P REFACE AND A C KNOWLEDGMENTS
The clinical cases referred to in this volume took place during my predoctoral and post-doctoral years of training, and while I have been careful to protect any client identity or information by changing names, using broad general descriptions, leaving out identifying information or altering narratives, I am in gratitude to the young people who were willing to share their lives with me. These people were important teachers. I have also not mentioned specific locations or agency names to further protect the identities of clients, supervisors, and colleagues unless they had previously published this information.
Early in my career and as a result of attending the Existential Phenomenological Psychology master’s program at Seattle University, I decided to focus my expertise on conducting psychological assessment from a more existential perspective that included a cross-fertilization of theories. At the moment, very little theory and research has been developed on how to conduct psychological assessment from a communitybased perspective that utilizes an interdisciplinary approach (Mercer et al., 2016). Thus, the major aim of this book has been to integrate critical-historical orientations, ethnographic methodologies, continental philosophies, cultural and psychoanalytic geographies, psychoanalytic perspectives (most useful for discourse analysis), and post-colonial theories with the process of psychological evaluations in order to increase the potential of assessment as an act of ethical relations and social justice. Some scholars have made great progress in these directions (Fischer, 1994; Finn, Fischer, & Handler, 2012; Finn & Tonsager, 1997; Handler, 2006; Tharinger et al., 2007, 2008, 2009, 2012; Tharinger & Pilgrim, 2012)
and it is my hope to develop their work even further into cross-cultural and community contexts.
This book would not have been possible without a number of people who contributed to the formation of ideas outlined in each chapter and its current format. First, I need to acknowledge the following journals (and associated editors) for their permission to rework material that had been previously published. Chapter 2 appeared as an article published in 2014 in The Journal of Phenomenological Psychology, 45, 61–71, under the title “The Ghettos Intern: Culture and Memory.” David Goodman and Katie Howe were co-authors on this original essay. Chapter 6 had been previously published in 2010 under the title “Levinas in the hood: Portable social justice,” in the Humanistic Psychologist, 39, 305–311. Chapter 7 was originally titled “The foot fetish: Events, reversals and language in the collaborative assessment process” and published in 2016 as a book chapter in L. Laubscher, C. Fischer & R. Brooke (Eds.), The Qualitative Vision for Psychology: An Invitation to the Human Science Approach, Pittsburgh, PA: Duquesne University Press, 290–305. Lastly, sections of Chap. 4 were published in an article titled “African American Young Men and the diagnosis of conduct disorder: The neo-colonization of Suffering” in the Clinical Journal of Social Work, 43 (4), 431–441. Sascha Atkins-Loria was the first author on this article, along with Courtney Mitterling as another co-author.
There are a number of colleagues who share the same vision of psychology as a discipline of relational ethics, and I am grateful for the ongoing dialogues with them and how they have influenced and shaped the ideas in this book. I want to begin by thanking two very special colleagues, David Goodman and Brian Becker, who have journeyed with me into these disciplinary territories. Many of our earlier conversations, that began in a small corner office in Cambridge, MA, were instrumental to the growth of the book and its final production. I am indebted to their friendship, ecnouragement and ongoing support. I am grateful for Peter August, whose scholarship and insights into language, time, and writing have also been crucial for the development of this project. Most importantly, I want to thank Peter for his uncanny wisdom that can transform despair into imagination. Sascha Atkins-Loria (2014) wrote a brilliant thesis on African American young men and the diagnosis of conduct disorder as a graduate student, and I want to thank her for her excellent research on this topic and our continued work together. I give many thanks to Derek Hook for his review of this work and for his wonderful scholarship. Nicolae Dumitrascu
helped with so many insights in this book through our conversations and the co-faciliation of the assessment seminar at the Danielsen Institute of Boston University. I want to thank Bill Adams for his early mentorship that set me forth on a positive path and for his continued friendship. I am grateful to Lynne Layton, Paul Reynolds and Jill Bloom for their insight and comments towards the final stages of this project. Lastly, I am in debt to all my professors in the MAP program at Seattle University and colleagues within Divison 24 of APA.
Several students assisted with some of the research for this book and their support was invaluable. Thank you to Tyler Zielinski, Peri Zarella, Sara Carabbio, and Hanna Day-Tenerowicz. There were many clinical supervisors along the way who taught me about relationships, culture, and the human heart: Dott Kelly, Ray Shellmire, Steen Halling, Jan Rowe, Timothy Catlow, Audrey Rosenberg, Barbara Mercer, Sandra Jenkins, and Douglas Goldsmith.
Kathy McKay and Badia Ahad were two of my first readers and editors. These two people are enormously gracious and kind, and give brilliant editorial feedback.
My friends and family are my life-blood and have supported me through this work. Thank you, Stacey Dunn, Emma Dunn, Amanda Ragonesi, Heidi and Tap Richards, Ruby Richards, Desiree and Lee Mottard, Allison Keehn, Mimi and Chris Evans, Gabriel Evans, Finn Evans and Robin Evans, Jessie Macdonald, Douglas Macdonald, Morgan and Courtney Macdonald, Isla Macdonald, Claire Dalzell, Red Dalzell, Jeff Chapman, Jacqueline Aug, Carolen Hope, and Wendy Wilder-Larsen. A special thanks goes to Juelie Dalzell—who saved my life and taught me about justice.
REFERENCES
Atkins-Loria, S. (2014). Defining suffering: Young African American men and conduct disorder. Unpublished master’s thesis. Smith College, Northampton, MA. Retrieved from http://scholarworks.smith.edu/ cgi/viewcontent.cgi?article=1829&context=theses
Finn, S. E., Fischer, C., & Handler, L. (2012). Collaborative/therapeutic assessment: A casebook and guide. Hoboken, NJ: Wiley.
Finn, S. E., & Tonsager, M. (1997). Information-gathering and therapeutic models of assessment: Complementary paradigms. Psychological Assessment, 9(4), 374–385. doi:10.1037/1040–3590.9.4.374.
Fischer, C. T. (1994). Individualizing psychological assessment. Mahwah, NJ: Lawrence Erlbaum Associates. (Original work published 1985).
