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Cultural Dıfferences And Mısunderstandıngs In Theraphy/Counsellıng Of Mıgrants Wıth Turkısh Background
MAKALE #8468 © Yazan Psk.Bade VARDARLI | Yayın Şubat 2012 | 2,379 Okuyucu
According to the announcement of the newspaper Welt (2010), almost %20 of the population has migration background. Turkey constitutes the biggest migrant population with the number of 2,9 million migrants with Turkish background, in Germany. (see Weltonline 2010) This diversity creates major difficulties and the growing need of multicultural counselling. This counselling process is affected by the counsellor’s own culture, attitude,
theoretical perspective and also by the client’s culture, values and it creates a multiplicity of variables. Therefore cultural and lingual communication difficulties between counsellors, therapists and clients from different cultural backgrounds often exist. Misunderstandings, uncertain diagnostics, misinterpretations of values, rules or attitudes can be the result of
miscommunications. The problems owing to working people with migration background, may affect negatively the functionality of working with them. (see Uçar 2005:3)
For that reason making provision against such problems is necessary.
Ibrahim (1985) indicated that a major assumption for culturally effective counselling and therapy is that we can acknowledge our own basic tendencies, cultures and the limits of our cultural perceptions. It is essential to understand our own cultural heritage and world view before starting to set about understanding and assisting other people. (see Ibrahim 1985:627) This understanding emphasizes the awareness of one’s own life style and capabilities and the recognition of several structures, world views and developing an understanding for several cultures. To counter cultural differences counsellors should investigate their cultural background and be open to flexible definitions of “appropriate” or “correct” behaviour (see
Bolton 1987:1) By the affect of increasing need for multicultural counselling and therapy several corporations, institutes have been founded in Germany with the aim for developing multicultural counselling and therapy. DTGPP (Die Deutsch-Türkishe Gesellschaft für Psychiatrie, Psychotherapie und psychosıziale Gesundheit) is one of them which was helpful to me while writing this essay.
Although the variety of culture is vast, I will try to explain some important components of Turkish culture. The examples in this essay will include the types of cultural issues and their effects on the counselling situation. While universal categories are necessary to understand various cultures and human experiences, losing sight of specific individual factors would lead to ethical issues (see Ibrahim 1985:629). The danger of stereotyping clients and other influences such as provenance or socioeconomic status may affect counsellors.
Bolton (1987) indicated that the most common danger in counselling is to oversimplify the client’s social system by emphasizing the most obvious aspects of their background. Individual clients are influenced by several factors, such as ethnicity, national origin, life stage, educational level, social class and sex roles. Counsellors should consider all factors of the client’s personal history, family history, social and cultural orientation. (see Bolton
With the help of examples I will examine the influence of culture-specific factors on the counselling of migrants with Turkish background. First, I will define and explain the cultural differences and misunderstandings. After that, I will take a closer look at different approaches to psychological illnesses and cultural values such as several family structures and nation of honour. Affects of Islam and the language problem of migrants are also the issues
that I will explain. At the conclusion, I will finish my essay by discussing the issues that arise from cultural differences and possible resolution advisories.
Cultural Differences and Misunderstandings
Culture is a term that has different meanings. According to Harris “A culture is the total socially acquired life-way or life-style of a group of people. It consists of the patterned, repetitive ways of thinking, feeling, and acting that are characteristics of the members of a particular society or segment of a society” (see Harris 1975 cited from Birukou et al. 2009:3).
Commonly culture is attributed to the senses such as, shared attitudes, values, goals, beliefs, life styles, behaviours that are learned. Cultures have their own rules, norms, values, myths, traditions, rituals, identities etc. We are affected by culture as members of them and culture shapes our behaviours, beliefs and world view. (see Birukou et al. 2009:4-8) It is clear that people who do not share a common background, behave differently.
