quick because the exile has nothing to go back to. To Akhtar (1999a), the inability to fantasize deprives the exile of nostalgia, a common defense among immigrants. For Boulanger (2004), the immigrant process of loss manifests itself through dissociated states including “. . . affects, dreams and inexplicable enactments” (p. 356). These states represent the culture and aspects of the country of origin. Boulanger disagrees with the exile / immigrant distinction. The immigrant is on a quest to assimilate and will rarely acknowledge the absence (“absence” meaning a dissociated experience from the past) evoked by the loss of a contextual community. If immigrants pay attention to these memories, they risk experiencing alienation and depression. In this context, Boulanger describes the fear of never again being fully known. Later in his writing, Akhtar (2007) captured the specifics of immigration in terms of losses, nostalgia, and pain in the process of separating from the country of origin. The losses include the following: 1. Separation from a familiar ecological surround. 2. Loss of valued personal possessions. 3. Alteration in man-animal relationship.

39 4. Encounter with new utensils of living. Akhtar intentionally left people and family outside the scope of his description of loss. Conversations regarding nostalgia for many immigrants revolve less around people and more around landscapes, precious objects, animals common in that geographical area and the specific ways in which they used to operate in their daily life with such mundane things as utensils. Denford (1981) explained that the immigrant can safely long for concrete and stable aspects of home, whereas people are not concrete and stable. They could leave or die. Some immigrants experience intense pain when learning about natural disasters or war in the homeland, because these disruptions can destroy the longed-for stability. Eng and Han (2000) explained loss and melancholia as more social than individual. This differs from Freud’s melancholia, which only involves the self in the mourning process. The authors posited that the immigrant could not work through loss within a Freudian model, which would require the host country to contribute certain factors to the immigrant’s process of loss and subsequent integration. Such contributions might include the new country’s desire to integrate and accept newcomers. Eng and Han stated that these factors are scarce in the U.S., where immigrants often feel like perpetual outsiders with a sense of not belonging. Beltsiou (2016) seemed critical of the literature’s emphasis on displacement and mourning of the homeland. The scholar cast doubt on the assumption that the immigrant feels he or she once belonged, arguing that immigrants leave countries of origin specifically to escape a feeling of not belonging. Home can just as easily be outside the homeland and inside it. Immigrants carry their earlier experiences of culture and family,

40 which continue to influence life choices regardless of their current location. The act of cutting off earlier ties can evidence resistance and self-preservation. Beltsiou emphasized idealization and romance of the new place focusing on immigrants’ sense of excitement around change and growth. This perspective resembled Akhtar’s (1999a) description of the exile’s idealization of the new country, but Beltsiou seemed to identify with the experience of those who come to a new country without necessarily being an exile escaping from war or natural disasters, and still have a romance with the new country. Beltsiou was not an exile. Her 2016 work provides a different perspective of being an immigrant, but without the experience of nostalgia and loss.

Not feeling at home or the trauma of dislocation. Immigration scholars have commonly described a prolonged sense of not feeling at home. Some immigrants feel they do not belong to the host country or the country of origin. The host country rejects them as strangers, and the homeland rejects them as deserters. A more intrapsychic factor involves the feeling of being uprooted from the country of origin, which leaves an absence, a sense of disconnection. Akhtar (2007) conceptualizes this as “geographical dislocation” or the “trauma of dislocation.” The external world provides a necessary sense of continuity and input, whose disruption entails significant mental pain. Akhtar describes this interruption as “. . . pain, regret, and feelings of unbelonging (of oneself to the external world, and of the external world to oneself) that emerges and causes great distress. One just does not feel ‘at home’” (pp. 168-169).

41 Denford (1981) contemplated this sense of unbelonging, particularly when returning to the country of origin, asking, “What are the implications of a late return? Psychologically, surely, one cannot reverse a death that has been mourned? The objects have been given up, allowed to be dead” (p. 331). This describes the complex internal experience of immigrants who have left the country of origin and experienced loss, with which they have apparently come to terms. Mourning the homeland experience brings closure, and reunification with it feels emotionally disconnected and dislocated, a kind of an emotional dissonance.

Language. Scholars have emphasized the role of language and double consciousness in the psychological struggle of immigration. Pérez Fóster (1996) stated that “. . . language is acquired within a complex matrix of social-contextual, object-relational, intrapsychic, and psycholinguistic elements” (p. 99), and that for the bilingual speaker, languages are “. . . signifiers of unique self-representations internalized at the time of respective language acquisition and early usage.” Language has abundant meaning and identifications, all connected to deep emotional and early object-identification processes. The acquisition of and attachment to language draws from early years of attachment formation. Walsh (2014) stated that language develops in an object-relation context. Alves (2016) considered the use of original language as a metaphase of resistance to the host culture. Ainslie and others (2013) observed that speaking the new language might lead to

42 “. . . disequilibrium in self-structures and narcissistic wounds” (p. 668) due to the disparity between an individual’s talents and what one can verbally convey in the new language. Therefore, the native language loses its utility and is experienced as a loss. This can result in clinging to the past via nostalgia and idealization of one’s original culture.

Acculturation. Vargas Llovera (1996) observed that ethnic minorities from underdeveloped countries suffer processes of (a) rejection, (b) acculturation, and (c) marginalization. The host country expects immigrants to reject their original identities in exchange for acceptance, which causes profound psychic conflicts, especially regarding loyalty. Vargas Llovera (1996) described this social requirement, known as “assimilation,” as a process experienced by a minority group that has moved to a country with an established dominant culture. Assimilation requirement ultimately results in the annihilation of the original cultural identity. The host country can perceive the immigrant as an intruder or as a welcome peer. Grinberg and Grinberg (1989) explain that how the new country welcomes the immigrant will influence how the immigrant develops attachments with the new country. The development of attachments also depends on the types of object relations that the immigrant experienced prior to relocation, as well as the object relations of the receiving community. All these factors combine with the processes of (a) adaptation, (b) adjustment, and (c) assimilation determine how a given immigrant will fit into the new country and community.

43 Boulanger (2004) argued against assimilation and criticized psychoanalysts who work towards it with clients. To Boulanger, these analysts collude with the immigrant’s attempts to dissociate memories from the culture and country of origin. This perspective raises the prospect that the psyche cannot truly assimilate, since assimilation demands disavowal and denial of the former self. Boulanger proposes a more integrated space in which multiple selves can coexist without one colonizing the Other. Eng & Hang (2000) also contend assimilation is impossible for the Asian and immigrant of color because of skin color or facial features. Garza Guerrero (1974) proposed the term “cultural shock” to denote a three-phase mourning process. Cultural shock concludes with two possibilities: integration to the new culture, or resistance characterized by stagnation within an idealized past. The first phase of cultural shock entails a traumatic encounter with the new culture. The obvious incongruence between internal identity and the external world is complicated by feelings of sadness, anxiety, hostility, and desperation. External reality can no longer help maintain continuity in the identity process. Thus, environmental feedback stops corroborating the ego. Guerrero (1974) says, “. . . a sense of continuity, consistency and confirmation are particularly in danger in this phase of culture shock” (p. 419). The second phase is reorganization. By this point, the immigrant has experienced some level of acceptance of the new culture. A reaffirmation of the past cultural identity occurs, by way of two core elements: good internalization of past object relations, and a more accurate realistic perspective on the past culture. The immigrant can now introject aspects of the new culture into the self.

44 The final phase entails the development of a new identity. This is characterized by a process of continual editing that coexists with sustained feelings of longing for the past culture that, while strong, do not overwhelm the immigrant. As one identifies with certain aspects of the new culture, a sense of ease and belonging emerges, providing a sense of sameness, continuity, confirmation, and reciprocal corroboration.

The Immigrant Psychotherapist and the Psychodynamic Encounter Transference and countertransference. Throughout the history of psychoanalysis, the concept of transference has received wide discussion. Transference, as conceived from a traditional perspective, indicates the client’s feelings toward the therapist as they pertain to the client’s psychic structure and conflicts. This is consistent with Freud’s initial explanation, in which the client transference requires further analysis and exploration. Early practitioners began to understand that transference includes more than the client’s distorted views of the therapist. Analysts also have their own subjectivity, or countertransference. A contemporary psychoanalytic perspective will include the importance of therapist’s subjectivity, while acknowledging the client’s sense of the therapist’s subjectivity, and the client’s sense of the therapist’s reaction toward them. When grappling with their own fantasies and possible feelings involving the therapist, clients learn about their own psychology and the therapist’s psychology. Aaron (1991) explained that clients are constantly trying to understand the therapist’s individual psychology and will communicate it “. . . indirectly through allusions to others, as

45 displacements, or through descriptions of these characteristics as aspects of themselves, as identifications” (p. 36). Understanding how transference manifests in the clinical encounter clears the way for a new consideration: how transference manifests in the clinical dyad when the therapist is an immigrant. Akhtar (1999c) discussed how the therapist’s identity factors into transference and countertransference. Patients might demand to know more about the immigrant therapist’s identity, which to Akhtar indicated the need to establish limits. By setting these limits, clients will be able to elaborate on their fantasies and ideas regarding the therapist’s identity which would help to steadily elucidate the client’s inner conflicts. Other examples of these dynamics include (a) clients’ disguised and displaced references to the therapist’s ethnicity and race, (b) clients trying to protect the therapist from feeling like a foreigner, and (c) clients wanting the therapist to use their native language. Comas-Díaz and Jacobsen (1991) outlined the multiple ways transference can emerge in clinical encounters between therapists and clients from similar culture and ethnic backgrounds. These transference configurations include (a) the omniscientomnipotent therapist; (b) the traitor; (c) the autoracist; and (d) ambivalence. The omniscient-omnipotent therapist involves the client idealizing the therapist into the good parent, the savior, or the hero / heroine. The savior has achieved success in an oppressive society and can therefore rescue the client, who takes a passive role in treatment. The traitor manifests when the client feels envy or resentment at the therapist’s success and believes the therapist is “selling out.” In autoracist transference, the client experiences identity conflicts with their cultural background; this results in strong negative feelings about themselves, which they project onto the therapist. In ambivalence,

46 clients might appear comfortable with similarities between their cultural and ethnic identifications and those of the therapist, but clients fear that the similarities will bring too much closeness. Comas-Díaz and Jacobsen (1991) discussed transference in dissimilar dyads. When client and therapist do not share cultural or ethnic backgrounds, four specific transferences might occur, including: (a) overcompliance and friendliness; (b) denial of ethnicity and culture; (c) mistrust, suspicion and hostility, and (d) ambivalence. Overcompliance-and-friendliness transference usually occurs when there is a power differentiation in the therapeutic dyad. Clients who belong to minority groups comply to avoid conflict or negative perception. When the client belongs to a dominant cultural group, the patient could comply to be a good patient or benevolent to the minority therapist. Denial of ethnicity and culture lessens discomfort with reality and power differentiation. Mistrust, suspicion, and hostility indicate that the client questions the therapist’s ability to help, given ethnic and cultural differences; if left unaddressed, this mistrust can lead to hostility. Finally, ambivalence involves the client forming an attachment with the therapist while simultaneously directing negative feelings toward the therapist. The literature included several examples of countertransference for immigrant psychotherapists in the clinical encounter. Comas-Díaz and Jacobsen (1991) described several instances in which countertransference can be present in dyads with similar cultural and ethnic identifications—for example, an immigrant psychotherapist with an immigrant client. These instances include: overidentification, the idea of us and them,

47 distancing, cultural myopia, ambivalence, anger, survivor’s guilt, and finally, hope and despair. Overidentification can lead therapists to provide too much therapy that is supportive, instead of analytic and challenging. The idea of us and them can surface when therapists feel a shared identification with the client due to belonging to an oppressed minority group. In such instances, therapists might attribute the client’s problems to ethnic-group victimization, and avoid the client’s personality traits, inner conflicts, and self-destructive behavior. Distancing takes place when therapists fear overidentification, as there are similarities in their own struggles with the client. Cultural myopia describes the moment when therapists cannot look beyond shared values with the client, thereby hindering therapeutic progress. Ambivalence takes place when therapists introduce into the therapeutic encounter their own ambivalence towards struggles with racism, ethnic identification, assimilation, and multiculturalism. Ambivalent feelings pertaining to ethnicity and race can transform into the sixth type of countertransference, anger, especially when closeness developed in the therapeutic dyad leads to intrapsychic conflicts. Survivor’s guilt resurfaces in successful therapists who have escaped poverty, oppression, low income, and poor education while leaving family and friends behind; to manage their guilt, they might focus on activism and politicizing the clinical encounter, thereby failing to explore the client’s intrapsychic presentation. Hope and despair can arise when the therapist seems hopeful about the client’s future, but also feels despair for the client’s difficulties due to adversity in the therapist’s past.

48 Some analysts delineate countertransference as arising from their own experiences. For instance, several immigrant therapists might recognize that their histories of immigration interfered with successful treatment. Carlisky and Kijak (1993) discussed several clinical examples. While treating a client, one therapist’s conflict with his own history of family migration was reactivated. The therapist tried to minimize and distance himself from his own experience and history of family migrations. Connecting with the suppressed understanding that he belongs to a family of immigrants helped the therapist understand the vicissitudes of moving to another country. In another anecdotic case, a client was deciding whether to move to another country. The therapist tended to advise against the move, to avoid problems related to immigration. The therapist explored his personal history and realized that his own migration, which he experienced at a young age, had entailed economic and emotional losses. The therapist connected his personal history with the interpretations he shared with the client in the clinical encounter. This allowed the therapist to develop a different approach to interpretation and identify new opportunities to explore the client’s subjacent conflicts. Akhtar (2006) assumed that the immigrant psychotherapist’s countertransference requires attention to avoid potential complications including: (1) difficulty in maintaining cultural neutrality vis-à-vis his “native” patients, (2) wondering about the patient’s choice of him particularly as the analyst, (3) scanning the patient’s association for interethnic clues to deepen the transference, (4) negotiating the dilemmas posed by conducting analysis in a language other than one’s mother tongue, and (5) avoiding shared

49 projections, acculturation gaps, and nostalgic collusion in working with homoethnic immigrant analysands. Aaron (1991) did not recognize a clear line between patient and therapist subjectivity. Ruiz (2015), in a similar stance, detailed his experiences as an immigrant therapist with countertransference, stating that in the clinical encounter he can monitor his internal states for shifts related to his experiences of migrating between Mexico and the United States. While listening to a client’s description of single-status experience, Ruiz recounted having “. . . the distinct feeling of migrating to a different level of experience, which felt charged, connected, along with an allowance to roam more ‘Wild West’ landscapes” (p. 129). Ruiz used “Wild West” to describe the excitement and sense of risk he felt when crossing the U.S./Mexico border as an adolescent. When “Wild West” feelings surfaced during the clinical encounter, Ruiz (2015) recognized it as a cue that he was embarking on deeper internal travels with the client. This recognition helped Ruiz consider possible unconscious processes pertaining to the client’s experience. Also, Ruiz’s Spanish-language associations signaled to him that the client was in touch with deeper internal states. Ruiz commented on the idea of overidentification with clients, stating that he could separate his experience from that of the client by his own process of inner working splits. In this regard, countertransference did not obstruct the therapeutic process or indicate the need for more therapeutic work. It instead facilitates unconscious development and informs the therapist of the client’s emotional state. When describing a clinical case, Mattei (1999) mentioned her ethnic identification and how, despite ethnic similarities, differences in the dyad created a shared space for

50 identification. During one instance, Mattei stared at the client’s physical traits, just as Mattei imagined others would stare at her. She realized that she was identifying as a White North American therapist when working with the client, when she was in fact a therapist of color. Language also played a role with this client. Spanish was Mattei’s (1999) first language and her client’s second language. Mattei mentioned instances in which she spoke Spanish with the client, cognizant that Spanish was her father’s language, and thus the language of the aggressor. Mattei helped the client to experience the language of her parents in a new way. Lobban (2016) discussed her experience of overidentification with Spanish spoken by her client’s boyfriend. This alludes to the reference by Comas-Díaz and Jacobsen (1991) to overidentification in similar ethnic dyads. Lobban felt protective of her client’s boyfriend because, in her judgement, he was being subjected to mainstream culture, as represented by her client. In fact, her client’s apparent intolerance of her boyfriend speaking a language besides English was an enactment between client and boyfriend. Initially, Lobban (2016) did not recognize that her advocacy for the boyfriend’s right to speak another language was a countertransference. The enactment consisted of the boyfriend making her client feel like a “foreigner,” so that the client could understand how it feels to be an outsider. On the other hand, the client also made him feel like she was intolerant of his right to speak a different language. Another case discussed by Lobban (2016) involves her identification and feelings of kinship toward a White European client who left corporate America to join Barack

51 Obama’s political campaign. Their discussions of politics seemed necessary to the client’s development of self and identity. At first, his identity resembled that of his father, as a capitalist. The therapist provided space for this development, which seemed easy because the political values of client and therapist were congruent. However, a moment of separation occurred when the client resorted to conflicting family patterns, which the therapist found problematic. Despite both being immigrants, the therapist and client came from different families and contexts, as the therapist realized. Beltsiou (2016) related the multi-layered and complicated nature of experiences shared with her client, pre- and post-migration. As a White immigrant therapist in a therapeutic dyad with a client who is an immigrant of color, Beltsiou described her discomfort of acknowledging her privilege as her client pointed out how racial difference prevented Beltsiou from fully understanding the client’s experiences. This difference also prevented the client from feeling fully at home with Beltsiou, which deepened the client’s transference of loneliness and alienation in relation to the therapist. Beltsiou also described her initial reflections and reactions during the first phone conversation and initial treatment with the client, in terms of social signifiers of racial identity and accent. Beltsiou explained these reflections as her attempt to locate “home” for her client as she wondered about his historical context. At the same time, in her countertransference, Beltsiou asserted that she attempted to find the client and make him recognizable to her. In that search for recognition, they found a common experience of un-belonging. Delboy (2020) discussed an instance of countertransference that related to the unconscious social hierarchies of Peru, although the related treatment took place in the United States. This occurred within a clinical encounter that Delboy experienced as

52 uniquely visceral, corporeal, and profound. Language factored into this experience, as both Delboy and the client spoke Spanish as their first languages. However, there was also the mutual and exclusive experience of being Peruvian. Indeed, Delboy found himself experiencing the client from a unique Peruvian social and racial location which resembled social interactions in Peru. Delboy acknowledged that this sense of shared racial and social-class identification implied its opposite: the dissociation process that takes place when the therapist is not aware of cultural, racial, and social biases even when sharing the same country of origin with the client. As such, Delboy argued, the unconscious includes the social and cultural.

Historical overview on psychoanalysis and race. Early psychoanalytic discourse implied that psychoanalysis could be applied to all subjects regardless of ethnic, cultural, or geographical origins. For example, early theorists did not allude to race or skin color, although Freud referenced “primitivity” to symbolically discuss underdeveloped subjectivities. This term and the theory behind it are considered racist. Brickman (2018) discussed several articles written by Freud such as “Group Psychology and the Analysis of the Ego,” and attested to the racial tone of Freud’s writings. Brickman observed that: Freud developed his theory of how modern subjectivity arose out of primitive groups or communities. In so doing, he provides us with his implicit psychology of primitivity, demonstrating the ways in which the psychic configurations of members of “primitive” groups differ from those of the modern individual subject (p. 103).

53 According to Brickman (2018), the idea of primitivity is associated with being in a group or crowd. In a crowd, people do not own their own subjectivity and instead share a group subjectivity that is often irrational and finds representation in the idea of the unconscious. The primitive is presented as a threat from the past, the opposite of a modern and civilized society. Freud used this framework to develop his theory of group psychology. Brickman (2018) implied that Freudian explanations of primitivity and group behavior are racist. In contrast, Bruce (2007) and Dalal (2006) explained that Freud’s idea of group psychology could help understand racism. Racism could be considered a response to a group phenomenon that drags people, while in a trance and in hypnotic-like states, to work in a contagious process. Insofar as Bruce and Dalal agreed in their interpretations of Freud, the scholars posited that when individuals lose their civilized sensitivities, they regress to a savage and primitive state that makes acts of racism possible. This analysis helps explain racist actions. The scholars offered two additional explanations that account for racism: (1) racist individuals are responding to a transference they remember through repetition, and (2) the individual is pushed toward acting in certain ways in a response to their instincts. However, Bruce’s (2007) preferred explanation for racism is that it is a process of splitting, repression, and projection. Hamer (2014) also used Freud’s theory to explain racism in regard to aggression, stating that “. . . groups export aggression from inside themselves as a means for stabilizing and cohering identity through the mobilization of libidinal regard for that identity” (p.217).

54 These explanations utilize early psychoanalytic theories. Otherwise, the early psychoanalytic literature has said little about race. Some scholars considered Freud’s excision of race from psychoanalysis as a compensatory process (Gilman, 1993). During Freud’s time, the “dark” Jew “. . . was not considered ‘white.’ The Jew was described as inherently pathological, intellectually deficient, sexually degenerate, and predisposed to diseases such as syphilis and insanity” (Suchet, 2004, p. 424). Moreover, during Freud’s lifetime, society emasculated Jewish males. According to Gilman (1993) and Suchet (2004), Freud transferred his Jewish-male inferiority complex to the theorization of a female inferiority complex. When Freud theorized about women’s inferiority, he was actually theorizing about his own perceived inferiority as a Jewish male.

Current Psychoanalytic Literature on Race and Psychotherapy The racial and cultural context versus the intrapsychic debate. As with immigration, some psychotherapists and psychoanalysts agreed that race had received insufficient discussion (Ainslie et al., 2013; Leary, 1997). Some, like Suchet, believed that the interpretation of psychic conflict is characterized by “. . . a privileging of sexuality as a central organizing principle to identity formation, to the exclusion of other social differences” (2004, p. 424). Mainstream psychotherapy has seen efforts to write about and research race. However, these efforts at times have placed all non-White people within the subgroups categories, creating psychotherapy models to address those assumed needs within those groups (Moodley & Palmer, 2006).

55 These models do not provide a psychotherapy experience that helps subjects deconstruct their subjectivity based on racial identification. Some scholars have pushed race and other social-political factors to the margin, arguing that “. . . these multicultural variables cannot explain the inner life of a client nor do they offer a modicum of psychotherapeutic explanation of a client’s ‘subjective distress’” (Moodley & Palmer, 2006, p. 22). The dilemma of neutrality has also colored the psychoanalytic tradition, preempting discussions of race (Layton, Hollander, & Gutwill, 2006). Some scholars argued for the study of newer notions of multiple-identities and multiple-selves to understand the intrinsic experience of people of color, race, and racial identity. Harris (2012) proposed terminology including “multiplicity” and “shifting selfstates” to understand racialized subjectivity. Harris argued that relational theory does not position the explanation of human subjectivity in the essence of the subject, but in the social, and as a result, in emergent constructions. The emphasis on multiplicity raises a racialized subjectivity. Harris explained that attachment-related patterns are developed within a multiplicity that is multimodal and multiply configured. Multiplicity and shifting states can be considered forms of dissociation that result from trauma, but they can also become “. . . a site for contested identities for resistances to surveillance, for refusals of mirroring and interpellation, for camouflage and resistance” (p. 208). Layton (2013) theorized that “. . . culture is inextricable from subject formation” (p. 1). Culture is not an addition to the psyche, a resistance to a deeper experience, nor is it an external influence on psychic formation. Rather, culture constitutes a deep part of psychic life. Layton also suggests that the therapeutic process is influenced by

56 unconscious and conscious micro-processes that are “. . . inflected by culture and culture inequality in which the development of the subjectivity takes place” (2013, p. 4). Therefore, both Harris and Layton considered subjects’ race-related formation of identity and psychic life from within an intrapsychic perspective. In this way, the scholars address concerns that attention to race does not attend to the internal life of human experience. Dalal (2006) also criticized reducing the human subject to individual, internal, and childhood experiences, and only locating human suffering in these realms. Dalal supported a more inclusive explanation in which the social not only helps explain individuals and their relation to their own racial identities, but also to understand racism. Dalal argued that if childhood and inner dramas provide the only avenues for inquiry, we will understand racism as a projection of hatred toward the other—in which case, what explanation do we have for a whole group of people being racist against another group? How the victimized group, which does not have hate at its core, does not project problematic aspects of its psyche into the Other? Dalal considered racism a detachment process in which, in order to create difference, the Other is named and located outside of a given racial group. In this model, humans do not encounter strangers; humans estrange other humans and transform them into “the Other.” Moss (2003) argued for a psychoanalytic method that understands racism as a mechanism of hate. The idea that people can understand racism or hate without identifying with it strikes Moss as an intellectual process, or a moral issue perceived as being external to oneself, or “not me.” Moss argued that to understand hate, we must resist the temptation to disidentify from it, stating, “It is only an intimate familiarity— finally unbearable, and therefore transient—with these deadly hatreds that gives us any

57 chance to diminish their influence” (p. xx). Also, disidentification may occur when “. . . dangerous identificatory proximity provokes disruptive flight rather than disruptive recognition” (p. xix). Moss argued for psychoanalytic-minded therapists to hold the part of themselves that identifies with racism and hatred while working with their clients. It is only in such instances that the therapist can seize the opportunity to influence the analytic process from the inside.

Normative unconscious. Some scholars argued that culture is deeply ingrained in psychic experience and manifests in unconscious processes. The identity of the person is engrained in cultural norms and is dominated by identity categories (Layton, 2002). Layton states that the term “normative” indicates unconscious forces that intend to maintain the status quo by reinforcing dominant cultural norms such as racism, sexism, classism, and homophobia. Social and historical inequalities are manifested in the individual, creating intergenerational trauma (Layton, 2002). The individual splits off attachment relations and societal acceptance from thoughts or feelings that would threaten the establishment’s approval. Society shames and sanctions parts of the self; in response, individuals disapprove of their own ways of being in the world, regarding their cultural, racial, or gender identities. The individual then splits off those unfavored parts of the self as notme. This inhibition can result in future enactments that sustain inequalities by creating blind spots around how humans create suffering in each other. These enactments can take place in the therapeutic process and the psychoanalytic and psychotherapy professional

58 community. Racism embedded in the psyche can be disavowed but still reproduce racist dynamics in the community in which subjects participate and belong.

Skin color. Authors on this topic have theorized and deconstructed the notion of skin color through an analysis of the meaning of whiteness. Suchet (2007) describes and deconstructs the notion of whiteness by first naming its historical context in which it emerged. The notion of whiteness was created in the 17th century with the purpose of privileging White skin people to avoid solidarity between White and Black people in order to keep the laboring class under control by the white elite. Suchet explains that this experience serves White psychodynamics. Whiteness is an ideology that provides a sense of safety to avoid feelings of lack, vulnerability, or humiliation. It is less a matter of color than a “hierarchical position of power in relation to another” (p. 869) sustained by power relations and institutions. This definition implicates psychoanalysis exists within the context of whiteness and the White power structure. Hamer (2014) considers the concept of whiteness as “a logic of domination” (p. 218) that intends to establish difference based on race. In the U.S., whiteness emerged out of competitive relationships between indigenous Americans and European colonizers. Hamer considered whiteness as an idea, an ideal, and an ideology. Tummala-Narra (2007) ascribed four signifiers to skin color: 1.

An indicator of a sense of belonging.

59 2.

Reflection of cultural ideas on beauty, both good and bad, that impact self-image and self-esteem.

A role in disidentification or identification from one’s ethnic group or U.S.

mainstream culture. 4.

The potential of racial trauma and colorism to influence intrapsychic processes. Within this framework, therapists go beyond the consulting room and explore skin

color in their own lives. Tummala-Narra recommended encouraging clients to explore the four signifiers outlined above. While eliciting this material in therapy might be difficult, Tummula-Narra believed that it can add valuable information and intrapsychic understanding otherwise overlooked. Williams (1996) discussed skin color as it pertains to transference and countertransference in the consulting room, via examples of skin color’s eminent role in dyads of similar racial groups and intraethnic experience. These examples include the possibility of omniscient-omnipotence transference, in which the client experiences an ideal and perfect parent. Therapists’ skin color can indicate their ability to understand the experience of a person of color. Or the opposite could occur. Clients might project their own internalized racism onto the therapist, generating dislike for the therapist as a person with bad intentions. Williams encouraged early explorations of clients’ childhood experiences with caretakers and with skin color, believing these topics might help predict clients’ transference experiences in the clinical encounter.

60 The Psychotherapist of Color and the Psychodynamic Encounter Transference and countertransference. Psychoanalysts and analytically oriented psychotherapists of color have written about their experiences with clients and transference during the last few decades. ComasDíaz and Jacobsen (1991) mentioned transference and countertransference dynamics with clients of similar and different ethnic dyads and ethnic presentation. Tang and Gardner (2006) explained that clients might assume that they will be understood by a therapist who shares a similar skin color. Clients can also experience overidentification or distancing with the therapist due to internalized racism. Clients may also project racial stereotypes that can help them explore aspects of themselves (Holmes, 1992). White clients may experience the following feelings, according to Yi (2006): superiority, hostility, fear of the black psychotherapist’s aggressive powers, and contempt and devaluation of the non-native psychotherapist’s clinical skills and linguistic competence. Race could help clients transfer object relationships and organize feelings of inferiority. Clients may refuse to acknowledge race or resist the therapist’s interpretation of race-related projections (Holmes, 1992). Tan (2006) mentioned that White clients’ desire for a therapist who looks like them, or the emergence of racist transference, might stem from clients’ need for similarity. However, this need is a defense against painful feelings of difference and separation. This defense might also be present in the White client who chooses a therapist of color but says there are no differences between them. Furthermore, racism in transference prevents growth and exists at an infantile level of the paranoid-schizoid position.

61 Several psychotherapists of color have given their accounts of the ineffectiveness of the traditional idea of neutrality or blank screen. Neutrality removes therapists’ responsibility for their own feelings and participation in racial enactments. Leary (1997) stated that when she opens the door to her waiting room to greet a new patient, the fact that she is a woman of color carries important social meaning and becomes an important self-disclosure. Therefore, she argued, the therapist of color cannot hide behind neutrality, because the therapist and client live in a world that oppresses people of color. This is especially true when the oppressive narrative inhabits each participant’s subjectivity and is represented in the color of their skin. Tang and Gardner (2006) asserted that countertransference experienced by the psychotherapist of color differs from that of the White therapist. The White therapist usually navigates feelings of guilt due to witnessing injustices against minority clients and how they benefit from their own White privilege, as well as anxiety around reparation. The anxiety of minority therapists, on the other hand, might involve fear of clients’ racism, racist attitudes, and prejudice. These therapists are often concerned about their ability to be therapeutic when listening to clients’ racist thoughts. Tang and Gardner (2006) explained that in comparison with White therapists, minority therapists tend to be more aware of racial implications in their interactions with clients. They also feel more comfortable discussing race due to their constant exposure to race related issues in their lives. However, whether race should be discussed depends on the judgement of each therapist. Tang and Gardner (2006) argued that race is an important topic to discuss, even if not raised by the client. However, if the therapist feels constant pressure to discuss race in the clinical process, anxiety around the issue might be

62 the cause. Yi (2006) posits a need for caution against the tendency to attribute all client difficulties to racism’s lack of intrapsychic meaning. White therapists might carry prejudices that the client of color is aggressive, impulsive, lacks insight, etc. These biases can also be carried by therapists of color due to their own internalization of racism and social privilege. Holmes (2006) mentioned another possible variable experienced by successful professionals who overcame disadvantaged backgrounds. These professionals often feel they are betraying their communities and families. They carry guilt and feel haunted by their crime of success, given the larger impact of racism and discrimination on their communities of origin. Holmes states: The kind of damage under discussion here is a more fundamental damage to the self, in that it causes fundamental doubt of one’s capacities. Such doubt may lead to stunted use of one’s abilities, limitation in actual success achieved, or the eventual wrecking of a high level of success (p. 220). These struggles could manifest as countertransference and cause therapists to (a) underestimate their capacities to analyze clients, (b) undervalue their contributions, or (c) minimize lingering childhood traumas they need to overcome. These doubts might be reinforced by supervisors and colleagues.