Handler, L. (2006). The use of therapeutic assessment with children and adolescents. In S. Smith & L. Handler (Eds.), The clinical assessment of children and adolescents: A practitioner’s guide (pp. 53–72). New York, NY: Taylor and Francis Group.
Mercer, B., Fong, T., & Rosenblatt, E. (2016). Assessing children in the urban community. New York: Routledge.
Tharinger, D. J., Finn, S. E., Arora, P., Judd-Glossy, L., Ihorn, S., & Wan, J. (2012). Therapeutic assessment with children: Intervening with parents “behind the mirror”. Journal of Personality Assessment, 94(2), 111–123. doi:10.1080/00223891.2011.645932.
Tharinger, D. J., Finn, S. E., Gentry, L., Hamilton, A., Fowler, J., Matson, M., et al. (2009). Therapeutic assessment with children: A pilot study of treatment acceptability and outcome. Journal of Personality Assessment, 91(3), 238–244.
Tharinger, D. J., Finn, S. E., Wilkinson, A., DeHay, T., Parton, V., Bailey, K., et al. (2008). Providing psychological assessment feedback to children through individualized fables. Professional Psychology: Research and Practice, 39(6), 610–618. doi:10.1037/0735–7028.39.6.610.
Tharinger, D. J., Finn, S. E., Wilkinson, A., & Schaber, P. (2007). Therapeutic assessment with a child as a family intervention: A clinical and research case study. Psychology in the Schools, 44(3), 293–309. doi:10.1002/pits.20224.
Tharinger, D. J., & Pilgrim, S. (2012). Parent and child experiences of neuropsychological assessment as a function of child feedback by individualized fable. Child Neuropsychology, 18(3), 228–241. doi:10.1080/09297049.2011.595708
CHAPTER 1
Introduction
The idea for this book emerged in a singular moment. During the third year of my doctoral program in psychology, I worked as an intern for an African American agency in the inner city of Portland, Oregon, where I primarily conducted psychological evaluations. In my mind’s eye, I can still see Ron, my supervisor, sitting behind his desk, legs crossed, with the top of his head peeking out above the 25-page psychological report I had just written. It had taken me weeks to write the report; I had combed over every piece of data and synthesized every important detail of this young man’s life, drawing on information from a comprehensive psychological assessment battery. In my review of the results, I was careful to consider the test scores from a “cultural perspective,” especially regarding the normative data for African American performance on psychometric measures.
Ron was tough and never minced words; he demanded that I continually find ways to account for my social and political position as a White clinician. I assumed from his silence that, once again, I had failed to meet that standard. He wanted a clear recognition that I worked within what Spivak (1988) calls the “European hallucination.” He wanted me to acknowledge that my standpoint “not only discloses the world to participants, it also conceals it, and for the ruling class and those in positions of power their partial view of the world corresponds to their own interests and obscures the operations of the very power they benefit from” (Harding, 2003, as cited in Parker, 2015, p. 724). What Ron asked of
© The Author(s) 2016
H. Macdonald, Cultural and Critical Explorations in Community Psychology, DOI 10.1057/978-1-349-95038-6_1
his interns went far beyond the notion of “cultural competence”; he demanded a more Foucauldian (1970) stance. He wanted evidence, in the written language of the report, of how truth, knowledge, and power were brokered during the assessment process. As I sat across from him, I could feel his unspoken commentary brewing, and I prepared myself to become unseated from the comfort of professional authority.
In Ron’s office were rows of beautiful African masks carved out of metal and wood. Some of the faces were fierce, some serene, and others appeared to stare right through one’s body to the core of one’s being. Over the course of the two years I worked with Ron, we had many discussions about where the masks were from and the archetypes they evoked. Ron often took my interest in the masks as an opportunity to teach me about how the masks spoke their own language and what they might mean in the context of their creation. During one of our conversations, I suggested that the masks stood in opposition to the linguistic violence and oppression of the colonial order imposed on Africa in the late 1800s and throughout the 1900s. He rapidly shot back in an angry tone, “No. This is the mistake you keep making. You compare Africa to the West as if Africa only had something to say in its resistance or in relationship to the West. Your interpretation only justifies you and your perspective.” As Achille Mbembe (2001), who has articulated a similar point, writes in his book On the Postcolony,
It [Africa’s inaccessibility] flows from there being hardly ever any discourse about Africa for itself. In the very principle of its constitution, in its language, and its finalities, narrative about Africa is always pretext for a comment about something else, some other place, some other people. More precisely, Africa is the mediation that enables the West to accede to its own subconscious and give a public account of its subjectivity. Thus, there is no need to look for the status of this discourse; essentially, it has to do at best with self-deception, and at worst with perversion. (p. 3)
Implicit in this quote are the traumatic repercussions and complications of the entangled relationship between the oppressor and the oppressed, a relationship whose complex dynamics ultimately go beyond their original binary positions. Through continued discussions with Ron, I began to view the entire enterprise of psychological assessment as grounded in some of the same assumptions I had made about the African artwork on his office walls.
I discovered that the mainstream discourse within psychology, and within psychological testing in particular, was a self-referential system that assumed nothing could truly exist beyond its prescribed boundaries—that local sociopolitical knowledge as it related to the construction of selfhood was seen only in comparison to dominant psychological systems. The encounter with difference or the Other was immediately reduced and adopted into the metanarratives and master frameworks set forth by acceptable models of diagnosis, treatment, and experimentation already established in the literature by Eurocentric researchers and institutions. To paraphrase Mbembe (2001): What did the discourse of the inner city have to say for itself? What kinds of knowledge had been produced creatively and in a life-affirming manner right from the city sidewalks and the people who lived there? Was psychological testing a new form of colonial discourse that extended established forms of structural violence, racism, and oppression? And if these questions were to become the clinical starting point, would we not produce more accurate assessments and therapeutic interventions to begin with?
Ron finished reviewing the report and tossed it onto his desk as I held my breath and waited for him to speak. He stared off into the distance in a silent pause and then said one word: “Identity.” He continued, “You have everything in this report, including the kitchen sink and all kinds of stuff you don’t need, to explain this young man’s life. But what you don’t have is any mention of how he thinks about who he is in the world and the development of his identity as a young African American man.” Summing up, he added, “This young man’s life is filled with social agency and movement but you write his life as though he is one-dimensional; a postcard would have more to say.”