Cultural factors play an important role in the counselling of individuals. It is important to consider cultural differences and various cultural concepts in counselling. Individualismcollectivism is a basic dimension of cultural variability in cross cultural research. Several studies have suggested that individualism-collectivism are contrasting cultural syndromes and they are linked with differences in people’s social perceptions and social behaviour and in the
style of social interactions (see Han, Shavit 1994:327). In individualistic cultures people are tend to prefer independent relationships to others and they have less in-group goals and more personal goals. In collectivist cultures people are more likely to have interdependent relationships to others and in-group goals are more important than personal goals. Collectivist cultures are associated with interdependence, harmony, family security, social hierarchies, and cooperation (see Han, Shavit 1994:328-329). According to the individualism-collectivism approach, it is possible to say that Turkish culture is more collectivist and German culture is more individualistic. In reality, these terms cannot be acceptable for all German people and
for all Turkish people but they are helpful to understand and generalize some cultural differences. For example there are some cultural differences in the relation with time. Especially in western cultures timing, punctuality and temporal liabilities are very important. In many eastern cultures, punctuality and being late is not an important issue. When a Turkish client comes late to her/his appointment, it does not always mean that the client does not care
about her/his appointment, it is because of the different understandings of punctuality. (see Wogau 2004:131)
A German psychologist, Kielhorn, who worked 12 years in Kreuzberg with
migrants, describes Turkish clients as follows:

“Türkische Patienten kamen nie allein, sie kamen in Scharen, in Begleitung ihrer Angehörigen und Freunde. Sie umlagerten die Anmeldung, standen in Trauben im Flur oder hockten sich auf den Fußboden. Fremdartig war ihr äußeres Erscheinungsbild. Den Schlafanzug trugen sie unter ihrer Tageskleidung. Frauen waren halbverschleiert. Haare und Hände mit Henna gefärbt, sie hatten mehrere Pluderhosen und Röcke an. Sie wollten sich zunächst gar nicht untersuchen lassen. Vom Arzt erwateten sie fast magische Fähigkeiten. Sie antworteten z.B. auf die Frage nach den Beschwerden: ‚Doktor Du musst wissen!’ oder ‚Doktor du mich verstehen’
auch wenn sie das erste Mal in der Sprechstunde waren.“
(Kielhorn 1984, cited from Kentenich et al. 1984:15)

This description of Kielhorn shows us how strongly cultural differences are linked with the perception of others. It also serves an example of miscommunications and misunderstandings due to culture. It is clear that language incompetence is an important reason of cultural miscommunication. Many migrants are not able to speak and understand German sufficiently or they prefer to speak in their mother tongue while counselling because
they believe that they can express themselves better in their mother tongue. But language incompetence is not the single reason of communication problems. Various understandings of illnesses (especially the psychological ones) also affect individual’s behaviour through counselling or therapy.
Different Cultural Approaches to Psychological illnesses
In some Mediterranean countries, illness is frequently regarded as something that comes from outside, invades the body and takes control if it. Sometimes clients do not know what the problem is and they can not differentiate physical and psychological illnesses. They feel themselves overall sick and they feel anxious because of their psychological problems but
they do not know the relation between their physical health and their psychological health.
Especially Turkish client’s approach towards psychological symptoms is interesting. For example women with Turkish migration background tend to describe their illnesses by explaining pain in their bodies. A German woman could say that she has depression, but in such situations Turkish women say that they feel pain. (see Ucar 2005:11-12) They focus on body pains in psychological illnesses more than feelings. Ucar gives an example for this
“Im Falle von Yasemin, 9 Jahre alt, Schülerin der 3. Klasse wurde vom
Schulpsychologischen Dienst eine Entwicklungsverzögerung diagnostiziert und
deshalb eine psycho-motorische Therapie empfohlen. In Absprache mit den Eltern begann ein Deutsche Therapeut mit der Behandlung. Nach 3 Sitzungen haben die Eltern die Behandlung abgesprochen. Als ich nachgefragt habe, warum die Behandlung nicht fortgeführt wurde, antwortete Mutter ‚Eine solsche Behandlung bringt für meine Tochter nichts. Der Psychologe spielt nur mit meinem Kind oder macht einige Bewegungen mit ihr. Aber mein Kind hat Bauchschmerzen, auch öfter Kopfschmerzen und kann nicht schreiben und lesen. Der psychologe gibt ihr kein Medikament gegen Schmerzen. Das Kind muss für die Schule lesen lernen, nicht spielen, das bringt nichts.’.“
Ucar 2005:7
This example shows us, some parents with migration background do not know child therapy and they are not able to differentiate psyche and body. Therefore they prefer using medicines in psychological disorders. Believing that psychologists are the doctors of batty people (deli doktoru) is also common in Turkish culture. People who get psychological support are
accepted as abnormal and unreliable in Turkish society. Therefore counselling or therapy is the final solution for them. Sometimes they tend to hide that they get psychological support because of the concern that they would be perceived and judged as batty and unreliable. This pressure is strong. Indeed patients with somatic symptoms tend to be shown more tolerance and understanding by the community than those with psychological symptoms which is regarded as personal failure (see Schouler 2008:653).