The immigrant psychotherapist of color in community. McIntosh (1992) worked outside the psychoanalytic community, but enumerates the multiple ways she enjoys White privilege, as it pertains to her sense of belonging to community groups. "I can go home from most meetings of organizations I belong to

63 feeling somewhat tied in,” McIntosh writes, “rather than isolated, out-of-place, outnumbered, unheard, held at a distance, or feared" (p. 33). This description has relevance for IPCs and their sense of belonging to the psychotherapy community. Some IPCs have recounted that during professional training, they were not encouraged to bring racial differences and dynamics in the therapeutic encounter (Tang & Gardner, 2006). Brickman (2018) referenced Janice O. Bennet’s subjective experience as an African American psychotherapist and sense of belonging to the psychoanalytic professional community, describing “. . . a sense of invisibility and of finding herself ‘other’ in the psychoanalytic community she has joined . . .” (p. 199). This invisibility related to the suspicion that psychoanalysis exists within a larger system of White theory and practice. Black Psychoanalysts Speak (Winograd, 2014), a documentary presenting interviews with several black psychoanalysts, depicts common struggles with unbelonging related to the professional psychoanalytic community. Interviewees enumerated ways they have felt as “the other” via microaggressions from colleagues and clients. One analyst describes rarely receiving a white-client referral from colleagues. Another mentioned a first-time client who did not acknowledge him as the analyst, expecting someone different. Interviewees addressed the lack of theory to explain racism and race, despite psychoanalysis containing the necessary conceptual tools. Another topic is the difficulty of blending in a White dominant community, when that community does not seem to embrace diversity and does not seek diversity among analyst candidates—in short, when the community shows no interest in adapting to current social changes regarding race and immigration.

64 The psychoanalytic and psychotherapy community has preconceived notions about poor and non-middle-class individuals, and these preconceptions can make the community appear inhospitable to both analysts and client. Altman (2010) discussed the tendency to dismiss poor and racial minorities as unanalyzable. The criteria for being analyzable relies on middle- and upper-class characteristics. Ego strength indicates the capacity to tolerate silence, but this might be a cultural characteristic rather than a personality trait related to primitive qualities. Altman (2006) argued that some Asians, Latinos, and African Americans are assigned qualities of being irrational, emotional, impulsive and, therefore, primitive. The documentary “Psychoanalysis in El Barrio” (Christian et al., 2016) featured immigrant psychoanalysts in the United States. During interviews, these analysts pointed out that the psychoanalytic community assumes that poor and non-middle-class individuals are not suited for analysis because day-to-day needs overwhelm their capacity for self-reflection. This is a common assumption among theorists in the trauma field, as well with authors such as Judith Herman (1992). Herman proposed that traumatized clients need to fulfill their basic needs in order to have the emotional stability required for processing and reflecting on past traumas. However, this requirement might exclude clients unable to afford a middle-class lifestyle, and it ignores how analytic and psychotherapeutic processing could be useful for self-organization during a crisis.

Theoretical Framework The subjective experience of the IPC touches on many variants, including how IPCs experience (a) themselves, (b) their clients, and (c) the psychotherapy community.

65 My theoretical approach in this study explored topics including (a) how psychotherapists have experienced loss after immigrating to the United States, (b) interactions with clients pertaining to racial and immigrant identity, and (c) perceptions of the psychotherapy community.

The immigrant self. Literature about immigration documents the development of nostalgia following the loss of familiar places, family, and community. By contemplating nostalgia via Freud, we can consider how the subject invests in objects, given the internalization of these idealized objects as part of the self. Losing connection with these objects amounts to losing a part of the self, which explains nostalgia’s longevity. Akhtar (1996) mentions that nostalgia involves a desire to recapture an idealized past that elicits mental pain and joy. This involves the activation of defenses such as (a) splitting, (b) denial, and (c) primitive idealization. For Freud, mental pain entails investment in an idealized object and subsequent separation from it. Freud’s observations on melancholia (1917) align with extended immigrant grieving experiences, which Eng and Han (2000, p. 670) believe constitute mourning without end. While the individual experiences melancholia, investment in new objects is limited. From a Kleinian perspective, Akhtar (1996) posits that progress toward the depressive position might entail the renunciation of omnipotence and development of ambivalence. The immigrant realizes the limitations of both home and host countries but does not split either place into good or bad objects. Denford (1981) describes clients who love their country of origin and did not experience external factors that forced their

66 migration, but who nonetheless emigrated for better employment prospects. However, Denford found that many immigrants felt that leaving would free space to be themselves, away from parental restrictions. This helps explain the contradiction of leaving such a beloved place. From a Winnicott perspective, Denford states: The act of emigration might be understood as having converted the individual’s whole world into a play or “transitional space” (Winnicott, 1971), where the freedom to be himself and to develop is not inhibited by the unconscious elements derived from primary experience or that are associated in his mind with his incompleteness or the years of his childhood (p. 329).

Experience with clients. Klenian ideas are useful in conceptualizing racism within a therapeutic dyad as society has created categories of black and white in order to have a place for projections and introjections. By creating an “Other,” a group of people can locate negative attributions of unwanted meaning or psychic content outside the collective. The Other racial group then introjects the unwanted meaning. Inter-racial therapeutic dyads involve a continuous projective identification complex process. Yi (2006) uses Stolorow’s (1987) concept of projective identification to explain how projective identification seems to exclude the therapist’s responsibility in evoking feelings within the client.

The immigrant psychotherapist of color in community. Kleinian theory could also help explain discrimination and racism, which my study assumes impacts IPCs. The experiences of these psychotherapists are not

67 sufficiently examined through writings, publications, and trainings within the psychotherapy and psychoanalytic community—perhaps because the community fears projected annihilation and aggression. The human subject, as conceived by Klein, develops mechanisms of projection and introjection of persecutory fears. Instead of acknowledging their capacity for aggression, the psychotherapy community perpetuates the aggression through controlling how the IPC grows professionally based on an unconscious persecutory fear of annihilation. Therefore, the one who comes to annihilate them is the foreign IPC. This annihilation might manifest as a fear of being replaced by a different ethnic or racial group in the field of psychotherapy. Relational theory stresses the social nature of the human subject. The idea that early relationships are internalized explains some immigrants’ difficulty with separating from their countries of origin, as this separation might imply a new and foreign experience of oneself. Complete separation from early objects symbolized through the country of origin might be terrifying, since lack of investment in these objects leads to profound isolation (Mitchell, 1988). This might explain the difficulty of the IPC to develop a sense of belonging in the new country or the psychotherapy community. However, this difficulty might also come from the environment, as the psychotherapist prioritizes “entry into the human community” and “intense ties with others” (Mitchell, 1988, p. 29). This explains why analysts of color insist on creating space for themselves in the psychoanalytic community despite unfair treatment (Winograd, 2014). They hope to bond with others while simultaneously “. . . [escaping] the pain and dangers of those bonds, the sense of vulnerability, the threat of disappointment, engulfment, exploitation and loss” (Mitchell, 1988, p. 29).

Relevant Studies Only two studies closely resembled my current work presented in this dissertation (Barreto, 2013; Gulina & Debrolioubova, 2018). First, Barreto’s phenomenological study (2013) included eight immigrant psychotherapists. The research explored the topic of becoming a therapist in a country different from one’s own.

Barreto wanted to better understand how adjusting to a new culture gave voice to the lived experience of immigrant therapists. Participants emigrated from another country to the United States. They described challenges in their practices related to cultural differences. Barreto presented findings via four central themes:

Facing cultural shock and threats on identity.

Adjusting professionally to a different culture.

Developing a new identity.

Counseling across cultures. These experiences challenged the participants’ professional identities and helped

them develop competencies. Ultimately, the challenges benefitted the therapist-client relationship and the individual client. Not sharing the same culture as clients was not always a limitation, and sometimes aided their professional development and performance. Barreto’s work shows that certain implications and challenges await psychotherapists with dual identities and loyalties, but this duality also carries benefits and advantages.

69 The second study (Gulina & Dobrolioubova, 2018) is an interpretative phenomenological analysis. Researchers interviewed 16 psychotherapists with different clinical backgrounds. The study had two purposes: “. . . first, to explore the bilingual therapist’s experience of working in a second language; and, to explore the major functions of language within the therapeutic setting” (p. 3). From this study, five themes emerged:

Listening and understanding the client;

Interventions and interpretations;

Potential impact of language on the therapeutic encounter;

Therapist’s point of view; and

Therapist’s experience of self.

The findings showed differences in the understanding of language function in the consulting room, including:

The immigrant therapist’s loss of confidence by not mastering the native language.

The feeling of loss of creativity, richness, and uniqueness of language-use during interpretations.

The feeling that their lack of understanding of cultural nuances could undermine their understanding of transference.

A feeling of having a different experience of the self when using the new language.

70 There were other studies not closely resembling the topic of my dissertation; however, they touched upon several issues related to the current study. One of these studies (Jasinskaja-Lahti et al., 2006) highlighted the benefits of ethnic support networks, while showing that immigrant well-being benefitted most from the perception of a responsive and supportive host country. The researchers conducted their study in Finland with a sample of Russians, Estonians, and immigrants from other countries from the former Soviet Union. The study showed that perceived discrimination significantly impacted psychological well-being. This is important to consider when discussing the relationship and experience of the immigrant psychotherapist with the psychotherapeutic community.

The willingness of ethnic-minority psychotherapists to treat ethnic-minority clients was a central theme in research by Turner and Turner (1996). Ethnic-minority psychotherapists saw more than twice the proportion of ethnic-minority clients than did non-Latino white providers (24.0% and 11.7%, respectively). This finding explains how societal stratification influences the psychotherapeutic community, where psychotherapists’ identification with race and culture determines availability of and access to treatment.

Berger et al. (2014) worked with 221 Los Angeles County community mentalhealth professionals to assess the relationship between cultural competency and (a) therapist characteristics, (b) therapeutic orientations, and (c) person-level and agencylevel practices. Results from an online survey indicated that compared to white therapists, ethnic-minority therapists were (a) more personally involved in communities of color, (b)

71 more likely to use a cultural framework in clinical practice, and (c) perceived their agencies to be more culturally sensitive. These findings question the strength of connections between minority and host communities, insofar as White therapists, on the whole, fail to sufficiently interact with minority groups. Also, the findings make clear that minority groups view immigrant psychotherapists as capable of helping because the therapist understands the experiences of immigration and of being an ethnic minority.

Chapter III

Methodology Introduction

This mixed-method phenomenological study intended to understand the subjective experience of the immigrant psychotherapist of color (IPC), specifically as that experience pertains to the IPC’s relationship with (a) themselves, (b) their clients, and (c) the broader psychotherapy community. The study intended to look at the prevalence of loss and to examine the relationship between discrimination and experiences of not feeling at home, and IPCs’ sense of inclusion in the psychotherapy community. The study incorporated a transformative, sequential mixed-methods approach. A mixed-methods approach is defined as the collection, analysis, and integration of quantitative and qualitative data in a single study (Creswell, 2014). In this study, the mixed-methods approach incorporated a sequential design involving a two-phase project. Within this kind of design framework, the researcher begins by (a) collecting quantitative data, (b) analyzing the results, and (c) using the results to recruit participants for a qualitative phase (Creswell, 2014). The qualitative phase makes use of a phenomenological approach, which Creswell (2013) defines as extracting common meaning from several individuals related to their lived experiences of a concept or phenomenon.

73 My study made use of a transformative framework, especially since my research had an explicit goal: the creation of a more just and democratic society. This goal permeated the entire research process of this study, including (a) formulating problems, (b) drawing conclusions, and (c) using results—all as described by Mertens (2003). Therefore, this study entailed the integration of (a) a quantitative sequential design, (b) a phenomenological approach, and (c) a transformative framework. All elements of the study incorporated a theoretical social-justice lens.

Hypotheses and Questions To better understand the subjective experience of the IPC, the quantitative portion of this study asked one specific research question: What are the range and variation of scores related to the experience of loss recorded by IPCs who complete the Demands of Immigration Scale (DIS)? (Addendum A) I also posited two hypotheses. First, an inverse relationship exists between the experience of discrimination (as measured by the DIS) in the host country and how included the IPC feels in the psychotherapy community. Second, and again as measured by the DIS, an inverse relationship exists between the experience of not feeling at home in the host country and how included the immigrant psychotherapist of color feels in the psychotherapy community. The qualitative phase of this research focused on the following question: What is the subjective experience of the immigrant psychotherapist of color? Secondary questions followed, including: 1.

How does the IPC describe their immigration experience?

74 2.

How does the IPC describe their sense of self as it pertains to their immigrant and racial identities?

How do the immigrant and racial identities of the IPC emerge as part of the dynamic between the immigrant psychotherapist and the client?

How does the IPC describe the experience of being an immigrant therapist?

How will the IPC describe their subjective experiences with the psychotherapy community in relation to their immigrant and racial identity?

Rationale for a Mixed Method Research Design The major reason to use a mixed-methods design in this study involved complementarity, which Green (2007) defined as “. . . using mixed methods for the purpose of gathering different information to seek broader, deeper and more comprehensive social understanding by using methods that tap into different facets or dimensions of the same complex phenomenon” (p. 101). The standardized instrument and survey (Addendum A) helped tap into immigrants’ personal understanding of their individual experiences of (a) loss, (b) not feeling at home, (c) discrimination, and (d) inclusion. Elsewhere, in-depth interviews (Addendum A) with IPCs facilitated a deeper subjective understanding of IPCs’ experiences during immigration, and their professional experiences in the context of client work and interactions within the psychotherapy community. IPC immigration experiences included rich stories that added perspective to their lived histories. Overall, the incorporation of different methods helped us understand the phenomena of the subjective experience of the IPC from different angles.

75 The second major reason to use a mixed-methods approach was development, defined by Green (2007) as research in which “. . . the results of one method are used to inform the development of the other method, where development is broadly construed to include sampling and implementation . . .” (p. 102). The sampling process for the qualitative component was influenced by participant responses to the screening interview, the Demands of Immigration Scale (DIS) and survey (Addendum A). Participants were going to be selected to participate in in-depth interviews depending on their scores and demographic information but there was a change to methodology in this regard (see “Changes in methodology” at the end of the chapter). Members of the selected sample included participants who did not confirm the hypothesis of the study, or the researcher’s assumptions. This was an example of negative case analysis (Hanson, 2017). This selection approach helps expand general perspectives, as well as knowledge and assumptions related to the current phenomena. The mixed-methods approach allowed this study to provide a comprehensive understanding of the IPC. The quantitative and qualitative phases of the study appealed to a broader audience interested in studies with either or both methodologies, which was necessary to create more awareness of the issues addressed in this study and transformative change. The quantitative method provided the means to validate traditional scientific knowledge, which in turn allowed us to gauge the prevalence and significance of the following IPC life experiences: (a) loss, (b) not feeling at home, and (c) inclusion and (d) discrimination. The objective data from empirical data-gathering (Creswell, 2014) provided a general understanding of the IPC immigration experience. Depending on the prevalence,

76 generalization, and significance of these experiences, we questioned why the IPC experience is not more widely discussed. The qualitative phase offered a more in-depth discussion of the phenomenon. Participants could deepen and provide their own subjective experience, as the DIS could not expand on the subjective experiences of the IPC. By incorporating a qualitative phase, the study gave a platform to a group of minority psychotherapists. This would allow mainstream psychotherapists to hear IPCs’ perspectives on how they experience their personal and professional lives. On this point, Sweetman, Badiee, and Creswell (2010) made the following argument: . . . it is important to integrate methodologies that are sensitive to marginalized communities and such sensitivity is found within qualitative research, in which the politics of inquiry, the emphasis on values, and the goal of social justice hold center stage (p. 441). The IPC was able to reflect on and express (a) experiences, (b) ideas, and (c) values that, most likely, would otherwise have remained unheard. IPCs had the opportunity to fully express themselves without fear of retaliation or scrutiny. Regardless of the specifics of any given political climate, a group of IPCs speaking their minds about their experiences would constitute an important political statement. This is even more true given the political climate in the United States at the time this dissertation was completed. The incorporation of a mixed-methods approach implied an acknowledgment that all methods have their biases and weaknesses, and that in order to better understand reality, we needed a triangulation of data sources (Creswell, 2014). Schwandt (2000) said

77 that all research is interpretative and different methods suit different kinds of understandings. Johnson, Onwuegbuzie, and Turner (2007) explained that mixed methods allow researchers to include several (a) data-collection strategies, (b) methods of research, and (c) philosophical views. The triangulation of data sources that result from mixed methods (a) allows researchers to be more confident of their results, (b) stimulates the development of creativity when collecting data, and (c) uncovers contradictions (Johnson, Onwuegbuzie, & Turner, 2007). For the purpose of this study, I valued the importance of multiple methods for research because it allowed me to reach out to a larger group of participants, in order to gain a larger sample with perhaps a variety of perspectives. I was interested in seeing how this method combination (a) clarified the topic, (b) informed each other, and (c) contradicted and / or brought similarity of experiences.

Rationale for Specific Methodology Sequential process. The mixed methodology in this study incorporated a sequential process in which the quantitative portion occurs first, followed by the qualitative portion. The quantitative phase of the study consisted of the administration of (a) a screening interview, (b) the Demands of Immigration Scale (DIS), and (c) quantitative survey (Addendum A). The administration of the screening interview, the Demands of Immigration Scale (DIS) and survey also served as a recruitment process for the qualitative phase, as participants described their interest in participating in in-depth interviews. This approach will help

78 move the study from a general understanding of the immigrant psychotherapist to a more specific appreciation of individual participants.

Phenomenological approach. The phenomenological approach influenced the qualitative phase, via an exploration of what it was like to be an IPC through a long, in-depth interview (Addendum A). This exploration occurred through the expression of IPCs’ subjective experiences. According to Creswell, “. . . a phenomenological study describes the common meaning for several individuals of their lived experiences of a concept or a phenomenon” (2013, p. 76). The research described common experiences for participants as a result of experiencing a phenomenon (Creswell, 2013). The shared experiences, or object of human experience, for all participants resided in their IPC identities. Creswell (2013) pointed out that the philosophical discussion of this approach includes a resistance to the subjective-objective perspective, given that this perspective addresses the subjective experience of the phenomenon and the objective experiences common to other people. Therefore, it is common for phenomenological studies to fall between a continuum of qualitative and quantitative research, which this study was able to do.

Transformative framework. A transformative framework centers on actively choosing a minority group that would be “. . . considered of concern if the author made an argument for how its members were oppressed, marginalized, or underrepresented” (Sweetman, Badiee and Creswell,

79 2010, p. 146). Also, the transformative framework contains an advocacy stance intended “. . . to shape a more equitable society in the United States and around the world” (Sweetman, et al., 2010, p. 441). The transformative framework implies that the study should declare “. . . the use of a transformative paradigm” and indicate “. . . how the data collection and outcomes would benefit the community under study” (Sweetman, et al., 2010, p .446). An inclusion of diversity and oppression in the literature review is also important in this type of framework. Sweetman and others (2010, pp. 442-443) listed criteria that help assess whether a study incorporates a transformative framework. These criteria are based on a 2003 account from Mertens that explained how the researcher incorporated new criteria based on research in which Mertens evaluated studies that fully embody elements of a transformative framework and mixed methods. The criteria included the following questions: 1. Do the authors openly reference a problem in a community of concern? 2. Do the authors openly declare a theoretical lens? 3. Were the research questions (or purposes) written with an advocacy stance? 4. Did the literature review include discussions of diversity and oppression? In addition, Mertens presented several useful questions for collecting data from marginalized groups (pp. 442-443): 1. Did the authors discuss appropriate labeling of the participants? 2. Did the data collection and outcomes benefit the community? 3. Did the participants initiate the research, and / or were they actively engaged in the project?

80 4. Did the results elucidate power relationships? 5. Did the results facilitate social change? 6. Did the authors explicitly state their use of a transformative framework? With this in mind, the current study made an argument for how the participants are marginalized from the psychotherapy community. This study intended to prompt discussion about a topic that is insufficiently discussed in the psychotherapy community and neglected in the psychoanalytic literature. This lack of engagement raised the issue of social justice, considering that the research sample constitutes a minority group in society. The study used a transformative paradigm and described issues of oppression and diversity throughout the research, particularly in the literature review. The research benefited the IPCs in that it exposed how they felt when navigating their complex identities in a foreign country that had minimal understanding of their experiences. I hope that the results can be spread and discussed among different communities within psychotherapy and psychoanalysis. Further, I hope this discussion changes perspectives and thinking around issues of immigration and race, and that the psychotherapy community will feel implicated in these issues. A discussion of the study results in the psychotherapy community will bring to the surface an expected resistance if the results elucidate “power differential dynamics,” a common element in the transformative approach.

Research Sample The quantitative phase of the study determined which respondents participated in the qualitative phase. The study employed a purposeful quantitative sampling in which I

81 recruited 50 psychotherapists through snowball sampling, subject to availability and success of the sampling. From this initial sample, I selected eight psychotherapists for the qualitative sampling. Creswell (2013, p. 81) mentioned Polkinghorne’s (1989) recommendation that researchers interview from five to 25 individuals who have experienced the phenomenon under review in a phenomenological study. The ideal sample for the qualitative phase of my study was eight, although that number depended on the attainment of what Creswell calls “information saturation” (2013), a term that refers to the point in research where no new information can shed light on the subject.

Inclusion criteria. This study had two different sample populations. The first sample participated in the quantitative phase. For inclusion in this phase of research, a participant must: 1.

Be a psychotherapist who immigrated to the United States.

Have immigrated to the US when they were 13 years old or older.

Have one year of psychotherapeutic experience.

Have some degree of theoretical psychodynamic background.

Be licensed in the state where they practice.

Be a person of color, which this study defines as a non-white person.

To participate in the qualitative phase, the participant must: 1.

Be a psychotherapist who immigrated to the United States.

Have immigrated to the US when they were 13 years old or older.

82 3.

Have one of experience in psychotherapeutic practice.

Practice psychodynamic psychotherapy and/or psychoanalysis allowing them to treat their clients in long-term psychotherapy treatment (one year or more).

Be licensed in the state where they practice.

Be a person of color, which this study defines as a non-white person. The reason to establish 13 years old as the age of entrance to the US and forward

was because the study wanted to make sure the participants could elaborate on their mourning experience and attachment to their home country. Someone who emigrated to the US earlier in life has not created the same attachment to the home country as someone old enough to go through challenges in the acculturation and adaptation processes.

Exclusion criteria. Individuals born and raised in the United States were excluded, except those born and raised in Puerto Rico and other US territories. White immigrants were excluded from the study because the intention was to explore subjectivity among people of color. Excluding White immigrants from the study indicated the assumption that an immigrant who is a person of color would have unique experiences in a country like the US in which divisions and stratifications based on race and ethnic background are common. TummalaNarra (2020) made this distinction between White and non-White immigrants stating, “. . . immigrants of color were targets of racism and endure the detrimental psychological and physical effects of racism to a far greater degree than White immigrants in the United States” (American Psychological Association, 2012). Given the study explored racial dynamics of discrimination within the psychotherapy community, it is necessary to make

83 this exclusion in the sample to capture those experiences specific to the immigrant psychotherapist of color population. It is important to highlight that multiple studies have focused on sampling White immigrants while not exclusively paying attention to issues faced by people of color (Barreto, 2013; Gulina & Dobrolioubova, 2018) Therefore, race was considered as one of the main criteria for subject participation in the study. The screening process included a question targeting racial self-identification and how others identify the psychotherapist. I accomplished this by defining “psychotherapist of color” as a non-White person who had brown or dark skin tone or physical traits that distance them from the white European phenotype. The question allowed respondents to identify themselves as a person of color based on color of their skin and phenotype, as well as identifying their racial category. In addition, the first sample was more open regarding theoretical approach and years of experience, given that those factors might not influence the participants’ answers to the questions. The survey and Demands of Immigration Scale (DIS) (Addendum A) required straightforward answers. The second sample, however, required participants to reflect deeply about themselves and their relationships with clients in long-term psychotherapeutic and psychodynamic processes. Therefore, the criteria for the second sample were more specific, in order to facilitate the required self-reflective process. A non-probabilistic sample, or convenience sample, identified individuals for this study. The participants were not randomly selected because it was difficult to recruit participants, given the limited number of immigrant psychotherapists of color currently practicing in the community. My experience working as a psychotherapist in the

84 community with limited referrals for immigrant psychotherapists informed my understanding of this aspect of recruitment.

Research Plan I followed these steps as part of the research plan in the quantitative and qualitative phases: 1.

Participated in the collection of my own data in which I, as the researcher,

responded to the screening interview and survey, the Demands of Immigration Scale (DIS), as well as an in-depth interview (Addendum A). I analyzed the answers to the instruments and interviews, in order to identify potential difficulties in answering the questions and checking on my own personal biases with the phenomena before interviewing participants and analyzing data. 2.

Contacted individuals, institutions, and groups in order to begin recruitment.

Some individual recruitment took place via psychotherapists’ internet profiles and email. I contacted participants through word-of-mouth, email, and study advertisements through a flyer (Addendum B) on listservs, Facebook groups, community groups, and available referral lists. I contacted professional associations such as the National Association of Social Workers, the American Psychological Association, APA Division 39 (Psychoanalysis Division), the American Counseling Association, the American Association for Marriage and Family Therapy, the Chicago Psychoanalytic Institute, and the Institute for Clinical Social Work Alumni group, as well as other professional organizations that gathered minority psychotherapists such as Black Social Workers of

85 America and the Latino Social Workers Organization. Once these entities were contacted, they invited potential participants through their newsletters and social media platforms. 3.

Sent an initial link to those interested in participating through the Survey Monkey

platform. The corresponding webpage contained the consent and risk/benefits form (Addendum C). Once a recipient read the consent and risk/benefits forms, the participant automatically was directed to the screening questions (Addendum A) which determined if the participant qualified for the study and, if allowed to continue with the rest of the study, the demographic questions, the survey and the instrument via the online platform (Addendum A). When participants finished, they had the opportunity to indicate interest in participating in a long, in-depth, qualitative interview. The researcher’s email was available to communicate should they have interest in participating in a long, in-depth interview (Addendum A). 4.

Contacted participants who (a) took the instrument and survey, (b) fit the second

sample criteria, and (c) expressed interest in the long, in-depth interview. The participants were contacted as they expressed interest in the study. I introduced the second phase of the study and screened participants for the second time, to assure they fit the second sample criteria based on (a) race, (b) theoretical orientation, and (c) years of experience in the field of psychotherapy. I sent a second informed-consent form (Addendum C) for the second phase of the study via the DocuSign portal. I explained that the duration of the interview was up to two in-depth interviews for two hours and that it would be recorded with a voice recorder. The information would be kept for up to seven years and destroyed at the end of this time. 5.

The research interview took place via the online video platform, Zoom.

86 6.

The interviews stopped when eight participants, who had expressed interest in the

research and met the research criteria, had completed the long, in-depth interviews.

Data Collection In the quantitative phase of the study, I collected data via the administration of a survey, a quantitative survey, and the DIS (Addendum A). These three data-collection procedures, administered over the internet, serve to reach as many participants as possible, thereby increasing the sample. This approach (a) increased recruitment for the in-depth interview (Addendum A), (b) provided easy access to the participants, and (c) allowed for rapid data collection (Creswell, 2014). The survey was cross-sectional, with data collected at one point in time, at the beginning of the study. The screening interview assessed who qualified for the study. I later collected demographic information. The quantitative survey asked questions that helped understand the experience of the IPC in relationship to their clients and the psychotherapy community. The DIS (Aroian, Norris, Tran, & Schappler-Morris, 1998) (Addendum A) considered different variables related to the stress that immigrants endured in a foreign country. These variables, or domains, included: 1.

Language.

Loss.

Not at home.

Novelty.

Discrimination.

Occupation.

87 Ding, Hofstetter, Norman, Irvin, Chhay, and Hovell (2011) described the variables as follows: “Language” concerned immigrants’ perceived barriers in communication due to accent and difficulty in speaking a new language; “loss” pertained to emotional attachment to people, places and experience in home country, and a sense of loss after immigration; “not at home” referred to not feeling at home in the host country; “novelty” involved difficulties in dealing with new situations and in acquiring new skills in a new country; “discrimination” reflected the perception of not being treated as equally as native-born people, and being an outsider in the host society; and “occupation” pertained to disadvantages in the job market (p. 3). Each of these variables shed light on the stress that psychotherapists experienced after immigrating and living in the United States. Ding (2011) and others created a scale that included 23 items that explore several of the previously mentioned variables. In my study, participants were asked to rate the extent to which they had been distressed within the last three months, in accordance with Aroian (2003). The range of available responses, as also set by Aroian (2003), included: 1.

Not at all upset or Not applicable (0)

A little upset (1)

More than a little upset but not very upset (2)

Very upset (3) Once I began to collect the initial data, I organized it according to (a)

demographic categories, (b) questions, and (c) answers. This information remained intact until the end of the second phase of the study.

88 The second phase involved administering long, in-depth interviews (Addendum A) with participants. On the day of the interview, I reminded participants that the interview was going to be recorded through the platform Zoom and its recording feature. The interview took approximately two hours. I developed a set of open-ended questions to explore participants’ experiences with (a) themselves, (b) their clients, and (c) the psychotherapy community. Moustakas (1994) suggested that in phenomenological studies, the participants are asked two broad, general questions: What have you experienced in terms of the phenomenon? What contexts or situations have typically influenced or affected your experiences of the phenomenon? The study asked the following research question: “What is the subjective experience of the immigrant psychotherapist of color,” which calls to mind Creswell’s (2013) suggested question: “What is your experience with the phenomenon?” Participants answered this broad question via their responses to secondary questions. If any questions had evoked overwhelming or disturbing affects, I planned to pause the interview and/or offer referrals to participants, if they have not previously been in psychotherapy. It was possible that participants had already engaged in their own psychotherapy, given their background and the study’s specific selection criteria.