From that point forward, I realized that in order to heal or even conceptualize psychological wounds, their political counterparts would also need to be taken into account. In the format of the psychological report, I wondered how I could explore psychological, social, and political themes as they related to an individual within their own developmental trajectory. How could the test data give one a greater understanding of the ways in which social, political, and cultural systems interface with the psychological trauma of oppression and how, in turn, this impacts notions of human identity, cultural memory, suffering, and freedom? These are tricky questions because one may conclude that their answers imply that a more reflective and sensitive kind of psychology is required or that there needs to be more connection to political realms and more community
engagement. However, what I argue in the following chapters is not that we need a different methodology but that we need to become more aware of how psychology enters what is already political (Parker, 2015, p. 721). If taken seriously, this concept leads to a reorganization of what is thought of as the domain of “psychology,” and the recognition that psychology may not be the answer at all (Parker, 2015, p. 720). In many ways, I am advocating for a psychology of the postcolonial as set forth by Derek Hook (2005, 2012), where the conditions that produce racism and oppression are taken into account and where psychology “should thus be concerned both with analysis of oppressive uses of psychology and with enabling potentially transformative psychological forms that disrupt the balances of power and have social equality as their goal” (Hook, 2012, p. 16). As the field engages cultural matters more explicitly, particularly in diverse settings, what is required is a critical approach that accounts for the relationship between culture and power.
Scholars and researchers are typically well aware that the history of the United States is that of a racialized state and that the discourse of race is intricately interwoven with the experience and memory of dispossession, displacement, and impoverishment (Bhatia & Ram, 2001; Bhatia, 2002). Clinicians may also be aware of the power differential within a therapeutic relationship and the biases that may emerge from this uneven distribution (Prilleltensky & Nelson, 2002). However, when it comes to redressing oppressive histories in the context of case conceptualizations, psychological evaluations, or diagnosis and treatment, there is an enormous gap in both research and practice (Parham, 2002).
In particular, psychological assessment in the form of a community-based practice has been almost completely neglected in the literature (Mercer, Fong, & Rosenblatt, 2016). First, although there has been a great deal of literature produced on the perils of cross-cultural psychiatry (Kleinman, 1977) and psychotherapy (Cushman, 1995, 2013; Hook, 2004; Layton, 2006; Nelson & Prilleltensky, 2010), very little of the research has focused on the actual practice of psychological testing from a community-based perspective. In addition to the lack of sociopolitical perspective in this area, there is also an extreme shortage of theory that examines the practice of assessment beyond Freudian, Lacanian psychodynamic, and cognitivebehavioral models. In order to address these issues, this volume explores deeper questions of human existence, such as the construction of realities by those in power (Fanon, 1967, 1986) as well as discovered truths and the idea of community work as a form of relational ethics.
Thus, the overarching purpose of this book is to engage the practice of community-based psychology through case analyses, vignettes, and ethnographic descriptions. I draw upon cross-fertilized theoretical ideas and disciplines to demonstrate that clinical practice, in particular psychological assessment, requires the clinician to express more affirmative psychopolitical agency in the face of racial injustice within the urban environment. One of the major goals of this project is to engage the often-neglected postcolonial theory—domains of difference and displacement (Bhabha, 1994) and the voices of the subaltern (Chakrabarty, 2000; Spivak, 1988)—in conversation with psychological testing practices.
Each chapter offers nuanced, rich, and textured descriptions of an on-the-ground community practice that largely took place in the inner cities of the United States within communities where African American people are the majority. Through the cultural phenomenologies and critical theoretical explorations, I aim to highlight how “subject and object, self and other, psyche and culture, person and context, figure and ground, practitioner and practice, live together, require each other, and dynamically, dialectically make each other up” (Shweder, 1991, p. 73). We must view clinical relationships from the perspective of relational ethics, which includes discourse about cultural memory, freedom, power, and other events that break with the neoliberal expectation of “mutual reciprocity” (articulated, e.g., by Derrida, Levinas, Deleuze, and Foucault). By making this shift, therapeutic work can be a site of transformation, moving beyond fixed racial categories and bringing with it what I call “systems of portable social justice” (Macdonald, 2010).
Furthermore, this project suggests ideas about how clinical practice, in relationship to issues such as race and cultural memory, serves as a substantial vehicle for social justice against the backdrop of prejudicial criminal justice systems and mental health delivery systems. These systems often align their agendas with the continued existence of specific diagnoses and oppressive epistemologies (Alexander, 2012). The central argument that connects each chapter in this volume is that we deepen our models of clinical practice so that we understand healing from a historical perspective, as it might already exist within a person or community. Only by doing this can we reopen symbolic registers to allow cultural and social forms of suffering to speak on their own terms. Thus, the book offers a critique of how psychological discourse wires symptoms through pre-established paradigms without questioning how the paradigms perpetuate violence, even at the linguistic or symbolic levels. Also included are ideas for specific
interventions, such as restructuring the mission statements of communitybased agencies and reworking epistemological domains to account for Afrocentric psychologies where “clinical” knowledge and language is produced to mitigate neoliberal or neocolonial forces (Hook, 2004, 2005, 2008, 2012, 2013; Hook & Truscott, 2013).
In the following sections, I briefly review the history of communitybased psychological practices as well as current international trends within the field. Additionally, I outline some of the current and burgeoning models of community-based psychological assessment that have inspired the chapters in this book. Lastly, I provide summaries of each chapter.
COMMUNITY-BASED PSYCHOLOGICAL PRACTICES
In the mid-1960s, with the passage of the Community Mental Health Act (1963) and the Medicaid Act (1965), the need for community mental health (CMH) centers increased. In subsequent decades, the deinstitutionalization of the mentally ill continued to shift resources toward community practitioners and the development of CMH agencies. In the 1960s, many community psychologists who had been trained in clinical psychology found their training to be inadequate for CMH services. These psychologists developed innovative new approaches to CMH that focused on prevention, the use of nonprofessional helpers, community lodges as residential alternatives for deinstitutionalized patients, and selfhelp alternatives. These approaches embody values that provide a foundation for a vision of change: self-determination, caring and compassion, respect for diversity, and social justice (Nelson & Prilleltensky, 2010). Community psychology focuses on the importance of social context and uses an ecological perspective that looks at the fit between the individual and the environment (Rappaport, 1977). The community, rather than the individual, is viewed as the client, and the focus is on reducing the use of mental health services, strengthening community resources, and planning for change.