The official teachings of Islam prohibit the belief in supernatural powers. God’s will is the explanation of disease and God’s will, should be accepted. Notwithstanding, believing in magic is common in Turkish culture. The influence of traditional healing methods, such as the Muslim hoca (Muslim teacher or healer) should not be minimized. It could be also possible that such healers represent a link to their culture of origin for immigrants. In this
meaning, it plays an emotional role in the context of illness. (see Schouler 2008:655) It is common to perceive disasters as something magical which comes from outside and cover the body (see Ucar 2005:9). Especially when they can not heal with therapy or counselling, they tend to head towards superstitious beliefs back. Ucar gives an example for an extreme situation of looking for help from hoca. A Turkish worker had not has the opportunity for
going to hoca. Therefore he sent his worn clothes via post therewith the smell of his illness can be used as a healing method by hoca. (see Ucar 1982:5-6)
Another common belief is the evil eye (nazar) which is often associated with feelings of anxiety. The evil eye of an envious person can bring bad luck. In this meaning evil eye is also regarded to broken interpersonal relationships. For prohibiting bad luck a blue bead (nazar boncugu) is attached on clothes. If anyone becomes ill, it is common to believe that the illness exists because of evil eye. For example it is common to advice a person who has actually depression, to cast lead (kursun dökmek) in order to break the negative affect of evil eye. (see Schouler 2008:656) Such cultural interpretations of health and illness may have a particular psychological function, making it easier for people to deal with illnesses. On the other hand they delay getting psychological support.
Effects of Different Cultural Values
Groups, societies, or cultures have values that are largely shared by their members. These values are considered as important and valuable by the members of society. The values of a society can often be identified by noting which people receive honour or respect. Values identify what should be judged as positive or negative. Different cultures reflect different values. These values reflect the goals, morals, and wishes of a group, such as the way of living, important priorities one should have. Cultural values can be influenced by various features of the environment and history, including socioeconomic status, gender, race/ethnicity, geographic location, acculturation level, and religion. Members of cultural groups often share common values, attitudes, and behaviours. However, within any group there are differences in the amount to which an individual adheres or espouses a particular value. (see Ibrahim 1985:631-634)
In this chapter I want to mention about some common values in Turkish culture, which I find helpful to understand clients with Turkish background, such as family structure, notion of honour. Before discussing them, I think it is important to indicate that these explanations can not include all Turkish families, such cultural definitions are changeable due to region. These generalizations may be more common in families from Turkish villages, which
constitute the major Turkish community in Germany. This does not mean that the families which live in cities do not have such values but there may be differences in the strength of cultural values.
