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Flowers by the Window: Imagining Moments in a Culturally and Politically Reflective CAT

Brown, R., 2011. Flowers by the Window: Imagining Moments in a Culturally and Politically Reflective CAT. Reformulation, Summer, pp.6-8.

Rhona Brown offers this fictional account of a CAT therapy between a woman from an Alevi Kurdish background and a white British female therapist, as a means of illustrating how cultural and political understandings may both challenge and inform the process of therapy. This case study could be used as material for discussion and debate in a training context. Feedback on its use would be welcomed by the author, who can be contacted at rhona.brown@mhsc.nhs.uk.

Dilan is a 30 year old single Alevi Kurdish woman originating from near Erzincan in Eastern Turkey. She was active in pro-Kurdish educational and political campaigning activities which led to a number of brief detentions by Turkish police. The majority of these included beatings and intimidation, but after being serially raped during her fourth period of detention, and her life being threatened, colleagues arranged for her to leave Turkey. Threats had also been made against colleagues and members of her family. She arrived in the UK 5 years ago, and applied for asylum to the UK Border Agency.

Her asylum application was initially refused as the account she provided at that stage was deemed to be sketchy and inconsistent. She appealed the decision, and with a campaign of support through her local community centre and local asylum agencies, was granted indefinite leave to remain 2 years ago. After gaining this security, she became increasingly troubled by intense anger, depressive symptoms, and overwhelming feelings of loss. Staff at the community centre helped her to access counselling support from Rape Crisis, and she was referred on from this to a psychological therapies service.

She has engaged in a 24 session therapy with Pauline, a female British CAT therapist, who has used CAT tools in a flexible manner within the limits of Dilan's English language and literacy. She is articulate and expressive in her mother tongue Kurmanji Kurdish, but is literate only in Turkish because of the prohibitions placed on the Kurdish language within Turkey until recent years. Despite significant obstacles to education as a girl, and as a Kurd, she strived to complete secondary school, and achieved well. Since coming to the UK, she has learned enough English to attend sessions without an interpreter, but communication can be difficult at times, particularly if she becomes distressed. She lapses in and out of Kurmanji at these times, and while she understands that it is hard for Pauline to understand and respond to her distress at these times, she prefers not to have an interpreter involved. Pauline has felt unsure throughout the therapy that she really has a grasp of what is going on for Dilan, both internally, and between them in the alliance. When they began working together she knew very little about the position of Kurdish people in Turkey, and has done some internet research to help her understand this better.

Together they have identified some key reciprocal roles, and have sketched out a simple SDR in English to represent these. This includes:-

Violent, abusing, torturing - in relation to - EITHER powerless & broken OR angrily fighting back

Absent, failing to care - in relation to - let down & abandoned

Pauline refers to the diagram more actively than does Dilan in sessions, and she uses it as an internal map to help guide the work.

As a result of the complicated language issues, Pauline has struggled to write Dilan a reformulation letter which felt adequate or accessible, but at session 8 she read her a simplified letter in English, which Dilan said she would take home and think about. She said she would call on friends at the community centre to help her translate it if she needed to. However she has never referred to the letter since.

Dilan recognises that she oscillates between the state of 'angrily fighting', which feels familiar and safe, but tiring and depleting; and the strongly avoided state of being 'broken'. She describes how she, her family, and the larger community of Kurdish people have endured chronic discrimination and what Pauline understands as social exclusion. With this as a backdrop, Dilan also witnessed her father's violence towards her mother throughout her early years, her mother's periodic depression, and acute distress following the disappearance of her eldest brother when Dilan was in her early teens. While his body was never found, it was always assumed by the family that he'd been killed by the government because he'd become involved with a guerrilla organisation. The family coped with his loss by holding on to a heroic image of him, and Dilan had developed a keen sense of responsibility being passed to her to be the “just fighter”. Her way of doing this was through fighting hard to learn, and later to campaign and advocate for fair learning opportunities within her community despite the penalties and dangers of this. While her family circumstances were difficult, her parents valued her taking up this form of resistance against the state, which they viewed as a safer way to honour the memory of her brother. She was also supported by a teacher who recognised her to be bright and able, and was sympathetic to Kurdish issues.