Recently, CMH practices and programs around the world have faced growing criticism from policymakers, consumers, and service providers for being ineffective, overly reliant on treatment by professionals, and overly focused on symptoms (Parker, 2015). Many have called for new paradigms of mental health and new practices that can better support recovery, community integration, and adaptive functioning for persons diagnosed with psychiatric disabilities. Although there has recently been much
discourse about transformation and recovery, there has yet to be a critical and systematic review that unpacks the concept of mental health systems transformation or that examines strategies for how to create transformative change in mental health. The common experiences of the international perspectives represented underscore the importance of and the need for new paradigms. One clear idea regarding alternatives and opportunities for pursuing transformative change is to recognize biases hidden within the US tradition of community psychology. As critical psychologist Ian Parker (2015) writes,
These ideals usually today include stipulations about “health” and “wellbeing” which range from direct physical support to ameliorate sickness and poverty, which are themselves defined according to objective indices so that the value of the intervention can be measured, to moral frameworks which the community has to abide by if they are to receive help (Nelson & Prilleltensky, 2010). This version of psychology does effectively colonise communities with a model of social organisation that requires the exclusion of competing organisations, including political parties who have their own specific agendas for social change. In this case the surreptitious “structure” that the community psychologist introduces, one which must be in line with the institutional agendas and career trajectories of external agents, idealises the “community” and open transparent decision-making within it all the better to enforce its own criteria for membership and participation. In this way community psychology operates as a kind of politics, one which aims to displace rival forms. (pp. 727–728)
Community-based scholars in South Africa have responded to this critique and made enormous contributions to the growing international body of knowledge on the history of community psychology. Psychology, a progeny of Western ethnoscience, was central to colonizing structures and discourses that sought to center European American self-knowledge and science by marginalizing other-than-Western knowledge systems. They present a specific reading of the origins and development of community psychology and the construction of “community” in community psychology in South Africa. They do this as an attempt to redress South African psychology’s racially skewed systems of knowledge production, research, and service provision. This effort also registers an Afrocentric voice, located in South Africa, in the international community of psychology literature. South African community psychology developed in a context similar to that of community psychology in Latin America. In Latin America, many
forces came together to create the social context for the emergence of community psychology. These included academic influences based on Paulo Freire’s writings, critical sociology, a focus on political liberation, and the desire to transform unequal societies. Community psychologists in South Africa, like many of their colleagues in other social science and health promotion disciplines, began to align their research, scholarship, servicedelivery work, and broader activism in support of government initiatives and democratic development. These community psychologists began developing distinctive features and definitions that placed the accent on advocacy, lobbying, policy development, and provision of culturally appropriate mental health and psychological services for underserved catchment communities, including those who delivered testimonies to the Truth and Reconciliation Commission (Seedat & Lazarus, 2011). Community psychology’s distinctiveness was also characterized by its promotion of critical theories and research for explaining the determinants of the most significant psychosocial difficulties faced by the population, its focus on critical scholarship and paradigm development, and its curriculum reform and restructuring within tertiary institutions. In the post-1994 period, community psychology echoed critical psychology’s emphasis on the participation of Blacks and women in the processes of knowledge production. Community psychologists worked within groups that were involved in the development of regional forums for mental health, education and training, and health promotion, which reflected a general trend toward coordination of services and programs (Seedat & Lazarus, 2011).
Thus, community psychology in the West should consider broadening its gaze to understand and address new forms of exclusions. These exclusions are best understood within the context of persistent unequal distribution of power and resources, the nature and quality of interactions within poor communities, and the wider social and political systems as well as the workings of the existing economic and social order that seem to allow mainly the middle and upper-middle classes access to the marketoriented system.
Historically, there has been very little development in either theory or practice on community-based approaches to psychological assessment and very few agencies that support community-based evaluations for which the clinician enters the world of the client in order to conduct testing. Mercer et al. (2016) have recently published a groundbreaking book called Assessing Children in the Urban Community that describes the psychological assessment practices of an innovative community-based agency
in Oakland, California, that strives to integrate the complex relationship between social forces and the individual psyche. Much of the work they have accomplished has been based on collaborative and therapeutic assessment models that I have also used in my work as an assessor, which is described in more detail in Chaps. 5–7. But first, it is important to give a general description of these models in order to provide a context for the book as a whole.
COLLABORATIVE ASSESSMENT AND THERAPEUTIC ASSESSMENT MODELS
Collaborative and therapeutic assessment (TA) models differ from traditional assessment models chiefly in their focus on actively involving the client in the assessment process rather than relegating the client to the role of bystander. Stephen Finn and Mary Tonsager (1997) developed TA as a means of incorporating psychological testing (including the MMPI2) into the process of brief psychoanalytic intervention. Finn (2007) found that clients became more responsive to treatment interventions and recommendations when feedback and test results were shared with them during the assessment process. TA aims to effect change by allowing clients to reach a deeper understanding of themselves (Finn, Fischer, & Handler, 2012; Fischer, 2000; Handler, 2006). The TA method combines many psychological perspectives and principles, including phenomenological, intersubjective, interpersonal, family systems, narrative, and self-verification theories. Grounded in the core values of collaboration, humility, respect, compassion, openness, and curiosity, TA clinicians strive to forge a working alliance between themselves and their clients. Rather than taking on the role of the objective observer, the TA clinician occupies the role of the participant-observer, acknowledging the importance of transference and countertransference in the assessment process, and analyzing the insights they provide. According to the TA theory, the therapeutic alliance between the clinician and the client is crucial as the client’s comfort level with the clinician helps empower them to experiment with new ways of conceptualizing and reacting to the difficulties in their life (Mercer et al., 2016).