The Notion of Honour
The notion of honour plays a special role in Turkish culture and it is strongly related with family life. It is more closely associated with family and social life, for example a wrong behaviour of a family member may cause loss of family’s honour. A Turkish proverb tells us that “it is better to lose your life than your honour”. The notion of honour can be divided into three main categories: namus, seref and onur. In English all three terms are translated as honour. (see Schouler 2008:655)
Namus describes a person’s feelings towards moral rules. Namus is the honourable behaviour, and namusssuz refer to dishonourable behaviour of a person who disregards and violates the moral rules. The term namus is differentiate due to gender. The namus of woman is related with sexuality, chastity and modesty. The namus of unmarried girls is evaluated with virginity and their chaste behaviours. But remain virgin until marriage is not expected from men. If the unmarried girl is not virgin, it damages the honour of men in her family. Men are responsible from the namus of their female family members and their relatives. For married women there are also some restrictions. It is expected from women to be shy and silent at the presence of men. They should also take care of their behaviour and dressing. Sometimes it is not allowed to shake other men’s hand for women but men are allowed to shake women’s hand. Girls learn to take care of their clothes, since childhood. After puberty they start to wear head scarf. Clothes should cover all body parts except hands and face.
Dressing is different due to region, for example in cities mostly, girls do not get dressed like this and they do not wear head scarf. According to the term namus, women should stay at home, they should not beautify, they should do their sacred duties and household duties, they should respect to men. It is expected to be powerful, strong and courageous from men, while
it is expected to be shy and passive from women. According to Islam male children should be circumcised. Circumcision means to be belong to male community and becoming a man. After circumcision the child should not cry and he should not show weakness. A Turkish proverb tells us that “Men do not cry.” Being sensitive, fragile and showing emotions are not encouraged for men. Behaviours such as crying, being weak are attributed to women. (see Ucar 1999:4-9) Briefly, namus refers to gender specific roles, it is not winnable but it can be lose. Men are responsible the namus of the women in their family, therefore they are tend to restrict women’s activities.
Namus is a virtue ascribed to women. In contrast, seref (Ansehen) is a male ascription which means being respected by others. Seref plays an important role in society, but it does not play a big role in family. It is related to men’s prestige in society and associated with masculinity, strength, education, religiousness, hospitality, economical power. (see Schouler 2008:656) Ucar gives some examples, how migrants with Turkish background describe seref:
„Gut arbeiten, gut verdienen.“
„Mit guter Ausbildung gewinnt man Ansehen“
„Kluge Leute haben immer Ansehen.“
„Erführung der religiösen Pflichten.“
„Eine Hochzeitsfeier von 3 Tagen und 3 Nächten.“
„Einen Wolf zu jagen.“
Ucar 1999:10
Finally the term onur describes the sense of being proud of something and feeling honoured and respected. For example the parents can feel honourable because of their child’s success. In traditional rural Turkish families concepts such as onur, seref, namus play an important role. Family’s honour is upheld by the chastity and modesty of its female members which causes seeing women in family as subject to especial scrutiny and control. All members of family are obliged to bear themselves with dignity and avoid compromising their family’s reputation.
Affects of Islam
Muslims constitute the largest religious group in Turkey. Therefore Turkish culture has been heavily influenced by Islam. Especially in rural areas religiousness is an important fact. Allah is the God, the creator of the World, he effectuate life and death, health and illness, he directs the past and the future. The Islam is not a “monolithic block”, it exists from several types such as Sunnite, Shiah (see Ilkiliç 1998:63). In Turkey the major population is Sunnite.
Each Muslim has five duties that he should fulfil during his lifetime: the profession of faith, ritual prayer, alms tax, fasting during Ramadan, and the pilgrimage to Mecca and Medina. Observing these duties lead to social esteem, respect and acceptance within the community (see Schouler 2008:655).
Religious wedding (imam nikahi) is an important traditional ceremony towards Muslims. It means a special wedding which is blessed by God. (see Sharifova 2006:310) In Turkish culture it is common to do both civil marriage and religious marriage. Sometimes, especially in rural areas couples do only religious marriage. This type of marriage is not recognized by law, it is a traditional necessity. It may also causes having more than one wife with religious marriage. Some Muslims believe that Islam allowed man to have more than one wife, but it is a controversial issue. Most of Muslims do not accept it.
