The Leading Edge in Emotionally Focused Therapy

Episode 15: Working Cross Culturally
Release Date: January 28, 2021
Hosts: Dr. James Hawkins and Dr. Ryan Rayner

Episode Overview

This episode centers on the challenges and growth opportunities therapists face when working cross-culturally, particularly through the lens of Emotionally Focused Therapy (EFT). Dr. Hawkins and Dr. Rayner discuss how therapists can deepen their fluency in addressing the complexities of identity, marginalization, and cultural difference in the therapy room. A strong emphasis is placed on humility, ongoing self-awareness, and intentional alliance-building for effective cross-cultural therapeutic practice.

Key Discussion Points and Insights

1. The Challenge and Privilege of Cross-Cultural Work

• Opening Question: How do therapists effectively join with clients from backgrounds very different from their own? (00:00)
• Motivation: There's widespread desire among therapists of all backgrounds to improve cross-cultural practice.
  • “To change a system, we have to work together. There has to be multiple people moving and seeing problems and doing this together.” – Dr. Rayner (01:08)

2. The Importance of Self-Awareness

• Village Mentality: Dr. Hawkins emphasizes the value of learning from a broad, diverse ‘village’ of therapists and mentors (02:22).
• Self as Instrument:
  • Therapists must assess what they are bringing into the room—including their identity, history, and biases.
  • Dr. Hawkins shares mentors’ advice on understanding presence:
    • “I want to be aware of what I bring to the room...how I see the world and how it impacts how I view other people...so it’s not leaking out onto my client in ways that...can become blocks in therapy.” (03:11)

3. Cultural Identity and Emotional Experience

• Analogy of Accents:

  • “It seems like other people are the ones that have an accent...The fact is, all of us have an accent. So I think recognizing your accent, recognizing where you’re coming from, is absolutely essential to being fluent.” – Dr. Rayner (05:51)

• Case Example:

  • When a client brought up racial trauma, her therapist’s inability to engage with this part led the client to stop sharing, showing the negative impact of therapist unawareness (06:11–07:51).
  • “We’re not really winning in therapy when our clients have to begin to make those choices.” – Dr. Hawkins (07:32)

4. Marginalization, Therapy, and Attachment

• Not Just Content: Marginalization and cultural identity are not just “content” or “blocks”—they are central to attachment and emotional strategies (08:20)
  • “This is not content. This is attachment. Important material.” – Dr. Rayner (08:51)

5. The Role of Training and Resources

• Historical Gaps:
  • Training often overlooks these cross-cultural dynamics, but current and upcoming resources (e.g., Paul Guillory's book) are addressing this gap (09:03).
• Personal Reflection:
  • Dr. Hawkins: “How has your ethnic identity impacted your experience and your expression of your own emotion?” (09:18)
• Discussion at Home:
  • Dr. Hawkins describes asking his wife about emotional norms in her Caribbean culture to highlight that, while cultural differences exist, some emotional rules are universal. (10:06)

6. White Therapists and Identity Privilege

• Frequency of Racial Self-Reflection:
  • “How often do you think about your own race? ... My answer is, I never think about it. ... The problem with that is just because it doesn’t register with me, doesn’t mean that it doesn’t register with others.” – Dr. Rayner (11:21)

7. Initiating Cross-Cultural Dialogue in Therapy

• Bringing It Up:
  • Therapists, especially from majority groups, should proactively raise cultural topics in assessment and throughout therapy, rather than waiting for clients to do so. (12:16–13:22)
  • “It’s important that we take the risk to initiate conversations and open up that space, suggesting that we’re comfortable with it. We want to know.” – Dr. Rayner (13:13)

8. Alliance, Pacing, and Earning Trust

• From Lisa Palmer Olson:
  • Start with general cultural assessment but focus on building trust before addressing deeper issues of cultural trauma (13:27–14:51).
  • “Letting my humanity connect with their humanity, proving to them that I’m worthy of their trust.... sometimes I need to earn a little bit more trust before I go for those deeper level questions.” – paraphrased from Lisa via Dr. Hawkins (13:39)

9. The Extra Labor of Marginalized Clients

• Measuring and Adapting:
  • Dr. Hawkins shares the ongoing effort he and others from marginalized backgrounds expend to measure how much of their identity they can safely show in different contexts (15:00–17:21).
  • “That takes a whole lot of energy to do that day in and day out... That’s extra energy that I don’t have to put out as a white male.” – Dr. Rayner acknowledging privilege (16:37)

10. Integrating, Not Isolating, Cultural Attunement

• Throughout the EFT Process:

  • Attunement to cultural identity is not a one-time assessment but a continuous process (18:08).
  • “Attunement and alliance are things that you...always check...with your clients.” – Dr. Rayner (18:36)

• Points for Inquiry:

  • In assessment
  • When emotional cycles take hold
  • During deep therapeutic work and repair (19:00–20:19)