Plan for Data Analysis Data analysis was divided in two sections: quantitative and qualitative. At the end of both analyses, I conducted a comparison of findings to understand the difference in scope and depth of each finding. I wanted to know if the findings contradict each other, or if qualitative findings expand on the quantitative data.

89 I used Survey Monkey to collect information for the first section of the quantitative analysis. I used SPSS software as it had the capacity to generate results and reports, either as descriptive statistics or as graphical information (Creswell, 2014) and it has the capacity to analyze correlations. The results were downloaded on a spreadsheet or database. The data analysis of the quantitative data followed Creswell’s (2014) steps: 1.

Reported the information about the number of participants who did and did not respond to the instrument and survey.

Noted the outliers.

Determined a plan for descriptive analysis, in which (a) means, (b) standard deviation, and (c) range of scores will be determined for the following variables:

Loss

Discrimination

Inclusion

Not feeling at home

Identified a statistical procedure and report for the internal consistency, e.g., Cronbach alpha statistic.

Selected a statistical software program and provided a rationale for its selection. In this case, the study used SPSS Statistics software, which allows researchers to learn about the relationship between several predictors.

Presented the report in tables and figures and interpreted the results from the statistical test. I wanted to know if a statistically significant relationship exists between the

variables of “discrimination” and “inclusion,” as well as “not feeling at home” and

90 “inclusion.” I searched for these relationships by conducting a test of correlation, Fisher’s Exact, and a Chi Square test to assess the strength of the relationship between variables and to determine if there was a statistically significant relationship between the variables. Elsewhere, the internal consistency for the DIS has already been established (Tsai, 2002; Ding, et. al., 2011), as this chapter will presently discuss in detail. In the qualitative analysis phase, I followed the steps recommended by Creswell (2013) regarding phenomenological analysis: 1.

Collect the information by transcribing the interviews from the voice recorder and documenting observable, non-verbal behavior.

Highlight important statements or quotes that provide an idea of the ways in which the participants experienced the phenomenon.

Identify clusters of meaning from the previously selected statements and turn them into themes. Develop a textural description by using significant statements and themes to write a description of what the participants experienced.

Write a blended description that presents the “essence” of the phenomenon. I also incorporated Moustakas’ recommendation (1994) by describing my experience with the phenomena before analyzing the participant interviews in order to analyze my own experience with the phenomena and set aside possible biases. In the first step of the qualitative analysis process, after I analyzed my own

experiences and recorded the interview, I hired a transcription-services company to transcribe the interview. In addition to putting the interviews into writing, the transcription included a description of other factors that enriched the understanding and interpretation of the information provided. Kowal and O’Connell (2013) mentioned that

91 such a description “. . . is useful as a supplement to denote paralinguistic or extralinguistic behaviors as well as non-linguistic activities observed in dialogical interaction” (p. 67). The same authors mentioned that these extralinguistic communications include non-vocal bodily movements, or non-linguistic activity. This descriptive information was collected during the interview as I took notes. Once a transcription was completed, I read it multiple times to make sense of the overall experience and to take initial notes. These notes preceded and helped the next step, which was the coding process. The second step consisted of coding the transcripts and developing those codes into themes. Bazeley (2003) said that all ideas, issues, or experiences in this process should be assigned the same code if they convey the same meaning of experience. Therefore, codes for this study consisted of experiences that each of the participants shared in relation to answering the research question. I selected the codes that capture the issues that are: 1.

The most salient.

The most alien to the topic of the study.

Dealing with double meaning and metaphors.

Dealing with ideas accompanied by silences and affect.

Although, Creswell (2013) estimated a short list of five to 10 codes and later expanded the list to between 25 and 30 codes, I let the data drive the analysis and avoided entering the data analysis with any pre-conceived ideas about the coding process. The third step entailed grouping several codes of meaning within a single category or theme. Creswell (2013) defined categories or themes as “. . . broad units of

92 information that consists of several codes aggregated to form a common idea” (p. 86). These broad categories were established based on the code list. Each category conveyed a meaning of the experience of what it was like to be an IPC and their implications on all three areas of the research: (a) individual experience of immigration, (b) experiences with clients, and (c) experiences with the psychotherapy community. Other outcomes and ideas not related to or expected from the study, and that did not belong to these categories, were presented. In the fourth step of the analysis, I developed an overall description of the participant experience by describing it via (a) quotes, (b) statements, and (c) observations. This necessary process assured that the research accurately represents each participant’s experience of the phenomena in the coding and labeling process. At this stage of the process, through the procedure known as member checking, the description was shared with participants to confirm that it conveyed their experiences of the phenomena. Once this description was completed and confirmed by the participants, the fifth step of the data analysis consisted of developing a blended description. This included linking participants’ experiences with the literature. This linking to the broader literature and research was not conclusive but tentative, and as described by Creswell (2013), it conveyed a postmodern approach to data analysis. Also, I considered whether the qualitative phase expanded on the quantitative answers and findings.

93 Linguistic Considerations There was a possibility that some of the interviews were going to be in Spanish or that the participants and I switched from English to Spanish at any point in the interview. For this reason, I hired a transcription service that could provide transcription services in Spanish. I also considered defining specific terms or idioms that would help the reader understand the meaning of the experience being conveyed by the participants.

Ethical Considerations Issues of power. As a researcher, I came to the participant interviews from a position of power. I asked questions, and participants disclosed information that was personal and confidential. In order to guarantee respect for the participants, there was a consent form explaining (a) the research process, (b) methodology, and (c) how the information was collected, used, and discarded after the research concludes. Participation was voluntary. If participants decided not to participate in the study at any point in the interview process—before, during, or after—no demands were made, nor incentives provided, for them to stay.

Confidentiality. Participants’ identifying information was collected at the time of completing the consent form (Addendum C), but it was not disclosed in the research, nor was it identified with aliases during the quantitative phase of the study. During the qualitative

94 phase of the study, participants were not identified, thereby guaranteeing anonymity. I did not discuss participant information with anyone other than my dissertation committee. I made sure the location I chose to conduct the interview during the Zoom video was private and confidential. I disguised identifiable information related to participants’ stories and avoided specific life descriptions that made the participant identifiable. I stored collected data in encrypted documents within electronic password-protected files. Confidential information stored on voice recorders was kept in a secured locked box. Both electronic and voice records were secured at my home office. I was the only person with access to the stored files and voice records. The information was accessible to transcription services.

Conflict of interest. I did not recruit my clients to participate in the study, nor did I use my clients to recruit friends or colleagues in order to benefit my study. I did not take participants as clients after they completed the study.

Emotional risk. I made plans in case the interview evoked negative emotional states. In this case, participants could (a) pause the interview, (b) re-schedule, or (c) completely stop their participation. They could also refuse to answer questions. If a participant had not engaged in their own psychotherapy process, I planned to provide them with referrals. I provided participants with contact information on the consent form for the study chair and the

95 Institutional Review Board at ICSW, in case participants had concerns regarding the study (Addendum C).

Issues of trustworthiness. The DIS has been validated (Aroian et al.,1998) (Addendum A). Its reliability has been established across multiple immigrant groups. Cronbach’s alpha, which has proven reliable across multiple studies, is a coefficient that measures internal consistency on the relationship between items in a scale (Institute for Digital Research and Education, n.d.). The scale reliability was established with groups such as Jewish immigrants from the former Soviet Union. The reliability pertaining to immigrants in the United States (Aroian, 2003 & 2007; Ding et al., 2011) was fairly comprehensive when used with Chinese-Taiwanese immigrants (Tsai, 2002), and had good reliability and construct validity with Chinese-Taiwanese and Korean immigrants (Tsai, 2002, Ding, et. al., 2011). Aroian and others indicated the scale had an internal consistency of Cronbach’s  of .94 and test reliability of =.92 (2003). These scores indicate high reliability for both internal consistency and testing. The instrument has also been used in a descriptive correlational study with Latino adults in the United States (Coffman, M. & Norton, C.K., 2010). The scale’s internal consistency of Cronbach’s  for this study was .91 and the test reliability of  ranged between .69 and .85 for the six subscales. These numbers suggest the scale’s internal consistency is high and the test reliability is moderately good. The validation of the survey and in-depth interview (Addendum A) will consider suggestions for qualitative research from Creswell (2014) as well as Bloomberg and Volpe (2016), as follows:

96 1.

During the recruitment process, participants received information regarding the Chair and the school for which this study will be completed.

To assured validity of the study, the recruitment process for the qualitative portion was based on negative case analysis. I did not choose participants to confirm my assumptions or hypothesis. This allowed for a broader perspective on the problem.

I kept a reflective journal as I worked through the dissertation process, particularly during the in-depth interviews and data analysis.

I participated as an interviewee before interviewing participants and recorded my answers in order to analyze the questions, making sure they were clear and that I could gather the information necessary for an answer.

I developed a draft interview and asked individuals with the same characteristics as those who participated in the research to provide constructive feedback as to how the questions were structured, as well as the ways I could potentially bias the process.

For member checking, I emailed participants interview transcriptions and final descriptions of their experiences, asking for feedback on accuracy.

To clarify the bias I brought to research, I added a foregrounding that reflected on my rationale for the research and the personal experiences that might have influenced the choice for this topic.

I addressed discrepancies that contradicted the themes found in the research project.

97 9.

I included all information found in the data collection, even when it contradicted my assumptions on the topic (Bloomberg & Volpe, 2016).

10.

To guarantee authenticity or reliability of the study, I checked transcriptions for errors.

11.

I checked for omitted information from official transcript services by reviewing the recordings and making sure all the data had been added to the documents.

12.

During data analysis, I brainstormed possible interpretations that explain the findings (Bloomberg & Volpe, 2016).

13.

I used the summary provided by Bloomberg and Volpe (2016) regarding the Quality Assessment Chapter Check List to assess the accuracy of data analysis and interpretation.

14.

An interpretation outline was included as part of the study’s appendix to illustrate the development of the interpretation process (Bloomberg & Volpe, 2016).

15.

Findings provided answers to the research questions and hypotheses (Bloomberg & Volpe, 2016).

16.

Finally, recommendations were grounded in the (a) findings, (b) content, and (c) context, specifically taking into consideration the ways the study will benefit the following groups: a. participants of the study b. clients c. the psychotherapy community d. the population at large regarding (a) policy, (b) psychotherapy practice, and (c) research (Bloomberg & Volpe, 2016)

Limitations and Delimitations The limitations in this study include the following. I relied on participant answers when reporting their experiences. I trusted participants to tell the truth about their immigrant identity and professional credentials. Anyone could have taken the survey or instrument and provided untrue answers, especially as the screening, instrument and survey were administrated online. However, if the instruments were administered face to face, I would have been able to take into consideration other external factors such as participants’ demeanor and presentation; these factors could make it more difficult for participants to falsify information and enrich the discussion of the findings. Some of the findings were not generalizable to the larger population as the sample was relatively small consisting of 50 subjects. The study had a non-probabilistic sample. I had the impression that the instrument seemed to better fit immigrants who were in the country “not long enough.” This impression stems from how the instrument asked about certain struggles and challenges that might not affect someone living longer in the U.S., such as the IPC. This could have impacted the score results of the instrument, as participants already felt integrated in society. However, the instrument was tested with immigrants who had been living in the host country for a long time (Aroian, 2003). In addition, it will be the first time the instrument was administered to IPCs with an emphasis on race. Finally, I identified with the participants. I decided to research this topic because of my personal and professional experiences. Therefore, my own biases might factor into

99 the research process, including choice of topic, delimitation of the sample, literature review and theoretical approach chosen. Another limitation is that participants might have felt excluded from the psychotherapy community for other reasons beyond their immigration history, ethnicity, or race, but the study could not gather that information as it was beyond the scope of the study.

Changes to Methodology A few things changed regarding the methodology plan as I began the research process, such as the sampling process for the qualitative component and changes in the sequential process. I stated in the methodology chapter that the sampling for the qualitative interview would be influenced by participants' responses and scores of the screening interview, the Demands of Immigration Scale (DIS), and the survey (Addendum A). This meant that I would contact them depending on their answers and scores for the surveys and DIS. However, there was no way of knowing the participants' responses to the survey since it was anonymous. I instead let them know how to contact me if they were interested in being interviewed once they had completed the survey and DIS. They only had to confirm completion of the survey and DIS, as well as confirming that they met the inclusion criteria to participate in the qualitative interview. In addition, I had planned to follow a sequential process in which I would administer a survey and the Demands of Immigration Scale (DIS) online before initiating the qualitative interviews. However, the qualitative interviews began while actively administering the survey and DIS. This change was due to the length it took to find

100 participants to complete the online survey and DIS, while at the same time compiling a waiting list of participants for the in-depth interview. I would risk losing participants’ interest in in-depth interviews if I waited to find the 50 participants for the online survey and DIS. Only 50 participants out of 130 that responded to the survey met the inclusion criteria. Of those 50 participants, three completed the first seven questions for the survey but did not complete the DIS, reducing the number of participants to 47. Regarding the sample criteria, the study required participants to have three years of experience to participate in the survey and five years of experience to participate in the long, in-depth interview. The years of experience criteria was reduced to one year of experience for the subjects participating in the survey and the in-depth interview. Practicing psychodynamically or psychoanalytically was also changed to just having been exposed to psychodynamic psychotherapy. This change was made due to the difficulty in finding participants for the study.

The Role and Background of the Researcher As the main researcher in this study, I defined and argued for the importance of the research topic. In this process, I: 1.

Revised literature that explains the problem and expands on it.

Recruited participants and provided them with the screening instrument and survey.

Conducted participant interviews, opening a discussion of what it is like to be an IPC.

101 4.

Analyzed data and presented it to the psychotherapy and psychoanalytic community. I was aware that I had a similar background to the study participants: I was also a

member of a racially and ethnically identified group in society, and I was interested in exploring and analyzing dynamics of race and immigration that have impacted me personally and professionally. My background potentially impacted the research with my biases. However, because I knew the social and personal complexities of identifying as an IPC, this research provides unique perspectives on the topic.

102

Chapter IV

Quantitative and Qualitative Results This mixed-method phenomenological study intended to understand the subjective experience of the immigrant psychotherapist of color (IPC). The IPC experience included relationships between IPCs and (a) themselves, (b) their clients, and (c) the broader psychotherapy community, while living and practicing psychotherapy in the United States. This study intended to give space to a group of psychotherapists, often marginalized, to share their experiences of what it was like to be an immigrant psychotherapist of color. This chapter presents a first section with participants’ demographics and a second, quantitative section with findings on the IPC experiences of (a) loss, (b) not feeling at home, (c) discrimination, and (d) inclusion measured through several research questions and hypotheses. The third section of the chapter will present a qualitative finding report with the most important themes emerging from eight in-depth interviews. This research used a mixed-method phenomenological approach to collect data through survey distribution and in-depth interviews. Participants included 50 IPCs in the quantitative portion of the study. From the 50 IPCs, eight participated in the qualitative phase of the study. The data collected from the surveys was coded and analyzed via SPSS by doing a correlation test, Fisher Exact Test, and Chi Square analysis. The data collected

103 from the long, in-depth interviews were coded and organized, starting with a deductive and following with an inductive process, allowing the most prominent themes to emerge from the data. Each theme is presented with specific subthemes allowing for the organization of the material.

Participant Demographics The participants in this study were 50 Immigrant Psychotherapists of Color (IPC) who met the criteria for the quantitative portion of the study, but only 47 answered all the questions. Therefore, although the demographic report reflects 50 participants, other variable results reflected in the following pages showed 47 participants. Most participants identified as female, psychoanalytically or psychodynamically informed therapists aged 30 to 49 with master’s degrees. In the gender category, 39 (78%) of the 50 participants identified as female, while one participant (2.0%) identified as transgender, and ten (20%) identified as male. The frequency table below (Table1) indicates Asians were the predominant racial group with 20 participants (40%), followed by Mestizo with 16 participants (32%). All participants who identified as White were excluded from the sample. Table 1 Race

V a l i d

Black Asian Arab Biracial Mestizo Total

Frequency 8 20 1 5 16 50

Percent 16.0 40.0 2.0 10.0 32.0 100.0

Valid Percent 16.0 40.0 2.0 10.0 32.0 100.0

104 The following frequency table (Table 2) reflects the participants’ country of origin from where they emigrated to the United States. The prevalent countries of origin were India and Puerto Rico, with five participants each (10%), followed by Colombia with four participants (8%). However, there was a broad representation of participants from regions across the globe. They emigrated from North, Central, and South America; the Caribbean; Central, East, and West Africa; South and East Asia; and the Middle East.

Table 2 Native Country

V a l i d

Brazil Cameroon China Colombia Dominican El Salvador Ecuador Ethiopia Honduras Jamaica Japan India Lebanon Mexico Nepal Nigeria Pakistan Philippines Puerto Rico Saudi Arabia Singapore

Frequency 2 1 1 4 1 2 2 1 1 1 2 5 1 3 1 2 3 2 5 1 1

Percent 4.0 2.0 2.0 8.0 2.0 4.0 4.0 2.0 2.0 2.0 4.0 10.0 2.0 6.0 2.0 4.0 6.0 4.0 10.0 2.0 2.0

Valid Percent 4.0 2.0 2.0 8.0 2.0 4.0 4.0 2.0 2.0 2.0 4.0 10.0 2.0 6.0 2.0 4.0 6.0 4.0 10.0 2.0 2.0

105 Sri Lanka South Korea Taiwan Trinidad and Tobago Venezuela Total

1 1 2 3

2.0 2.0 4.0 6.0

1 50

2.0 100.0

As indicated in the following frequency table (Table 3), 32% of the participants lived in their country of origin between 13 to 17 years. Another group lived between 18 to 22 years (30%) before emigrating to the US. This means that 62% of the participants lived in their country of origin between 13 to 22 years before coming to the U.S.

Table 3 Time in Country of Origin

V a l i d

13-17 18-22 23-27 28-32 33-37 38-42 Total

Frequency 16 15 12 3 2 2 50

Percent 32.0 30.0 24.0 6.0 4.0 4.0 100.0

Valid Percent 32.0 30.0 24.0 6.0 4.0 4.0 100.0

In terms of the years lived in the U.S., the participants chose categories of between one to five years and 41 to 50 years. The range of 31 to 40 years was the most selected option by the participants at 22%, as indicated below (Table 4). Table 4 Years in the US Frequency V 1-5 a 6-10 l 11-15 16-20

Percent 4 8 4 9

8.0 16.0 8.0 18.0

Valid Percent 8.0 16.0 8.0 18.0

106 i d

21-25 26-30 31-40 41-50 Total

8 5 11 1 50

16.0 10.0 22.0 2.0 100.0

Professional Background All participants had a masters (64%) or doctorate (36%) degree in a field related to human behavior studies. More than half held clinical social work (34%) or clinical psychologist (26%) licenses. In terms of the time they have practiced as psychotherapists, they chose categories ranging from three years or less through more than 20 years. The four to nine years range was the most selected answer at 36%. Most identified generally working from psychodynamic, cognitive behavioral, and trauma-informed approaches. Other practice modalities were mentioned to a lesser degree. The frequency of their clinical orientation is shown in the graphic below.

107 Figure 1

The participants’ psychotherapy job positions were mostly at not-for-profit organizations (32%), at solo private practices 32%, or working at a private group practice (20%). The frequency graphic below (Figure 2) also identifies their clients' racial backgrounds. The majority of their clients were mostly Black and White, followed by Biracial and Mestizo. They selected Asian, Arab, and American Indian to a lesser degree.

108 Figure 2

Quantitative Results There were seven survey questions related to the experience of the IPC with their psychotherapy work with clients and their experiences with the psychotherapy community. The data reported in this section presents each question followed by a frequency report description of how participants answered these questions.

Survey Questions Results 1.

How much of an influence do you think your immigration history, ethnic and/or

racial background has on your approach and perspective on your psychotherapeutic work? Ninety-eight percent of the participants indicated they experienced some level of influence. Twenty-two participants reported some influence with Moderate Influence (44%) and 27 reported a High Degree of Influence (54%). Only one participant (2%) said

109 their background had No Influence on their approach and perspective on their psychotherapeutic work. Figure 3

IPCApproach 30

Frequency

0 No Influence

Moderate Influence

High Degree of Influence

IPCApproach

How much of an influence do you think your immigration history, ethnic and/or

racial background has on the way you and your clients relate? Ninety-eight percent of the participants indicated they experienced some level of influence. Twenty-three (46%) of the participants reported a Moderate Influence, with 26 (52%) saying there was a High Degree of Influence. Only one participant (2%) said their immigration history, ethnic and/or racial background had No Influence on the way they and their clients relate.

110 Figure 4

IPCRelate 30

Frequency

0 No Influence

Moderate Influence

High Degree of Influence

IPCRelate

How much of an influence do you think your immigration history, ethnic and/or

racial background has on what clients’ experience is of you in the clinical encounter? Ninety-four percent of the participants indicated they experienced some level of influence. Twenty-seven (54%) reported a Moderate Influence, and 20 (40%) reported a High Degree of Influence. Only three participants (6%) denied there was such an influence.

111 Figure 5

ClientExperience 30

Frequency

0 No Influence

Moderate Influence

High Degree of Influence

ClientExperience

How much of an influence do you think your immigration history, ethnic and/or

racial background has on the way you feel about your clients’ experiences? Ninety-six percent of the participants indicated they experienced some level of influence. Twentyeight (56%) said there was a Moderate Influence, and 20 (40%) said there was a High Degree of Influence. Only two participants (4%) said their background had No Influence on how they felt about their clients.

112 Figure 6

IPCFeeling 30

Frequency

0 No Influence

Moderate Influence

High Degree of Influence

IPCFeeling

Defining the psychotherapy community as “Environment, trainings, and

workspaces in which psychotherapists nourish their psychotherapy and clinical skills,” how much of an influence do you think your immigration history, ethnic and/or racial background has on the way you experience the psychotherapy community? On this question, 96% of the participants indicated they experienced some level of influence. Twenty-six (52%) reported a Moderate Influence, and 22 (44%) reported a High Degree of Influence. Only two participants (4%) reported there was No Influence.

113 Figure 7

IPCExpComm 30

Frequency

0 No Influence

Moderate Influence

High Degree of Influence

IPCExpComm

The two areas endorsed most frequently as being a High Degree of Influence were on question 1, “their approach and perspective on their psychotherapeutic work,” and on question 2, “the way they and their clients relate.” 6.

Defining the psychotherapy community as “Environment, trainings, and

workspaces in which psychotherapists nourish their psychotherapy and clinical skills,” how much of an influence do you think your immigration history, ethnic and/or racial background has on how the psychotherapy community might experience you? Ninety-six percent of the participants indicated they experienced some level of influence. Twentysix (52%) reported a Moderate Influence, and 23 (46%) reported a High Degree of Influence. Only one participant (2%) said there was No Influence.

114 Figure 8

CommExpIPC 30

Frequency

0 No Influence

Moderate Influence

High Degree of Influence

CommExpIPC

Defining inclusion as “The degree to which you feel like an esteemed member of

a group and needs for belonging and uniqueness are satisfied,” and psychotherapy community as “Environment, trainings, and workspaces in which psychotherapists nourish their psychotherapy and clinical skills,” how included do you feel in the psychotherapy community? Finally, 29 participants (58%) reported feeling Slightly Included, and only ten participants (20%) reported feeling Very Much Included, while 11 participants said they felt Not Included (22%). The previous question measures the variable Inclusion with the results presented by the following graphic:

115 Figure 9

Inclusion 35

Frequency

0 Not Included

Slightly Included

Very Much Included

Inclusion

Quantitative Questions and Hypotheses The quantitative question to be answered by this study was: What are the range and variation of scores for the experience of Loss recorded by Immigrant Psychotherapists of Color who completed the Demands of Immigration Scale (DIS)? I performed a frequency test of the variable Loss corresponding to the Loss Subscale in the DIS instrument to answer this question. The graphic below reflects that most participants were experiencing some degree of loss, with 42% feeling a little upset, 15% feeling More than a Little Upset but Not Very Upset, 15% feeling Very Upset. In comparison, 28%

116 responded Not at All or Not Applicable. In summary, 72% of participants asserted having various degrees of distress around the experience of loss. Figure 10

In addition to the previous question, the study intended to answer two hypotheses: 1.

An inverse relationship exists between the experience of discrimination (as

measured by the DIS) in the host country and how included the IPC feels in the psychotherapy community. 2.

An inverse relationship exists between the experience of not feeling at home (as

measured by the DIS) in the host country and how included the IPC feels in the psychotherapy community. I first ran a frequency subscale analysis on Discrimination and Not Feeling at Home. The results regarding the distress level of Discrimination for participants revealed the majority felt some level of distress, with 37% feeling A Little Upset, 21% feeling

117 More than a Little Upset but Not Very Upset, and 20% feeling Very Upset. Almost a third of the participants (22%) indicated Not at All or Not Applicable regarding feelings of distress around the variable Discrimination.

Figure 11

The results regarding the distress level of Not Feeling at Home indicated the majority felt some level of distress, with 34% feeling A Little Upset, 18% feeling More than a Little Upset but Not Very Upset, and 11% feeling Very Upset. On the other hand, more than a third (37%) said Not at All or Not Applicable regarding feeling upset about this variable.

118 Figure 12

A Correlation Bivariate 2-tailed test was used to analyze the variables Inclusion and Discrimination. The purpose was to determine the strength and direction of the relationship. This tested the hypothesis: An inverse relationship exists between the experience of Discrimination (as measured by the DIS) in the host country and how included the IPC feels in the psychotherapy community. In other words, while Discrimination scores increases, the Inclusion scores decrease or, vice versa, while Discrimination scores decrease, the Inclusion scores increase. The analysis did, in fact, suggest this negative directional result. The relationship was significant at the 0.05 level and is in the predicted direction. However, the relationship is not strong at -.297. There is a modest relationship between discrimination and inclusion, but in the predicted direction.

119 However, since inclusion is measured by a single 3-point scale, it may not be a very accurate measure of inclusion, so the correlation is low, or it may simply be that the relationship itself is weak. Although correlations of scales composed of individual Likert items are routinely done, I acknowledge that since Inclusion is a 3-point ordered scale, it does not fully meet the assumptions of Pearson correlations.

Table 5

Correlations Discrimination and Inclusion

Fishers Exact Test and Chi-Square Analysis for Inclusion and Discrimination The purpose of the Fishers Exact Test and Chi-Square Analysis for Inclusion and Discrimination was to examine if there is a statistically significant relationship between the two variables. The variables Inclusion and Discrimination were dichotomized as follows. Inclusion (Not Included, Slightly Included, and Very Much Included): 0 = Not Included 1 = Slightly Included, Very Much Included Discrimination (Not Upset or N/A, A Little Upset+, A Little Upset++, More Than a Little Upset but Not Very, Very Upset): 0 = means of 0 to 1.5 (Not Upset or N/A, A Little Upset+)

120 1 = means of 1.6 to 3.0 (A Little Upset++, More Than a Little Upset but Not Very, Very Upset) The previous analysis is represented as “D_GrpDiscrimination1.5”

Table 6

Case Processing Summary Discrimination and Inclusion

Table 7

Crosstabulation Discrimination and Inclusion

Table 8

Chi-Square Tests Discrimination and Inclusion

121 The relationship between Discrimination and Inclusion is statistically significant. The standard Chi-Square (two-tailed) is significant (0.034), the Fisher two-tailed is not quite significant (0.054), while the Fisher 1-tailed is significant (0.044). The relatively small sample shows test results around 0.05 (some a little below and one a little above). It is expected that if there were a larger N, then all test results would be significant. Since I hypothesized a directional relationship, using the 1-tailed result of .044 (which is consistent with the standard chi-square) is appropriate because the hypothesis intended to predict the direction of the variables. The predicted direction of the relationship is negative (inverse). If the relationship is as predicted, we would expect that there would be a lower percentage of the response “Not Included” in the “Not at All Upset” group than in the “little++, more, very upset group,” which is true (10% versus 35.3%). This relationship is moderate. The Fisher 1-tailed result is significant (.044). These results validate the hypothesis that an inverse relationship exists between the experience of Discrimination (as measured by the DIS) in the host country and how Included the IPC feels in the psychotherapy community.

Hypothesis 2 A Correlation Bivariate 2-tailed test was used to analyze the variables Inclusion and Not at Home. The purpose was to determine the strength and direction of the relationship. This tested the hypothesis: An inverse relationship exists between the experience of Not at Home (as measured by the DIS) in the host country and how included the IPC feels in the psychotherapy community. In other words, while Not at

122 Home scores increase, the Inclusion scores decrease or, vice versa, while Not at Home scores decrease, the Inclusion scores increase. Results suggest a negative directional correlation between variables. As one variable increases, the other decreases as predicted. However, the correlation is not significant at the 0.05 level. The strength of the correlation at -.121 is weak. Given the small sample size, there is relatively little statistical power to detect moderate or small associations or to claim a statistically significant relationship between the two variables The observed relationship suggests a negative and weak association between Not at Home and Inclusion. Since inclusion is measured by a single 3-point scale, it may not be a very accurate measure of inclusion, so the correlation is low, or it may simply be that the relationship itself is weak. Although correlations of scales composed of individual Likert items are routinely done, I acknowledge that since Inclusion is a 3-point ordered scale, it does not fully meet the assumptions of Pearson correlations. Table 9 Correlations Not Feeling at Home and Inclusion

123 Fishers Exact Test and Chi-Square Test for Inclusion and Not at Home The purpose of the Fishers Exact Test and Chi-Square Analysis for Inclusion and Not at Home was to examine if there is a statistically significant relationship between the two variables. The variables Inclusion and Not at Home were dichotomized as follows: Inclusion (Not Included, Slightly Included, and Very Much Included): 0 = Not Included 1 = Slightly Included, Very Much Included Not Feeling at Home (Not Upset or N/A, A Little Upset+, A Little Upset++, More Than a Little Upset but Not Very, Very Upset): 0 = means 0 to 1.5 (Not Upset or N/A, A Little Upset+) 1 = means of 1.6 to 3.0 (A Little Upset++, More Than a Little Upset but Not Very, Very Upset) The previous analysis is represented as “D_GrpNotTAtHome1.5” Table 10

Case Processing Summary Not Feeling at Home and Inclusion

Table 11

Crosstabulation Not Feeling at Home and Inclusion

124 Table 12

There is not an association between Inclusion and Not at Home based on the Fisher’s Exact Test and Pearson Chi-Square Test. The percentage of those who were (Not Upset, N/A, A Little Upset) and (Not Included) is 20% and those who were (More than a Little Upset, More than a Little Upset but Not Very, and Very Upset) and (Not Included) was 16.7 % -- a small difference with a small sample.