According to Islam women should use head scarf to hide their hair. Some Turkish women cover their hair with head scarf relaxedly, more religious ones use it to hide all of their hair. In Islam women are seen as dangerous, they have the capacity to tempt men because of their sexual attraction. Therefore they should hide their sexual attraction with their mode of dressing and behaviour. Another aim of covering body is protection from the glance
of others. To this it is written in Koran:
„Sag den gläubigen Männern, sie sollen ihre Augen niederschlagen, und sie sollen darauf achten, dass ihre Scham bedeckt ist (wörtlich sie sollen ihre Scham bewahren). So halten sie sich am ehesten sittlich (und rein). Gott ist wohl darüber unterrichtet, was sie tun. Und sag den gläubigen Frauen, sie sollen ihre Augen niederschlagen, und sie sollen darauf achten, dass ihre Scham bedeckt ist, den Schmuck den sie tragen, nicht offen zeigen, soweit er nicht sichtbar ist, ihren Schal sich über den Schlitz ziehen und den Schmuck, den sie am Körper tragen, nieman offen zeigen, ausser ihrem Mann,
ihrem Vater (...)“
Ilkilic, 1998:65
Talking about sex is not allowed, it is seen as taboo. When Turkish women have sexual problems, they tend not to talk about these problems even if with doctors or counsellors. The word ayip plays an important role on child rearing. Ayip means shameful behaviour. This word is used to emphasize incorrect behaviour. For example it is ayip to explain personal things to foreign people. Especially the non-educated Turks are respectful to educated people such as doctors and teachers. They show their respect by being quiet and shy. This situation may cause communication problems between doctors/counsellors and clients with Turkish background. Explaining their problems to them is also accepted as ayip. They abstain to talk about their problems, especially the sexual ones. (see Ucar 1999: 5-14)
Understanding of illness is also affected by Islamic beliefs. The term illness (marad) has different 24 relevancies in Koran. The first and the most frequent one means hypocrisy, faithlessness, suspicion from the existence of God. The second meaning includes somatic well being and doing the physical religious tasks such as fasting, praying. According to Islam the most important thing is being able to do religious tasks and being prayerful. When impairment of health prevents doing religious tasks, than the person accepted as ill. Ilkiliç gives an example in his article about the understanding of health in Islam:
“Frau Geiger, wissen Sie, was Gesundheit für uns Muslime ist?“
Etwas irritiert antwortete ich: „Nein“
„Ich werde Ihnen sagen, was unsere Gesundheit ausmacht: Zur Gesundheit gehört, dass wir das Gebet –vorschriftmäßig- durchführen, dass wir unsere Familie gut versorgen können, das wir eine Begegnungsmöglichkeit für die Gemeinde haben, und dass wir einen wohnortnahen Platz zum sterben wissen.
Aus einem Gesprach mit Herrn C. im Gesundheitsamt, 1996 cited from Ilkiliç 1998:66
According to Islam, God’s will is the most important factor of illness or health. Biological, chemical or psychological treatment can be helpful, but they can not change God’s will. In Sure (Koran chapter) 26 is named “When I am ill, God will heal me.” Thereby Muslims are obligated to endure and resign illnesses. To be in enjoyment of good health means not to have pain, physical handicap. If a person is able to do religious and social tasks, this person is healthy. The terms destiny and resignation also influence the understanding of illnesses. These terms are important in Islam, according to them patients should consent their illnesses. Therapeutic methods should not contradict with Islam. Muslims often ask the legitimacy /validity of counseling according to Islam. When contradictive situations with Islam exist, they ask for help to Muslim schoolmasters (hodja), if hodja allow to continue counseling, they carry on with counseling. (see Ilkilic 1998: 63-71)
Islam defines illness and getting well in relation with God’s wish. But it is important to consider individual differences and degree of religiousness. Religious influence life view and life style but it is necessary to draw attention to mistake of generalization. We need to keep individual differences in mind when we learn about any group. In each case, including of
Turks/Muslims, we learn about what characterizes the group and what differentiates it from other groups. In addition to these between-group differences, we need to keep seeing the within-group and individual differences, because the religion is often interpreted differently and religiousness of individuals is changeable. (see Dwairy 2004:133) Counsellors should focus on both problem-orientate and client-orientate solutions. It is important to take care of shaping conversation with respect to client’s belief.