The TA process includes six phases: referral and questions the client has specific to their lives; relationship-building; test administration; intervention, summary, and discussion; written communication of feedback; and follow-up. A distinctive aspect of TA is that, in the summary and
discussion phase, the clinician rates each piece of information to be conveyed to the client (or the parents of the client, if the client is a child) using a level system. The level system has three levels: Level 1 feedback is easy to hear and unlikely to invoke any anxiety; level 2 feedback is somewhat, but not entirely, aligned with the client’s (or parents’) existing understanding of the situation and is therefore likely to cause some anxiety; and level 3 feedback is entirely out of alignment with the client’s (or parents’) current conceptualization of the situation and has a high likelihood of inciting significant anxiety and distress (Finn, 2007). Especially in the stage of written communication of feedback, TA views the client’s psychology like a story and seeks to engage the client by reframing the story of how they came to rely on maladaptive coping mechanisms.
One of the hallmarks of TA is the way in which the process is structured according to each client’s individual conceptualization of their story and their needs. Near the beginning of the assessment, the client poses some questions they would like the assessment to answer, and the clinician–client team returns to these questions periodically throughout the process, ultimately answering most or all of the questions by the end. This approach engages the client more than the traditional assessment process might allow, and makes the MMPI-2 test more interesting to the client due to the personal adaptations given to it by the clinician–client team during the assessment process. When working with children, TA clinicians compose a fable tailored to the child’s life and share it with the child in order to help them understand how the pieces of their situation have worked together to create the circumstances that led them to psychotherapy. When working with adults, the clinician writes a letter answering the questions originally posed by the client in accessible, nontechnical language. These pieces of feedback allow the client to process difficult bits of information with the clinician as they move through the process rather than receiving all of the information at once at the end of their time with the clinician. As a result, TA tends to have better long-term outcomes than traditional assessment methods (greater adherence to treatment recommendations and follow-ups, greater symptom relief, etc.).
A NOTE ON RACE AND LIMITATIONS OF THE RESEARCH
As a White female clinician and American researcher, I am in many ways operating from a Eurocentric perspective. There are no confessions or insights that would allow me to fully escape my social and cultural
positions, and thus I must rely upon the accounts, writings, and theories generated by those who have lived experiences of racism and have been impacted by oppression. As a White person in the United States, I have benefited from the color of my skin and have utilized the privileges that have been afforded to me because of it. While consciously I seek to divest myself from racist practices, there are most likely unconscious investments that I am unable to disentangle. This is especially true since I have had access to abundant opportunities in education and employment, which has been the result of systemic racism. As Parker (2015) writes in his recent critique of community-based practices,
The two main traditions of community psychology in the English-speaking world are underwritten by institutional allegiances to university structures and external funding bodies which in different ways place a strain on their well-meaning attempt to empower people and even to politicise psychology. (p. 727)
Although I make consistent and conscious attempts to be aware of how my privilege lends itself to bias and to identify discourse that does not further racist epistemologies, “the benefits I receive from this system, the privileges I have as a White person, and my overall racial socialization within the current racial hierarchy are potential limitations” to the perspectives in this volume (Sascha Atkins-Loria, Macdonald, & Mitterling, 2015, p. 432).
Definition of Terms
In any discussion that involves race, racism, and ethnicity, it is first important to define the terms. Historically, the term race has been “posited represent real to identify biological differences two groups” (Williams, Gooden, & Davis, 2012, p. 26), while ethnicity has been used to speak of a shared cultural heritage. The term race has also been used in social classifications to denote the privileges of White people and the oppression of people of African descent. Furthermore, in following Gilroy (2006), I recognize that “racism is therefore a system that generates the groups we know as races” (p. 28). Thus, throughout this volume, I am careful to note that the term race operates in a complex fashion within the egoic, symbolic, and embodied domains (Hook, 2012) that perpetuate racist ideology.
For the purposes of this book, I will follow the lead of recent scholarship in using the terms “Black” and “White,” to identify ethno-racial groups. As Williams, Gooden & Davis (2012) state,
The word Black is used here to with a capital “B” to indicate an ethnoracial group, whereas the use of the lower case “b” is restricted to the black color. The word Black is sometimes used interchangeably with the word African American. Use of the ethnic identifier African American is specific to those born in America while the word Black is an all-inclusive word to refer to all people of African ancestry worldwide. The word “White” is used with a capital “W” to indicate the European American ethno-racial group in America. (p. 26)
Throughout this work, I have tried to use these terms in a thoughtful and consistent manner so as not to perpetuate negative stereotypes or oppressive epistemologies.
SUMMARY OF CHAPTERS
Chapter 1: The Inner City Intern, Part I—Culture and Memory
This chapter is meant to introduce the setting and major themes of the rest of the book. The central argument is a critique of the Eurocentric nature of mainstream psychology (Bhatia, 2002; Teo, 2015) and an elaboration of the creative adjustments needed when doing in-depth psychosocial work within minority communities. Many philosophers have argued that psychological time is a fundamental, inherent quality of consciousness that provides continuity and sequence to mental events—enabling memory. And, since memory is consciousness, psychological time enables the individual intentionality of consciousness. Levinas (1961/1969), on the other hand, argues that an individual’s past, in the most original sense, is the past of the Other. The irreducible alterity of one’s past sets the stage for the Other, who co-determines the meaning of the past.
The aim of this chapter is to explore cultural memory within my context as a Caucasian doctoral student entering into an African American community during an internship and my discovery that cultural memories are remarkably more complicated than a propositional description of historic events. This opening chapter further explores the ways in which cultural memory is not a record of “what happened” but a sociolinguistic, creative, meaning-making process. Histories can be contested. Memory,
on the other hand, never adheres to a strict true or false dichotomy. Memory is like searching for the Divine—it cannot be found; it can only be revealed in mysterious and small details. Memory is the intruding of the infinite, creating as an effect the idea of a finite (August, 2011); it is not a “representation” of the past, nor is it a kind of mnemonic system of subjectivism that mediates all of consciousness.