Qualitative Results The following findings represent central themes emerging from the long, in-depth interviews with eight immigrant psychotherapists of color in the United States who were interviewed after participating in the survey. There are contextual variations in how they discussed central themes, but they referred to the same central idea. There are also variations in emerging outlier themes that represent individual themes not mentioned elsewhere by other participants but relevant in their immigrant psychotherapist of color experience as it can enrich the discussion. Six major themes and one outlier theme emerged from this study:

125 1.

The impact of trauma and loss in the immigrant and person of color identity.

Struggling with racism in the psychotherapy community.

The impact of race and immigration on transference and countertransference.

Positive engagement with the psychotherapy community.

Having a sense of advocacy for minority clients and colleagues.

Absent discussions on race and racism in the therapeutic relationship.

The need for people of color to educate White people (Outlier).

A descriptive report of each theme with supportive quotes follows. The purpose is to better understand the subjects of the study by reading their own words as they describe their lived experiences.

Theme 1: The impact of trauma and loss in the immigrant and person of color identity . The first central theme emerging in this study was the process IPCs engaged in building a relationship with their immigrant and person of color identity. This relationship was established in their country of origin and later as they embarked on their emigration. The relationship implied having their history of immigration very present as they made decisions and lived through different life experiences in the U.S. In addition, this relationship suggested a process of reflection and integration of their new experiences.

126 Traumatic past experiences. As part of the IPC relationship with their immigrant identity, participants are conscious of their history, including traumatic experiences lived in their country of origin. Some of these experiences propelled their exit to the US, while other traumatic experiences were not directly attributed to their decision to leave but preceded their departure. These traumatic experiences included living in a homophobic and sexist environment, societal and political turmoil, poverty and inequality, stressful work environments, and family of origin trauma. Some might not have directly experienced traumatic events in their country of origin. Still, their immigration responded to societal migration forces already in place between their country of origin and the U.S. A participant spoke about living in a homophobic society as a source of distress because it did not allow him to go through an open exploration of his sexual orientation: So this is something that was not easy for me to pursue in my country of origin because I didn't know any gay people, so there was no sense of being able to be open and out while being gay. So I just thought, I just won't even go there. Another participant shared similar struggles of what it was like for him to live in a homophobic society when working as a lawyer in his country of origin: On the other hand, because I’m a gay man and living in a very homophobic society, I experienced oppression and discrimination… as a lawyer, I was immersed in a very homophobic world— because the legal world was very homophobic, especially at the highest levels… A participant also talked about the patriarchal society she was raised in and needed to leave behind:

127 But I had incentive to leave behind a society that was very patriarchal. Out of all the grandchildren of my grandfather, I did really well compared to all my cousins, but in that environment, it was like no matter how well you do, if you’re a girl, you would never be seen as someone who can become a successor. . . All these things, and I found that to be very toxic and unhealthy for me. It’s not the right environment for me to be able to really ultimately realize my full potential. Another participant described experiencing societal and political turmoil and this being a reason for leaving his country of origin: In my country at that time, the political situation was very difficult. In the 1980s, there was supposedly what the government classified as a civil war, but it was not a civil war. It was basically the left, the guerrillas, and the right, the government, and the military groups in between. This political turmoil in the participant’s country of origin impacted him personally as he and his family had to put measures in place to be safe. He shared a family story in which a relative was kidnapped and murdered, which was his starting point of reflection regarding whether he should stay or leave his country of origin: They literally took him out of his clinic with his stethoscope, with his gown, when he was

caring for some children and they kidnapped him, and it was known that

they were paramilitary groups. To make it short, unfortunately, he appeared a few days later dead, tortured. So all of that was terrible. So at that time, I used to say, “I don't want my children to grow up in an environment in which bombs, machine guns, those of the left against those of the right and us in the middle.”

128 A participant shared the experience of being very aware of the reality of poverty. Even though she experienced the impact of it not in her nuclear family but in her extended family, it was a visible reality that forced many to emigrate: Not everybody had the opportunity to have an education. A lot of my family members were not educated even though my small family unit was. So I saw them go through lots of hardships, and I just had that awareness around me of there being a lot of issues and economic hardships that we still need to address back in our country. Finally, a participant described her experience with family trauma when living in her home country: There’s trauma in the family, and when I was a teen, I didn’t necessarily was able to verbalize or piece it all together about what’s happening. I feel there was some neglect, and I was just talking to my partner about I thought my parents were, like I said, able to give me something that I can engage in, but then, they were not necessarily always there…I felt neglected at times, and I think that also fostered my feeling of independence because they were literally not there to help me.

Idealizing life in the U.S. Participants acknowledged being excited about starting a new life in the U.S. because of the good things they had learned and heard about the country. In some form, they idealized life in the U.S.: It was kind of interesting, because I think there was a part of me that always glamorized life in the US based on the TV shows I saw. Like it looked like all

129 people lived in exciting cities like New York City or something, and they get to work with the best technology, and the fanciest cars, and the coolest clothes, and they get to do any and everything they want to do. There didn’t seem to be any limitation on who they are and what they can be. And it sounded like, “Oh wow, that seems so exciting.” The same participant elaborated on how disappointing it was to realize the U.S. was not as it was portrayed in the media: It was when we got to college, the college itself. That was a culture shock because we ended up going to a small liberal arts college. And it’s in the middle of nowhere, really. . . And I remember my mother saying, “Where have I brought my children to?” And at that point, we weren’t really aware yet of what was in store. It was just a culture shock in the sense of, “This doesn’t look like what it looks like on TV when you go to college you supposed to be,” like if you watch A Different World or something growing up, the college seemed urban. It’s in the middle of a city and there’s lots of people. Nobody told you about trees and one stoplight in the town, and there are no stores in the town, you have to get somebody to drive you to the next town to buy clothes or to buy food. So, it was such an awakening. She later stated how her perspective on the U.S. was more grounded and based on reality after the experiences she has lived through in the past years, There’s a lot of opportunity to do things that I couldn’t do in the Caribbean, but I think the rose-colored lenses are off. I can see that, yes, there are opportunities but

130 there are often barriers in front of those opportunities. And there are often little extra hoops you have to jump through in some cases to get to those opportunities. So, I feel like I have a more realistic understanding of what it is to be a Black woman in this country. A participant’s disappointment shattered her idealization when witnessing and confronting issues the country faced at the time, such as terrorism and racism: It was like I came in August 2001 and then, September 11 happened when I was in community college. That’s crazy because I had no idea how that—like right now, looking back, I can see how that changed my life because of the xenophobia was so much worse after all that. Yeah, I’m Asian. Maybe that affected me a little less, but generally, economically, culturally, America just became not the great place that used to be in the ‘90s. I just heard the ‘90s when Clinton administration was around, it was a good time…

Separation and grief from country of origin. Participants' separation from their country of origin was a source of distress and embedded in their relationship with their immigrant identity. They described the pain, the grief, and the emotional disruption that implied separating from their country of origin and their families. These stories of separation have remained in their psyche as they have embarked on new experiences in the host country, shaping their relationship with their identity. In their accounts of separation from their home country, some spoke about not being emotionally present in the process of leaving or not remembering their emotions during their emigration. Others shared how exciting it was for them to start a new chapter

131 in their lives only to encounter discrimination and cultural shock. A participant described how leaving her support network was emotionally disruptive: “I think the hardest was to leave behind teachers that really took care of me, friends that were very close to me.” She subsequently mentioned how difficult it was for her to come to the U.S. and experience xenophobia, propelled by the post-911, anti-terrorism narrative: “I didn’t sign up for the post-September 11 xenophobic America suicide, you know. I didn’t sign up for that, but that’s kind of what I got.” A participant described how he had to leave his family in his country of origin to start to make the transition of bringing them to the U.S. He reported that separation from his family in order to accomplish his goal of emigration was one of the most challenging experiences in his life: . . . I felt so bad. The emotional part impacted me a lot because my children were in my country, despite the fact that in December of the first year I was here, I went to see them, and I came back. But it was emotionally difficult. They were perhaps two of the most difficult years of my life because I left my children. I felt responsible, guilty for not being with them, etcetera. But I adjusted, you know. A similar sense emerged for a participant when reflecting on her mother’s decision to leave her second home country with her and her sister, where she had lived during her teen years before finally emigrating to the U.S.: That was hard to say goodbye to friends, and to realize that I wouldn’t have a base in my second home country anymore. And it’s funny. Even in my home country, at that point, I had my grandmother and my great aunt still there, so there was

132 kind of a base in my home country. But it was their house; it wasn’t really my house. She explained how the trauma of separation remained when returning for vacation, and the sensation that she was not part of the experience of living in her home country: Not to say that when I was there, they didn’t include me in stuff, but I always noticed every time it was coming to the end of my visit in my home country, and I’m going back to my second home country, and my friends or my cousins would start talking about what they were going to do the week after I leave, I would always get so jealous, and I’d feel so disappointed, and like, “They get to do stuff here, and I won’t be here. I’m not a part of this.”

The participant’s statement introduced the fact that some IPCs missed their lives in their home countries. There is a sense of missing people and places and being treated more fairly or held in a higher social status. A big loss among all the losses and missing experiences was the inability to use their voices as strongly as they had in their countries of origin, depending on their mastery of the language of their new country: I was given responsibilities, and I felt respected by my peers and my teachers. I felt rewarded for things I was good at, talents that I have. Yeah, I was placed in important positions in different spaces. . . I mention that because that is what I miss the most, and that shaped my personality. I see myself as a leader; I see myself as a strong woman. I was always told I’m a strong woman. I have a strong voice. That is also what I’m the least prepared for when I came here.

133 Relationship with self-identity. Their relationship with self-identity also entails staying in touch with their country of origin or speaking about the place they come from. ICPs connect with their culture through different means, such as finding a supportive community and linking with cultural elements. As a result of missing their country of origin, participants stay in touch and visit when they can in order to establish and keep a strong connection with selfidentity: It has been difficult; there have been difficult times. There are things that I don't have, and I know I will never have. Still, my best friends are not here. My closest friends are my lifelong friends from my home country, and they remain a very significant part of my life. I go back to my home country twice a year. I miss my friends, but they are very present.

In this instance, the relationship to the country of origin became a source of solace and support. The participant felt isolated due to the rupture from his previous social life but staying connected with friends from his country of origin allowed for the nurturance of self-identity. These ways of relating to self-identity manifest in how participants speak about what it is like to be themselves, what it is like to be different in a foreign country, and how they embrace their identity and carry it through various life experiences: Sometimes, because some of my partners have been White, their families and their friends have been White. Sometimes I'm the only person of color at a dinner table or something and, therefore, having different points of view, and I have to then be the spokesperson for people of color. And then facing discrimination,

134 judgments, things I carry within myself, always thinking that I'm being watched, that what I do will be judged in different ways because of my personal color, that people will think if I'm working in the garden in the front yard, that I'm the gardener. In this instance, the IPC has felt the weight of what it is like to walk through life being different, the expectations it generates in public perception, and the roles he carries in society, such as the issues he chooses to discuss at the dinner table. The relationship to self-identity becomes a source of solidarity as he becomes a spokesperson for people of color when feeling singled out and different in the host country.

The outsider as identity. A participant stated that experiencing U.S. society as an outsider gave him a perspective on U.S. politics and society that others born in the U.S. might not have. He said, referring to people born and raised in the U.S., “It's difficult for them to really think something else is going on in other countries and pushing for that, again, feels like being an advocate for issues that no one else is interested in.” The participant explained how it was easier for him to comment on things not working well in the US. In that sense, he reported how his colleagues saw him as a bridge to the external world.

Immigrant and person of color identity development as a process. For IPCs, their immigrant and person of color identities developed over time. They described how these were new identities when arriving in the US and often were imposed on them, resulting in their rejection of those identities. Their initial rejection of

135 those identities can be mistaken as being racist or having some form of self-hatred. However, they explained that they were not immigrants in their countries of origin; therefore, identifying as “immigrants” was a completely new concept and experience they did not identify with, despite living through it. The concepts “person of color” and “racial identity” were either nonexistent or conceptualized differently in public discourse in their countries of origin: Identity was something that I never thought of until I came to the United States. I had never had to think of identity. Everyone looked like me, spoke like me. I didn't even have to think in terms of being a Black person. I never used the words "I'm Black" until I came to the United States. It was through self-reflection, observation of the new societal dynamics, and listening to others speaking about race and immigration that IPCs began to relate and use these identity concepts: It became more—if I'm like perfectly honest with you, I gradually started to think about the label "person of color" and then directly identified myself with it in the last three to five years…I was getting to know one of my colleagues, and we went out for lunch, and she mentioned this thing. She said, “But like for a person with a racial identity, blah, blah, blah.” Then, I listened to it and nod. I went home and asked my boyfriend, “What’s racial identity? What does that mean?” Google racial identity. Another participant stated about identifying himself as an immigrant: I think it's difficult to identify myself as an immigrant because of my visa. It's a “Non-Immigrant Visa.” . . . On one inside, for me, it's professional, working in

136 the United States with non-immigrant (visa) and (at) the same time, I'm living the experience of being (an) immigrant . . . I arrive here where I'm nothing, starting from zero, starting to see how life is in United States, start(ing) to relate with people from other cultures and start(ing) to live some distress because of the situation, because of the society, see(ing) how . . . my fellow immigrants coming from my home country live or experience here in United States. This statement exemplifies the struggle of coming to the U.S. and being assigned a label not yet integrated into one’s identity. It is common to use these concepts in public discourse in the U.S. as they have become mainstream ideas. However, new immigrants of color might not understand or identify with basic terms attributed to their self-identity in U.S. society.

The process of adaptation. The previous example also indicates that IPCs go through a process of adaptation manifested in unique ways. Besides learning how they are identified and categorized by society, they make the U.S. home and adapt to U.S. society. In their adaptation process, some have found communities that helped them embrace their sexual orientation or gender identity, which was previously openly rejected in their country of origin. The process of adaptation also included learning to master a new language. Also, it took them some time to understand the idiosyncrasies of U.S. society and the psychotherapy community, such as how the profession is practiced in the U.S. and the issues spoken about among colleagues, including issues of diversity. A participant mentioned adapting to U.S. society by living through different life phases in the U.S.

137 The experience of cultural shock. In this process of adaptation, participants also discussed going through a process of initial shock when interacting with their new physical environment: And the plane was a little wobbly. I remember they offered this very strange— they said, “Do you like some Jolly Ranchers?” And I don't even know what a Jolly Rancher was; at least it’s some kind of gummy. I don’t even know. I just thought, seriously, this is what you offer people in the plane, that little thing? Another participant observed the U.S. through the eyes of a new person coming for the first time to the country. She recalled being surprised at the aesthetics of the country: And what was memorable was leaving my home country’s airport behind and just seeing the state of what the airport was, and then landing into the airports in the US, and just coming out of the airplane and seeing the lights, and just seeing how different everything was. I was shocked. I had never seen something like that in my life. It was glamorous, and that was kind of shocking for me because I’d never experienced that; so many lights; it was really, really clean, I noticed. I had never experienced that kind of cleanliness in a public space because I wasn’t used to that in my home country. So, I remember that was remarkable for me.

Disconnecting from reality. Another participant described the shocking experience of being in a foreign country by feeling disconnected from her surroundings: In my sophomore year, I walked into the dining hall, and all the White women looked like the same person to me, and all the White men looked like the same

138 person to me. And I think it was like a momentary psychotic episode. And I just was like, okay, I got to get out of here. The same participant described a sense of betrayal when encountering a change of weather accompanied by a sense of shock, as she came from a country with warmer weather: And then, the next day, I woke up, and it was sunny outside. And I thought, “Okay. It's sunny now. It's going to be warm,” right? And so I put on my crew socks and my ribbed jeans, and my sweatshirt. And I stepped outside, and it was, of course, even colder because after the snow, when the sky clears, it's now in the 20s. And I remember stepping outside and the shock of the temperature and looking up at the sun and feeling betrayed. I felt like the sun had betrayed me.

Ambivalence about staying. A participant who has not been in the U.S. for very long reported his initial uncertainty about the length of his stay. He expressed a strong connection with his country of origin and considered returning if unable to manage feelings of nostalgia, a common experience for immigrants and part of their grieving process: At this moment, I feel like in the limbo in the middle because, for example, in my case, I said if someday something happens and I don't feel so much comfortable, or I really have a lot of nostalgia, and I want to go back to my country, I will go back. One participant returned to his country of origin to pursue a doctoral degree where he could feel comfortable and connected with his environment. Another participant returned

139 and stayed for a year to complete one academic year when feeling a deep sense of disconnection with the people around her. One participant returned to her country of origin to formally end her college program through a formal transaction that needed to be done in person. She ended up staying longer than expected and was not sure about returning to the U.S. All participants eventually returned to the U.S.

Belonging or not belonging. Another immigrant identity experience expressed by participants was the struggle of belonging or not belonging. Belonging also relates to the experience of not feeling at home, which often exacerbates feelings of homesickness. A participant expressed how she tried to force herself to belong to U.S. culture and groups in which she participated. One of the ways she was able to resolve this issue was to realize she was forcing her entire self to belong: And so, it's like—I mean, that piece of a part of me belongs there, and a part of me belongs here. I think, what helps me with that is I don't try to make my whole self belong here. But I do—if I think, do I feel like I'm American? I don't. I feel like an observer of this culture.

In this sense, the participant discusses an identity dilemma that generations of immigrants face after immigrating to a new country. It is a source of distress to realize how different they are from other people and their environment, as is the rejection that is often experienced while at the same time one is expected to assimilate and develop feelings of belonging. However, it is a source of comfort when they realize that the ideal of belonging as a whole person should not be expected.

140 Participants also believed that not fully belonging to the host country allowed them to analyze reality differently. It gave them the capacity to distance themselves from the cultural reality, assume an observer stance, and become more critical of society: But if you're already from another country, it's easier to see what doesn't work and comment

on it. So I'm socially outspoken about dysfunction in American

politics or culture or something like that.

A sense of privilege. A self-experience reported by participants was the sense that they were privileged in society. They reported having a sense of privilege when living in their countries of origin and the U.S. They described moving through privileged spaces due to their social class and professions in both countries. When speaking about privilege in their country of origin, they reported that their experiences allowed them to interact in academia, have professional experiences, and have an overall sustainable life compared to other members of society: I would say that in terms of my emotional experiences, it was mixed because, on one hand, because of some factors, like my social class, education level, and so on, I was in a dominant position within that society. And my profession, I was a lawyer, so that would give me a position of power in society.

Experiencing oneself as a lighter skinned person. In that self-experience of privilege, some reported the color of their skin playing a factor in being better positioned in society in their country of origin and the host country.

141 Most understood the color of their skin was lighter than others or that they were considered White in their countries of origin: And I also realized I still tend to get privileged treatment because people hear my accent and I’m a lighter colored Black woman than some of my friends, that I probably haven’t faced the same intensity of discrimination that some of my colleagues or friends, or even my sister has had, because she’s a little bit darker than I am, and she has expressed having had really difficult experiences because she was dark. Another participant reported being privileged, not so much due to the color of her skin but for having less of an accent. Another participant explained experiencing White privilege: I think that I experience the White privilege with my clients—that I have White privilege. But at the same time, within our culture, because I’m more yellow than brown or black, then I pass as an immigrant who has lighter skin color, and I’m educated. My race is perceived as a benefit among my peers and clients. He reported being a White person in his country of origin but noted, “On one hand—and this is a very dominant feeling—is that I changed my identity from being a White person in my home country and becoming a person of color in the U.S.”

Comparing oneself to other less privileged immigrants of color. In addition, some IPCs compared themselves to other immigrants who they understood experienced more discrimination than them in the U.S. Some of the factors

142 that drove more discrimination toward other immigrants, according to the participants, were having darker skin, having a more complicated immigration status, not being as fluent in English, or having more challenging life experiences. A participant mentioned his questioning of whether he deserved to be interviewed as he imagined his experience not being as traumatizing as others:

So there's also in this sharing with you of my difficult experience compared to a non-immigrant therapist, there's this feeling that, oh, maybe my immigration experience is not as scarring as someone else's, and do I have a right to be here in this interview or something like that, right? So I'm feeling compassionate with myself while I'm saying that, too.

In short, IPCs expressed in multiple ways their relationship to their immigrant identity and the feelings that emerged as a result. These feelings related to their immigration history, traumatic experiences, their relationship with their country of origin, and what it is like to be different while living in a foreign country. In addition, the immigrant identity developed over time as they went through a process of adaptation. In this process, participants struggled with cultural shock, disconnection from the new reality, feelings of betrayal, uncertainty about their stay in the U.S., feelings of not belonging, and a sense of privilege.

143 Theme 2: The impact of race and immigration on transference and countertransference. The second central theme emerging consistently through the interviews was IPCs facing racism in the psychotherapy community. IPCs described racism as being present during their training programs and admission, and in reading materials and dissertation discussions.

Not addressing IPCs’ specific needs. They also mentioned racism manifested in the lack of understanding of immigration and racial dynamics and the absence of conversations about significant clinical experiences of IPCs among colleagues and in continuing education programs. Some acknowledged the psychotherapy community was currently having discussions on race and immigration but wished they had offered them earlier, as they had to learn to handle racial situations in the clinical encounter on their own: But in terms of, again, the general community addressing how to deal with issues of racial bias when you encounter them, nobody taught me that in school. And that doesn’t come up when you go to CEUs or workshops. Nobody talks about that, which makes sense because many of them are not experiencing that. So these are solutions I’ve had to seek out for myself. There’s no manual that teaches how to deal with this thing . . . when a client asks you where you’re from, what are your degrees, where did you get educated . . . But now I’m seeing so many CEUs popping up about race and racial trauma, and I’m like, “Well, that’s

144 nice. I don’t really need it right now, but it would have been useful to have that three, four years ago.” Even though there was not an explicit racist confrontation with the psychotherapy community referenced in the previous quote, there is a lack of interest, and therefore action taken to meet the needs of the IPC. The participants’ experiences were that the psychotherapy community had not addressed specific racial-related needs in a long time. They experienced a lack of concern in teaching about the issues IPCs care about, resulting in some dropping out from White dominant institutions: But also, to understand like—built into this training is not talk about racial inclusion. There’s nothing about pervasive trauma. It talks about transgenerational trauma. But it doesn’t talk about social or racial trauma, which a lot of people who come into the training were people of color. That’s what they’re there for, because that’s who they’re working with, is people who have these issues. A participant reported her experience as a student in the classroom when learning to become a psychotherapist. She explained an interaction in class in which she spoke up about a chapter assigned in which the description of Black people was poor. She noted that her classmates did not speak up to what she criticized because they could not see it until she discussed the problem with the chapter. In her account of this experience, she said: …I just knew that that chapter wasn’t going to do anybody any favors if they decided to go out and work with Black clients. It was really interesting to see— the professor says she thought that chapter was weak, but I’m curious. She never said what she would have said in its place. She never said, “Well, I would also

145 offer these other readings for people to have a better idea.” Nor did she have a conversation in class that I can remember where she said more about it. So, it’s kind of like, “If I didn’t say anything, what would people have gone on to think and do?”

Inefficient response to racism. A more explicitly racist incident in the psychotherapy community, although not recognized as such by the community, included an IPC being singled out, reported for ethics violations, and ostracized by colleagues and professional associations after taking the initiative to work on a podcast about the Black experience. She discussed issues related to colonialism and Christianity and their systems of oppression, but encountered opposition: . . . apparently, a student in a graduate program was assigned that episode to listen to. And she, as a White, young woman, felt that we were being racist to White people in our discussion of colonialism and Christianity…and she filed an ethics grievance against us. So, we got a letter from the Ethics Committee saying, “This has been filed against you.” We had to provide a letter saying, “Well, this is where we were coming from, here’s the context of all this” . . . They said, “The thing has reached an impasse, would you want to meet with them?” And at that point in time, neither one of us had paid our dues. So, we’re like, “If we’re not members, you don’t really have jurisdiction over us at this moment with this ethics thing. So, this is where we stop, and we hope you guys figure out how to work with Black people in the future.”

146 It was evident to the participant that the institution lacked the capacity and agency to identify racism in the complaint and confront their member about her actions by taking a neutral stance. The institution, in this instance, preferred to handle the problem as another conflict when this presented as a complaint with racist implications, which would have required a more direct approach with the complaining member. Also, the participant understood that the institution’s actions reflected a lack of understanding of racial dynamics.

Treating the IPC as incompetent. Other participants reflected on their difficulties when participating in psychotherapy consultation groups in which facilitators and colleagues were mostly White. One participant observed racial dynamics in which either she was treated with extra kindness, or facilitators provided preferential treatment or validation to White psychotherapists equally competent while not providing validation of the IPC’s contributions to the group: Microaggression is one of those things where you’re like . . .it makes you question whether or not you’re crazy when you’re actually experiencing it. And you know, we just had this parallel experience in the same classroom, sitting literally next to each other and both commented on the same case material in the last five minutes, and one person got treated with silence; the other person was treated with praise. The participant mentioned that IPCs’ race-related concerns or questions in the psychotherapy community tended to be treated with silence. She was in awe of how

147 educated psychotherapists could not have basic conversations about race. There was an overall sense that the psychotherapy community did not offer IPCs the necessary tools and in-depth group discussions to address their concerns and consultation needs. Participants shared that sometimes they were treated as incompetent professionals in some instances, and academia was given as an example by one participant. He stated he was only assigned classes related to working with people of color. He also applied for several positions including president of an educational institution but was rejected for disguised racial considerations, such as not being “presidential” enough. He stated he was aware that some perceived him as incompetent, which he attributed to speaking with a different accent and not presenting as the traditional White person. The participant mentioned being able to read nonverbal reactions and understanding when colleagues were patronizing to him: When the community behaves in that way, like patronizing me, and “Oh, poor you, we are going to be patient, and we are going to give you some space.” Very quickly, I use that. I go like this (participant lifted his head up), and I start, kind of, showing off. Then they are, kind of, shocked, like, “Oh, he knows. He knows.” The same participant expressed perceiving a lack of patience toward him when colleagues offered him time to speak, but disguising it under the guise of inclusivity: I think because I’m in social work, at times, I feel that they take this paternalistic approach. “Let’s hear the person of color. We need to be open and inclusive. Let’s open a space for this poor person, who is a person of color.” Then because I start with my accent and so on, oh my gosh, it is like they need to be patient to listen.

148 A participant reported an instance in which he was singled out and made fun of by a colleague in the presence of other psychotherapists, using as a reference his country of origin: On one occasion, I was sharing my experience when a person made a comment, supposedly as a joke, saying that that was the way we practiced in my country. And I had to clarify that, “First of all, I did not practice psychotherapy in my country. I practiced medicine. All the knowledge that I have, all the training that I have was obtained in the United States.” So what I was using was what she had possibly been trained on as well. The previous participant learned to be polite when attacked with a racist or ethnocentric statement. At the same time, he would show their ignorance and assumptions about him in his response. Another important issue raised by an IPC was how, when psychotherapists were hired to important positions, colleagues assumed employers hired them to fulfill a diversity requirement, thereby overlooking their competencies. The general assumption was that they did not have to put any effort into getting the job because they did not have to demonstrate their competencies and skills to get hired but only had to be a person of color. On the other side, they felt some job interviewers overlooked their real skills and only focused on the organization’s or private psychotherapy practice’s diversification needs. One participant said that a job interviewer suggested she could help a minority couple on their caseload when, in fact, she was not competent in couples therapy. She said that had the interviewer looked at her resume, she would have understood her actual competencies.

149 Racism and running a private psychotherapy practice. Private practice can also be a source of concern for the IPC. Racism can manifest itself in many particular ways, from not receiving colleagues’ referrals to only getting people of color referrals. However, the field of solo private practice can also be a refuge for IPCs to escape controlling and racist agency or psychotherapy group environments. One participant stated, “And then I began to think about doing my private practice because I said I can’t be under someone else’s control any longer.” However, the clients of color who can afford private psychotherapy are limited, and psychotherapists of color suffer the repercussions of such racial inequality financially: When I then got licensed and began to look for my own clients, it was real pain. And I thought I bet this wouldn’t happen if I were a White guy. So I felt bad, difficulty. Also, that our clients, if they’re immigrants, people of color, queer, etcetera, I mean, all of the disadvantages in society. They may have less money, income, resources. One participant expressed concern that she would become a starving psychotherapist if she opened her psychotherapy office in private practice. She attributed this conclusion to the race-related conflicts she experienced in the community; she understood those conflicts would curtail her from the source of referrals needed to survive independently in psychotherapy practice. A participant shared a hiring experience for her psychotherapy practice with a White colleague. She expressed frustration at the lack of cultural competency of a White psychotherapist she intended to hire:

150 I remember we interviewed someone from my practice, and I asked her what are her thoughts about diversity? Right? And she said—she startled first, right, because here’s a Black person asking her about diversity. I was interviewing her with my White business partner, and she’s White. So she startled, and then she said, “Well-well, you know, I-I recognize my-my privilege. I recognize my White privilege.” And I was like, uh-huh, okay…You really don’t have thoughts about diversity if that’s the best you can come up with. She expressed her frustration at her White colleague’s biases when discussing the need to hire a person of color the next time: And I said to my business partner, after that…“I would really like for us to, the next time we hire someone, to make an effort to hire a person of color.” And she startled. And she was like, “But, I mean, I’m not going to hire someone who’s not qualified.” And I was like, “What the fuck!” … And I was like, “That’s your first thought that you come up with about hiring a person of color?”

Lack of IPCs in the psychotherapy community. Besides her frustration with the lack of competency among colleagues around issues of race, this participant also expressed concern about the lack of IPCs in the field of psychotherapy. She recognized this as a detriment for communities of color: And also, it’s hard when people want that. And my caseload is full. It’s heartbreaking to know that people are looking for someone who they can feel looks like them or can resonate with them in that way, someone who is not a part of the oppressive patriarchy or just someone that they could settle with.

151 Not having enough IPCs in the field to refer clients to is a systemic racial problem that clients of color and psychotherapists have to confront often. The previous examples explain how racism in the psychotherapy community manifests in different areas of psychotherapy practice. According to the participants interviewed in this study, racism was present implicitly and explicitly. Participants struggled with racial situations, such as a lack of education and lack of support specific to the needs of the IPC. Other racial struggles pertained to the lack of understanding about the needs of the IPC and subsequent explicit microaggressions.

Theme 3: The impact of race and immigration on transference and countertransference. The third central theme pertains to the experiences IPCs had in treatment with clients. In addition to how clients responded to the IPC’s identity in treatment, participants discussed how their identity as immigrants and as people of color emerged in the clinical encounter. These experiences manifested through transference and countertransference dynamics.