11. Clinical Illustration: Validation vs. Coaching

• Validation:
  • Validating a client’s learned self-protective strategies (even if costly) is crucial, especially when these are rooted in cultural pain (20:19–23:10).
• Restoring Fluency:
  • “We don’t develop fluency until we’re responded to. So if life has taught me...that part of me is unacceptable...that part of me never gets responded to...now we’ve divided self again. What an opportunity we have to be with people in a way that helps them bring all of themselves back together.” – Dr. Rayner (23:10)

12. The Therapist's Responsibility: Intentional Curiosity and Alliance

• Active Exploration:
  • Therapists must be intentionally curious and willing to risk discomfort to create corrective emotional experiences for clients. (25:54–26:53)
  • Notable Story:
    • "There is no way in the world I thought you as a white therapist would get that. But it's good to hear that you do." – Client to George Fowler, as shared by Dr. Hawkins (26:30)

13. Integration without Stereotyping

• Attunement, Not Overcorrection:

  • Over-focusing or essentializing cultural identity is as problematic as ignoring it. Every client’s cultural experience is unique (28:47–29:52).

• Cultural Assessment Question:

  • "I'm just wondering how has your ethnic identity impacted your experience of your emotions and of the world? And how is that impacting the current relationship that we're coming in with today?" – Question developed with Dr. Kathryn Rehm (30:13)

14. Applicability to Other Marginalized Identities

• Beyond Race:
  • These principles apply to therapy with clients marginalized due to sexual orientation, gender identity, etc. (31:31)
  • “It’s heartbreaking...that someone’s experience of life is that some part of me is so awful, I can’t even have it in the room with you.” – Dr. Rayner (31:31)

Notable Quotes & Memorable Moments

• Dr. Ryan Rayner (02:58): "You can’t change a system linearly. To change a system, we have to work together."
• Dr. James Hawkins (06:55): "We’re not really winning in therapy when our clients have to begin to make those choices [about what parts of self are safe to bring]."
• Dr. Ryan Rayner (08:51): "This is not content. This is attachment. Important material."
• Dr. James Hawkins (13:21): "As therapists, we set the tone of creating safety and for vulnerability to happen in the session."
• Dr. James Hawkins (16:20): "I measure my surroundings all the time...are they threatened by my body presence? ... That takes a whole lot of energy."
• Dr. Ryan Rayner (17:21): "It is a privilege of mine and people like me. ... I don’t ever have to factor my race in."
• Dr. James Hawkins (23:10): "Sometimes these are cultural adaptations that people make as a protection because they’re just not quite sure if I can let these parts of me be seen."
• Dr. Ryan Rayner (26:30): "[Client says:] 'There is no way in the world I thought you as a white therapist would get that. But it's good to hear that you do.'"
• Dr. James Hawkins (32:23): "No client has to take a part of themselves and put it into the closet...we want to invite their full humanity to be involved in the experience, because for EFT, it is an experiential change model."
• Dr. Ryan Rayner (32:59): "We go into the closet with them...so we change the room. No, it doesn’t have to be a closet anymore."

Practical Application & Takeaways

• Regularly reflect: Examine how your own cultural background and identity affect your work.
• Proactively ask: Don’t wait for clients to raise issues of identity—invite discussion early and repeatedly, but pace based on trust-building.
• Validate and honor: Recognize culturally-learned strategies as adaptive and protectively motivated.
• Avoid assumptions: Don’t stereotype; let clients tell you what is salient for them.
• Integrate curiosity: Make cultural attunement a seamless, ongoing part of therapeutic work, not a special topic.

Resources & Recommended Colleagues

• Dr. Paul Guillory: “Emotionally Focused Therapy with African American Couples” (Book, 2021, Routledge)
• Dr. Catherine McKay, Dr. Kathryn Rehm, Alana Katz, Lisa Palmer Olson, George Fowler, Joy & Dustin McGowan, Zamed Berhe, Fayon Villa: Mentioned as important voices and resources across diverse backgrounds (02:22, 13:27, 30:13, 33:18)

Key Timestamps

• 00:00: Opening question about joining across cultures
• 03:10: Importance of self-awareness as therapist
• 06:11: Case of cultural trauma missed in therapy
• 08:51: Marginalization as attachment, not "content"
• 13:21: Setting the tone for safety and vulnerability
• 15:00: "Measuring" – being vigilant about identity in the room
• 18:08: Integrating cultural attunement throughout therapy
• 23:10: Clinical examples of cultural adaptation
• 26:30: Impactful story about a client feeling seen by a white therapist
• 30:13: Key assessment question for cultural identity
• 32:23: The therapist's responsibility to invite "full humanity" into therapy

This episode provides a heartfelt, practical, and nuanced discussion of cultural attunement in EFT and psychotherapy broadly, blending vulnerability, professional wisdom, and real-world applicability for listeners aiming to grow on their own leading edge of learning and healing.