Chapter
2:
The Inner City Intern, Part II—The Moral Geography of Conduct Disorder
The purpose of this chapter is to explore different frameworks for interpreting deviant or “conduct-disordered” behaviors within the inner city environment. In an article titled “Justice, Deviance, and the Dark Ghetto” (2007), Tommie Shelby states, “If the overall social arrangement in which the inner city poor live is unjust, this requires that we think about what their obligations are quite differently than we should if the society were judged to be just” (pp. 126–127). However, as clinicians we often inadvertently assume that the inner city poor participate in a system of justice that is fair to all, and thus we make biased diagnoses based on this faulty perspective. Scholars such as Johnathon Metzl (2009) have consistently shown that African American young men have differing rates of diagnosis within certain diagnostic categories such as schizophrenia, depression, and conduct disorder. According to Sascha Atkins-Loria (2014), “They are disproportionately underrepresented among those diagnosed with affective disorders such as major depressive disorder but overrepresented among those diagnosed with schizophrenia and conduct disorder (Adebimpe, 1981; Cameron & Guterman, 2007; DelBello, Lopez-Larson, Soutullo, & Strakowski, 2001; Feisthamel & Schwartz, 2009; Kilgus, Pumariega, & Cuffe, 1995; Mandell, Ittenbach, Levy, & Pinto-Martin, 2007; Neighbors, Trierweiler, Ford, & Muroff, 2003; Wu et al., 1999),” (p. 24). Furthermore, Henggeler and Sheidow (2003) note the correlation between the diagnosis of conduct disorder in people who live in communities where they are exposed to violence, neighborhood criminal activity, and lack of public resources and social mobility (p. 506). There are various hypotheses for these diagnostic disproportions, but in general, two key factors appear to be at play: impoverished environments and clinician bias. Drawing upon the work of Shelby (2007), I examine frameworks for interpreting deviant or “conduct-disordered” behaviors within the inner city environment. I explore questions such as: How do we
examine these behaviors within a sociocultural lens without minimizing the potential risks of such behaviors? How much is an individual responsible for their own actions within the context of systemic and brutal forces of oppression and injustice? Can clinicians be aware of our culpability for our contribution to the injustice of the urban poor and have worthwhile clinical insights at the same time? I use these questions to frame a critical analysis of current paradigms in clinical practice. These topics are explored using a descriptive ethnographic vignette of a strip club in the inner city.
Chapter 3: The Colonial Archive, Stereotypes, and the Practice of Psychological Assessment
This chapter discusses how social stereotypes as well as the fear of being stereotyped affect both client and clinician, thereby influencing psychological assessment and diagnosis. Steele (2010) and colleagues have demonstrated through numerous empirical studies that when a person feels that they are under the threat of being stereotyped in an academic or test-related setting, their performance is impaired. Equally important, but supported by fewer studies in the literature, is the way in which histories of racial injustice may impact the clinician’s perception of the client due to stereotypes or inaccurate historical representations that may operate in the clinician’s conscious or subconscious mind (especially if they identify as a White clinician) and lead to implicit bias (Bhatia, 2002; Steele & Aronson, 1995).
For example, the prevailing research on the use of the Rorschach in cross-cultural settings or within African American communities is largely focused on understanding “differences” between White American response sets and African American norms (Presley, Smith, Hilsenroth, & Exner, 2001). These differences, such as a “lower frequency of cooperative movement” (p. 1) for African Americans, are reportedly interpreted within social and cultural frameworks. For example, according to Presley et al. (2001), the fewer responses that involve thematic cooperation on the Rorschach are seen as reflecting the idea that “most members of our society are less likely to be sensitive to or responsive to [African Americans’] needs relative to others” (p. 1). The danger here is that specific responses on the Rorschach are too easily generalized to a population that has experienced a profound historical catastrophe; to redress the violence of this history requires a great deal more than increased clinical sensitivity. Although these studies claim to support the continued clinical utility of
the Rorschach for diverse populations, researchers are unable to account for the unconscious production of social stereotypes and the propagation of White fantasies about racial difference when contextualizing the narrative data (Layton, 2002, 2006).
Chapter 4: Street-Corner Therapy—Identity, Space, and Community Practice
Very little of the literature on community-based clinical practice focuses on the relationship between physical space, identity, and trauma (Hook, 2013). However, understanding how these domains intersect becomes vital when working with clients in nontraditional settings such as foster homes, street corners, restaurants, and parking lots. Through a case analysis, this chapter explores how the narrative of trauma is altered if the therapist and the client are able to explore the actual space of trauma in unison (e.g., on street corners where community members have been shot or murdered). For example, Dixon and Durrheim (2000) prioritize the domain of “spatiality” and “offer the notion of a ‘grounds of identity,’ so as to emphasize the ways in which physical (and socio-discursive) space operates as a resource of identity” (as cited in Hook, 2013, p. 28). In this context, space and identity are co-constructed simultaneously. At the same time, then, entanglement of space and identity complicates notions of transference and countertransference, and other boundaries between the client and the therapist. Thus, another major focus of the chapter is the development of theoretical models and processes of imagination that can account for such countertransference and that show that the psyche of the person is not separate from his or her surrounding world.
Chapter 5: Levinas in the Hood—Portable Social Justice
This chapter offers an in-depth case analysis that draws on the philosophy of Emmanuel Levinas as a basis for the practice of psychological assessment. The aim of the chapter is to contribute to the growing body of literature around applications of this Levinasian line of thinking to psychology. These ideas were originally pioneered by Kunz (1998) in The Paradox of Power and Weakness and more recently in works such as Marcus’ (2008) Being for the Other, Orange’s (2011) The Suffering Stranger, Goodman’s (2012) The Demanded Self, and Freeman’s (2013) The Priority of the Other
In his philosophy, Levinas demonstrated that it is precisely our obligation to the Other that liberates the subject from his or her own self-belonging, or operative intentionality. As a clinician working with African American adolescents in foster care, I have found not only that ethics is the first philosophy but also that seeing the face of the Other becomes a daily imperative for survival and not a philosophical abstraction. Race, ethnicity, social class, education, age, and language are just some of the categories around which the assessor or therapist often forms misperceptions of their clients and their families, leading to profound cultural mistrust and situations where, as Levinas (1961/1969) would say, one is reduced into totality. The focus of this chapter is on what happens when totality breaks into pieces within the cross-cultural context and the “glean of exteriority,” or of transcendence, happens in the face of the Other. What happens when the world undoes itself in an instant and we are not who we think we are? What happens when the face emerges as a primordial signifier? I explore these questions through the case of a 17-year-old African American female who was referred to a community agency for a psychological evaluation. I highlight the relationship between the assessor and the client to demonstrate the movement from totality toward infinity within the cross-cultural context.