Where are the White clients? One of the main manifestations of race in the clinical encounter was the absence of White clients in the caseloads of most participants interviewed in this research. Most IPCs said their caseload mainly consisted of people of color or members of marginalized communities related to sexual orientation or gender-identity minority groups:

152 But I remember feeling resentful at the beginning that I had to—like why aren’t just more White clients coming to see me, why does it have to be that I’m identified as a niche specialty person because I'm a person of color or as a man, not as a queer person?. . . And I do actually, I have White clients. But if they don't come, that's their loss. In the last sentence, the IPC has managed to find some resolution to a pattern he has observed in which White clients would not choose to work with him. He placed the problem on White clients instead of internalizing it. Another participant experienced a similar situation: I have two or three patients, White, but most of them, they're from a lot of countries. I know I'm in a country of immigrants, but I ask myself, why not White people?...I see this pattern. And as I think from what I listened from my colleagues from the same agency, it seems that they have more White patients. This participant also managed to come to terms with this reality when analyzing his initial screening phone calls with White clients who seemed disappointed when speaking with him: "I listen like, ‘Ahh, thank you.’ Something like, not what I was expecting or— and then you understand: it's not me." The IPC’s way to come to terms with this reality was by thinking that not everyone would like him.

Similarities in the transference from people of color. Participants also discussed clients’ transference when choosing a therapist and how racial similarity and difference were embedded in the transference. IPCs reported that most clients of color had a positive transference. They explained that clients were

153 mirrored in the therapist with clients sharing sameness due to racial, ethnic, cultural, and language similarities. They explained that race was a topic they easily engaged in. Said one: "The people of color, some of them will very joyfully engage the subject about— but again, it's about commonality and about positive transference." This discussion was mainly about the issue of race as something they had in common. In other instances, the positive transference presented in the lack of racial tension in the relationship: So, I show up now as this person who looks like them, talks a little different, but also is not forcing them to do stuff, is inviting them more than coercing them, you know what I mean? And validating a lot of who they are and what they want to do.

People of color negative transference towards the IPC. While most psychotherapists highlighted the positive transference from minority clients, some IPCs experienced negative transference when working with similar groups of people. A participant indicated that his assumption a minority client he was treating wanted to talk about race resulted in the client's resistance to speaking about their racial identity. In this instance of negative transference, being from the same country of origin made the client feel too close to their maternal or paternal experiences. In the assumption that it would be easy to work with clients with similar racial or cultural affinity, the sameness brought to the surface negative experiences not yet resolved with their parents and any conflicts they might have with their country of origin. . . . in couples especially, it’s being interesting for couples to have some assumptions about like the wife might make an appointment with me knowing

154 that the husband's an immigrant or male or something like that. And that therefore, he might come to therapy because I might understand him better. And then they come, and it doesn't sometimes go well, because he has a very complicated relationship with his mother or something, and . . . it's just scary, and then they'll run away afterwards.

Differences in the transference from people of color. IPCs also reported differences between IPCs and their clients, even if both are similar in race or cultural identification. A participant explained that, for the most part, their differences were not a source of negative transference: They don’t dwell on what are the differences or what are the advantages or disadvantages. The message they get is, he has traveled so much, and here he is so successful and with me, working with me. That’s how they see me.

This participant made an exception when speaking about differences being a source of clients’ negative transference. Differences in social class might be a source of tension when the IPC is privileged, and clients are from marginalized communities. The participant explained being very aware of the ways his country of origin was rooted in classism and how he participated in it. He explained that he perceived classism as not being as evident in the U.S. when he generally interacted in society, which helped him contain his usual ways of relating under a classist paradigm. However, it would emerge in sessions when interacting with clients from his same ethnic and language background who are underprivileged: “I cannot keep in check my old self, and some clients may

155 perceive my classism, and that may create a negative reaction.” This statement presents both transference and countertransference reactions, but the participant recognized how both transference reactions are not exclusive but coexist together.

White clients’ transference toward the IPC. Participants also discussed White clients’ transference. The transference oscillates between being positive and negative. Some highlighted White clients' difficulty in speaking about race. Some participants understood it was easier to talk about race when there was sameness in the psychotherapy dyad, as opposed to differences. A participant described how a client resisted speaking about race: Well, some White clients are really hesitant to talk about me being a person of color. They'll say things like, “I didn't completely get on your website that you only work with people of color. If I did, then maybe I wouldn't have come. I don't want to take the spot away from someone else who might need you more.” So I've had things like that said. I've heard other people say that “I guess we could talk about all of these things, but when I ask you, I don't really get any answers from you about who you are. So how can we talk about your experience of being a person of color?” The participant mentioned these examples; although the client demonstrated interest in the IPC’s identity experience, they demonstrated avoidance to speak about their feelings regarding the IPC being a psychotherapist of color. A participant recalled having interactions with White clients who undermined his capacities:

156 First of all, many of them see you as having taken the place of someone else who does not belong to you. As it happens that illegal immigrants come to take jobs from people who are legal in this country. More or less from that perspective. Also, they maybe see me as that I don't have enough experience or enough studies to do this work. This participant mentioned hanging his diploma on the wall, and clients usually were curious about it. It was a starting point of conversation for many of his clients, who generally seemed surprised and curious about him having a Ph.D. or having studied at a prestigious university. A participant discussed having negative interactions with clients who she described as having diminished her experience of self and human dignity in session. She decided not to share the details of the encounter in the interview. Still, she explained how she had decided to become stricter about disclosing her personal life with clients. She described not experiencing racial biases in sessions recently and thought her clinical work was not “out of the ordinary” regarding immigration and race.

Clients’ assumption that sameness will facilitate understanding. Finally, a participant discussed a common assumption by minority clients that IPCs will understand their experience. Focusing solely on the commonalities of their experience, they limited discussion about how both members of the dyad are different, bringing some dilemmas to the IPC: But in doing that, I think there's some assumptions that I understand their experience, and then that alienates them. So it's so delicate this, do I know your

157 world, do I not know your world, how much do I need to convey information that will make you relaxed and be comfortable, and how much do I need to withhold so that there's more space for you to grow. And tell me who you are—very delicate work.

White clients not seeing difference becomes a source of dilemma for the IPC. Not seeing their differences becomes a silencing of potentially helpful discussions. A dilemma emerging from this transference is the IPC’s countertransference response questioning how much they should reveal about their differences, their immigrant identity, and its implications for treatment:

Well, again, sometimes it's like, do I bring attention to the fact that I may not understand aspects of their life because I came here 25 years ago, or that I do understand aspects of their life because I'm an immigrant, like, do I talk about those things, or do I just let them stay with their fantasy and their transference?

Immigrant psychotherapist of color countertransference. In discussing their countertransference, IPCs reported various responses to their clients. The countertransferences shared included those evoked when differences emerged between IPCs and White clients. Those feelings were: feelings of otherness, not fitting in, feelings of nostalgia, feeling unseen as a person of color, feeling not worth their money, devaluated, intimidated, overly self-conscious, envious, rejected, tested, and scrutinized. One participant wondered why a client chose him instead of a White

158 psychotherapist. He perceived that White clients devaluated him by the scrutiny he received and, as a result, he said he tried to show himself as an expert:

And even for me, in countertransference, I feel more this need to show that I know, to show me (myself) as a professional, to show me (myself) as an expert . . .I feel something in his eyes or something about…I feel some evaluation, and I see also some devaluation, like . . . where did you study, and where did you come from? Tell me about your expertise, they have more…White people, they ask more (of) these type of questions. But sometimes—why? Because I'm people of color?

Several participants resented their competency being reduced to their racial and cultural identity, as they felt they offered other competencies that are often overlooked. The negative countertransference IPCs experienced with minority clients related to IPCs behaving as if they were back to a hierarchical society, enacting social class differences that were present in their country of origin.

Countertransference responses related to sameness. Other countertransference responses related to the experience of sameness are feeling empathy toward being Black, freedom to self-disclose, joy in shared experiences and cultural affinity, the therapeutic work being experienced as rewarding, and having the unique experience of connecting by speaking English as a second language or by speaking the same language. One participant mentioned having a deep sense of respect

159 for minority clients, as he understood that being in their position meant being discounted and disrespected in society. There was a recognition for IPCs that their identity as immigrants and as people of color brought clients to their door, helping deepen their connection. A participant explained how she felt deeply connected with the immigrant experience, being an immigrant herself, and how she tried to use that experience in the service of her clients: I think I have more empathy and understanding of what it’s like for a client that struggles with their language. I think I’m better at—“You don’t need to know every word. You don’t need to understand every word your client’s saying.” It’s about the affect, and it’s about the gestalt.

In this case, she used her previous experience of having difficulty communicating fully during her first years in the U.S. Based on her immigrant experience, it was essential for her to attune to the client independent of their fluency in English. Another participant mentioned how her experience of being an immigrant and a person of color shaped her identity to the point that she used it to understand clients with similar experiences: I think it shapes my identity in that I become aware of being different, and it makes me more empathetic towards those people who also feel different, who also feel like they’re not a 100 percent belonging to the situation. And I think that has helped me as a therapist, even looking for ways to be more understanding, to build empathy with someone, like, “Yes, I can kind of relate to not fitting in, sometimes, or just feeling like I’m culturally behind or not getting what’s

160 happening in this situation.” So, it’s made me more understanding, more empathetic.

Managing countertransference responses on race and immigration. IPCs have resorted to managing their interactions with clients in multiple ways to cope with their countertransference. One of them mentioned establishing more explicit boundaries: Because sometimes I've had circumstances where that has been used to discriminate against me . . .Yes. So that's why I am, moving forward, I am very careful about saying this is what I am, this is where I'm from. So I go ahead and assess, ask more questions about what's their reasoning for asking me that question. Usually, most people would come and say, "I'm just curious." Then I go ahead and answer. If I think that the reason why they're asking me is inappropriate, I will redirect. The same participant mentioned resorting to the principles of neutrality, rationalization, and emotional distancing, particularly with clients with whom she shares similarities. The participant assumed a neutral stance when working with clients who evoked similar feelings or life experiences she has had: …sometimes, the issue of transference, when you see a situation that you’ve probably been in, in a client, and then I have to recognize that feeling for what it is and find a way to rationalize it, and manage it, and recognize it for what it is, and resolve it, probably through supervision, probably through consulting with peers…

161

Another participant brought up the topics of race and racism with clients when she felt it was critical to have such a discussion: There's almost like a relief that comes in people just by it being brought up, right? Because otherwise, we're both in our own worlds, trying to have this conversation without offending the other person, but I'm your therapist. So I have to be able to have this conversation with you.

This participant highlighted that she expected clients to understand the importance of agreeing to disagree on topics of race and immigration. She also mentioned assessing how willing she was to undertake such conversations on a given day before redirecting a discussion on race. However, she would also engage clients who have the potential for more meaningful discussions on the issue of race.

A bridge between immigration history and psychotherapy work. In listening to IPCs’ interviews, I noticed that most presented a theme that came through their history and later resurfaced as they talked about their clients' feelings. An IPC mentioned how traumatic it was for her to lose her voice when she first came to the U.S. due to her inability to communicate clearly in English. She eventually discussed her capacity to empathize with clients who were unable to communicate clearly due to a language barrier; as for her, there were so many ways humans communicate beyond the use of words. She described having come to terms with not understanding everything through verbal expression.

162 An IPC described his dislike of using an authoritarian approach when working with clients. When he discussed his family history, he described his struggles with his father. He said his father was strict, unreasonable, and had little flexibility. The IPC mentioned instances where he was disrespected and needed to assert himself with authority figures throughout his life as an adult in the U.S. The IPC eventually described how society underestimated and treated immigrants poorly. He developed a strong sense of advocacy and protectiveness toward immigrants. He emphasized treating immigrants with the utmost respect and relating to them at the same level, knowing they probably felt intimidated by his status in society as a psychotherapist and as a social worker. He discussed examples in which White doctors at the hospital where he worked as a social worker would talk down to their clients or had little sense of how their authority made immigrants feel intimidated or misunderstood. He felt his duty was to help doctors lessen their authoritarian approach toward patients. A participant described how she experienced herself as an observer of U.S. culture. The sense of being an observer came from her experience of feeling like an outsider due to being an immigrant. This participant found that eventually her capacity to become an observer of U.S. culture allowed her to feel comfortable describing and explaining in detail issues of race and culture to White people, including to her White clients. In summary, it is apparent that psychotherapists and clients’ race experiences were present in the therapeutic encounter, even if they did not notice it. Psychotherapists' subjective experiences of what they found important to discuss in treatment – the racial issues they paid attention to within themselves and their clients, how they managed their

163 experience of immigration and race – all were present in psychotherapy sessions with clients. Issues of race and immigration manifested when clients questioned why IPCs were not getting more White clients on their caseloads, when IPCs were having difficulty engaging clients in meaningful conversations about race and immigration, or during the positive and negative transference and countertransference experiences around immigration and race.

Theme 4: Positive engagement with the psychotherapy community. One of the central themes of the study relates to how IPCs have felt the psychotherapy community has provided space for positive engagement, despite the struggle with racism in this community. They understand the psychotherapy community has been influenced and benefited from the current trends on racial discussions, which has forced it to examine its racism.

Recent changes in the psychotherapy community. IPCs look positively to the fact that many in the psychotherapy community have taken initiatives to be more inclusive of people of color. A participant mentioned her surprise at how well received she has been by the psychotherapy community she practices and trains in: But I've actually been surprised that I have not—often in those settings, I haven't felt like my color was a thing that separated people from me. I feel like I've been very well received when I've done these trainings.

164 Some perceived a gradual change in the psychotherapy community they had not seen before. Those changes in the community have included having more conversations around racism in their organizations, encouraging self-reflection about race within themselves and their clinical psychotherapy practice, and welcoming initiatives to diversify the field of psychotherapy. One participant noted: We’ve been having a lot of conversations and pushing for a lot of things for people to diversify the field, and to be more inclusive with what they do, and to learn about their biases and stuff that are at play in what’s going on. Some of them considered the connection that changes occurred in the psychotherapy community in concert with the Black Life Matters unrest after the killing of George Floyd in 2020. A participant understood this social unrest as being a starting point for many communities to deepen their conversations about race in the psychotherapy community: Then all this whole last year with the George Floyd killing and the awareness of Black Lives Matter, just as this whole awareness and the whole country that we've got to look at discrimination. And even with me, too, gender, all those kinds of stuff. So now, people like me, I think I'm courted and more welcomed anyway. So I feel more seen now. I see more, other people like me speaking up and being welcomed. Some of the ways the participants expressed feeling welcomed in the psychotherapy community included: being invited to present as keynote speakers at important professional events, being looked to for case consultation, being receptive to the IPC’s

165 feedback regarding race in the organization, and being open to learning from them on skill sets and treatment approaches in which they specialized.

Psychotherapy community helps in adaptation. A participant mentioned finding the psychotherapy community very helpful in his early adaptation process to U.S. society. Practicing psychotherapy in a foreign country has expanded his view of the world, his practice, and the population he serves as a psychotherapist. He mentioned the psychotherapy community's emphasis on issues related to the LGBTQ community, race inequality, immigration, and trauma has been enriching for him. These are not topics emphasized in the training he received in his country of origin.

There is still progress to be made. Although participants described the progress made on race and immigration, they also mentioned there still being a lot of work to look forward to in moving toward inclusion in the psychotherapy community. A participant described how her professional association moved positively toward a direction of inclusion, but then moved back toward the opposite direction: We also have a committee, a DEI committee, Diversity, Equity, Inclusion Committee, in the Association. But interestingly, at one point, they didn’t want to have the chair of that committee be involved with the board. So, the board of directors would have been making decisions and enacting policies without consulting with the chair of the DEI Committee.

166 The same participant reported having mixed feelings about the psychotherapy community's progress toward inclusion. She mentioned having mixed feelings because her professional association showed ambivalence in providing space to develop a psychotherapist of color roundtable. She stated after the association allowed them to have the roundtable for psychotherapists of color, they had to defend the importance of the group after a White psychotherapist complained that the roundtable only included psychotherapists of color. The participant stated the roundtable was in jeopardy of being suspended multiple times in the following years after new leadership opposed the roundtable. She said she used her advocacy skills in this situation, causing the association to finally agree to keep the roundtable. The participant mentioned expressing her disappointment at how unequipped the members of this association were to manage issues of race. Another participant expressed a similar view in which she considered that, despite the psychotherapy community’s efforts, it still has a lot of work to do: The Sensorimotor Psychotherapy world is really trying to shift and provide for more diversity and inclusion. The Somatic Experience world says that they're doing that, but they're actually really struggling with doing that because these are both very White institutions.

In summary, participants have had positive and meaningful experiences in the psychotherapy community. Some of them felt happy about the changes, and some had hoped that these changes had taken place sooner. Others connected the changes to the social uprising taking place in society. Despite the community moving toward a direction

167 of inclusion, participants said that the advance made by the psychotherapy community was still a work in progress.

Theme 5: Having a sense of advocacy for minority clients and colleagues. The fifth central theme emerging in this study was a deep sense of advocacy for minorities and people of color. This countertransference was present in all participants, but it was so consistent in their narrative that it needed to be highlighted as an independent theme. Also, this sense of advocacy transferred to colleagues and cohort members who were immigrants of color. Their sense of advocacy manifested in how participants felt about the world around them and their actions to support their clients and colleagues.

The therapist advocate. Participants responded to their sense of advocacy for minorities by advocating for clients at their organizations and workplaces. Some mentioned advocating for their clients as being one of the reasons they were marginalized at the workplace and eventually fired. A participant mentioned her hesitation to get excited about new resources for the community she worked for, as it usually excluded providing help to the immigrant population. Her analysis of the benefits and resources clients could access usually excluded the immigrant client: Ending homelessness only includes American citizens. Medicaid, Medicare, Department of Human and—you know, HUD—Housing and Urban Development only covers people who are Americans. They don’t cover people who are victims

168 of human trafficking. Somehow, their status got screwed up, so who do these people go to, and who is going to be sympathetic to them?

For this participant, it was essential to her as she rose to positions of power that provided her with privilege and access to people with resources, to commit to helping the immigrant population. A participant discussed his advocacy efforts for his clients when working as a social worker. He also discussed how, before becoming a social worker and advocating for his clients, he had to advocate for himself and his Latino classmates when in social work school. He stated he had to learn how to develop a sense of self-advocacy as he encountered a hostile environment in the U.S. In living this harsh reality in his own life, he was able to empathize and found the courage to speak up for his clients once becoming a social worker: And then, in the Hospital, one of my biggest goals was to train, educate the doctors, the nurses so that they understood that if the mother did not take the child to the Hospital, it was not because she did not care, because she was neglecting him. It was because she had to choose between going to work and feeding the family or going to the Hospital and missing a day of work that many times would lead them to get fired. So it took time for doctors to understand. He found it critical to train other professionals interacting with his clients to empathize and place themselves in their shoes. He expected professionals and colleagues to understand what it was like to experience disadvantages in life from the lens of an immigrant.

169 Another participant shared a similar internal experience of identification with the immigrant community. This identification also fueled his sense of advocacy for his clients: So even though at a personal level— because I have so many other advantages— the pains of the undocumented immigrants resonate so deeply inside. So that has changed my attitude in terms of becoming a social advocate. It’s a huge transformation. A participant expressed solidarity and a sense of advocacy for immigrants coming from his native country, knowing they are largely discriminated against in the U.S.: . . . you feel that you have some responsibility also as a professional developing in United States, to try—I don't know if it's to help, but at least to advocate for people in need that they are similar like you, that's something that I feel.

. . . and also to see you’re surrounding(ed) off(by) other people of your same background living all the rejection, difficulties, not have a paper, not have the same opportunities, that's why also you feel like that, you would like to advocate for them, to do more for them. Empower this, for example in my case, immigrant community. A participant also shared her sense of duty to immigrant clients. It is essential to her that minority groups can receive the care they need. Her sense of duty came from her own experience and understanding about the difficulties people of color and immigrants encounter in U.S. society:

170 Sometimes, it feels like a duty, like a civic responsibility, I would say, at this point, for me, especially with the issues around Black people, around immigration rights, around refugee rights . . . So at this point, it’s become a civic duty for me to contribute my voice to the psychotherapy community so that way I can make sure that adequate care, or adequate awareness, is being acquired about people of color, and immigrants, and other people.

An advocate for the IPC. A participant described engaging in activities to advocate for psychotherapists of color. This advocacy included creating consultation groups for psychotherapists of color to discuss issues that emerged for them clinically with clients and in the psychotherapy community. She discussed the reasons to create such spaces: There are a lot of therapists of color who these things are happening, but they're not thinking about them or noticing them or referencing them or checking in with how they affect them personally. The participant's reflection about this group implied the need to have a space for psychotherapists of color to feel comfortable sharing their experiences of racism and exclusion. In this way, IPCs would get the support they need without concerns that they will experience microaggressions. The same participant mentioned an instance in which she had to call out her colleagues for not thinking about the experience of psychotherapists of color when dealing with White supremacy: . . . I was in a training where they were talking about how to work with White supremacy, right? At the end of the training, it's like, how do you work with this

171 issue in therapy?. . . and the group came back, and they read what they had discussed. And I said, “I just want to acknowledge that nothing in your discussion referenced what happens for a person of color dealing with a client that's bringing that to them, that it wasn't even a part of what you thought to discuss.” And they were like, “Oh yeah.” I try to do it gently but firmly because I feel like—if I don't speak to it, who's going to? And it turned out, in this training, two other people actually did speak to it. So that's I think—I've grown to a place where I feel a sense of competency in the work enough that I can speak to it in that way.

In short, for many IPCs, a sense of being an advocate for the immigrant of color community was evident in their experience. Most of their sense of advocacy came from their own lived experiences as an immigrant of color and their understanding this was an underserved and marginalized community. Most developed their sense of advocacy by having to advocate for themselves. Some of the advocacy efforts manifested differently, such as advocating for clients of color at the workplace and allocating resources. At the same time, others used their advocacy efforts to support their colleagues and cohort members. Some IPCs perceived they were the only members of the psychotherapy community interested in advocating for their clients and colleagues of color.

Theme 6: Absent discussions on race and racism in the therapeutic relationship.

172 One important central theme emerging from the interviews was that race was not an issue in the psychotherapy encounter; it was not discussed in sessions or was considered irrelevant to the therapeutic process.

Race and culture are not relevant. A participant discussed the idea of race not playing an essential role in psychotherapy work with clients. He had initially expressed feeling devaluated as a therapist by those who have decided not to work with him, as he perceived there was a racial issue in clients’ decisions. However, he understood race and culture were not relevant issues in his work with clients when stating the following: Beyond that if he is of color, someone that listen to them, someone that establish a therapeutic relationship. I think once that you have established a therapeutic relationship, your cultural—in case of the psychotherapist, is in that second place from my point of view.

His conclusion came from his cultural background and racial identity not emerging as a problem in the therapeutic encounter with clients. He explained that his clients are primarily people of color and the issue of difference in the clinical encounter was irrelevant to them, but that he was empathic and able to help with their problems. He also explained how race and difference were not issues he dwelled on when clients came to his office. However, he mentioned how he constantly struggled with feeling devaluated when becoming aware that White clients do not seek his help. He mentioned continually reminding himself that not everyone would like him. He also recalled the case of a mother who was surprised his interventions were better than the White therapist who

173 used to see her child before him. In addition, he stated the belief that the fact that both he and his clients were immigrants would bring them closer therapeutically, especially when both spoke English as a second language during their treatment.

Race discussions are emotionally overwhelming for clients. A participant who worked with a highly marginalized population understood discussions of racism were not relevant to clients as they were only concerned about their basic needs. She also stated that exploring trauma was not something she encouraged. Her understanding was that marginalized clients do not have enough emotional capacity to sustain such discussions: “For practical reasons, serving the most marginalized and most traumatized women of color community—people are not ready to explore their trauma. It’s all about safety first.” For this participant, trauma-related discussions were emotionally overwhelming, and race-related discussions were irrelevant as this is a discussion only those who have their basic needs covered can address. In essence, the idea this participant wanted to convey was that expecting discussions about race in the clinical dyad was something someone in a more privileged position could afford to have. Another participant described how racism did not affect her as in the past, particularly how it did not affect her negatively in the clinical encounter. The reason for it not impacting her was that she perceived it as the client needing help and growth. She also would assess whether someone bringing a highly racist discussion in session is beneficial to the treatment and might decide to redirect the client: And so sometimes, that's what I've been able to say, “Okay. This doesn't feel like this is necessarily relevant to the therapy that we're doing right now. And so we're

174 going to have to agree to disagree on this, and let's get back to the therapeutic piece that we're working on.” The participant's understanding about her decision to redirect her client was that the client’s discussion on racism was used as a defensive mechanism to avoid the issues she came to psychotherapy to address. The ICP explained that she had previously engaged in racial conversations with this client, in which she had confronted her on her racism, but felt she did not want to engage in such conversation with the client anymore. She mentioned that many people, including some of her clients, might not have the emotional regulation necessary to undertake conversations on race, despite her awareness that she needs to bring up the topic in sessions with some clients who are ready for this conversation. However, she understood that this client had enough emotional regulation to redirect the conversation.

Difficulty seeing racial transference. A participant stated he was sure immigrant clients had negative reactions toward him as a person of color but felt he was blind to them. Most of his psychotherapy work has been with immigrant clients and, therefore, he felt clients did not dwell on their differences. Still, he also admitted it was difficult to see if clients experienced him negatively due to racial differences. However, he felt the issue of social class was more present than race in the clinical encounter. He explained this being the case because he would bring his experience of classism learned in his country of origin to their interaction. It was difficult to leave that experience behind when interacting with disadvantaged populations. He explained his difficulty looking at any potential negative

175 reaction from clients due to race and having more awareness about differences due to social class and education: You know that I am sure they are, but I’m blind to those. It is like it is difficult for me to see them. I don’t know if at times . . . I cannot keep in check my old self, and some clients may perceive my classism, and that may create a negative reaction. I feel that at times, that it is more present in me more than the social class. . . I think that even though it is not so much in my narrative, it is in my feelings, it is the IQ part, the education part. It’s like that for me.

He reflected on how his clients might see him as a White person due to his lighter skin color and perceive his privilege. Thus, race has been in the clinical encounter by the participant being aware of his social privilege due to colorism. The participant also stated other factors that impact the therapeutic encounter besides race, such as that he was legally allowed to live in the U.S. and spoke English. Those differences have become healing factors for him as he has stayed grounded despite his social privilege.

Race is not an issue to focus on. Another participant stated race was not an issue he focused on during treatment. He mentioned he had not noticed a difference regarding his being a person of color or an immigrant in the therapeutic encounter. He added the possibility that his clients’ requirements to meet basic needs such as housing, medical care, and job security were contributing factors that prevented race and immigration from emerging in sessions or affecting the therapeutic relationship. He also acknowledged that the clinic’s treating clients with respect and having an inviting office space might ameliorate clients’

176 discomfort with issues of immigration and race, contributing to these issues not being discussed. This participant, however, mentioned having the impression that some clients might perceive him as taking the job from someone else, just as when undocumented immigrants are accused of taking natural citizens’ jobs. He also mentioned that his diploma on the wall was a source of discussion, as clients seemed surprised, curious, and impressed by his accomplishments: First of all, many of them see you as having taken the place of someone else who does not belong to you. As it happens that illegal immigrants come to take jobs from people who are legal in this country. More or less from that perspective. Also, they maybe see me as that I don't have enough experience or enough studies to do this work. I’m telling you that I have both my Ph.D. and master's degree from these Universities. When they look at it, I don't do it for that purpose, but they immediately comment that "Oh, from such and such University!" This participant also mentioned White clients being interested in learning how he has succeeded. He vaguely remembered an instance in which a client interviewed him on his training and expertise: Many years ago, I don't exactly remember the details, but someone did ask me where I had obtained my studies, what I had done in my country. I think it was a way to make sure that I had the ability to help them. That was perhaps the only time, but otherwise, actually, if it has happened, I haven’t noticed it. The participant in this quote referred to not having many challenges in sessions with clients due to being an immigrant and a person of color.

177 Cautious around issues of race. Another participant decided not to go into details about experiences of microaggressions due to confidentiality concerns in her first interview. In a subsequent interview, the participant explained she had a negative experience when a client had asked about herself and her background. Therefore, she decided to be more cautious about disclosing personal information to clients to protect herself. She later discussed barely noticing differences in her work with clients while being an immigrant of color, and that discrimination from clients was minimal. She explained that issues of race surface in the clinical encounter when clients ask about her background, at which point she would proceed with caution. The participant also mentioned that clients are more curious about her religion and country of origin than her race. She has framed these questions as something positive by perceiving them as something clients do to connect with her. One participant’s words summarized what most participants stated in one way or another regarding race not emerging in session with clients. She also acknowledged part of it was related to her being oblivious and not being trained to think about it: Frankly, I wish I can tell you that it comes up all the time about me being a person of color, but I feel like me being blissfully ignorant for a long time about my own racial profile and—I didn’t know I was supposed to think about it until all these academic environments, social justice movements…All these things make me think about it.

178 …The time when my client talked about chakra with me in front of my intern and my intern was cringing. My intern was like, “She’s totally racially profiling you. That’s not okay.” I was like, “Oh, it’s all like gist for the mill.” I want to know about how the client thinks about chakra and how she thinks I feel about chakra.

…I think that the fact that I don’t have very heavy accent helps me in my professional practice with clients. My experience of how that plays a role either is because clients don’t verbalize it, they don’t tell me, or I’m not trying to make it a problem. I’m not motivated to make it a problem. It’s only when the problem is super in your face, then you’re like, “Oh, this is a fucking problem,” but it’s not that often. I think, for the most part, that awareness was gradual, and it wasn’t always at the forefront of my mind.

Why is it difficult to talk about race? A participant shed some light on what makes it difficult to discuss issues of difference in the clinical encounter:

So it's been difficult for me to go there because I feel I might lose clients. But more and more, I'm able to go there without that fear, partially because I have more clients, and even if one went away, I could have another one. So some of it is about economics. Some of it is about expertise or what time just build up. . . And I think it's partially because, somehow, me and my clients, both of us try to

179 create a good rapport between us. So because we have this positive transference, it's really scary to disrupt that by mentioning difference.

Overall, there is a sense among participants that the topic of race and immigration was not raised in session when pertaining to their relationship with clients. Some participants mentioned it being easier to discuss when there are racial and immigration similarities in the clinical dyad. Some did not think racial issues emerged in the clinical encounter when they clearly alluded to racially related events.

Theme 7: Feeling comfortable educating White people (an outlier). One of the participants explained that a narrative that permeated the therapeutic encounter was that people of color should not educate White people. The participant discussed this issue in the context of being a psychotherapist of color in constant interaction with White clients and colleagues who felt curious about her background but at times thought they should not ask about her experience, afraid to burden her. She understood the importance of educating White people because no one knew herself and the community better: There's just so many things that no one can read about me, right? So I feel like that's one of the differences is that I'm okay with people wanting to—I'm okay with educating people about myself, where I feel like there's a context here of that you shouldn't do that, or White people shouldn't expect you to educate them. But I'm like, I don't know who is going to teach a White person about me because I don't exist in a book anywhere.

