The importance of acknowledging difference in psychoanalytic psychotherapy

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Rachel Abedi is a Child and Adolescent Psychotherapist working at the Tavistock and Portman NHS Foundation Trust and in Tower Hamlets CAMHS. Her doctoral research focus is on how CAMHS clinicians engage with Muslims. She has presented her research at the ACP annual conference (2018), the Muslim Mental Health Conference (2020), the Tavistock (2020) and at various CAMHS clinics. She also has an interest in Islamic Psychology, and is working to improve engagement with Muslim communities in the field of child mental health.

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Single case studies are often used in psychoanalytic psychotherapy research to identify potential mechanisms of change. Sean Junor-Sheppard undertook such a study, which was published in the Journal of Child Psychotherapy in 2019. He explored how the transference relationship in cross-cultural psychotherapy might help adolescents from Black, Asian and minority ethnic (BAME) backgrounds to negotiate their identity.

In this study, Junor-Sheppard, who is from a black Caribbean background, undertook intensive psychotherapy with a Muslim girl of Bangladeshi heritage for three and a half years. He explained the context of the socio-political ‘hostile environment’, exemplified by the UK Home Office’s ‘hostile environment policy’, which aimed to deter illegal immigration, but also affected immigrants with a right to live in the UK. For example, there have been reports of Commonwealth migrants being wrongfully denied access to services and in some cases deported, termed the ‘Windrush Scandal’.1 Consequently, migrants have described feeling ‘othered’.2 The author noted that this ‘hostile environment’ was infused with post-colonial ideas and beliefs, and included an element of Islamophobia, which he felt was particularly prevalent at the time.

Junor-Sheppard proposed that these racialised ideas might have been internalised by the patient, resulting in her denigration of her Muslim, Bangladeshi self. He considered the patient’s experience of him in the transference was to see him as ‘other’, because of their perceived differences, and therefore incapable of understanding her. In the countertransference he was initially angry and dismissive of her religiously informed experiences. He later reflected that her resistance may have been shaped by a fear that CAMHS would replicate the prejudice experienced in wider society, and by a sense of being pushed to betray her mother.

Junor-Sheppard described that he therefore thought it is important to acknowledge and hold these wider political and cultural realities in mind when working with BAME adolescents, in order to create a safe space in which their impact can be explored. If the dynamics of difference are denied, he felt the therapist could unconsciously attempt to ‘colonise’ the patient’s mind by imposing ‘western’ psychoanalytic ideas. The clinician might therefore become drawn into an enactment of the patient’s defensive positions, so confirming them. He argued that this might only be avoided when the therapist understands the colonising process from their own perspective, via the countertransference.

Junor-Sheppard acknowledged that we are all influenced by internalisations of societal ideas of self and other, regardless of the background we belong to. As a white Muslim, I am curious about his response to the patient’s faith identity, and whether or not it was different to his own. I felt that this study resonated with my own experience of working with children, young people and families in CAMHS, and may help other clinicians think about the complexities of working with families who are of a different religion or race to their own.

Referring to

Junor-Sheppard, S. (2019) The ‘hostile environment’ and the therapeutic journey of an adolescent girl, Journal of Child Psychotherapy, 45(3), 274-290. doi: 10.1080/0075417X.2019.1702077.


1 Taylor, R. (2018) Impact of ‘hostile environment’ policy. House of Lords Library Briefing:

 2 Hill, A. (2017) ‘Hostile environment’: The hardline home office policy tearing families apart. The Guardian:


Defence mechanisms: in psychoanalytical theory, defence mechanisms are thought to prevent conflict between the conscious mind and unconscious desires. For example, Freud proposed that the defence mechanism ‘repression’ involves preventing unacceptable thoughts from reaching conscious awareness. If defence mechanisms do not mature they may become unhelpful.

Countertransference: the feelings stirred up in the therapist arising out of the therapeutic relationship, which may be a response to transference.

Resistance: reluctance to engage in an aspect of therapy.

Transference: the feelings stirred up in the patient arising out of the therapeutic relationship, which are thought to unconsciously echo feelings experienced in an earlier relationship.


A timely commentary and a prompt to clinicians to think about oneself and ones relationship with our pts in respect of culture, ethnicity, and religion. Thank you

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