Published:
December 2022
Issue:
Vol.17, No.2
Word count:
3909
About the author
-
PhD (Dean’s list), MAAT(Clin), MDes, AThR
Ying (Ingrid) Wang is a post-doctoral research fellow at the Centre for Arts and Social Transformation, the University of Auckland. Her research interests include arts-based research in arts therapy, education, well-being and social transformation. She also has research experience in the public mental health sector and has been involved in a number of projects focusing on Asian communities’ mental health in Aotearoa New Zealand. Ying also practises as a registered arts therapist specialising in displacement trauma, sexual trauma, depression, anxiety and other mental health issues. She is passionate about the power of creativity in both clinical practice and academic research.
This work is published in JoCAT and is licensed under a CC BY-NC-ND-4.0 license.
Seeds of growth: Improving cultural competence as an immigrant arts therapist
Ying (Ingrid) Wang
Abstract
This paper highlights a Chinese New Zealand creative arts therapist’s experiences in working with clients from a Māori background through arts-based inquiry and critical autoethnography. This study attempts to showcase how the power of creativity provides the opportunity for a therapist from an immigrant background to deal with her own anxiety about working with clients from diverse backgrounds, and to gain knowledge and cultural competence through creative interventions in the therapeutic relationships. It also proposes that the cultural knowledge from the immigrant therapist’s own cultural background is an influential element in working with clients from diverse cultural backgrounds. In this article, I am interested in exploring how my own cultural knowledge and wisdom, my empathy and sympathy for learning about my clients’ cultural experience, and the power of arts for working with clients creatively, can improve therapeutic rapport and outcomes.
Keywords
Identity, immigrant, cultural competence, critical autoethnography, arts therapy
Introduction
As a form of living inquiry from the perspective of the artist/researcher/teacher, a/r/tography is a well-established qualitative research methodology (Irwin, 2004). As a creative arts therapist and arts-based researcher, through this arts-based research I extend the original concept of a/r/tography to showcase how I as an immigrant artist/researcher/therapist use arts-based inquiry to explore self in practising creative arts therapy with clients from diverse cultural backgrounds. Through an autoethnographic voice, I intend to provide my powerful insights from a vulnerable perspective into working with clients from a Māori cultural background as an immigrant Chinese creative arts therapist practising in my adopted culture. Sussman (1995) indicates that in the therapy/psychotherapy profession, therapists do not discuss the difficulties in their practice because of a “taboo regarding self-disclosure” (p.3). With this project, through my own voice as an immigrant creative arts therapist, I challenge this taboo by modelling use of the vulnerable self in the creative therapeutic process. Through personal voice and creativity, I, as an immigrant creative arts therapist, explore my personal and professional experiences in working with clients from a Māori cultural background from a lens of critical autoethnography, in order to co-create knowledge in non-ordinary language through my storytelling (Holman Jones, 2016, p.228). I also use poetic inquiry to explore my identity-formation process socially and politically (Faulkner, 2017), and to engage my readers emotionally and intellectually (Furman et al., 2006).
I moved from China to New Zealand more than two decades ago. As an immigrant therapist practising in my adopted country, I am always interested in how my cultural background impacts on my creative arts therapy practice and research. However, I only recently realised my own cultural ignorance. I have to admit my embarrassment – my knowledge about Māori culture was very limited. I always stood quietly in gatherings when someone was doing a Māori introduction or karakia. I would pretend to sing by mouthing words silently when joining in on Māori songs at functions. My closest Māori cultural contact was through the cultural performances in tourist hotspots or at my children’s school’s Matariki celebrations. I bought a greenstone pendant for myself as a decoration without knowing the significance of the stone and the carving process. As an immigrant, I tried my best to fit into New Zealand’s colonised Western culture, but for too long I did not give a thought to fitting in with New Zealand’s Indigenous culture.