180 The participant believed the idea that people of color should not educate White people allowed White liberal people to avoid being educated. She understood White people would miss information that would benefit them and, consequently, the immigrant and people of color community. The participant also thought this narrative permeated liberal and anti-racist circles, allowing for disconnection and preventing conversations between racial groups. She understood this narrative emerges when White people feel uncomfortable talking about issues of race. Therefore, it can be used to calm down the anxious or uncomfortable conversations with people of color. The participant also questioned the idea that educating White people was a burden. She expressed enjoying talking about her experiences as a minority and would take any opportunity to educate the psychotherapy community and her clients.

181

Chapter V

Quantitative and Qualitative Findings Introduction This mixed-method phenomenological study intended to understand the subjective experience of the immigrant psychotherapist of color (IPC). The IPC experience included a set of experiences that occur between IPCs and (a) themselves, (b) their clients, and (c) the broader psychotherapy community while living and practicing psychotherapy in the United States. This study intended to acknowledge an otherwise forgotten minority group of psychotherapists in writing and professional discussions and facilitate awareness of the IPC experience In this chapter, given the mixed methods approach of this research, the analysis will be presented, first, in two sections: (1) quantitative analysis and (2) qualitative analysis. Later there is a section with a blended analysis in which the researcher will explain how both findings support, contradict, or expand on each other.

Quantitative Findings and Discussion The immigrant psychotherapist of color and their clients. The first four questions in the survey were related to the IPCs' sense of self and their work as psychotherapists with their clients. The research data indicates most

182 participants felt their racial, ethnic, and immigration history had various degrees of influence from moderate to high influence on: 1.

Their approach to psychotherapeutic work.

How they and their clients related.

What clients experience was of them.

How they felt about their clients' experiences.

These results might be self-evident as some authors have written about how psychotherapists who are immigrants or representing a racial minority group have unique needs and challenges concerning their racial and immigration identities (Akhtar, 2006; Comas-Diaz, 1991; Tang and Gardner, 2006; Tummala-Narra, 2004). These findings might also be self-evident because, given their training emphasis on transference and countertransference dynamics, it would be difficult to imagine a psychodynamic community that assumed the IPC's background would not influence the therapeutic encounter. However, until most recently, the psychotherapy community has educated and trained psychotherapists as if immigration, ethnic, and racial variables were not significant (Moody & Palmer, 2006). Indeed, there is a tendency to equate racial and immigration variables to any other personal variable a psychotherapist might bring to the psychotherapy encounter. Sometimes, race and immigration are not seen as distinctive pieces in transference and countertransference processes. On this point, Leary (1997) said that we could argue that the issue of race is just another personal variable like age and gender, but given the times we now live in, the disclosure of race in the clinical encounter is of a different order. Therefore, the tendency in the psychotherapy community to approach race and

183 immigration as simply any other demographic disclosure might indicate a reluctance to acknowledge its importance. It is a process of disavowing and minimizing the unique implications that such disclosures bring to a clinical encounter. A finding of significant relevance was that in all of the first four survey questions, only 2% of participants said their immigration, ethnic and racial background had "No Influence" in their psychotherapy work with clients. My inference was that the participants who reported that their background did not influence their work with clients were influenced by a traditional psychoanalytic training. My inference was confirmed when they responded that they were trained in psychoanalysis only. Traditional Freudian psychoanalytic thinking tends to posit minimum attention to how psychotherapists' variables and social context matter, unless they are highlighted as an obstacle to deepening the treatment. According to a traditional understanding of psychoanalytic thinking (Freud, 1915, p.164), it is considered a problem to admit that your background might be influencing the psychotherapeutic process and indicates requiring further psychoanalytic treatment for the analyst. This previous idea is a literal application of Freudian thinking when he says, “…we ought not to give up the neutrality toward the patient, which we have acquired through keeping the counter-transference in check.” Therefore, I assume that IPCs with such training who respond to this survey will not admit the impact their background has on their countertransference without confronting internal shame. However, that only 2% of the participants denied such influence in their psychotherapy work seems promising. The fact that 98% of the sample thought there was an influence in their therapeutic work with clients speaks positively about two things:

184 1. A group of minority psychotherapists who have clarity regarding there being some intersection between their identity and their psychotherapy work, despite the psychotherapy community lacking discussion on the issue, and 2. The evolution of current psychotherapy and psychoanalytic thinking in considering immigration, ethnicity, and race as significant variables. Despite 98% of the participants agreeing about some degree of influence in their work with clients, it is necessary to highlight differences in the degree of influence on each aspect mentioned above. First of all, there is a difference in responses between questions 1 and 2 and between 3 and 4. While the first two questions were general inquiries regarding IPCs' approach and perspective in their psychotherapy work and how the IPC and their clients relate, questions 3 and 4 were related to transference and countertransference. The High Degree of Influence decreased when the survey asked participants how their background influenced transference and countertransference. The difference in responses might indicate that traditional training still lies buried in participants' conceptions of neutrality. Some might have thought there was some influence but not a strong influence, almost as if not wanting to make immigration, ethnicity, and race a big issue. Therefore, one area to explore would be to learn more about what kind of training participants had on how to look at transference and countertransference concerning immigration, ethnicity, and race in their practice with clients.

185 The immigrant psychotherapist of color and the psychotherapy community. The following two questions in the survey were related to the IPC's experience with the psychotherapy community. The research data indicates most participants felt their racial, ethnic, and immigration history had various degrees of influence from moderate to high influence on: 1.

The way they experience the psychotherapy community, and

How the psychotherapy community might experience them.

The participants were again consistent in affirming that their background influenced how they were being experienced by others. For the question regarding how the psychotherapy community experienced them, the High Degree of Influence increased slightly in comparison to the first two questions (IPCs' approach and perspective on their psychotherapy work and how the IPC and their clients relate) to 46% while the Moderate Influence response decreased to 52% and No Influence stayed at 2%. Still, the High Degree of Influence was not higher than Moderate Influence. These questions were similar to questions 3 and 4 when asking about the influence in relation to their clients, but these asked about the influence in their experience of the community and the experience of the community of them. These were questions of how others saw and perceived them and vice versa. Their answers could be an attempt to try not to admit that immigration, ethnicity, or race had a strong impact on their world experience. Despite this subtle shift in percentage between questions 3 and 4 from questions 5 and 6, it is still an important finding when considering 96% felt their immigration, ethnic and racial background had various degrees of influence on the

186 experience they had of the psychotherapy community and of what the psychotherapy community experience was of them.

Inclusion. The results marking the most drastic difference were those for the final survey question, “How included do you feel in the psychotherapy community?” When looking at the findings initially, the evident conclusion might be that most IPCs felt included, with 58% feeling Slightly Included and 20% feeling Very Much Included. Nevertheless, those who felt Not Included had an increase of 22% when comparing it with 2% or 4% when measuring feeling No Influence in previous questions. In other words, out of 50 participants, 11 responded that they did not feel included. And for those who reported feeling included, the majority reported only feeling Slightly Included (58%). When 58% of participants reported feeling Slightly Included, this might mean they have felt some level of exclusion. It also means they had some positive experiences in the psychotherapy community that helped them answer they felt Slightly Included. However, it also indicates they still had experiences of exclusion that did not allow them to respond Highly Included. There might be multiple reasons for these findings. Among these are: 1. Even though some IPCs might feel included in a particular psychotherapy community, all will not feel similarly included in the same community. 2. The psychotherapy community is made up of multiple communities, and the feelings they experienced within several communities may vary.

187 3. There is a possibility that only parts of the IPC self-identity felt included while other parts felt rejected. In addition, we are assuming these feelings related to the variables of immigration, ethnicity, and race. Still, participants had other personal identities and work experiences that made them different which could have contributed to those feelings of not feeling included, which is beyond the scope of this study.

Hypothesis: Discrimination. As noted in the finding report in Chapter IV, the study confirmed the hypothesis that an inverse relationship exists between the experience of discrimination (as measured by the DIS) in the host country and how included the IPC feels in the psychotherapy community. Therefore, the more the IPC felt discriminated against in the U.S., the less included they felt in the psychotherapy community. One possible way to understand this finding is that exclusion dynamics were transferred from the broader community or host country into the psychotherapy community. Although some might argue that confirmation of this hypothesis should be obvious, the assumption was far from obvious because the variables measured experiences in two different communities: the host country and the psychotherapy community. There is a perceived notion that psychotherapists trained to work with pain and trauma would understand the importance of inclusion, diversity, and social justice. However, the opposite might be true when taking into consideration this finding. Despite learning about trauma, inclusion, diversity, and social justice values in their training, the psychotherapy community still engages in some exclusion of IPCs. This finding is not

188 surprising to sociologists as they argue there is a structure in place to maintain minorities in a particular social location in society. Bonilla-Silva (2015) indicates liberaldemocracies claiming to be beyond racism still maintain a racial structure in which racial groups are hierarchically ordered allowing social practices to emerge fitting the position of racial groups in the racial regime. Winograd (2014) supported this statement when indicating that practices of exclusion in the psychotherapy community might exacerbate a sense of loss and not belonging for psychotherapists of color. Practices of exclusion, such as the lack of attention in the literature and research about race and immigration, can interfere with IPC’s full inclusion in the psychotherapy community. Indeed, the IPC will not feel the community speaks about their experiences, making the community prone to biases in supervision, consultation groups, and training (Tummala-Narra, 2004). In the end, these practices of exclusion will hinder the IPC's success and participation in the community. One possible example of systemic exclusion in the psychotherapy community is that most practitioners are White (American Psychological Association, 2015; Council of Social Work Education, 2017). In addition, when looking for participants for this study in a Latino psychotherapy list, most were White Latinos, which is a caution about the possibility that similar exclusionary practices might be happening within minority groups. Also, Non-White Latinos might have more difficulty fitting into a White dominant psychotherapy community. When looking for racial demographics about psychoanalysts in the US for this study, I found a quantitative study exploring the decreased interest in psychoanalytic training (Katz et al., 2012). The study found cost, time, and negative institutional

189 atmosphere issues were possible factors for decreased interest in psychoanalytic training. The authors advocated for radical organizational change. However, the study failed to explore race as possibly being connected to minorities not wanting to attend a White dominant institution; or the possible race-related connection to prohibitive training costs. Nor did it mention race in the demographic report on participants. This example further supports the lack of inclusion of IPCs’ concerns and realities. It also demonstrates that even quantitative research, far from being objective, can also present biases in that information and minority perspectives are left out of our collective discussions. In this dissertation, IPCs indicated that their clients’ demographic profile was diverse. Their caseloads included a significant number of minority clients and White clients, which contradicts the myth that IPCs are suitable only to see minority clients. This myth has been used to discriminate against psychotherapists of color by not referring White clients to them (Winograd, 2014). In the discussion about the lack of representation of people of color in the psychotherapy community, a study found that minority psychotherapists were more personally involved with communities of color than White psychotherapists (Turner & Turner, 1996). The study reported that minority psychotherapists saw more than twice the proportion of ethnic-minority clients than nonLatino White providers. In this sense, there might be a willingness on the part of IPCs to work with minority clients, and clients sense that minority therapists understand their experience. Clients might feel the need to find a safe space to shield themselves from racial microaggressions. Turner & Turner (1996) also supported the idea that White therapists needed to engage more with communities of color.

190 In addition, this finding supports the understanding that the field of psychoanalysis and psychotherapy exists within the context of whiteness and the White power structure. The White power structure engages in systemic practices of exclusion and discrimination, and the psychotherapy community participates in those practices, significantly impacting IPCs' experience of self. One study indicated that perceived discrimination significantly impacted immigrants' psychological well-being (JasinskajaLahti et al., 2006) while highlighting the benefits of ethnic support networks. Feeling less included adds to the vicissitudes already present in immigrants’ experiences of loss and mourning, language adaptation, ethnic identification and racism, trauma, and generational issues (Ainslie et al., 2013). Other qualitative studies (Fleming, Lamont, and Welburn, 2012; Pearling et al., 2005) concluded that discrimination triggers feelings of being over scrutinized, overlooked, underappreciated, misunderstood, and disrespected, while race-related stress could be perceived as an attack on an individual’s identity. It also heightens one’s hypervigilance and triggers a state of psychological arousal (Williams, 2018). Indeed, sociologists (Lipsitz, 1995) have pointed out that discrimination has a negative impact on health outcomes for African Americans and Mexican Americans who were college-educated and worked toward upper-class mobility. Studies indicated the main reason was that, despite having financial security and living in safer communities, they were subjected to discrimination daily as they constantly interacted in White dominant environments, as opposed to recently arrived immigrants who would cluster together in closer support networks. Scientists (Williams, 2018) have mentioned that higher levels of discrimination narrow the arteries over time, contributing to high levels

191 of inflammation, cortisol dysregulation, shorter telemeter length, and oxidative stress, which are precursors for disease and a shorter lifespan. In summary, the findings suggest significant implications when the psychotherapy community participates in discrimination practices against the IPC. They might be contributing to IPCs' poor health outcomes and adding layers of trauma to their already complicated immigration experience.

Hypothesis: Not feeling at home. As noted in the findings report in Chapter IV, the study could not confirm a relationship between variables for the hypothesis: An inverse relationship exists between the experience of Not Feeling at Home (as measured by the DIS) in the host country and how Included the IPC feels in the psychotherapy community. One possible way to understand this result might relate to using a three-point scale for the question measuring Inclusion and the small sample size. Despite not being an association, the variables did move toward the predicted direction (increased feelings of homesickness and decreased feelings of inclusion). Nevertheless, participants did feel less included and did not feel at home, but those experiences were not linked to each other according to the hypothesis finding. Therefore, not finding an association does not detract from the importance of the profound immigrant experience of not feeling at home, compounded by other experiences such as not feeling included. The study simply does not have the data to support this claim. The findings might be related more to the study design than the actual reality that immigrants experience with such variables.

192 In addition, not feeling at home might vary depending on how long the immigrant has lived in the U.S. The literature explains that the longer someone lives in the new host country, the more the person develops adaptation, acculturation, and integration, allowing the immigrant to lessen feelings of homesickness (Garza-Guerrero, 1974). Guerrero stated that even though there might be sustained feelings of longing for the past culture and, while strong, they do not overwhelm the immigrant. In other words, as one identifies with certain aspects of the new culture, a sense of ease and belonging emerges, providing a sense of sameness, continuity, confirmation, and reciprocal corroboration. Therefore, I expected some degree of adaptation for the sample of this study, licensed psychotherapists actively seeing clients. Becoming a psychotherapist in the U.S. requires time and effort, allowing adaptation to develop and the ICP to gradually feel more at home. On the other side, the instrument DIS hardly captures the experience of Not Feeling at Home in the way described by the literature review in this research. For example, one of the Not Feeling at Home subscale questions simply asks the respondent to rate the statement, “I do not feel at home.” I wanted to capture a deeper experience, which is hard to capture in an instrument. Akhtar (2007) described it as a more intrapsychic factor involving the feeling of being uprooted from the country of origin, which leaves an absence, a sense of disconnection. However, if the IPC has built a home in the U.S., those feelings might lessen and may not influence their experiences with the psychotherapy community. I had already predicted this to be a limitation of the quantitative approach and knew that the qualitative approach would be the key to capturing the experiences in an in-depth way.

193

Question loss. On the subscale questions related to the experience of Loss, 72% of participants asserted having various degrees of distress around the experience of Loss. This experience involves emotional attachment to people, places, and experiences in the home country to that extent that the immigrant lost this attachment after emigrating (Ding, Hofstetter, Norman, Irvin, Chhay, & Hovell, 2011), while Garza-Guerrero (1974) described it as a reaction to a real loss of a loved object. The painful yearning to recover what was lost is reminiscent of earlier infantile object loss or separations. When object loss is significant enough, it represents a threatening, transforming, and remodeling force to the identification systems of the mourner. Some have asserted that practices of exclusion in the psychotherapy community might exacerbate the same sense of loss and of not belonging that psychotherapists of color often experience (Winograd, 2014). Interestingly, the variable Not Feeling at Home has a similarity with the experience of Loss. While Not Feeling at Home describes a sense of disconnection and feeling uprooted from what is familiar, creating a longing for that experience of mirroring and reciprocity from the environment, experiencing Loss describes an experience of emptiness and absence. However, both experiences might overlap when an immigrant leaves a familiar place. They are difficult to differentiate because Not Feeling at Home can make an immigrant long for what has been lost. When looking at the findings, the experience of Loss seemed more prevalent in the experience of immigration for IPCs than Not Feeling at Home. While 72% reported some degree of Loss experience, only

194 63% reported some degree of distress about Not Feeling at Home. Still, 63% is nearly two thirds of the sample.

Qualitative Findings and Discussion Structure of the analyses. The qualitative analysis was organized by themes and how each participant responded to the research questions. The main research question is: What is the subjective experience of the immigrant psychotherapist of color? From this main question, several additional questions follow, including: 6.

How does the IPC describe their immigration experience?

How does the IPC describe their sense of self as it pertains to their immigrant and racial identities?

How does the immigrant and racial identity of the psychotherapist of color emerge as part of the dynamic between the immigrant psychotherapist and the client?

How does the IPC describe the experience of being an immigrant therapist?

10.

How would the IPC describe their subjective experience with the psychotherapy community in relation to the IPC’s immigrant and racial identity? To organize the initial research analysis, I used The Analytic Category

Development Tool by Bloomberg (2016) as a model and adapted it for this research. I adapted it by calling it The Qualitative Analysis Process Tool, synthesizing the material for analysis as follows: research questions, themes, implications, recommendations. An adaptation to this tool is in Addendum E. I also used the Interpretation Outline Tool,

195 presented by Bloomberg (2016), for a second layer of analysis. This tool is a diagram that proposes an analytic process that structured the analysis for each theme. I used points 1 to 7 with each research question. At the end of the qualitative analysis, I elaborated on point 8. An adaptation of this tool is located in Addendum E. While the previous chapter intended to separate the unit of analysis and find themes to understand and tell the story participants shared, this chapter intends to present a coherent narrative with my subjective interpretation. To do this, I incorporated quotes from participants, literature, and theory to help make sense of the content shared in the previous chapter. I conclude by discussing my subjective experience while going through the process of analyzing the content.

Theme 1: The impact of trauma and loss in the immigrant and person of color identity. The question to be answered by this emergent theme is: How does the immigrant psychotherapist describe their immigration experience? The Immigrant Psychotherapist of Color presents a myriad of experiences that shape their self-identity. A profound sense of identity is shaped by the country they come from, their mother tongue, the reasons they emigrate to the U.S., and cultural groups affiliations. These experiences shape their perception of the world, which most often presents by experiencing the world as an observer or an outsider. IPCs described the immigration process as an initially exciting event that later evolved into one fraught with challenges and traumatic responses. One possible explanation for this is the idealization that immigrants bring when, disillusioned with

196 their country of origin, decide to embark on a new chapter of their lives in which only good things can happen in a new country. Instead, they faced discrimination, segregation, and rejection by the host country. They also faced the challenge of working low-wage jobs, being undervalued in social status, or not being entirely accepted in society, creating a sense of disconnection. The feeling of disconnection magnifies due to a perceived separation from their previous sense of self or identity, their family of origin, and physical spaces in their country of origin which functioned as a holding environment. Consequently, a sense of disconnection evolves into loss for those experiences that nurtured and helped form their self-identity. IPCs had the task of adapting to a new environment to reconstitute and reorganize their self-identity. They integrated parts of the new environment into their identity as they adjusted. A participant, for example, recalled struggling with the idea that she had to fully belong to a country that was not fully welcoming. Akhtar (1999c) discussed this issue as one of the struggles for immigrants when stating how they faced pressure to assimilate, which is complicated by a disappointing welcoming from the new country. The participant managed this struggle by coming to terms with not fully belonging when she stated, “I mean, a piece of a part of me belongs there, and a part of me belongs here. I think, what helps me with that is [that] I don't try to make my whole self belong here.” Some authors have elaborated on this struggle by adding that the process of adaptation gets complicated by loss as immigrants lose a part of themselves when moving forward into a new life. Freud (1917) discussed this dilemma in Mourning and Melancholia, explaining the reason for mourning without end is due to feeling invested in

197 object representations, being in this case family, country, past self, and language. In relational terms, a complete separation from early objects symbolized through the country of origin might be terrifying since lack of investment in these objects leads to profound isolation (Mitchell, 1988). Losing connection with these objects amounts to losing a part of the self, which is a painful experience as one participant asserted: “I guess that in relation to me, I feel that something’s lost. And I have to leave something in this place and people behind and some part of myself behind.” Some researchers who studied immigrant psychotherapists have found that losing cultural references was so profound that it was compared to dying and a threat to identity (Barreto, 2013). The demands of immigrating to a new country also involve psychic reorganization that manifests through not remembering how it felt to emigrate or disconnecting from reality when surroundings do not seem familiar. This psychic reorganization presented when a participant stated: In my sophomore year, I walked into the dining hall, and all the White women looked like the same person to me, and all the White men looked like the same person to me. And I think it was like a momentary psychotic episode. And I just was like, okay, I got to get out of here. Not seeing herself mirrored in others and surrounding environments was disorganizing. It was not until this participant returned to her country of origin for a year that she could reorganize and reaffirm the part of self that was not mirrored in the host country, providing her with an experience of belonging. This experience helped her reaffirm her identity and contributed to developing a sense of integration. Melanie Klein helps us understand the splitting that emerges in feeling a sense of belonging and not belonging

198 when having two different contexts informing one’s internal experience. In other words, how can we coexist with both contexts, allowing the new identity to emerge while fully embracing the previous identity and integrating them without resorting to feeling your previous identity is being threatened. In Kleinian terms, this will be called a sense of ambivalence. The following research question was also answered when discussing their struggles with labels such as person of color, Black or immigrant: How does the IPC describe their sense of self as it pertains to their immigrant and racial identities? IPCs felt it took time to assimilate the terms person of color, Black, and immigrant into their new identity. The psychoanalytic literature confirms this experience by describing the immigrant identity as an intruder, involving a shocking and traumatic experience about the emergence of a new sense of self. Ainslie (2017) said this identity arrives suddenly and without warning, intruding upon the existing identity, which was nurtured, held, and sustained by a community of people in the individual’s early life. The evolution of the immigrant identity was also an emerging theme in previous research in which participants’ feelings of threat to their already established identity decreased as the immigrant psychotherapist engaged in professional activities (Barreto, 2013). The emergence of their immigrant and person of color identities manifested as they discussed their sense of privilege compared to other immigrants who do not have access to the communities and resources IPCs had. Several participants in this study attributed their privilege or feeling less discriminated against due to lighter skin than other immigrants or not having an accent. Some of them said they were referred to as White in their country of origin where there is a different racial stratification system. All

199 participants in this study who referred to themselves as having lighter skin than other immigrants, or not having an accent, were clearly and noticeably Brown and Black individuals. If they had lighter skin color, they had non-European phenotypes and an accent that distinctively differentiated them from the rest of society. I will argue these racial phenotypes that they thought provided privilege could still be used to discriminate against them. Therefore, calling oneself lighter skinned or not having an accent could be a subjective experience for them and for those who categorize them. They might be referring to colorism; however, one must ask oneself: what would it mean to identify oneself as a darker person or with an accent in U.S. society? One participant seemed to get to the bottom of the answer to this question when he expressed the following: …we are all defined in America [US] in our relationship to blackness. And as close we are to it or part from it is how much power we have… [it’s] also about the definite association of Black people that's been created over a long time that these people are slaves and good for nothing…And then we have to say, “Okay. Am I that person? I'm not that person”… Am I going to be thought of as a good person or a bad person, intelligent or unintelligent, prone to rage or reasonable? Therefore, identifying oneself as darker or with an accent for immigrants might mean acknowledging having less power in society than they wish. It also means moving further away from defining oneself closer to the European ideal and recognizing that even though there are privileges, there is a full range of things not socially accessible to participants of this research. Acknowledging this reality for the IPC who compared him or herself with other immigrants of color must be painful. There might be a resistance for the IPC to name themselves as too Black, too immigrant, and with too much of an accent

200 as a way to resist an imposed identity that would be to their detriment because of the negative perception these terms have in society. Frantz Fanon (1952) described his experience of struggling with his Black identity in a predominantly White society when recognizing the powerlessness of his place in society where Blackness was defined by the white gaze. In the words of Fanon: I’m not given a second chance. I am overdetermined from the outside. I am a slave not to the “idea” others have of me, but to my appearance. I arrive slowly in the world; sudden emergences are no longer my habit. I crawl along. The white gaze, the only valid one, is already dissecting me. I am fixed. Once their microtomes are sharpened, the Whites objectively cut sections of my reality. I have been betrayed. I sense, I see in this white gaze that it’s the arrival not of a new man, but of a new type of man, a new species. A Negro, in fact! (p. 95) There is also a reality participants entertain in their minds regarding privilege that goes beyond whether they are lighter skinned or do not have an accent. Overall, it is a fact that psychotherapists in private psychotherapy practice are in a different social class position than newly arrived immigrants of color in the U.S. (National Association of Social Workers, 2011). Images of immigrants being exploited and risking their safety to cross the border are easily accessible via the news and social media. The immigration journey is part of their reality as it is spoken by clients, students, and close people in their lives. It is understandable for them to consider themselves privileged as they do not have to endure such hardships. They might feel that their discrimination complaints do not compare to what other immigrants of color have to go through. However, I hypothesize that the more immigrants of color move up the ladder in social stratification, the more

201 subtle the discrimination will be. One participant described her privilege and the realization that her life arrangement had protected her against more blatant experiences of racism: I feel like I don't have a lot of harsh reminders because of how my life is set up right now. And I mean, because I have been privileged. I mean, I have a job where I make a fair amount of money. I don't have to worry about food or shelter. I'm not rich, but I don't struggle. And I surround myself with people who are already open to different cultural expressions. And so the life that I have right now doesn't really expose me to that very much. On the other side, through discussing their privilege, IPCs go against a misconception in society that immigrants of color do not enjoy financial and social stability. This participant mentioned liking to destabilize discussions around privilege in professional settings when she talks to them about her privilege. At the same time, there is a feeling of guilt IPCs might experience when mentioning their privilege. They refer to a difficulty people of color experience when having success, which is a sense of guilt that they have left their communities behind or are not experiencing the same hardships. An author mentioned this struggle as one in which they may feel they have betrayed their communities by living a comfortable life (Holmes, 2006). The community might ask, are you like one of us? Some sort of rivalry can explain this. Instead of celebrating the IPCs success, some minorities may perceive the IPC's success as a threat or as an indication that “you don’t get me.”

202 Theme 2: The impact of race and immigration on transference and countertransference. The question answered by this emergent theme is: How would the IPC describe their subjective experiences with the psychotherapy community in relation to the IPC’s immigrant and racial identity? IPCs described their subjective experience of being an immigrant and their racial identity when discussing their thoughts about interactions with the psychotherapy community. One particular finding was participants’ feeling of invisibility when the psychotherapy community did not address experiences of race and immigration in continuing education courses, training, and academia. Although some can argue studies focused on racial identity and immigration are currently more available than in the past, they recognized that there was silence around these topics for many years. As a result of this silence, IPCs felt unsure about managing racially charged situations in the clinic. They also felt isolated during training and school programs while, at the same time, trying to come to terms with their experience of not knowing if their feelings and experiences were normal. IPCs were also angry at the psychotherapy community's inability to openly acknowledge the IPCs’ clinical experiences and unwillingness to educate themselves – this in a profession that claims to work and care for traumatized people. It is understandable to have these feelings when a community does not mirror IPCs’ internal experiences. It exacerbated feelings of invisibility and exclusion due to being an immigrant in the U.S. IPCs alluded to the George Floyd protests as the catalyst of change for the psychotherapy community, but they wished this change had come sooner. It took

203 a tragedy in U.S. society for the psychotherapy community to begin to awaken and look to their complicit silence around issues of race. Therefore, how did it feel to be silently excluded from the psychotherapy community when the IPC experience was not worthy of a deep and meaningful discussion? When the psychotherapy community is dominated by White colleagues whose discussions are disconnected from the experience of the IPC, the IPC may have an internal struggle feeling a sense of belonging to this community, as many participants stated. As immigrants, they experienced an emotional disruption after leaving their country of origin, and this was exacerbated by an environment that did not provide the needed mirroring and holding after such migration. Tummala-Narra (2020) explains that this experience places a silent strain on the ego and creates “anxiety, confusion and despair related to not knowing how to be fully seen and present and at the same time invisible to the majority group” (p. 54). IPCs reported that it was already difficult enough to attend training programs that did not focus on their issues of concern; however, it became a burden to participate in programs where the IPC’s ethnic group was diminished and disrespected, or the IPC was treated as incompetent. A participant shared an example of how a professor did not address poorly written material about African Americans assigned to their class: So, it was interesting to have to speak up. And again, I was still evolving in my thinking as what it means to be a Black person in this country, but I just knew that that chapter wasn’t going to do anybody any favors if they decided to go out and work with Black clients. It was really interesting to see—the professor says she thought that chapter was weak, but I’m curious. She never said what she would

204 have said in its place. She never said, “Well, I would also offer these other readings for people to have a better idea.” Nor did she have a conversation in class that I can remember where she said more about it. So, it’s kind of like, “If I didn’t say anything, what [would] people have gone on to think and do?” Another participant reported being treated as incompetent in a consultation group: Microaggression is one of those things where you’re like . . .it makes you question whether or not you’re crazy when you’re actually experiencing it. And you know, we just had this parallel experience in the same classroom, sitting literally next to each other and both commented on the same case material in the last five minutes, and one person got treated with silence; the other person was treated with praise. In the first example, a possible message conveyed to the participant was that Black people were not worth the professor’s time to review how they were portrayed in the literature. It seemed unclear if the professor agreed to the ways Blacks were described in the literature, given her willingness to assign the reading without criticism of its content. The problem, as seen by the participant, was how poorly the chapter described Black people by subscribing to five ways to talk to Black people without really talking about them as people and their historical and contextual struggles. This is an issue mentioned by other participants when finding White psychotherapists using codes or phrases to address their work with people of color without understanding who they are as people. In the second example, the message possibly conveyed was that people of color were inherently flawed, unsophisticated, unintelligent, and, therefore, not the most

205 talented psychotherapists. A participant mentioned being embraced by the community but being reminded she was not like the other Black people who were always angry. In this situation, the community also had difficulty acknowledging the IPC’s incongruity with a commonly assigned stereotype: Black people were angry people. This participant questioned the psychotherapy community's inability to hold people of color's anger. However, it might be very common for immigrants and people of color to feel that given these stereotypes, they had to prove their competencies or fight against the internalization of negative societal messages about people of color, as this participant mentioned: Participant: And I…try to fight against myself…I really articulate…my truth, like, they (we) are very intelligent, they (we) are great, they (we) have a great…culture, they (we) have very good values, they aren’t better than us, they (we) can do everything. And yes, we are here. And that's why subjectively, it's so difficult. You start to—it's a lot of battles with yourself. Researcher: With so much negativity around the term person of color, it's very hard not to internalize some of that yourself, and that's why maybe we fight it. Participant: For me, it has been like a fight. And really also, you feel this responsibility to show the other people that it's not like they think….really, we are so intelligent, we have culture, we have value, we have great people in my home country, we have a lot of good things, and we are very good, and we are at the same level, or it can be even better than them. Just focusing yourself, try to be the best. And yes, in turn, I fight a lot against…(the) internalize(d)…negativity of being a person of color.