She has been reluctant to share any detail of her experiences in detention, but has spoken of how her fight to survive, to escape, and to remain in the UK, has been what has kept her alive and held her together for a long time. Without a clear focus for a fight, she risks shifting into the broken state she so detests. She fears that if she allows herself to become upset, she may lose all of her strength and be crushed. She has linked this to her societal position as an Alevi Kurd; to both her own and her family's abject distress over the loss of her brother; and also to the impact of sexual violation in detention.

Areas of focus for the therapy are agreed as:-

exploring ways Dilan can begin to allow and tolerate feelings of vulnerability;
helping her build up strategies for self-care rather than ploughing more energy than she should into caring for others in her volunteering role at the community centre; and
working out ways to manage and integrate her traumatic experiences in detention, if and when she feels ready to.

In the therapeutic relationship, Dilan keeps the focus of her fight outside of sessions, and relates to Pauline as an ally and a “sister” against the hardships she's undergone. Pauline often finds herself feeling quite admiring and in awe of Dilan's apparent strength and resilience in the face of such adversity throughout her life.

When she attends session 17 of 24, in mid March, Dilan explains she cannot make the next appointment offered, as it falls on Newroz, the most important festival of the Kurdish calendar. She asks that Pauline meets with her the following week instead. Pauline reminds her that she will be unavailable to do so because of Easter holidays which have already been discussed. Dilan becomes quite remote for the remainder of the session, talking in an educative manner about the significance of Newroz for her community, and referring at some length to the flowers indigenous to her homeland which feature in Newroz celebrations. She goes on to detail human rights abuses suffered by Kurdish farmers in the North East of Turkey in recent years as a result of their land being commandeered by western oil companies for the purpose of laying a major oil pipeline.

Pauline tries to make links between this material, Dilan's separation from her family at this important time, and the impending break in therapy. She also tries to spotlight the familiar fighting/advocating procedure Dilan seems to be entering into. While Dilan acknowledges both of these, she is uncharacteristically unwilling to expand upon them, and instead keeps her gaze beyond Pauline to the window behind her. At the end of the session, she leaves quite abruptly, without saying her customary warm goodbye, and Pauline is concerned when she then fails to attend session 18 three weeks later.

In supervision, the issue of Pauline's unavailability to her, and the impending ending of the therapy, stand out as obvious issues which have prompted an enactment of the absent-to-abandoned reciprocal role. However both she and her supervisor feel there is something else which has not been understood fully.

When Dilan returns for session 19, Pauline broaches these issues with her. Dilan talks realistically about her concerns for the future, but remains quite remote and de-emphasises the impact of losing contact with Pauline. As she's leaving the session she glances to the window again, and comments “Ah your flowers are gone. They always die when you cut them from the earth.”

Pauline recalls later that immediately prior to the previous session, another client had brought her a gift of a bunch of tulips, which she'd put in water in a vase by the window. She and her supervisor hypothesise about Dilan's leaving comment, and favour the possibilities that it indicated something of her sense of being “broken” through dislocation from her family and community, her dread of the ending of the sessions, or perhaps a critical attack on Pauline in response to her unavailability. Ultimately they agree that an uncertain and curious approach about the comment would be the most helpful position to take.

Pauline begins session 20 with reference to Dilan's comment, and tells her she was left wondering what she'd thought about the flowers that were gone. Dilan tells her she does not think Pauline will want to hear her thoughts. After a number of reassurances and invitations for Dilan to say more, she draws herself up and says she is sorry if what she has to say is hurtful. She goes on:-

“I come to see you as a sister but I am wrong. In my loneliest heart I had forgotten that Europe and the West do not really care for our struggle. Instead you buy tulips from the petrol station thinking you show beauty when all you buy is pain, the pain of my people begging and sending daughters out to trade their beauty for bread in the streets of Batman, then forever hatin bikarhatin u hemû mêr (becoming used by every man) like me too since that week in the police station. I am dead now like my brother. My father would ask me to eat poison for the shame I bring. Like the oil that cheats my heval (comrades) in Damal to run your motors, you take the tulips that grow in my dol (valley) and throw them out before the sun sets. Taking, taking and not telling when you have heard the truth of our pain. Not asking your top men to shout. You write me a letter but I already know my truth. Why you not write letters to your politicians, your police, your Europe?”