Family Structure and Marriage
The family occupies a key position in the Turkish society and culture. In Turkish families the father represents the family to the outside world. The father is the head of the family, and he makes decisions for the family. Older brothers may share this role with the father or take it over if the father dies. The mothers are portrayed as passive housewives who are controlled and oppressed by their husbands. Within the home, mother plays often a
predominant role. Their lack of contact with the outside world causes that they have weak German language skills and little knowledge of German society and culture, which could be seen as the way of ensuring the honour of the family is preserved. (see Schouler 2008:656)
Children are obliged to respect, obey and remain royal to their parents. Unmarried female family members are expected to retain their virginity before marriage. Female family members are responsible to do household duties. In some families female girls are not allowed to go to school. It is believed that they do not need education, they should just be able to do household duties because they will marry and they will supported by their husbands. The girls
are prepared that she will leave her family after marriage and she will start to live with her husband’s family. Showing respect to her husband’s family is another responsibility of women. Several conflicts could occur between daughter in law and the man’s family. When the father of the family goes abroad to earn money, his wife and children stay with his family.
His relatives take care of his wife and his children and protect them, in return for this he sent money to his relatives. In some regions daughter in law is not allowed to read the letters that her husband sent and she can not get the money. She should be respectful and silent, she can not express her feelings and longing. Ucar indicated that a woman, whose husband was
working in Germany, said that:
“Ich habe Angst, obwohl ich weiß, daß mein Mann nicht für immer in Ausland beleibt. Ich wohne hier bei Verwandten. Du kannst als Frau nichts machen, was du willst. Du kannst deine Bedürfnisse und Wünsche nicht äußern.“
Ucar 1986:52
When such conflicts increase, some women prefer to live alone with their children. In such cases the women must undertake both the roles of man and woman. In rural areas of Turkey, it is hard to live alone as a woman because of the strong social control. Sometimes, her husband must come back to Turkey to take care of his family. Such long term separations may
cause psychological illnesses and attempts to suicide. In fact, there is a special name for psychological illnesses of those women in common speech; the migrant’s wife illness (almanci karisi hastaligi). Psychological problems of these women may last after arriving migration country. The conflicts also influence men who live alone in a foreign country. By comparison with men, women are affected more intensively because of their social status. (see
Ucar 1986:49-59)
In rural areas a newly married couple is expected to live with the husband’s family. Since marriage meant the wife’s entrance into her husband’s family, it neither changed the residence of the husband, nor did it have any significance in terms of the transfer of property rights. They could set up an independent household after the husband’s father died. In this
system of residence it was the patriarch’s responsibility to provide a dwelling for the new couple, either under the same roof or in close proximity (see Duben 1985:82).Sometimes families are afraid of that their girl will be bad treated, therefore they seek a husband for their daughter in their neighbourship. Male members will always belong to the family but unmarried female members are often seen as guest members of the family. (see Kronsteiner 2003:298-302)
The consent and permission of the family members for the marriage is also an important issue. Some families allow choosing their husband/wife freely to their children. But forced marriages also occur. Men are freer to choose their wife. In some Turkish villages, the tradition “bride price” (baslik parasi) is still in force. According to this tradition, son in law must pay to girl’s family to be able to marry with her. Some migrant families choose
wife/husband from Turkey for their children. Because they believe people in Turkey are cleaner. They mean being decent and upright for girls. In some regions in Turkey cousin marriage is common. According to Tuncbilek and Ulusoy’s research frequence of cousin marriage was 20,92 % in Turkey, in 1983 (see Tuncbilek, Ulusoy 1983:7-26 cited from Ucar 2006:5) Each year this rate have decreased. Ucar indicated that the inter cousin marriage has
some social and economical reasons. The relatives develop a collective identity with cousin marriage, social control of women could be easier, the bride could be controlled both as cousin and daughter in law. It is also seen as a good way to make getting residence and work permit possible for the relative who lives in Turkey. Cousin marriage causes some health problems. The biggest risk is that the children of such couples have more hereditarily, genetic illnesses. The risk of being handicapped of children is doubled. Therefore it is important to inform people about the risks of cousin marriage. Counsellors who work people with migration background should be aware of the risk and if necessary, they should warn and inform their clients. (see Ucar 2006:3-11)