There is a variety of ways to describe an immigrant therapist – foreign-born, international, transnational, trans-located or immigrant (Chen, 1999; Falicov, 2007; Kissil et al., 2013b; Kitazawa, 2020). For an immigrant therapist, it is important to improve cultural competence in professional practice in order “to increase a sense of belonging and reduce feelings of professional isolation” (Kissil et al., 2013b). The outcome of therapy or psychotherapy, the therapeutic relationship between the immigrant therapist and the client, and the choice of treatment are impacted by the therapist’s cultural background and cultural experience (Vasquez, 2007; Casas et al., 2016). To address the therapist’s cultural competence, it is necessary to compare the differences between cultural competence, cultural knowledge and cultural awareness. A therapist’s cultural knowledge is the amount of their own understanding and knowledge of a particular cultural group’s historical, political and social experiences, and their norms (Soto et al., 2018, p.1908). A therapist’s cultural awareness is essentially their consciousness of their own cultural experience and background (Soto et al., 2018, p.1908). Cultural competence measures the therapist’s ability to engage actively and work effectively with clients from diverse cultural backgrounds (Domenech & Bernal, 2012; Smith et al., 2012). In previous studies, the therapist’s cultural competencies are emphasised to highlight the awareness of cultural impacts on outcomes of therapy or psychotherapy (Imel et al., 2011; Tao et al., 2015). This paper extends the understanding of how the immigrant therapist’s cultural competence impacts on the therapeutic relationship between the immigrant therapist and clients who are from diverse cultural backgrounds, and on the therapeutic outcomes.
As an immigrant arts therapist working with clients from different cultural backgrounds, my cultural competence contributes to whether the clients’ therapeutic experience is positive or negative (Rogers-Sirin et al., 2015). For example, Japanese arts therapist Megu Kitazawa (2020) reflects how she connects to her traditional thinking in her practice to improve the therapeutic outcomes. Akyil (2011) studies how her own collectivistic culture of being a female immigrant therapist from Turkey impacts on her work of conceptualising and intervening in her clients’ problems in a Western individualistic society. In this paper, I am interested in exploring how my own cultural knowledge and wisdom, my empathy and sympathy combined with an openness to learning about my clients’ cultural experience, and the power of arts for working with clients, creatively impact on the therapeutic rapport and outcome.
Separation between us
When I received the referral for my first client from a Māori background, I found myself sitting with my hesitation for several hours. I knew my knowledge about Māori culture was very limited. I could not remember my own pepeha, although I had practised it several times for work gatherings. Using a pepeha seemed to be an appropriate way to ‘show’ respect for Māori culture, but in my moment of hesitation I realised that my limited connection to the Indigenous culture of this land for me amounted to a decoration rather than a necessity. When I was reading the referral notes, I had fear and anxiety about accepting the case. I suddenly came to a doubtful self-realisation. Though I had immigrated to New Zealand many years earlier, I was still isolated culturally. I had only focused on learning about the Western culture of New Zealand, and I had neglected to familiarise myself with an important part of my adopted New Zealand culture – the Indigenous, Māori culture. I really knew so little about it. Besides the immersive cultural experiences at tourist sites and some Māori welcome rituals during my study and at workplace functions, I knew nothing else. I also realised that I did not have personal friends from a Māori cultural background. Somehow, my personal connections in my adopted land were colonised, not only by the habits of an immigrant who was craving to be accepted by the mainstream adopted culture, but also by my ignorance and selfishness. Mittal and Wieling (2006) point out that some immigrant therapists, especially those from different races and cultural backgrounds, often view themselves as an outsider in the host country. Reading through this Māori client’s referral notes, while feelings of hesitation and embarrassment welled within me, I felt I was an outsider. In the painting Separated (Figure 1), I see my root Chinese culture as a red colour which is disconnected from my adopted culture, the blue colour. In this case, it was the Indigenous Māori culture of my adopted land. After finishing this painting, I looked at it for a while. Red is a lucky colour in Chinese culture. We often use red to decorate weddings or festivals, for example, Chinese New Year. When I was young, I received red bags of money from my parents and grandparents, as Chinese believe this brings good luck. Blue reminds me of the dark blue or blue-green used in tā moko tattoo art in Māori culture. I used blue to represent the unfamiliar culture of my adopted land. This painting reveals my awareness of my cultural isolation and separation as an immigrant arts therapist.
Figure 1. Ying (Ingrid) Wang, Separated, 2016, watercolour on paper, 297 x 210mm.