Chapter 6: The Foot Fetish—Events, Reversals, and Language in the Collaborative Assessment Process
The last chapter expands on the themes in Chap. 6 and focuses on theoretical and practical frameworks for psychological assessment, such as the phenomenological perspective, that may be more useful in inner city contexts. Many thinkers in the field of phenomenological philosophy and psychology, such as Maurice Merleau-Ponty and Edmund Husserl, have shown that the lived world is a world of texture and depth. As clinicians and assessors, we often entertain the false belief that we can reside outside the fabric of existence, especially when we write psychological evaluations. One might wonder, then, if it is possible to write a psychological evaluation that includes “a language particular to the events it describes,” or a writing that incorporates hospitality and ethics. How do the phenomenologies of Being and Otherness speak to the experiences within the case of a severe foot fetish? Drawing on the early writings of Fischer (1970, 1973a, 1973b, 1976, 1979, 1994) and the descriptive language of preeminent Continental philosophers (e.g., Derrida, Levinas, Ricoeur, and Gadamer), I conceptualize the process of evaluation in a manner that deepens the human science perspective in the collaborative assessment process.
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notice the large amount of phelloderm which has been produced in the fork of the branch, at pd, where greater strength is required.
F . 152. Lepidodendron vasculare. Sections of dichotomously branched shoot.
A. From a section (10·5 × 9 cm.) in the Cambridge Botany School Collection.
B. From a section (8 cm. long) in the Cambridge Collection.
The section represented diagrammatically in fig. 152, A, has lost the outermost part of the cortex together with the leaf-cushions; it
consists largely of secondary cortex composed of radially disposed phelloderm cells and tangentially placed secretory strands (represented by the discontinuous black lines in the drawing): the dotted region in the central part of the axis is composed of primary cortical parenchyma, and the two spaces surrounding the steles contain portions of the lacunar middle cortex. Each stele possesses a narrow crescentic zone of secondary xylem; the amount is greater in the case of the right-hand stele, of which a small piece is shown on a larger scale; the striking contrast in size between the outer and more internal secondary tracheae is no doubt the expression of some unfavourable condition of growth. The position of the secretory zone beyond the secondary xylem is shown at sc, fig. 152, A.
F . 153. Lepidodendron vasculare. (From a specimen (16 × 7·5 cm.) in the Manchester Museum.)
An example of a large and partially decorticated stem is afforded by the specimen (16 × 7·5 cm.) shown in fig. 153. The irregularly ribbed surface is formed of rather thick-walled phelloderm, in which occur tangentially arranged rows of secretory strands. The tapered form of the secondary cortex as it abuts internally on the primary cortex is shown very clearly in the drawing (cf. fig. 151, C). The stele in this much older stem consists mainly of secondary wood.
F . 154. Lepidodendron vasculare. Shoot (2·8 cm. diam.) with two steles. (From a specimen from Halifax in the Williamson Collection, British Museum, No. 340.)
An interesting example of a small shoot, the largest diameter of which is 2·8 cm., is shown in fig. 154, A: the section was cut a short distance above the bifurcation of the stele into two approximately equal branches. The outer part of the cortex consists of phelloderm, pd, with the usual rows of secretory tracts, and primary outer cortex g; the middle cortex is represented by patches of parenchyma with a
few leaf-traces. To one of the steles, s′ (fig. 154, A), a crescentshaped band of secondary xylem has been added; the other stele, S, possesses no fully developed secondary elements.
Fig. 154, B and C, illustrates the anatomical features immediately external to the primary xylem of the smaller stele, s. The comparatively broad band of radially disposed parenchyma, m, is connected with the outermost elements of the xylem by a few rather dark and small crushed parenchymatous cells. The band m, which we may speak of as the meristematic zone, clearly consists of cells in a state of division; it is in this region that the secondary xylem is produced. Beyond the leaf-trace, (fig. 154, C, lt), occurs a portion of the secretory zone, some of the smaller cells of which show signs of disorganisation; but most of this tissue has been destroyed (fig. 154, B, sc). The outer edge of the secretory zone is shown in fig. 154, D abutting on the cells of the inner cortex, c′. The leaf-trace shown in the inner cortex in fig. 154, B illustrates the more oval or tangentially extended form of the xylem in this region, in contrast to the more circular outline which it exhibits on the inner side of the secretory zone.
F . 155. Lepidodendron vasculare. Outer edge of secondary xylem: m, meristematic zone; mr, medullary ray. (Drawn from the section shown in fig. 168, A).
The transverse section, part of which is reproduced in fig. 168, A, illustrates a characteristic feature, namely the juxtaposition of the outermost tracheae of the secondary xylem and much smaller cells of the meristematic zone. This is seen in fig. 155, which shows a small piece of fig. 168, A, on a larger scale. In plants with a normal cambium the segments cut off from the initial layer fit on to the elements of the xylem or phloem to which they are to form additions, but in Lepidodendron it seems to be a general rule to find each of the most external lignified elements abutting on a group of two or three much smaller cells. It is difficult to believe that the meristem shown in fig. 155, m, could produce secondary xylem elements equal in size to those already formed: in all probability had growth continued there would have been a marked difference between the size of the secondary tracheids, as in fig. 152, A, x2 , where there was no doubt some cause which interfered with normal cambial activity. This disparity in size between the secondary xylem elements and the adjacent parenchymatous tissue of the meristematic zone is by no means exceptional and may be described as the general rule. It is at least certain that in Lepidodendron vasculare, as in other species, the secondary xylem was succeeded by a broad band of parenchymatous tissue, from which new tracheae and medullary-ray elements were produced, and not by a narrow cambium such as occurs in recent plants.
v. Lepidodendron stems as represented by casts and impressions of partially decorticated specimens.
The differentiation of the outer cortex of a Lepidodendron into comparatively thin-walled and more resistant tissue has been the cause of unequal decay and the consequent formation of shrinkage cavities. In addition to the unequal resisting power of contiguous tissues, another important factor in determining the nature of casts and impressions is the existence of the cylinder of delicate cells in the outer cortex of stems and branches. As already pointed out, this meristematic cylinder or phellogen constitutes a natural line of
separation, as in the case of the cambium layer between the wood and the external tissues in a fresh Sycamore twig. The result of the separation of an outer shell of bark from the rest of the stem and the results of unequal decay in the more superficial tissues, have necessarily led to the preservation of the same specific type under a variety of forms.