Language Problem and the Term “Culture Interpreter”
Language differences may be the most important stumbling block to effective multicultural counselling and assessment. Language barriers hinder the counselling process when clients cannot express the complexity of their thoughts and feelings or abstain from discussing affectively charged issues. Counsellors may also become frustrated by their lack of bilingual ability. At the worst, language barriers may lead to misdiagnosis and inappropriate
placement. (see Bolton 1987:1)
Especially the first generation, who was born in Turkey and came to Germany in adulthood, have more incompetence with German language than second, third generation. It is common that their relatives or someone else translate their problems when they have health problems. According to the research of Universitaetsfrauenklinik in Wedding, half of the migrants needed a translator while treatment, between 1993-1995. Mostly their husbands,
relatives or personnel of the clinic translated their complaints. A professional translator was used only %2. Owing to the need of professional translators and multilingual information materials, more personal, whose mother tongue is Turkish, have been taken into service in clinics, hospitals in Germany. The executive director of Ethnomedicine Centrum Hannover, Salman indicated that, “Vorhandene Dolmetscher sind haufig aufgrund fehlender psychologischer, medizinischer und sozialer Kompetenzen kaum in der lage, die Bedarfslücke zu schliessen.” This centrum has synthesized the first medial translation service in 1990. The workgroup “Armut und Gesundheit” has also been dealing with this problem since January 2000. The aim of “Armut und Gesundheit” is encouraging intercultural competence of the medical personnel and increasing the number of foreign doctors, psychotherapists, psychologists and facilitating getting work permit for these personnel. They struggle to generalize multicultural counseling and multilingual information brochures and to found translation centrums like Hannover example. (see Richter 2001:54)
In the counselling and therapy process translation by relatives, friends can not be expected. Individual counsellors can also not be expected to have a command of all languages that are spoken by their clients or counsellors are familiar with all of the culture specific factors. It is important to offer counselling in a migrant client’s native language, few clinics have the personnel resources needed to provide such services or professional translators. (see Schouler 2008:665) J. Bot indicated that there is increasing need for culture sensitive counselling and therapy in Germany. Therefore the question appears: Is therapy with interpreters possible? The cooperators of the clinic, Phoenix, have evaluated the therapy with interpreters. According to this evaluation, the danger, that the interpreter may add his comment by interpreting, is big. Sometimes interpreters translate by sieving and knowing
both languages gives them a superior position. Therefore choosing interpreters and training interpreters has a special meaning. Another danger is that the therapist could loose his leadership roles in therapy at the presence of interpreter. For that reason it is important to define clearly the roles of interpreter and therapist in therapy process. The presence of
interpreter causes a new three-person-situation. (see2001:78) Moreover, talking about personal problems may be more difficult at the presence of third person and the clients may feel themselves under pressure.
Schouler (2008) gives an example which includes many issues that I mentioned in this essay. A female patient who came from an Anatolian village had depression. When she was 12 years old, she was raped by her uncle. She came to Germany when she was 15 years old. Following these traumatic events, she withdrew increasingly into herself. A was taken by her family to see several traditional healer or hodjas. At first it was thought that attractive young patient had been afflicted by the evil eye, than her relatives thought this situation existed due to lack of a husband. But she did not want to marry because of the fear that her relatives would understand she is not virgin. After her several suicide attempts, finally her relatives
decided to bring her psychiatry clinic. During her first sessions, the patient spoke about how happy she was to be able to talking with a woman about her problems without needing her relatives to act as interpreters. Her command of German was poor. She noted that she had been unable to talk freely without her brothers’ translation. (see Schouler 2008:656-658)
Intercultural communication is necessary for the effective care of clients with migration background. Acquisition a general picture of client’s psychological situation requires sufficient knowledge of her or his cultural background, personal biography. Therefore the culture-comparing competence of counsellors is an important issue in counselling. The proliferation of biculturalism or multiculturalism, trauma and migration
affects individuals. One the other hand considering individual differences and gender specific aspects are also important. (see Salman, Collatz 2001:48) Schouler (2008) emphasizes the role of gender in the therapy process. For example a female client with Turkish background who has been sexually traumatised should not be expected to relate the history of her trauma
through a male interpreter. Shame and taboos may also have a significant influence in this context.
