Complicated Grief, Attachment, and Art Therapy. Группа авторов

screams that seem to part the roof of the Lord’s house, before she collapses at the feet of the casket stand and is promptly whisked away. The most curious thing about her is that her grief tends to miraculously dissipate and she’s usually spotted later in the “after-tears” tent, gyrating with a Smirnoff in her hand (Ngcobo, 2015).

      Importantly, the tone in which this author examines cultural influences over grieving processes is somewhat sarcastic. This raises the important issue of understanding the group ethos when participating in the rituals of grief, as opposed to one’s personal grieving process; there might be cultural norms for ethnic groups and how they grieve, but each individual will have their own relationship to and opinion of that cultural norm.

      Perhaps it was presumptuous of me to assume the little girl had better reality testing than my student gave her credit for, because one cannot assume all black funerals (let alone this little girl’s father’s funeral) involve displays of emotion that, in comparison to white funerals, appear “outlandish.” Even my choice to use the term “black” as opposed to “African–American” was a conscientious one, because not all black Americans think of themselves as African, and not all Africans are black. On the other hand, to use the term “black” may also be perceived as (once again) stripping a populace of their cultural and ethnic heritage. “Black,” in this context, refers to a specific phenotype, as it is understood in a racist American perspective. But take what we might call a “black American” and place him in certain countries in Africa, and he might be considered “white” because of his American ethnicity.

      National identities can also impact the ways in which we perceive grief and loss. I was walking past various retail shops in New York City, accompanied by a Jewish Israeli friend and veteran. He kept staring at the Memorial Day signage and shaking his head when sales clerks, positioned at the entrances of these shops, would try to hand him a flyer and say, “Happy Memorial Day!”

      “You seem upset,” I prompted.

      “In Israel, Memorial Day is a solemn occasion. A siren goes off and everything just stops. Even the cars in the street. People just get out in the middle of an intersection and share a moment of silence. War isn’t happy. Death isn’t happy. And it’s not an occasion for a 40-percent-off discount.”

      In this section, I have provided examples of how important it is to examine grief in the context of culture, but these are by no means the only comparisons that can be made. An awareness of cultural norms for the rituals of grief is essential to ethical and responsible clinical practice, lest we make erroneous interpretations. This is particularly important for the art therapist and clinician in his or her role as a gatekeeper of services within institutions.

      Culture and attachment

      It’s worthwhile to mention the influence of culture over the socialization methods of parents in dealing with their children, which impacts the way children learn how to attach and grieve. In this context, culture is defined as the intersection of one’s socially assigned gender role, racial and ethnic identity, socioeconomic status, religious beliefs, national identity, and the physical products and observable manifestations of those things. Most of us are socialized to use culture (or certain aspects of it) as a cue for perceptions about temperament, sexuality, intelligence, athletic ability, aesthetic preferences, and so on.

      For example, a white, middle-class, American child may be encouraged to “cry it out” as a way of promoting self-regulation (Erikson, 1980, pp.59–60), and conforming to a democratic culture that “insists on self-made identities” (Erikson, 1980, p.99). Their healthy development therefore depends upon “a certain degree of choice, hope for an individual chance, and a conviction in freedom of self-determination” (Erikson, 1980, p.99). Any loss of identity, however, exposes the individual to childhood conflicts. Erikson points out the neuroses among men and woman during WWII, who could not stand the displacement of their careers and the other special pressures of war, as an example of this (Erikson, 1980).

      Additionally, we must consider the intersections of race, class, and gender in the formation of healthy attachments, and one’s reaction to the inevitable loss of those attachments. Pressure to conform, according to Orbe’s co-cultural theory, encourages minorities to adopt a variety of verbal and nonverbal communication practices, such as “mirroring” dominant appearances and language styles. They may also cognitively rehearse in extensive preparation, prior to interacting with dominant groups, and/or censor themselves. It is as if they have to create not only one, but two (if not more) “false selves” in order navigate everyday life (Allen, 2004).

      Culture impacts relationships in a variety of ways, particularly for minority groups who must contend with the persistent standards of a dominant group. The chapter contributions in Part III of this text are intended to provide an overview of specific populations and their experiences of grief. As a matter of practice, I would encourage the art therapist and practicing clinician to always research the cultural influences of the population he or she works with, including his or her own.

      Paradigms in working with diversity

      Paradigms in working with diversity are ever changing and evolving. The psychologists of the multiculturalism movement wanted to challenge the Euro–American cultural values and norms found in traditional psychotherapy approaches, which rarely addressed issues of power, privilege, and social context. This multicultural approach would give “meaning to minority and majority group identities as rooted in the context of particular social (gendered and racialized) interactions” (Tummala-Narra, 2013). And while it is important to investigate the cultural norms of the population you work with, we must also avoid the notion that once we have learned enough “facts” we are “culturally competent.” To assume so is the equivalent of slapping a label on someone: “I’ve read all there is to know about you and where you come from, so now I can comfortably put you in this box, having fulfilled my ethical duty.”

      This is not to demean researching particular cultures or to dissuade someone from doing their due diligence. Each and every art therapist should be well informed. However, as I mentioned above, there might be cultural norms for ethnic groups and how they grieve, but each individual will have their own relationship to, and opinion of, that cultural norm. Learning all there is to know about every culture on the planet is not only an impossible task, but an unnecessary one. In working with diversity, it is more important to adhere to guiding principles that show us how to access our essential humanness in a sensitive, honest, and respectful way, while being aware of our own cultural influences and contexts.

      Tummala-Narra (2013) offers an approach that builds on existing psychoanalytic contributions, such as self-examination, indigenous narrative, language and affect, social oppression, and cultural identifications. Her approach consists of five elements:

      1.Self-examination. Explore the effects of historical trauma and neglect of sociocultural issues in psychoanalysis on present and future psychoanalytic theory and practice.

      2.Indigenous narrative. Recognize clients’ and therapists’ indigenous cultural narrative, and the conscious and unconscious meanings and motivations accompanying these narratives.

      3.Language and affect. Recognize the role of contest in the use of language and the expression of affect in psychotherapy.

      4.Social oppression. Attend to how the client’s and therapist’s experience of social oppression and stereotypes of the other influence the therapist, the client, and the therapeutic process and outcome.

      5.Cultural identifications. Recognize that culture itself is dynamic, and that individuals negotiate complex, intersecting cultural identifications in both creative, adaptive ways, and self-damaging ways, as evidenced in the use of defense.

      To truly be culturally competent, we need to balance an appreciation and validation of the differences among us, with the “common forces of our humanity,” in equal measure. Additionally, in their text, Ethnicity and Family, McGoldrick, Giordano and Pearce (1996, p.7) warn that “It is only when the exclusion of outsiders becomes primary to group identity that one’s group identity reflects something dysfunctional—namely a negative identity: defining oneself as a part of a group that excludes others.”

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