Our knowledge of the anatomy of Lepidodendron stems enables us to recognise in fossils of very different appearance specimens in various conditions of preservation of one and the same type. Such names as Knorria, Bergeria and Aspidiaria are examples of generic titles instituted before any adequate knowledge of Lepidodendron anatomy was available.
Differences in age as well as different degrees of decortication have contributed in no small measure to the institution of generic and specific names which more recently acquired knowledge has shown to be superfluous.
a. Knorria.
The designation Knorria, after a certain G. W. Knorr of Nürnberg, was proposed by Sternberg in 1826[273] for casts of Palaeozoic stems of a type figured more than a century earlier by Volkmann[274] Goeppert, in his earlier works, published drawings of fossil stems which he referred to Sternberg’s genus: one species he at first called Didymophyllum Schollini. He afterwards[275] described some specimens which showed that the features characteristic of Knorria may occur on partially decorticated stems with leaf-cushions of the true Lepidodendron type. His specimens, preserved in the Breslau Museum, demonstrate the accuracy of his drawings and conclusions. Goeppert, and after him Balfour[276] , drew attention to the different appearances presented by branches of Araucaria imbricata when preserved with the surface intact and after partial decortication, as illustrating possible sources of error in the determination of fossil stems.
Although it is now a well-established fact that fossils bearing the name Knorria are imperfect lepidodendroid stems, the use of the
term may be conveniently retained for descriptive purposes. The specimen from the Commentry coal-field of France, shown in fig. 156, affords some excuse for the institution of several generic names for different states of preservation or decortication of one species. The cortical level exposed at e is characterised by spirally disposed peg-like ridges with truncated apices: it is this form of cast which is usually designated Knorria. The ridges vary in size and shape in different types of stem; they may be narrow as shown at e, fig. 156, or short and broad with rounded distal ends. In some cases they are forked at the apex, as in the partially decorticated specimen of Lepidodendron Veltheimianum represented in fig. 185, A.
F . 156. A dichotomously branched Lepidodendroid stem (Knorria mirabilis Ren. and Zeill.). (After Renault and Zeiller.) (¼ nat. size.) The original specimen is in the Natural History Museum, Paris. a–g, surface features exposed as the result of different degrees of decortication. (See vol. . p. 102, fig. 23).
The Knorria state represents the impression or cast of the outer cortical region too deep below the leaf-cushion region to retain any indications of the cushion-form; the ridges are the casts of the spaces produced in the cortex by the decay of the sheath of delicate cells surrounding each leaf-trace and by the decay of the thin-walled cells of the parichnos. The occasional forked apex of a ridge is the expression of the fact that the cast was made at the region where the parichnos divides into two arms (cf. p. 100). In certain specimens
it is possible to connect the Knorria casts with associated lepidodendroid stems which may be determined specifically; but when we have no evidence as to surface-features the fossils may be designated casts of lepidodendroid stems in the Knorria condition. Such casts are illustrated by numerous drawings in palaeobotanical literature[277] .
b. Bergeria.
This is another name first used by Sternberg in his classic work, Die Flora der Vorwelt, for casts of lepidodendroid plants such as Steinhauer[278] had previously figured as Phytolithus cancellatus. Brongniart[279] recognised that the application of the generic title Lepidodendron should be extended to include specimens referred by Sternberg to Bergeria, and a few years later Goldenberg[280] realised that this name does not stand for well-defined generic characters. The correctness of these views was, however, first satisfactorily demonstrated by Carruthers[281] and by Feistmantel[282] .
If a Lepidodendron stem loses its superficial layers of outer cortex and in this condition is embedded in sand or mud, the cast is distinguished from that of a perfect stem by the absence of the leafscars and by other features. It may, however, still show spirally disposed areas, corresponding approximately to the original leafcushions, which are characterised by a small depression or pit either at the apex or near the centre of each oval area: the pit marks the position of the leaf-trace and its parichnos strand. In some cases the exposed surface may be smooth without any indication of leafcushions, while narrow spirally arranged grooves represent the obliquely ascending vascular bundles passing through the cortex to the leaves.
Fig. 185, B, shows the Bergeria state of Lepidodendron Veltheimianum, which differs from the Knorria condition in the fact that decortication had not extended below the level at which the form of the leaf-cushions could be recognised. It is clear that no sharp line can be drawn in all cases between the different degrees of decortication as expressed by the terms Knorria and Bergeria.
A list of synonyms of Knorria, Bergeria, and Aspidiaria forms of stem and a detailed treatment of their characteristic features may be found in a recent work by Potonié[283] .
c. Aspidiaria.
In one of the earliest English books on fossil plants, the Antediluvian Phytology by Artis[284] , a specimen from the Carboniferous sandstone of Yorkshire is figured as Aphyllum cristatum, and a similar fossil is described as A. asperum. These are impressions of Lepidodendron stems in which the characteristic leafcushions are replaced by smooth and slightly convex areas with a narrow central ridge. To this type of specimen Presl gave the name Aspidiaria[285] , under the impression, shared by subsequent writers, that the supposed external features were entitled to generic recognition.
It is to Stur[286] that we owe the first satisfactory interpretation of fossils included under the name Aspidiaria: he showed that on the removal of the projecting convex areas from some of his specimens a typical Lepidodendron leaf-cushion was exposed (fig. 144, A, a). The Aspidiaria condition (fig. 144, A, b) represents the inner face of the detached shell of outer bark of a Lepidodendron stem, while in the Bergeria casts we have a view of the external face of a stem deprived of its superficial tissues.
In a Lepidodendron stem embedded in sediment the more delicate portions of the leaf-cushions would tend to shrink away from the internal and more resistant tissues of the outer cortex, thus producing spaces between each cushion; further decay would cause rupture of the leaf-traces and the superficial tissues would thus be separated from the rest of the stem. The tendency of Lepidodendron stems to split along the line of phellogen in the outer cortex is seen in fig. 148, A, g. The deposition of sediment on the exposed inner face of this cortical shell would result in the production of a specimen of the Aspidiaria type: the reticulum enclosing the spirally disposed convex areas is formed by the impression of the firmer tissue between the leaf-cushions.