Red
The luckiest colour from my culture
Wants to run through the blankness
Freely
Blue
The melancholy colour from the dark sky
Reflects suffering on the land
Sadly
With ignorance and selfishness
I cannot run though the sadness and the suffering
With blindness and foolishness
I cannot protect them if they are invisible to me
From red
I have power and compassion
I have the desire to comfort
The cold blue with the warmth from red
Working with Māori whānau, engagement is the most important key to the success of any intervention (National Centre of Mental Health Research, 2010, p.9; Lee et al., 2020). Fear and anxiety from the immigrant therapist block the willingness for engagement with a client. Rogers-Sirin et al. (2015) identify being “open to learn about the client’s culture” as an important category of a therapist’s cultural competence (p.263). Through this poetic exploration, I captured my empathy, compassion and willingness as an immigrant therapist to overcome my fear of lacking cultural knowledge of Māori tangata whenua and whānau, and increased my willingness to engage in the therapeutic journey with my Māori clients. My poetic exploration helped me to realise that to deal with one’s own anxiety and to gain the awareness of one’s lack of knowledge around the client’s culture is the first step toward the openness of learning. After the creative exploration, I was no longer sitting in my hesitation. Instead, in my heart was compassion for my client and the desire to heal my client with the power of art. I decided to accept this case, aware of my feelings of cultural ignorance, my compassion for the people of my adopted land, my openness to what I might face, and my willingness to learn about my Māori client’s culture.
Our names
I was anxiously waiting for my Māori client’s arrival. I made sure my room was tidy, and organised the art-making materials on the table. I wanted to present myself professionally. As an immigrant therapist, I felt I had to put in extra effort to create the image of a professional clinician in front of my clients. These extra efforts hint at my insecurity and lack of confidence as an immigrant therapist. Basker and Dominguez (1984) noticed that some foreign-born therapists downplayed their cultural differences as a strategy for gaining legitimacy. I used to downplay my cultural differences to manage my displacement trauma arising from my personal and professional experiences. My confidence as a clinician was impacted by the many times clients asked to be referred out as soon as they heard my Chinese-accented English. My insecurity grew from the experience of being questioned about my therapy capability when my referrals learnt my Chinese name. To deal with my insecurity and lack of confidence, I chose to use my English name as my practice name, thinking this might be more accepted, and I avoided phoning my new clients so they would not hear my accented voice, instead emailing them using my full professional registration titles. I did not want to stand out, or to present myself as an immigrant therapist when I had new referrals from a different cultural background.
My Māori client arrived. I stood up and presented my warmest therapist smile. I introduced myself with my English name, and called her by name when I invited her to sit on a comfortable sofa. She looked at me politely. She asked me where I was from. Later on I learnt that, in Māori culture, the first question asked in exchanges is “Where are you from?” rather than “Who are you?” (Smith, 2019, p.5). In Māori culture, it is important to introduce “where I am from” through “geographical landmarks, eponymous ancestors and tribal canoes that tell a story of relationship to the land and its people” (Smith, 2019, p.5). However, I had no such culturally sensitive answer in my mind. I simply answered, “I am from China, but I have lived in New Zealand for many years now”. In my answer, I sensed my insecurity again. I did not want to be seen differently, and had tried to downplay my difference by adding “lived in New Zealand for many years”. Then she asked my Chinese name. I introduced myself again, using my Chinese name. She smiled and repeated my name, in her thoughtful and gentle voice. She asked why I did not use my Chinese name. I paused, and did not know how to start. This question exposed my vulnerability. I was not sure how my displacement trauma about adopting an English name might impact the dynamic in the therapeutic space. As an immigrant therapist, I do not want to be vulnerable in the therapeutic space. I do not want to lose ‘control’ of the therapeutic space as a therapist, or as an immigrant.
CONTROL
Chineseness I was hiding
Opportunity for me to question
Notice my shame and fear to remember
Trauma from displacement
Reopen these feelings and memories
Only way for me to get out
Let my vulnerability run free
Akyil (2011) points out that immigrant therapists have one advantage in working with clients from other cultures in that they have a tendency to be hyperalert to how clients might perceive things, because of these immigrant therapists’ experiences of having to deal with differences (p.168). My poetic exploration encourages me to understand the self as an immigrant arts therapist by embracing my traumatic experiences and my vulnerability, and I can then find the power to deal with uncomfortable feelings from being a minority in my professional work (Kissil et al., 2013a; Canvin et al., 2022). By expressing the fear of losing ‘control’ in my poetic exploration, I see my strength to face my vulnerability in the therapeutic relationship between myself as an immigrant therapist and my clients from my adopted culture. Drawing on this strength, I opened up about my memories of being pressured to adopt an English name for job-seeking when I had just graduated from my Master of Design degree. I shared the meaning of my Chinese name, and its significant link to my ancestor and the culture of my homeland. I expressed my desire to be known by my Chinese name in my clinical practice.