206 Tummala-Narra (2020) spoke to this IPC’s struggle when writing, “many immigrants feel compelled to manage impressions of their respective ethnic and/or religious communities as an attempt to diminish negative stereotypes, discrimination, and aggression” (p. 54). At an unconscious level, although it might be common sense to correct stereotypes about one’s ethnic or religious group, it can also be a form of community preservation. Tummala-Narra also argued regarding the dominant White community that, “When people of color defy stereotypes of being stupid, lazy, and so forth, there is a reckoning with the real past of American history. White Americans are faced with the reality of their conscious and unconscious aggressions against racial minorities” (p. 53). Fanon (1952) also speaks to the experience of moving up the latter professionally while being Black, but the professional community is still quick to make negative assumptions about the Black professional’s abilities: Here was the Negro teacher, the Negro physician; as for me, I was becoming a nervous wreck, shivering at the slightest alert. I knew for instance that if the physician made one false move, it was over for him and for all those who came after him. What, in fact, could one expect from a Negro physician? As long as everything was going smoothly, he was praised to the heavens; but watch out – there was no room whatsoever for any mistake. The black physician will never know how close he is to being discredited. I repeat, I was walled in: neither my refined manners nor my literary knowledge nor my understanding of quantum theory could find favor (p. 97).

207 One must consider that there are implications for IPCs' experience of self when constantly receiving negative messages about who they are as part of a racial or ethnic group of people. A constant negative mirroring of their experiences might feel like a psychic split in which IPCs, while knowing themselves and understanding their strengths and capacities, receive the opposite message from the psychotherapy community. Even though the splitting might feel deeply personal, it reflects an actual splitting taking place in the psychotherapy community. Within a schizoid position (Klein, 1946), the psychotherapy community assumes a negative outlook toward the IPC while the IPC receives support from colleagues and clients who, in many instances, are people of color. There is projected aggression in the psychotherapy community’s denigration of the IPC who is made to feel “less than,” incompetent and unskilled. The source of this projected aggression is the psychotherapy community’s immediate and large-scale racism in which it is immersed, including the U.S. history of colonialism and slavery. Instead of acknowledging their capacity for aggression and making amends for the U.S. historical perpetuation of racism, the psychotherapy community engages in exclusion, silence, and invisibility when it comes to minority psychotherapists. In addition, the presumed incompetence of the psychotherapist of color, expressed through the assumption they were hired to important positions to fulfill diversity quotas for the organization, is a very common assumption on a broader scale in U.S. society. Through this assumption, the psychotherapy community diminishes IPCs' capacities and skills, reducing them to the color of their skin. Although being a person of color has become a requirement for some job descriptions to diversify a generally White organization, these psychotherapists are as equally competent as White psychotherapists.

208 These requirements have been added to job descriptions due to the tendency to overlook competent psychotherapists of color for job opportunities. Some might argue that the most qualified psychotherapist should be chosen for the job and that requiring that a person of color be hired could result in discrimination; however, this argument ignores the many candidates of color, who, for just having names that sounded Black or Latino – or for being a minority – were disqualified and overlooked. These discriminatory practices are not openly acknowledged and are difficult to prove. However, a theorist attests to such practices when discussing the concept of color-blind racism (Bonilla-Silva, 2015), in which there are raceless explanations for all sorts of race-related affairs. He gives the example of the lack of diverse hires in universities around the country, but it is explained as the administration only hiring the best applicants and their decisions having nothing to do with race. This explanation excludes looking at the systemic racial barriers for professors and students of color.

Theme 3: The impact of race and immigration on transference and countertransference. Two research questions answered by this emergent theme are: How does the IPC describe the experience of being an immigrant therapist? And: How does the immigrant and racial identity of the IPC emerge as part of the dynamic between the immigrant psychotherapist and the client? In participants’ accounts, there was a tension between having very positive feelings about working with minority clients and struggling with White clients who rejected them as therapists or made racist statements in session.

209 IPCs had very positive countertransference toward minority clients, as they generally seemed to have a positive transference toward the immigrant therapist. It was evident in their accounts that most of their clients were people of color or belonged to minority groups. They expressed joy and they experienced the work as rewarding. At times, negative feelings toward the IPC emerged when the minority client had negative parental figures in their life who identified or closely resembled the therapist’s cultural or ethnic group. An IPC, for this instance, assumed a client of color would be eager to speak about race but was confronted with the client’s resistance, a transference recognized by Holmes (1992) as being common among clients of color. In many instances, the IPC felt protective of their clients and colleagues who identified with a minority group. Sometimes, a rejection presented as White clients not scheduling appointments with the IPC, furthering the racial split in the psychotherapy community and society at large. It also presented as a scrutiny of the therapist’s education and expertise, making the IPC feel devalued regarding their professional skills and competency. Armstrong and Wildman (2012) discussed a similar issue with professors of color when students asked about their credentials every year. They said a professor of color who often received this question realized it could mean the White students were asking what qualifies the professor of color to teach them. The rejection also presented when White clients engaged in offensive race-related material in a session that would be touching upon sensitive racial issues for the IPC. This engagement seemed as if the client were oblivious to the fact that their therapist was an immigrant and a person of color who would take offense with their racial statements, deepening feelings of invisibility in the consultation room.

210 Clients' obliviousness about their therapist's racial and ethnic identification could also be interpreted as clients knowing about their feelings about race at an unconscious level. The client appeared oblivious, but the racism operating at an unconscious level would surface in the relationship between the client and the therapist as a form of enactment, or how the client would operate in the world. A term that can refer to this experience is “normative unconscious,” which understands the unconscious as dynamically and deeply engaged in our social context. Layton (2002), who proposed this term, states that the term “normative unconscious” indicates unconscious forces that intend to maintain the status quo by reinforcing dominant cultural norms such as racism, sexism, classism, and homophobia. Therefore, one can rationalize White clients' rejection actions as mere choices made when selecting a therapist and having nothing to do with race, or that issues brought into the consultation room had nothing to do with the IPC but, instead, the client. However, (1) considering normative unconscious is present in the psychic experiences of both client and therapist, and (2) that enactments typically occur in the therapeutic work, the interpretation of client actions with the IPC should include issues of race. At a minimum, racism should be considered as a possible interpretation in these instances. IPCs managed their countertransference in multiple ways. For example, a participant felt she could not speak about an experience of denigration that occurred in the consultation room with a client. It took further inquiry in the form of a second interview for the participant to explain how she felt denigrated and how she understood her boundaries were violated when a client used her ethnic or racial disclosure against her. This incident resulted in her establishing firm boundaries with clients and managing

211 disclosure with cautiousness. In this instance, we can consider this experience of setting clear boundaries as a way to protect herself from potential danger or threat from clients who could inflict harm in session. However, establishing clear boundaries, although for the purpose of protecting oneself, closes the door to having any potential discussion with clients about race. Setting boundaries in the form of not disclosing or not speaking about one’s identity can potentially cut off a part of the therapist’s self that is nonetheless present in the room. Another important aspect found in the research was IPCs discussing how neutrality was used as a tool when encountering clients who resemble their story or identity. It was the understanding of one of the IPCs that neutrality, rationalizing, and emotional distancing were necessary in such instances: Participant: …when I’m working with clients that are immigrants, or maybe second generation…sometimes, the issue of transference, when you see a situation that you’ve probably been in, in a client, and then I have to recognize that feeling for what it is and find a way to rationalize it, and manage it, and recognize it for what it is, and resolve it, probably through supervision, probably through consulting with peers… Researcher: Uh-huh. Uh-huh. Yeah. I think that’s a little bit about how you manage it. I’m wondering more about your feelings, your emotions. Participant: Okay. So, in terms of feelings and emotions, it’s just nothing out of the ordinary, in terms of seeing maybe sadness, or happiness, or feelings like that. I think it’s a position of neutrality.

212 The IPC was alluding to a traditional principle often taught in psychotherapy schools and training in which neutrality is a gold standard to avoid impacting or influencing the client. Comas-Diaz (1991) mentioned distancing as a common countertransference response for minority therapists when encountering clients with a similar background. As mentioned in the literature review, distancing occurs when therapists fear overidentification when there are similarities in their struggles and clients’ struggles. Carlisky and Kijak (1993), for instance, point out how distancing could be an obstacle to successful treatment. In a clinical example they used to bring this point, they discussed how a therapist’s conflict with his history of family migration evoked a sense of distancing from the client’s clinical presentation. They mentioned that it was not until the therapist could connect with their own forgotten immigration history and struggle that the therapist could finally empathize and understand the patient. On the other hand, neutrality in the psychoanalytic world and psychotherapy field has been contested for a long time and has implications in discussions of race (Layton, Hollander & Gutwill, 2006). A neutrality stance does not facilitate IPCs' therapeutic work, especially with racial minorities. Instead of assuming a neutral position, the IPC could empathize with clients who have similar stories and racial identities because not many people understand how it feels to be discriminated against, ostracized, and othered in a racially divided country. When conceptualizing neutrality from the perspective that one’s conflicts should not intrude into the therapeutic process, it leaves the psychotherapist of color with the dilemma of whether to assume a supportive stance when minority clients experience discrimination and possibly not being able to acknowledge race-related

213 countertransference implicated in the therapeutic process. It could potentially leave IPCs feeling ashamed if they experience intense anger or pain after feeling victimized in racerelated dynamics in session. It can also activate defensive processes to deny their complicated feelings toward clients and follow the traditional understanding of neutrality. Tummala-Narra (2004) calls our attention to a different version of neutrality that might be more attune with exploring racial processes in transference and countertransference. She quoted Alonso (1985) on his definition of neutrality as an attitude of hovering attention to the client and the therapist’s internal response. This hovering attention challenges IPCs to examine their conflicts and worldviews and, when pertinent, use it in favor of the psychotherapy encounter.

Theme 4: Positive engagement with the psychotherapy community. The research question answered by this emergent theme is: How would the IPC describe their subjective experience with the psychotherapeutic community in relation to the IPC’s immigrant and racial identity? Despite having experienced racism in the psychoanalytic community, IPCs mentioned having rewarding experiences within the community. They were embraced and held in high regard by community members. The psychotherapy community invited them to present in important professional forums, approached them for case consultation, and was receptive to learning about race or specific skills and training they may offer. When looking at the fact that IPCs have also felt included, embraced, and part of the psychotherapy community despite the racism experienced, I think about the complexity of experiences in community the IPC may have as a person of color. The

214 stories shared by participants seemed painful and traumatic, deepening existing feelings of exclusion and isolation in the host country. However, they could recognize those positive experiences that developed into a sense of growth and belonging. An explanation for this result is that those institutions or groups in which participants felt marginalized and excluded were not the same as those where they felt embraced. Many told stories of how these racial dynamics preceded them, leaving institutions or groups, and they later joined communities that embraced them. An example of this was given by a participant who said he was fired from a job he felt discriminated against after advocating for clients of color. He later opened his private practice and joined a psychoanalytic training group in which he was vocal and felt more included and accepted. Other experiences involved leaving consultation groups but joining other projects. In addition, feelings of inclusion in the psychotherapy community can also be attributed to the persistence of the IPC to work toward a more inclusive psychotherapy community, despite the rejection experienced. A participant mentioned that she struggled with the community to have a psychotherapist of color roundtable at a conference. Although not feeling fully embraced but excluded in this association, she moved this initiative forward by gathering support from other clinicians of color and advocating for the roundtable to remain at such conference through the following years. She made changes happen and stayed in the association despite feeling excluded. Staying in the community meant the IPC had to fight against, and put resistance to, the psychotherapy community’s tendency to exclude psychotherapists of color.

215 A Kleinian theoretical approach may highlight the dichotomy of exclusion and inclusion as the presence of opposite experiences, the good and bad, coexisting simultaneously – a form of community split. It reveals a form of depressive position in which the community and the IPC experience sadness within the progress made after confronting the imperfect reality of racism in a community that also attempts to be inclusive. Relational theory would consider IPCs' insistence in remaining in the community and advocating for themselves as the human tendency to prioritize “entry into the human community” and have “intense ties with others” (Mitchell, 1988, p. 29). As stated in the literature review, IPCs hope to bond with others while simultaneously “. . . [escaping] the pain and dangers of those bonds, the sense of vulnerability, the threat of disappointment, engulfment, exploitation and loss” (Mitchell, 1988, p. 29). In the end, the experience of inclusion was not given to IPCs but one they had to fight for in the midst of racial disappointments. Another issue discussed by several IPCs was the massive George Floyd protests and unrest that provoked many communities to reflect on their participation in racism, including the psychotherapy community. Some IPCs felt more courted and prioritized in discussions of race as a result. Suddenly, the psychotherapy community asked for IPCs' opinions and encouraged their participation. Therefore, it was not an intrinsic experience in which self-reflection and openness happened spontaneously without outside social forces impacting the psychotherapy community's self-reflection and openness on racism. For many IPCs, the psychotherapy community's openness and willingness for selfreflection was a relief because the community could finally see some of the racism that

216 was always evident for the IPCs. There was also resentment because they felt it took too long for the community to see and mirror their experience.

Theme 5: Having a sense of advocacy for minority clients and colleagues. The research questions answered by this emergent theme are: How does the IPC describe the experience of being an immigrant therapist? And: How does the immigrant and racial identity of the IPC emerge as part of the dynamic between the immigrant psychotherapist and the client? An advocacy role was intrinsically tied to IPCs’ immigrant and person of color identities, as throughout their lives they experienced first-hand discrimination and rejection. They had personal accounts about how difficult it was for them to succeed, taking them double the effort to accomplish their goals compared to professionals with privileged backgrounds. They have lived and worked in communities where wealth and privilege were not the norm. Therefore, these close personal experiences are related to their understanding of their role when working as psychotherapists with minority clients and colleagues who had similar experiences. They had a particular sensibility that helped them empathize with underserved populations, responding accordingly from a place of conviction. Identifying themselves as advocates is an important relational consideration since it brings to discussion the psychotherapists’ marginalized self in relation to their clients. IPCs would feel invested in connecting with clients’ experience of marginalization and struggle as persons of color in the U.S. In similar ways, clients would also try to make sense of the psychotherapists’ subjectivity, regarding how much the psychotherapists understood discrimination and exclusion. Thus, this is one of the first reasons minority

217 clients seek a psychotherapist of color. The psychotherapist and client's experiences of marginalization can become a point of connection that facilitates a deeper understanding of the client's internal struggles. If marginalization is an important piece in the client’s history, they may sense through the transference the psychotherapist’s position in this regard and will make moves in treatment accordingly, either defensively or toward having a deeper connection with the psychotherapist. The previous considerations about the IPC’s sense of advocacy toward clients brings into account whether neutrality should be a goal or if it would facilitate treatment when the psychotherapist is an immigrant. In this regard, Akhtar (2006) speaks of several countertransference experiences for immigrant analysts. He mentions one difficulty being the analyst’s or therapist’s inability to maintain cultural neutrality vis-àvis his “native” patients. I would challenge this notion and bring a more postmodern view that considers that neutrality could be difficult to attain for any psychotherapist. Not being able to maintain cultural neutrality as an immigrant psychotherapist should not posit a problem nor potentially bring complications to the treatment when society does not have a neutral view on culture, race, and immigration. In addition, none of the IPCs interviewed for this dissertation mentioned having a dilemma with cultural neutrality. They actually highlighted and questioned society’s biases and distorted views on race and immigration and felt this would position them as observers of reality since they had an outsider perspective. Cultural neutrality might be more of an unattainable dilemma for dominant racial groups who may think they can afford such neutrality by virtue of belonging to the dominant culture. In fact, presenting immigrants psychotherapists’

218 inability to attain cultural neutrality positions White U.S.-born psychotherapists as better capable to work with immigrants due to their presumed ability to have cultural neutrality. On the other side, there is value in exploring personal experiences attached to IPCs immigration and racial history that could potentially position them in assuming a paternalistic view of, and approach to, minority clients. There is an argument being made regarding advocacy not being psychodynamic enough, as it might be seen as not conducive to deepening psychodynamic treatment. One example of this could be the potential that IPCs could immediately assume an advocate role without understanding clients’ full story and potential inner conflicts. After being marginalized in specific ways, some IPCs might feel their clients need the help they themselves needed when the client’s experience might be different. There might be projection and overidentification (Comas-Diaz, 1991) resulting in advocacy efforts with the hope to connect with clients while in fact getting in the way of deepening clients’ treatment. An IPC mentioned, for instance, having a similar issue with their own psychotherapist of color – feeling projected-upon experiences of marginalization that did not resonate with them. Nevertheless, IPCs assuming an advocacy role with their clients of color might happen more often because they know they present clinically different than privileged clients. IPCs have the power, the privilege, and connections to facilitate concrete help that would eventually provide stability in clients’ lives and therefore deepen the therapeutic process. It could be easier for a White therapist to distance themselves from an advocacy role and assume a strict traditional psychoanalytic role when they have not experienced marginalization.

219 IPCs also advocated for their peers and co-workers to create spaces to discuss racial issues that colleagues might not allow themselves to explore openly in a dominant White community. IPCs’ desire to open these spaces among psychotherapists of color is also intrinsically related to their identity. In being willing to open these spaces, the IPC is clear that it does not come from a place of neutrality. They understand their history of experiencing microaggressions from White colleagues will remain implicit in IPCs’ memory and impede psychotherapists of colors’ sense of safety in sharing their thoughts around experiences of marginalization in the psychotherapy community. They would have to constantly explain themselves to White colleagues who might want to understand, taking away from the therapeutic and clinical experience of an allpsychotherapist of color group. Their advocacy for these initiatives comes from knowing that bias against IPCs in the psychotherapy community exists. Therefore, there is a need for spaces for IPCs to have clinical discussions processing their own experiences and struggles with clients and marginalization in the psychotherapy community.

Theme 6: Absent discussions on race and racism in the therapeutic relationship. The research question answered by this emergent theme is: How does the immigrant and racial identity of the IPC emerge as part of the dynamic between the immigrant psychotherapist and the client? There were some psychotherapists who, when asked about dynamics of race, said it was not something they thought about, nor did they consider it an issue in the work with their clients. Some said the issue of race was simply not important or necessary when thinking about their work with clients. However, it was

220 evident that the issue of race was present in their narratives when describing their psychotherapeutic work. An emerging question I had while looking at this result was this: why would an IPC not name race and difference as an issue present in the work with clients? I thought a better question would be: How has society given people of color permission to pay attention to dynamics of race? How are psychotherapists being taught to think about the issues of race and difference in the clinical encounter with clients? How would speaking about race force the IPC to acknowledge their social location and disadvantage in society by bringing up feelings of disempowerment, vulnerability and despair in relation to their clients? And is there a risk that by acknowledging race and racism in the clinical work, the IPC will be perceived as incompetent and incapable of remaining neutral? They are mainly practicing according to how they have been trained and, therefore, a different result should not be expected. It was difficult for IPCs to identify issues of race and racism as part of the dynamic with their clients when most of their clients were minorities. Some participants idealized themselves and their own racial or ethnic group, seeing themselves as the helper, given the helplessness assumed to be presented by minority clients. Others simply assumed an automatic connection was present due to racial or ethnic commonalities. However, those with psychoanalytic training and extensive experience were able to reflect deeper about the intersection between their multiple identities and their work with minority clients. They were far from believing such idealizations. They were able to speak of challenging experiences with White clients related to racism, but also to speak about how they learned not to make assumptions about clients’ ability to connect with them simply because of shared ethnicity and race. They also pointed out that good

221 training that focuses on long, in-depth psychotherapy, transference and countertransference, unique differences, and complexities among the clinical dyad was helpful in fostering a sense of security and safety when bringing issues of race in the psychotherapeutic encounter. When looking at the lack of race related discussions in treatment and lack of awareness of these dynamics in the work with clients, it is important to highlight how this is consistent with what society currently allows people of color to do. IPCs pointed to the lack of training and education opportunities on issues of immigration and race in the psychotherapy community. And although they know first-hand about these issues, some of them did not learn skills of how to open a discussion on issues of race with clients, which requires a certain skill set and fine attunement to the therapeutic process. In this sense, their experience was not different from White colleagues who confess not knowing how to focus or address race in psychotherapy. The difference for psychotherapists of color might be that it could be very threatening for IPCs to open these conversations with White clients because their own sense of identity might feel threaten or under attack. IPCs might also see these discussions as hardly necessary when working with minority clients because they feel more invested in their commonalities rather than their differences, especially when both have experienced racism from the larger community. Both might find their relationship a refuge and a safe space from the constant racial aggressions in society and therefore identifying racial issues in their relationship might become another disappointment. In addition, the IPC, like any other psychotherapist, might not want to risk disrupting the therapeutic relationship by bringing up such topics.

222 The present finding not only brings to attention the lack of emphasis on race in psychotherapy training but also in supervision. The psychotherapy community needs knowledgeable supervisors who are sensitive to topics of immigration and race and who have managed these issues in their own psychotherapy work with clients. Trained supervisors are necessary, especially since traditional notions of psychotherapy not suitable for IPCs and their clients were present in some of IPCs’ description of their work. These notions are possibly taught in supervision, furthering the gap between what is taught by supervisors versus what the IPC needs. If the IPC is receiving a traditional training in which the goal is to remain neutral, for example, how would a supervisor perceive the competency of an IPC who brings these issues to supervision? Some IPCs might fear opening a discussion about how they sense racism in the clinical encounter because it could be perceived as the IPC’s countertransference, signaling the need for further self-reflective work. Supervisors without the proper experience or training may question the IPC’s perception, thus furthering feelings of isolation and incompetence. Indeed, if the training received by IPCs is the traditional, widespread notion that marginalized clients are unable to reflect about their own experiences in psychotherapy because they are only concerned about surviving their day-to-day life and need instead concrete assistance, some IPCs will incorporate such notions into their work with their clients. This notion was shared by one of the participants regarding working with the homeless population. A psychoanalytic writer has a different view on this issue after working with a homeless person who was able to do psychodynamic work. Lupenitz (2002) discussed a case about her psychoanalytic work with a homeless woman. She described how her homeless client challenged her assumptions regarding homeless

223 clients’ lack of emotional and financial stability making them unable to commit to their therapeutic work. This client worked with the author for about 10 years in psychoanalytic psychotherapy. In further exploration of Lupenitz’s work, I found that she established a project to provide in-depth and long-term psychotherapy to the homeless population. Another example of how the notion of minorities not being ready for in-depth psychotherapy is being challenged by minority psychotherapists and psychoanalysts is the documentary “Psychoanalysis in the Barrio” (Christian et al., 2016). This documentary discusses the notion that vulnerable populations cannot afford to explore their trauma since the only thing they need is to have their concrete needs met. In this documentary, minority analysts criticized this argument as one that attributes to the White and privileged clients the capacity for self-reflection, while putting minorities in an inferior category. They were critical of the idea of minority clients being unable to reflect, fantasize, think and share with another person who is interested in helping them. A homeless person may not be interested in talking to a psychotherapist who is not interested or curious about how homelessness, joblessness, or poverty is traumatic (an assault on the body and psyche), especially when a society has failed them because they are perceived as unworthy. A good social work tenet – "begin where the client is" – gets lost somehow, as well as the idea of exploring how the outside world affects the inside world. The psychotherapy community needs to reflect on how it came to the conclusion that minority clients are devoid of a rich internal world with a capacity to reflect. How is this notion indeed not racist? And why would IPCs need to learn these ideas without a clear discussion of where these notions were coming from?

224 A traditional psychotherapy assumption discussed by one participant was the idea that the therapeutic relationship supersedes issues of race and culture. The participant discussed and assumed this notion as a tenant for his practice, in spite of bringing up examples in which he perceived his ethnic background played a role in how minority families perceived his work. He felt that, generally, the clients he saw were more focused on how he could help and not on his ethnic or racial background. However, in one instance he mentioned a minority parent being surprised at how the IPC’s therapeutic work with their child was more effective than the previous White therapist they used to work with. The parent intended to provide this feedback as a compliment, overlooking the hidden bias in the statement. The parent pointed out that ethnicity could have played a role in their child feeling more comfortable. The IPC emphasized to the parent that it was his skills and not his race or ethnicity that made him effective, which went along with his belief that race and ethnicity had no impact in the therapeutic relationship. The previous case example was embedded with racial and ethnic transference and countertransference reactions. The IPC’s ethnic countertransference included being upset about how the parent was using ethnicity to categorize his effectiveness. Also, feeling implicitly denigrated by the parent’s surprise was present in his narrative. The parent’s racial transference included having internalized the racist idea that minorities are incapable of providing professional and effective work. Even though the IPC resisted the idea that his ethnicity played a role in his ability to help, it was an idea presented by the parent but one that he rejected. In spite of the implicit bias in the parent’s statement, this seemed to be an important moment for the parent when realizing the fact that a minority psychotherapist

225 could understand and relate to their child’s experience more effectively than a White therapist. Maybe it was the first time the parent experienced a minority in a position of power exercising their role professionally and effectively due to the lack of opportunities for this encounter to take place in society and the general suspiciousness that society has about the capacities and abilities of minorities. The parent’s realization might help in their own process of accepting themselves by rejecting internalized racist assumptions that minorities are incapable of doing anything equally competent or better than another White professional. While the IPC’s perception that he was being reduced to his ethnic identity might be related to his refusal to acknowledge race and ethnicity’s impact in the therapeutic relationship, it could have possibly reminded him of previous experiences in which he had to prove his competency as a person of color. A training that helps and supports IPCs identify these transference and countertransference reactions could be very helpful. The IPC’s previously discussed notion about the therapeutic relationship superseding issues of race and culture might come from the fact that issues of race were not widely discussed in his psychotherapy training, as per his report. In this way, psychotherapists are left blind to how race permeates all relationships, in spite of it not being spoken about openly. Also, the idea of discussing race in psychotherapy seemed to be perceived as something wrong – i.e., becoming the bad object in the therapeutic relationship – when, in reality, it can go in many directions: positive or negative, deepening or keeping the therapeutic work at a surface level, closing or opening the therapeutic relationship.

226 Furthermore, the fact that race was present but not identified as such in this case made me think about the normative unconscious. Through the normative unconscious, society shames and sanctions parts of the self; in response, individuals disapprove of their own ways of being in the world, concerning their cultural, racial, or gender identities (Layton, 2002). In this case, the parent disapproved some parts of themselves and, possibly that of their child, that related to their cultural and racial identities. The IPC disrupted this unconscious process through embodying his ethnic identity while in the role of a competent psychotherapist. It was difficult for the IPC to look at this process because of the training received but also because race and ethnicity is generally implicitly present but not spoken of. It permeates all relationships and structures of society, making race dynamics a norm that is not further thought about or discussed. I think a question to be asked from all of us is, how open and attuned are we to perceive ethnic and racial issues? And why is not race an area of consideration to think about with clients in the same way we think about relationships, attachment, the unconscious, and our subjective experiences with each other? In short, some IPCs, on one hand, had the ability to highlight when they were discriminated against in other aspects of their lives. As per their disclosures, they have fully integrated their racialized identity. They were outspoken when minorities were being misrepresented or discriminated against. However, some had a very hard time discussing race when it pertained to their clients. We can have all possible interpretations about this dichotomy, from fear to disrupt the relationship to dismissal of a reality in order to protect themselves against further harm. They know first-hand what is like to be hurt by racism and opening the door to such discussion requires furthering their sense of

227 vulnerability. Not seeing race or being blind to it when it relates to the therapeutic relationship, makes it possible for them to not see their clients and the race-related process unfolding in front of them. They also foreclose being seen as a racialized person by the client. This last statement goes along with their reports of struggling with being labeled as a minority or a person of color. If society does not racialize them, it frees them from listening to negative assumptions and notions from their clients about who they are; however, further exploration of client’s racialized notions of the therapist will be foreclosed.

Theme 7: People of color can educate White people (outlier). The research question answered by this emergent theme is: How does the immigrant and racial identity of the IPC emerge as part of the dynamic between the immigrant psychotherapist and the client? This result was an outlier, given the general widespread idea that White people should not expect people of color to explain or educate them. Providing explanations is seen as another burden placed on people of color who later would need to prove their points when arguing that something was discriminatory or racist against them. Educating White people might become exhausting to people of color who were already subjected to discrimination and oppression. In many instances White therapists, when confronted, because of their own shame might rationalize their racism, which might further traumatize psychotherapists of color. The general idea is that White people should take responsibility for their own racism, not expect people of color to take care of them after being subjected to racism and, instead, find ways to educate themselves.

228 Educating White people can also be a struggle because it reveals a power differential in society, as White people are not expected to explain themselves in society in the same ways White people expect minorities to explain themselves. Tummala-Narra (2019) speaks to this struggle: “As a racial minority woman, at times, I fluctuate between feeling frustrated with accommodating others who do not know nearly as much about my sociocultural world as I know about theirs, and recognize that all of us, regardless of race, coexist in a traumatic framework of race in the U.S.” Nevertheless, the IPC who discussed her willingness to educate White people, explained this could become a barrier for White clients to engage in meaningful conversation with psychotherapists of color who actually have something to share with them about race. The IPC explained having felt White people with progressive views had resistance to her explaining racial dynamics to them because “people of color are not supposed to educate them.” The IPC’s racial identity emerged between her and her client because the IPC liked to talk about herself, as well the barriers racial and ethnic minorities faced. She said she has always educated others throughout her life after moving to the U.S. This participant reported feeling at ease with educating the White community and confronting them on racial dynamics and provided the researcher with several examples. In this sense, this seemed to be a very unique experience for this participant, one that parts ways with the general idea that educating White people is an endeavor in which people of color should not engage. This idea made me consider how important it was to not to make assumptions about how people of color think or feel about certain generalized notions. It seems that educating White people was a powerful experience for

229 this participant but should not be expected from all people of color, who have not offered explanations nor shown willingness to educate the White community. Also, in this participant’s case, she did not mention having felt discriminated against as a psychotherapist of color and, as a result, having to explain how she has been discriminated against to White people. The context of her statement referred to generally educating the White psychotherapy community and her clients when she felt it was necessary to confront them for their racism toward minorities. She also mentioned it in the context of knowing that many ignore the reality of minorities and who better than a minority to let White people “know about” who they are? In one way, I can understand this position, not as something that White colleagues should expect from IPCs, but as something IPCs offer because they understand it could serve as a healing and empowering process for them as a person of color. Such is the case for this dissertation, which intends to educate the White psychotherapy community but is equally empowering for me. No one expected it from me, but I understood it would help and contribute positively to psychotherapists of color who have struggled to find the words to communicate their subjective experience to the psychotherapy community. To summarize, most IPCs have undergone traumatic life experiences and loss as part of their immigration history, which has in turn impacted their clinical work. In some instances, IPCs had a hard time identifying race and immigration transference and countertransference, even while talking about those same issues. One possible explanation for this result might relate to the fact that they are being educated in programs that do not train them as if race and immigration issues are relevant. IPCs

230 struggled in the psychotherapy community due to the psychotherapy community’s inability to identify and manage race related situations. IPCs understood that not everything they experienced in the psychotherapy community was negative, and those positive experiences served them in their process of adaptation. Some of the reasons for a mixed experience with the psychotherapy community might be related to having different experiences in several communities. Nevertheless, some persist: they stay and work toward making those non-inclusive communities more inclusive. Finally, an outlier theme emerged, regarding the comfort an IPC felt in educating White people. She found it to be an empowering experience, in spite of this issue being controversial for communities of color who are often expected to explain “who they are” to the White majority in the U.S.