Pauline is taken aback by the strength of Dilan's words, and does not understand some of what she refers to. What she does grasp initially induces a guilty paralysis, in contrast to her previous sense of being helpful and useful to Dilan. She finds it hard to make a response, but is able to reflect Dilan's angry disappointment, and encourages her to elaborate on some of the points she's raised so that she can understand them better. She comes to understand that the tulips in her office were a powerful sign for Dilan, signifying both the richness and connectedness of her community in Turkey, but also signifying her perception of capitalism, the West's readiness to consume the resources of her country while contributing to the exploitation of the Kurds, and ignoring human rights abuses. She is helped by the diagram generated previously, and is able to sketch onto this a taking/exploiting - in relation to - depleted/exploited reciprocal role which helps her feel she has acknowledged some of the issues Dilan has raised. The words Pauline writes mean little to Dilan but she does feel that Pauline has listened to her and has understood something of what the tulips in her office meant to her. They agree to continue to meet but to make space to think further about what therapy can and cannot be.

Pauline seeks additional consultation with a charity specialising in mental health and human rights abuses, and accesses further information which helps her to contextualise Dilan' difficulties within the political and cultural position of Kurds within Turkey. This, in conjunction with her existing supervision, helps her to think therapeutically over the remaining 4 sessions rather than feel entirely overwhelmed by Dilan's anger and disappointment. However as she begins to understand more about the realities of Dilan's context, she continues to feel some ongoing sense of shame about her relative privilege as a professional British woman, and the limitations of psychotherapy in resolving the societally-located pain and distress described by this client.

The subject of the goodbye letter troubles Pauline, and she discusses it at length in supervision. She raises the idea of it with Dilan, explaining its intended purposes within CAT, but also acknowledging how it may carry particular meanings for Dilan, as voiced at session 20. This prompts Dilan to express more about her disappointment with the UK, where she'd believed she would find “listening ears” and some supportive action in support of her people's struggle to be recognised and liberated. She describes how she quickly mislaid the reformulation letter, and linked this to a sense of irritation about repeatedly telling her story (to the UK Border Agency, to her solicitor, to those supporting her asylum appeal campaign, and then to Pauline) without seeing any change to the circumstances of her community. They explore the possibility of generating an account of Dilan's experiences to act as testimony, which can be shared and used to raise awareness of the Kurdish situation at a broader level. This is not possible to do within the remaining contract, but Pauline helps Dilan make contact with a Kurdish human rights organisation in the UK, and with an online testimony project.

Having talked this issue through, Pauline feels more comfortable about drafting a goodbye letter, using as straightforward English as she can. She also tries to incorporate some of the Kurmanji terms Dilan has used, with help from an interpreter. As she writes it, she feels frustrated that the letter cannot include much of what she'd like to convey. When she reads it out loud in the penultimate session, and stumbles over the one or two Kurmanji terms she's included, this prompts Dilan to smile and correct her pronunciation in a kind manner. She comments that she's grateful that Pauline has worked hard to understand her. She doesn't attempt to write a goodbye letter to Pauline, but at the final session brings her instead a pencil sketch of some flowers growing in the park opposite the building where they meet.

The author would like to thank the following for helpful comments on earlier drafts of this piece:- Jude Boyles and Kirsten Lamb of the Medical Foundation for the Care of Victims of Torture, North West Office; Amir Hassanpour of the University of Toronto; Debby Pickvance and Kath Sykes of Macartney House Psychotherapy Service, Manchester Mental Health & Social Care Trust; and Tony Ryle. She extends particular thanks to Mustafa Gundogdu of the Kurdish Human Rights Project, London, for his careful and informative help in strengthening the cultural and linguistic authenticity of the material.

Author:

Rhona Brown, Clinical Psychologist
Manchester Mental Health & Social Care Trust,
Department of Clinical & Health Psychology,
Gaskell House, Swinton Grove, Manchester M13 0EU
Tel 0161 277 1140 Email: rhona.brown@mhsc.nhs.uk

Full Reference

Brown, R., 2011. Flowers by the Window: Imagining Moments in a Culturally and Politically Reflective CAT. Reformulation, Summer, pp.6-8.

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Flowers by the Window: Imagining Moments in a Culturally and Politically Reflective CAT

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