After my second attempt at introducing myself through my story about my name/s, my Māori client began to share her stories about her Māori name. Through her sharing, I learnt the history of Māori people being forced to give up their language. I felt her pain of being addressed with the Europeanised pronunciation of her Māori name at school by her teachers. I heard her anger over having to correct people again and again about the pronunciation of her children’s Māori names because of others’ laziness and ignorance. Then I invited the client to teach me to pronounce her Māori name correctly. When this client and I finally mastered saying each other’s name correctly, we laughed together. By sharing my Chinese name and showing my vulnerability associated with it, I gained the opportunity to start understanding and recognising my client’s mātauranga Māori in order to provide more effective services to her (National Centre of Mental Health Research, 2010, p.13). Rogers-Sirin et al. (2015) suggest empathic connection is an essential part of positive therapy, therefore displaying empathy is an important part of cultural competence for therapists. This name-exchange experience showed me that the empathic connection between me as an immigrant arts therapist and my Māori client was not in a single direction from the therapist, but it was a two-way interaction between the therapist and the client. Through being able to embrace my vulnerability in being an immigrant therapist, and being able to display my vulnerability through the story of my name, my Māori client opened up about her vulnerability from her Indigenous social and historical traumas. I realised that being an immigrant therapist from a cultural minority creates an advantage for building rapport with Māori clients, who are also from a social minority.
Cultures in us
One day, when I was doing arts therapy intervention with one of my Māori clients through symbols and metaphors, I was asked by this client about the symbols and metaphors for happiness in my Chinese culture. I picked up a piece of paper and cut out a ‘double happiness’ symbol. I explained that this is a traditional Chinese ornament design, and normally used as a lucky symbol at weddings. The client was fascinated by my quick paper-cutting skill, so I showed her again slowly. She tried to follow my steps, and to learn how to make this symbol herself. When she finally managed to cut her ‘double happiness’, she was so happy and asked where I had learnt this paper-cutting. I explained that it was from my grandmother. Then I shared a Chinese fable about happiness and luck. This story was about an old man’s bad luck in having lost his horse, but his misfortune turned to good luck when it saved the old man’s son’s life by helping him avoid going to war. I explained that this old Chinese fable, The Old Frontier Man Loses His Horse, teaches people to understand that misfortunes may reveal themselves to actually be blessings. From this story, our conversation expanded to how past traumas and misfortune in life can turn out to be blessings. At the end of the session, the client asked to take her ‘double happiness’ symbol home. After the client left the session room, I looked at my ‘double happiness’ on the desk (Figure 2). I realised that by sharing my culture in this therapeutic space, I doubled the happiness of connecting to my own culture.
Figure 2. Ying (Ingrid) Wang, Double happiness, 2021, cut paper, 120 x 120mm.
As an immigrant therapist who was educated in a Western education system, I feel my own culture was not highlighted and emphasised enough in my learning journey. Kissil et al. (2013b) use the term “cultural meta-perspective” to describe the immigrant therapist’s privileged position of being able to look outside of the “culture box” because of their two cultures (p.139). I also see my position as an immigrant therapist as being outside the “culture box” and being able to offer clients from other cultures an alternative and flexible viewpoint from my Chinese root culture (Cheng & Lo, 1991). When I was doing my PhD study, I reconnected to Chinese ancestral knowledge and wisdom for my arts-based research (Wang, 2021). Through this experience, I was encouraged by my discoveries and learnt how to connect more with my own culture for my clinical practice as well. I introduce crafts from my culture to my clients; I use music from my culture for movement interventions in my sessions; I apply symbols and metaphors from my culture in shared arts-making interventions with my clients; and I teach my clients Chinese writing and reflect on the meaning in these characters as part of therapeutic goals for their recovery journeys.