Blended Findings and Discussion Both quantitative and qualitative findings provided the researcher with very rich information regarding the IPC experience. The quantitative findings provided the study with important clues about the experience of being an IPC with themselves, with their clients, and as part of the psychotherapy community. However, the qualitative findings were able to confirm and expand on the meaning of those findings.

The Immigrant sense of self . The DIS indicated that 72% of participants presented with various degrees of distress around the experience of Loss. While the percentage of distress around Loss was

231 high, the DIS did not offer much information related to how participants experienced Loss. However, during interviews participants elaborated on such experiences as going through a process of initial cultural shock and feeling lost, which led them to miss home and want to return to their home countries. They explained that in spite of being in this country for many years, the experience of not being with family and friends remained an important Loss: It has been difficult; there have been difficult times. There are things that I don't have, and I know I will never have. Still, my best friends are not here. My closest friends are my lifelong friends from my home country, and they remain a very significant part of my life. I go back to my home country twice a year. I miss my friends, but they are very present.

IPCs also mentioned missing not only family and friends but being held in high esteem in society: I was given responsibilities, and I felt respected by my peers and my teachers. I felt rewarded for things I was good at, talents that I have. Yeah, I was placed in important positions in different spaces. . . I mention that because that is what I miss the most, and that shaped my personality. I see myself as a leader; I see myself as a strong woman. I was always told I’m a strong woman. I have a strong voice. That is also what I’m the least prepared for when I came here.

The loss manifested in that when coming to a new country, their social status changed to becoming a minority, which is often considered a second-class status in society. The loss

232 experienced by this participant seemed to have important implications for her sense of self, as she was struggling with losing a part of herself in her home country. How IPCs experienced Loss while emigrating to a foreign country factored into their work with clients. A participant mentioned how she misses home when in racially charged dynamics with clients because, had she stayed in her country of origin, she would not have had to experience such difficulties. Feelings of Not Feeling at Home were also high, at 63%. Not finding a strong association between the variables of the study (Not Feeling Included and Not Feeling at Home), did not mean participants did not experience these feelings. Although not directly referencing Not Feeling at Home, they mentioned how inhospitable the U.S. and the psychotherapy community could be at times. They described a lack of reciprocal feedback to reaffirm their identity while living in the U.S. Although they did not mention having a constant feeling of missing home, they reported how they stayed connected with their country of origin, and how they missed spending time with elements of their culture as well as with family. Also, the idea of not having anything left in their country of origin (family, friends, property) emerged as a concern regarding losing connection with their sense of self.

The immigrant psychotherapist of color and their clients. There was some indication in both the survey and qualitative interviews that participants struggled with identifying their clients’ transference and their own countertransference regarding immigration, ethnicity, and race. It presented in the survey when half the participants said there was a Moderate Influence of immigration, ethnicity

233 and race in their transference and countertransference. It presented in the qualitative interviews when a participant mentioned having a hard time identifying negative transference from their clients related to immigration, ethnicity, or race. I also noticed some participants could barely elaborate directly on issues of immigration, ethnicity, and race regarding their clients. Some of them said culture and race were not issues they focused on and, as such, it was secondary to them: Beyond that if he is of color, someone that listen to them, someone that establish a therapeutic relationship. I think once that you have established a therapeutic relationship, your cultural—in case of the psychotherapist, is in that second place from my point of view. Some denied its presence and underplayed its importance in the clinical work. It was my role as a researcher to code the meaning of the participants’ experience and identify their transference and countertransference as part of my analysis of their transcribed interviews, as some were not explicit about these issues. In a study (Hayes et al., 1998) in which psychotherapists had to identify their countertransference after their sessions, for example, only one therapist was able to identify issues of racial countertransference. The particular psychotherapist did not identify racial countertransference in subsequent sessions. Pérez-Foster (1998), on the other hand, asserts that countertransference attitudes in cross-cultural therapeutic dyads “are often (1) disavowed by the clinician; (2) exert a powerful influence on the course of treatment; (3) and though unspoken, are frequently perceived by the client.” The arguments of both studies confirm a tendency I perceived in which several IPCs avoided identifying and,

234 therefore, deepening their understanding of their and their clients’ racial transference and countertransference.

The immigrant psychotherapist of color in the psychotherapy community. Another interesting finding was that quantitative findings reflected that participants felt Moderately Included at a 58% rate; however, this did not necessarily reflect that they felt fully included in the psychotherapy community. This finding might mean they have had good experiences despite the negative ones. The qualitative data supported this finding, as most psychotherapists felt there were positive experiences in the community along with the negative experiences they have encountered. IPCs were able to expand on some of the initial questions I asked myself during the quantitative analysis regarding the invisible variables the quantitative survey was not able to capture reflecting the experience of not feeling included for the IPC. Given that there are nuances within issues of immigration, ethnicity and race, those nuances could answer how inclusion and exclusion might look differently for each IPC. Some participants in the qualitative interviews attributed their sense of privilege or being less discriminated against due to having a lighter skin tone than other immigrants, or not having an accent. It seemed that the closer they were to the American Ideal of whiteness, the less discrimination they encountered. Bonilla-Silva (2013) sheds light on this discussion regarding the influence of skin color on issues of inclusion when he explains that the U.S. is moving toward a model in which assimilated light-skinned Latinos will be co-opted as the new “New Whites,” followed by a group of “Honorary Whites,” while Black Latinos will be kept at the lower

235 level of the “Collective Black.” His idea of Whiteness within the immigrant population posits an important discussion on how race is an important factor when considering how included or excluded an IPC might feel in the psychotherapy community. In addition to skin color, having an accent was mentioned by participants as a factor that possibly explains the variability of feelings of inclusion in the quantitative findings. There are studies affirming that having an accent poses direct distress on social acceptance when moving to a foreign country (Kayaalp, 2016). While authors have written about the use of language as an instrument of power (Bourdieu, 1977), Tomic (2013) contends that language is instrumental in the production of discourse to reaffirm whiteness, while it is also instrumental in the devaluation of the immigrant identity. In trying to expand our understanding of issues of exclusion manifested through the quantitative findings, the qualitative interviews found participants were angry, given that the psychotherapy community had not had the ability to openly acknowledge the IPC’s clinical experiences and was unwilling to educate itself on issues of immigration and race. This affirms that if the psychotherapy community is not able to embrace the experience of the IPC as an immigrant, Black or Brown person, then they will not feel included. The study also pointed to interesting findings regarding racial segregation within the psychotherapy community and its implications. Participants in the qualitative interview mentioned that, given that the majority of psychotherapists were White, there was a lack of psychotherapist referrals, biases in the hiring process, and inhospitable environments in consultation groups and training programs. They mentioned that in spite of having White clients on their caseloads, they barely received White client referrals

236 from other professionals. This could be related to two important things: (1) White clients choosing not to work with IPCs and (2) White psychotherapists’ assumption that IPCs and White clients were not a good match. Somehow, this dynamic resembles the practices of segregation taking place in the broader community, which can explain why participants’ experience of inclusion transferred from the broader society or host country to the psychotherapy community. The consequence of this segregation is lack of access to wealth in the same way as White psychotherapists, and wealth being concentrated within the White elite. In spite of this segregation, the majority of participants reported in the survey that they had White clients on their caseloads, contradicting the myth that IPCs specialize in only providing services to minority clients.

Clinical Implications Considering the implications of immigration and race in areas of transference and countertransference, this could be an area of continuous improvement in traditional psychoanalytic thinking in the U.S. and around the world. Traditional notions of neutrality might hinder the IPC’s ability to attune to those racial and immigration experiences and their influence on the psychotherapy encounter, either through transference or countertransference. It is imperative to reflect on how training might prevent IPCs from favorably connecting with their immigration, ethnic and racial identities and use them in the service of the clinical encounter. This study was not aimed at comparing responses between white immigrants and immigrants of color, but the results have led this researcher to recommend more studies that include immigrants from different races and ethnicities. In such studies, there could

237 be a comparison regarding the different responses to racial transference and countertransference based on racial identification. Such studies could shed some light in the field of psychotherapy on how the racial identity of immigrant psychotherapists impacts their approach to racial transference and countertransference. There could be other factors that might have been contributed to feelings of exclusion for IPCs that were beyond the scope of this study. Factors such as gender identity, sexual orientation, and levels of adaptation or assimilation to the host country’s culture – in addition to immigration, ethnicity and racial identity – should be included in future studies. As I analyzed the findings, I thought about how these factors could have influenced participants’ feelings of inclusion, but they were not able to mention those, given the limited scope of the study. Therefore, I recommend a study in which intersectionality is taken into consideration when exploring race. Another important recommendation concerns to how a community should relate to an IPC, which could be a reflection of how a host country should embrace an immigrant. If feeling less included correlated to an increased experience of feeling discriminated against, the call to the psychotherapy community is to work toward making a non-hostile environment for IPCs, whose feelings of homesickness, dislocation, and adaptation played a huge psychological process in their subjective experiences. The idea would not be to provide exaggerated attention to the IPC to make him or her feel included, but to bring attention to oneself as a member of a racial majority in regard to how perceptions could bias one’s own experience of the IPC. Given the variety of responses from the IPCs regarding how included they felt in the psychotherapy community, it would be helpful if future studies explored this

238 hypothesis: is there a positive correlation between the closeness of the IPC to the American ideal of Whiteness and how included they feel in the psychotherapy community? The American ideal includes skin color, or colorism, but also accent and acculturation. White therapists need to engage more with communities of color in order to mend the gap of segregation by relinquishing their usual position of dominance. It is important to understand IPCs’ worldviews, which in turn helps in interactions with IPCs. One of the things minorities might feel is that White therapists are uninterested in their worldview, their background, and their lives as unique individuals. Finally, I recommend the psychotherapy community considers the importance of consultation groups exclusively for psychotherapists of color in order to discuss their experiences in the psychotherapy community as well as their clinical work with clients. Having a space exclusively for psychotherapists of color can provide the necessary safety for psychotherapists to explore and become aware of experiences they have not allowed themselves to connect with emotionally. These groups should be led by psychotherapist of color. Having an exclusive group for psychotherapists of color would relieve them from having to explain their world view to White psychotherapists or enduring and being hypervigilant about possible microaggressions. They can instead use their energy to support each other. In addition, training for the general psychotherapy community on issues of race and immigration should be a priority.

239 Subjective Experience of the Researcher In writing the analysis for this study, I struggled with reporting participants' responses in which they disavowed the importance of race in the clinical encounter. As a person of color, I am aware of the excessive scrutiny people of color receive related to competency and skills. I feared that participants would be unfairly criticized for reporting such findings. However, by looking at these findings in context, I was able to include a discussion on how not acknowledging race as an important issue in clinical practice was a reflection of the psychotherapy training IPCs received. As I listened to and reflected on IPCs' opinions on different race-related issues, I revisited similar professional and personal experiences. I have struggled personally with whether to educate White people about who I am as a person of color, or about how I have felt discriminated against by them. As I was writing this portion of the analysis (Theme 7), I felt torn, as if having to decide a particular position on this issue. But I realized that it is a very fluid experience in which one must determine what is best in the situation one confronts in the moment. I struggled the most when listening to how participants denied the impact of immigration and race in the clinical work, while at the same time hearing how they struggled with clients’ racial biases. It was difficult to reconcile such contradictions. As I processed the material, I had to be aware of memories that came to me about clinical processes with clients in which race and immigration were undeniably present. Even more difficult was hearing that some IPCs had positive experiences in the psychotherapy community without mentioning negative experiences. Those reports elicited memories of when that was not the case for me. Therefore, putting participants' words into writing and

240 understanding that their experiences were different than mine was a struggle but essential to protecting the integrity of the research process. I understood that everyone was on a different path regarding their understanding of their location in society and the world. I reminded myself of the times I denied or disavowed clients’ discriminatory behavior against me by dissociating to protect myself from the painful reminder that, for some, I am seen as “the other” and “less than.” However, it took time, supervision, training, and self-reflection to allow myself to get in touch with such feelings of vulnerability. I should expect acknowledging and managing racism to take similar efforts for participants. There was a kind of kinship I experienced with psychotherapists who were very thorough in explaining their experiences with discrimination and the many contradictions they confronted with clients and the psychotherapy community. I reminded myself that these stories were the reason I decided to conduct this study. I felt proud that my study could serve as a vehicle to make their voices heard, which provided me with a sense of determination to continue and finish this project.

241

Addendum A Screening Interview/Instrument/Survey/Qualitative Interview

242

Screening Interview: The Subjective Experience of the Immigrant Psychotherapist of Color Demographic Information 1. What is your gender? a. Female b. Male c. Other (Specify) _______________________________ 2. What is your age? a. 21-29 b. 30-39 c. 40-49 d. 50-59 e. 60-69 f. 70-79 g. 80-older 3. What region did you and your immediate family come from? a. North America b. Central America c. The Caribbean d. South America e. Asia f. Europe g. Africa h. Australia i. Middle East j. Other______________________________ 4. Please add the name of the country where you were born: _____________________ 5. Please add the number of years you lived in the country where you were born: ________ 6. Please add the name of the country where you were raised if different: ______________ 7. How long have you been living in the United States? ____________________________ 8. If you have lived in more than one country, list the names and time spent living in those countries. ________________________________________________________________________ ________________________________________________________________________ 9. a. b.

Do you consider yourself a person of color? Yes No (If no, please skip to question 13)

243 10. Bonilla-Silva (2015) describes how we “. . . conceive ‘race’ . . . as primarily a biological or cultural category easy to read through marks in the body (phenotype) or the cultural practices of the groups” (p.1359). With this definition in mind, What criteria do you use to identify yourself as a person of color? (Choose all that apply): a. Skin Color b. Other phenotype (physical) traits c. Cultural background d. Other _____________________ 11. In your encounters with the external world, are you perceived differently from how you perceive yourself in terms of skin color? a. Yes (If yes, how are you perceived?_______________) b. No (If no, please skip to question 13) 12. Bonilla-Silva (2015) describes how we “. . . conceive ‘race’ . . . as primarily a biological or cultural category easy to read through marks in the body (phenotype) or the cultural practices of the groups” (p.1359). With this definition in mind, What criteria do you think others use to identify you as a person of color? (Choose all that apply): a. Skin Color b. Other phenotype (physical) traits c. Cultural background d. Other ________________________ 13. What race do you identify with? a. Black b. White c. Asian d. Arab e. American Indian f. Biracial g. Other______________ 14. What is the highest level of education you have completed or the highest degree you have received? a. Associate degree b. Bachelor’s degree c. Master’s degree d. Doctoral degree 15. Please add other special professional psychotherapy related training you have: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 16. What is your main theoretical orientation? (Please select the top two that influence your work the most). a. Psychodynamic oriented e. Structural Family Therapy (Relational, Self-Psychology, Object f. Internal Family Systems Relations, Jungian) g. Imago b. Psychoanalytic h. Parent-Child Psychotherapy c. Cognitive Behavioral i. Play Therapy d. Family Systems j. Humanistic

244 k. l. m. n. o.

Gestalt Trauma Informed Body based Psychotherapy EMDR Art Therapy

p. q. r. s. t.

Dialectical Behavioral Emotional Focused Therapy Hypnotherapy Neurofeedback Other__________________

17. a. b. c. d. e. f. g. h. i. 18. a. b. c. d. e. f.

Which of the following categories best describes your current job position? I am a psychotherapist at a not-for-profit organization I am a psychotherapist in solo private practice I am a psychotherapist in a group private practice I am a psychotherapist at a hospital or health care facility I am a psychotherapist at a public school I am a psychotherapist at a private school I am a psychotherapist at a private institution (non-medical and non-educational) I am a retired psychotherapist Other (please specify) ______________ What is your clients’ age range? Check all that apply. Infants (0-4 years old) Children (5-11 years old) Adolescents (12-17 years old) Young Adults (18-29 years old) Adults (30 to 59 years old) Seniors (60 years and older)

19. a. b. c. d. e. f. g.

How would you identify the racial identity of your clients by percentage? Black _______% White_______ % Asian _______ % Arab _______ % American Indian ______% Biracial ______% Other _______________%

20. What psychotherapy modality do you practice? (Check all that apply) a. Individual b. Group c. Family d. Community e. Couple f. Other _______________________ 21. Identify the professional communities you belong to, interact and/or participate, in which you are considered a racial minority: (Check all that applies) a. Group private practice b. Not-for-profit organization c. School or graduate program

245 d. e. f. g. h. i. j. k. 22. a. b. c. d. e.

Training program Professional association Agency/Program Professional committee Professional institution Board of directors Volunteer agency Other ____________ How long have you been practicing as a psychotherapist? 3 years or less 4 to 9 years 10 to 15 years 16 to 20 years More than 20 years

23. a. b. c. d. e. f. g.

What kind of professional license do you have? Licensed Social Worker Licensed Professional Counselor Licensed Clinical Social Worker Licensed Clinical Professional Counselor Licensed Marriage & Family Therapist Licensed Clinical Psychologist Other_____________________________

246 Demands of Immigration Scale (DIS) Instructions: Below are a number of problems people who have immigrated might have. For each problem, think about how the problem fits your recent (within the last three months) personal experiences as an immigrant. Circle the answer that best describes how upset or bothered you are by each of the problems. 0= not at all upset or not applicable 1= a little upset 2= more than a little upset but not very upset 3= very upset In the United States: 1. Americans have a hard time understanding my accent 2. When I think of my past life, I feel emotional and sentimental 3. Even though I live here, it does not feel like my country 4. I need advice from people who are more experienced than me to know how to live here. 5. I am disadvantaged in getting a good job

0 2 0 2 0 2 0 2 0 2

My work status is lower than it used to be

0 2

7. 8. 9. 10. 11.

As an immigrant, I am treated as a second class citizen I have difficulty doing ordinary things because of a language barrier Americans don’t think I really belong in their country I miss the people I left behind in my original country I have less career opportunities in America

0 2 0 2 0 2 0 2 0 2

12.

Talking in English takes a lot of effort

0 2

13.

Americans treat me as an outsider

14.

I must learn how certain tasks are handled, such as renting an apartment I do not feel that this is my true home

0 2

15.

0 2 0 2

16.

I have to depend on other people to show or teach me how things are done here

0 2

1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3 1 3

247 17.

I do not feel at home

18.

I feel sad when I think of special places back home I cannot compete with Americans for work in my field People with foreign accents are treated with less respect The work credentials I had in my original country are not accepted I am always facing new situations and circumstances When I think of my original country, I get teary

0 2

19. 20. 21. 22. 23.

0 2 0 2 0 2 0 2 0 2 0 2

1 3 1 3 1 3 1 3 1 3 1 3 1 3

Do not reproduce without permission of author. Please use the following when citing the DIS: Aroian, K.J., Norris, A.E., Tran, T.V., & Schappler-Morris, N. (1998). Development and psychometric evaluation of the Demands of Immigration Scale. Journal of Nursing Measurement, 6(2), 175-194.

248

Quantitative Survey Instructions: Please select the best answer for each question. 1. How much of an influence do you think your immigration history, ethnic and/or racial background has on your approach and perspective on your psychotherapeutic work? a. No influence b. A moderate influence c. A high degree of influence 2. How much of an influence do you think your immigration history, ethnic and/or racial background has on the way you and your clients relate? a. No influence b. A moderate influence c. A high degree of influence 3. How much of an influence do you think your immigration history, ethnic and/or racial background has on what clients’ experience is of you in the clinical encounter? a. No influence b. A moderate influence c. A high degree of influence 4. Has much of an influence do you think your immigration history, ethnic and/or racial background has on the way you feel about your clients’ experiences? a. No influence b. A moderate influence c. A high degree of influence 5. How much of an influence do you think your immigration history, ethnic and/or racial background has on the way you experience the psychotherapy community? a. No influence b. A moderate influence c. A high degree of influence 6. How much of an influence do you think your immigration history, ethnic and/or racial background has on how the psychotherapy community might experience you? a. No influence b. A moderate influence c. A high degree of influence 7. Defining inclusion as: “The degree to which you feel like an esteemed member of a group and needs for belonging and uniqueness are satisfied” and psychotherapy community as: “Environment, trainings and workspaces in which psychotherapists nourish their psychotherapy and clinical skills,” How included do you feel in the psychotherapy community? a. Not included b. Slightly included c. Very much included d. Extremely included

249

Qualitative Long Interview

The interview is divided into three main sections: the relationship with yourself as an immigrant and person of color, the relationship with clients and the relationship with the psychotherapy community. On each section, I am going to start with a few prompt questions and then I will follow up with other deeper or more specific questions. Immigrant Psychotherapist of Color and their experience with themselves: We are going to start with your own personal inner experiences as it pertains to your identity as an immigrant and a person of color. When did you come to the US? How old were you? Why did you come to the US? Tell me about your experience of leaving your home country behind. What was that like? What has been your experience like living in the US? Tell me about your current experience being in the US now. Tell me about your experience of being an immigrant in the US. What does it mean to you to identify as an immigrant? What is it like? How does it feel? How do you think your identity as an immigrant shapes who you are? Tell me about your experience of being a person of color in the US. What does it mean to you to identify as a person of color? What it is like? How does it feel? How do you think your identity as a person of color shapes who you are? Anything else you wish I would have asked? Immigrant Psychotherapist of Color and relationship with clients: Now moving toward your experience as an IPC and your practice, How did you decide to become a psychotherapist?

250

If you were a psychotherapist back in your home country, what was it like for you to work as a psychotherapist then? How did you think about your experience of being a person of color while working as a psychotherapist in your home country? What is it like for you to work as a psychotherapist in the US? How has it been for you to work with clients being a person of color? (Countertransference) What do you think comes to your clients’ minds in terms of working with you being a person of color? (transference) How do you think it has been for them to work with you who identify as a person of color? How does the experience of race or racial identity manifest in your clinical work with clients? How has it been for you to work with clients being an immigrant? (Countertransference) What do you think comes to your clients’ minds in terms of working with you being an immigrant? (transference) How do you think it has been for them to work with you who identify as an immigrant? How does the experience of immigration manifest in your clinical work with clients? Have there been any instances in which your being different (Ex. accent, appearance or color of your skin) has been an issue for your clients or a topic of discussion in your clinical work? Could you elaborate and talk more about those instances? What does your clients’ experience of you mean to you? Immigrant Psychotherapist of Color and the Psychotherapy community: And then talking more about the psychotherapeutic community which for this study is defined as, “The environment, training and workspaces in which psychotherapists, including IPCs, nourish their psychotherapy and clinical skills. These environments consist of (a) training institutes, (b) organizations, and (c) academia or consultation groups, in which psychotherapists interact with other likeminded professionals in the fields of social work, psychotherapy, and / or psychoanalysis.”

251 What has it been like for you to be an immigrant and a person of color in the psychotherapy community? How does your immigration and racial identity influence your relationship with the psychotherapy community? How does the psychotherapy community relate to you and engage based on your identity as an immigrant and a person of color? How do you engage or relate to the psychotherapy community based on your identity as an immigrant and a person of color? Have there been any instances in which your being different (Ex. accent, appearance or color of your skin) has been an issue (Ex. Evaluations, advice in supervision, comments, decisions) in the psychotherapy community that you would like to share? What does the psychotherapy community experience of you mean to you?

252

Addendum B

Recruitment Flyer

253

Are you an Immigrant Psychotherapist of Color?

Photo courtesy of: Roberto Carlos Roman •

Are you a licensed psychotherapist practicing in the US?

•

Did you immigrate to the US from a foreign country or a US territory at any point in your life?

•

Are you a person of color?

If you answered yes to all of these questions, you might qualify to participate in a very exciting study! What is this study about? The participants will take an online survey in which they will rate and answer questions related to their experience with immigration, their work with clients and their experience with the psychotherapy community.

Merari E Fernandez Castro is the principal investigator in the study which is sponsored by the Institute for Clinical Social Work. She is a Licensed Clinical Social Worker with a psychotherapy practice in Chicago. If you want to know more about her go to www.merarifernandez.com

There is more… In addition, you can opt to further participate in the 2nd phase of the study for an in depth interview to elaborate on your responses to the previous questions.

Where do I go to take the online survey? Click on this link HERE to participate on the first part of the project. Please, contact Merari Fernandez at mfernandez@icsw.edu or at (773) 234-7246 if after the online survey, you are interested in participating in the face-to-face long interview.

254

Addendum C Consent Forms

255

256

257

258

259

260

261

Addendum D

IRB Authorization Forms

262

Office for the Protection of Research Subjects (OPRS) Institutional Review Board FWA# 00015903

At Robert Morris Center 401 South State Street Chicago, IL 60605 312-935-4232/312-9354225 info@icsw.edu

April 4, 2020 Merari Fernandez 200 Ridge Ave Apt. 1C Evanston, IL 60202 RE:

The Subjective Experience of the Immigrant Psychotherapist of Color IRB Protocol Number: 62

Dear Ms. Fernandez: Your response to the stipulations for the project The Subjective Experience of the Immigrant Psychotherapist of Color has satisfactorily addressed the concerns of the ICSW Institutional Review Board (IRB) and you are now free to proceed with the human subjects protocol. The ICSW IRB approved your study by expedited review. The expiration date for this protocol was 4/4/21. Your IRB protocol number is 62. The risk designation applied to your project is less than minimal risk. Copies of the signed consent forms must be printed and kept in your records. If there is a need to revise or alter the consent form, please submit the revised forms for IRB review, approval, and date-stamping prior to use. Under applicable regulations, no changes to procedures involving human subjects may be made without prior IRB review and approval. As a reminder, you may not recruit current or former clients to participate in your study. Nor may you recruit active ICSW staff, faculty or students. The regulations also require that you promptly notify the IRB of any problems involving human subjects, including unanticipated side effects, adverse reactions, and any injuries or complications that arise during the project. If you have any questions about the IRB process, or if you need assistance at any time, please feel free to contact me at 773-263-6225 or visit our Web site at http://www.icsw.edu/information/students-and-faculty/forms-anddirectories/.

263

Office for the Protection of Research Subjects (OPRS) Institutional Review Board FWA# 00015903

At Robert Morris Center 401 South State Street Chicago, IL 60605 312-935-4232/312-9354225 info@icsw.edu

April 4, 2021 Merari Fernandez 200 Ridge Ave Apt. 1C Evanston, IL 60202 RE:

The Subjective Experience of the Immigrant Psychotherapist of Color IRB Protocol Number: 62

Dear Ms. Fernandez: Your response to the stipulations for the project The Subjective Experience of the Immigrant Psychotherapist of Color has satisfactorily addressed the concerns of the ICSW Institutional Review Board (IRB) and you are now free to proceed with the human subjects protocol. The ICSW IRB approved your study by expedited review. The expiration date for this protocol was 4/4/21 and now it has been renewed until 4/4/22. Your IRB protocol number is 62. The risk designation applied to your project is less than minimal risk. Copies of the signed consent forms must be printed and kept in your records. If there is a need to revise or alter the consent form, please submit the revised forms for IRB review, approval, and date-stamping prior to use. Under applicable regulations, no changes to procedures involving human subjects may be made without prior IRB review and approval. As a reminder, you may not recruit current or former clients to participate in your study. Nor may you recruit active ICSW staff, faculty or students. The regulations also require that you promptly notify the IRB of any problems involving human subjects, including unanticipated side effects, adverse reactions, and any injuries or complications that arise during the project. If you have any questions about the IRB process, or if you need assistance at any time, please feel free to contact me at 773-263-6225 or visit our Web site at http://www.icsw.edu/information/students-and-faculty/forms-anddirectories/.

264

Addendum E

Qualitative Analysis Tools

265

1.1 Qualitative Analysis Process Tool: An adaptation from The Analytic Category Development Tool by Bloomberg and Volpe (2016). Research Question How does the IPC describe their immigration experience?

Theme

How does the IPC describe their sense of self as it pertains to their immigrant and racial identities? How does the immigrant and racial identity of the IPC emerge as part of the dynamic between the immigrant psychotherapis t and the client?

Theme 1: A relationship with my immigrant and person of color identity.

Theme 3: Transference and countertransfere nce related to race and immigrant identity.

Theme 6: Absent discussions on race and racism in the therapeutic relationship.

Implication s IPCs have unique histories and experience s of self not well understood . IPCs have unique histories and experience s of self not well understood . There are particular experience s in the clinical encounter barely discussed nor understood in clinical training. IPCs have difficulties navigating racial dynamics in the clinical encounter.

Recommendati ons Acknowledgm ent of the IPCs immigration history.

Understanding IPCs unique experiences in the therapeutic encounter.

Identifying IPCs difficulties in navigating racism in the clinical encounter.

266 Theme 7: The need for People of Color to educate White people. (Outlier)

How does the IPC describe the experience of being an immigrant therapist?

Theme 3: Transference and countertransfere nce related to race and immigrant identity.

Theme 5: Having a sense of advocacy for minority clients and colleagues.

How would the IPC describe their subjective experiences with the psychotherape utic community in relation to the IPC’s

Theme 2: Struggling with racism in the psychotherapy community

There is an urgent need to address gaps in understand ing People of Color experience s. There are particular challenges in the clinical encounter barely discussed nor understood in clinical training. IPCs recognized society lack of support to minorities increase their sense of isolation and difficulties. IPCs encountere d unsupporti ve racist professiona l environme nts that were in detriment of their

Closing the gap in understanding People of Color experiences.

Understanding IPCs unique experiences in the therapeutic encounter.

Supporting IPCs inclination to advocate for minority clients and colleagues.

Describing the ways the psychotherapy community has engaged in racism toward IPCs.

267 immigrant and racial identity? Theme 4: Positive engagement with the psychotherapy community.

professiona l growth. IPCs have encountere d positive experience s that have supported their adaption process.

Identifying how the psychotherapy community has been helpful to the IPC.

1.2 Interpretation Outline Tool: An adaptation from the Interpretation Outline Tool presented by Bloomberg and Volpe (2016). 1)

How does this theme relate to the research question?

Describe the corresponding findings

Ask: What is going on here? What is the story these findings tell? Why is this

important? What does this mean? What can be learned here? 4)

What assumptions am I making?

What are other possible interpretations?

Add supportive participant quotes

Add supportive literature and theory

How does my positionality and my identity (social, cultural, political,

psychological, institutional) influence the research process?

268

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