Uçar (2005) defines the term “Culture Interpreter” to emphasize the problems between migrants with Turkish background and German counsellors, psychologists. He defines the terms as follows:
Ein Kulturdolmetscher ist ein Dolmetscher als mittler zwischen verschiedenen
kulturelllen Systemen. Dolmetschen in diesem Sinne ist mehr als eine blosse
Übersetzung der Sprache in eine andere Sprache. Es ist eine übersetzung der
kulturellen Normen, Werte und Verhaltensweisen der Menschen von einer Kultur, um sie für Menschen anderer Kulturen verstandliche zu machen. Diese
Verstandigungstatigkeit oder mittlertatigkeit setzt voraus, dass der Dolmetscher nicht nur die beiden Sprachen beherrscht, sondern beide kulturellen Systeme gut kennt.
Uçar 2005:3
He emphasizes the necessity of interpreting the norms, values, attitudes, terms from different cultures to other cultures. Achieving this requires the sufficient competence of culture interpreters. Not only verbal communication, but also non-verbal communication such as gesture, eye-contact, closeness, distance, spacial-temporal perceptions may have different cultural meanings and play an important role in communication. Thus an intensive eyecontact may be interpreted as aggression or respect. For example in Turkish culture aggressive attitudes of male children is tolerated, but German people tend to interpret such attitudes negatively. (see Uçar 2005: 3-11) Therefore not only language problems but also cultural differences may cause misunderstanding and miscommunication in the process of therapy or counseling.
As the examples showed us cultural differences affect counseling process heavily. Especially in the countries, which have a big migrant population, problems often exist. Learning the information about a client’s psychological condition requires general knowledge of his or her cultural background. Counselors cannot adopt the client’s ethnicity or cultural
heritage, but they can become more sensitive to these differences. Counselors who work with migrants, should be able to avoid the problems of stereotyping and wrong expectations due to their own culture and values. Clinical sensitivity, knowing the importance of values, beliefs
roles and attributions are necessary for effective outcomes. Examining own assumptions, accepting the multiplicity of variables which constitute an individual’s identity, and development of a client centered, balanced counseling method will support effective help. (see Bolton 1987:3)
The therapist needs to be willing to reflect on his or her stance, and to
learn as much as possible about the socio-cultural background of each patient. Culture specific factors have a big role in counseling process. Recognizing and accepting these factors without stereotyping them is important. The solutions discussed with the patient should be compatible with his or her cultural background. It is important to keep in mind that clients with migration background deserve the same degree of professional attention as clients from same cultural background. While family members often are often asked to translate in the absence of professional interpreters, such situations may lead other problems such as the family members may add their command or they may have problems while translating and they are generally not prepared or trained to deal with traumatic content.
Interpreters who come from same cultural background may remain the danger of identifying with their experiences. Interpreters should therefore be offered assistance such as workshops, supervision or special programs to help them deal with feelings that arise during counseling. (see Schouler 2008:665-667)
The personnel, who is able to understand and interpret two different cultures, is supported due to increasing need for multicultural psychologists, counselors, psychotherapist and health care providers, in Germany. Moreover there are several corporations, institutes which have been founded to support these developments. Precautions and developments are not enough but they become widespread every passing day. Such promising improvements should be supported by government. Thus the misunderstandings and miscommunications due to culture differences would be accomplished.
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