When I was discussing recovery progress for a report with one of my Māori clients, I asked what elements in our sessions had helped him in this therapeutic journey. He told me that it was my Chineseness. He said that my willingness to connect to my own root culture encouraged him to think of his own connections to his Māori culture. He also appreciated the fresh perspectives which my use of Chinese wisdom brought into his awareness. Using culture in an appropriate way is one of the categories of cultural competence (Rogers-Sirin et al., 2015; Lee et al., 2020; Huet & Kapitan, 2021). As an immigrant arts therapist, I not only need to use my clients’ cultures in an appropriate way, but also use my own culture appropriately and creatively.
I also learn about and apply my Māori clients’ culture in my therapeutic space. When one of my Māori clients was close to her due date for her new baby, her anxiety about giving birth during the Covid-19 pandemic became increasingly unbearable. In one session, a few days before her due date, I shared a Māori song I had just heard on YouTube. This song was called ‘Te Rina’ (Taurima, 1999; Chung & Chung, 2018). I especially love the line “Taku hei tiki e, taku nei ra ura” (You wear a tiki around your neck, here before the glowing sun), because it reminds me of the first time I held my baby girl in my arms, and seeing a ray of warm sunlight on her peaceful face (Wang, 2020, p.207). The version of the song that I shared with this Māori client was sung by a Korean immigrant couple in the Māori language. During a period of Covid-19 lockdown, in the virtual arts therapy room, we listened to the song together. My client smiled as she heard the faintly Korean-accented Māori singing. The following week, she attended her online session at our agreed time. When I asked how everything was going for her, she turned her camera to the side. To my surprise, on my screen I saw a beautiful sleeping baby’s peaceful face. I felt speechless, my heart full of joy. Then my client told me her new baby had arrived when she was playing the song ‘Te Rina’, which I had shared with her. She said, in that moment, she felt I was with her spiritually. When she said that, I could not hold back my tears. With tearful eyes, I looked into the screen with pride, with hope, with the sense of belonging to this land, and warmed by aroha. I realised that by sharing my openness to my client’s culture and worldview, I had created the connection to my client, but also to this adopted land (Figure 3).
Figure 3. Ying (Ingrid) Wang, Seed of growth, 2017, watercolour on paper, 420 x 297mm.
A little seed
Using all its strength
Spreading in all directions
Growing into
This strange soil
Up and down
Inside and outside
Infusing with hope
For connecting
For belonging
For walking through
This shared journey
Discussion
This paper provides my authentic insights from working with my Māori clients through arts-based inquiry and critical autoethnographic narratives. Through my stories, I emphasise the important elements of cultural competence from my experiences as an immigrant therapist. Openness to my own fear and anxiety about lacking knowledge of other cultures helps me as an immigrant therapist not to avoid dealing with clients from other cultures. Willingness and desire to care for clients from other cultures enables me as an immigrant therapist to find my compassion for them. Developing a two-way interaction of empathy enhances the healthy rapport between me and my client. Embracing my own vulnerability arising from being a minority enables me as an immigrant therapist to provide a comfortable therapeutic space for my clients from other cultures to open up about their own vulnerability. Using my own culture in a therapeutic space provides fresh viewpoints for my clients from other cultures. Using my clients’ cultures in an appropriate way creates more therapeutic connections between me and my clients, both culturally and spiritually.
As an immigrant arts therapist, I argue that an attitude of openness toward being more culturally competent is more important than cultural knowledge itself in working with clients from other cultures. It is understandable that an immigrant therapist cannot be knowledgeable about all other cultures, especially as assuming adequate cultural knowledge can be damaging of therapeutic relationships (Rogers-Sirin et al., 2015; Lee et al., 2020; Huet & Kapitan, 2021). An immigrant therapist’s awareness of their own culture can potentially enhance their therapy practice through use of their own culture creatively and appropriately. Therefore, for the immigrant therapist, improving their cultural competence includes connecting or reconnecting with their own culture, and being proud of their own cultural practice, including culturally-appreciative arts-making methods. Through openness, willingness, compassion, empathy, connecting with one’s own culture and learning about other cultures, as an immigrant therapist, I create a bridge across the cultural gaps between myself and my clients from other cultures.
Glossary
aroha love
karakia Māori incantations and prayers
Māori Indigenous Polynesian people of New Zealand
Matariki Māori name for the cluster of stars also known as the Pleiades; for many Māori, it heralds the start of a new year
mātauranga values, knowledge, culture and world view
pepeha introduction of yourself in Māori
tā moko tattoo art in Māori culture
tangata whenua people of the land
whānau family group
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