INTRODUCTION

This article is based on a small but pioneering Master's study which explored the practice of cultural sensitivity in systemic psychotherapy in Northern Ireland (NI), a contested jurisdiction within the United Kingdom (UK) with a protracted history of sectarian division and political conflict and more limited immigration experience than other UK jurisdictions (England, Scotland, Wales). Cultural sensitivity is an issue of significance to contemporary psychotherapeutic practice with recent national and international events returning the spotlight to the UK's history of slavery, colonialism, and systemic racism. Such events include the overt use of xenophobic rhetoric in the run-up to the UK's 2016 EU membership referendum which led to an increase in hate crimes targeting Black and minoritised¹ ethnic communities in the UK (Booth, 2019), and the Windrush Scandal, which saw Black British citizens, predominantly from the Caribbean, who arrived in the UK between 1948 and 1973 to fill post-Second World War labour shortages, unlawfully denied the right to work, housing, health care, social welfare, and in some cases detained or deported (Williams, 2020). The global COVID-19 pandemic further exposed the impact of structural inequalities and systemic racism with Black, Asian, and minority ethnic communities² over-represented in infection rates and deaths (Patel et al., 2020) and disproportionately targeted by lockdown violation fines (Currenti & Flatley, 2020). These events coupled with the resurgence of the Black Lives Matter (BLM) movement across the world, following the racist murder of George Floyd in the United States (US) police custody, viewed by millions across the globe in May 2020, galvanised many individuals and organisations, including the UK systemic community, to confirm their commitment to social justice and anti-racism (AFT statement BLM, 2023; Dreyer et al., 2020; Joseph-Salisbury et al., 2020; Kelly et al., 2020; Lebow, 2020). But how are these commitments expressed in systemic theory and practice?

SYSTEMIC THEORY RESPONSE TO CROSS-CULTURAL PRACTICE AND RACIAL INEQUALITY OVER TIME

Systemic theory has long grappled with cultural difference and racial inequality – from Bateson's ethnographic study of the Iatmul people of New Guinea during the 1920s (Bateson, 1958) to the seminal first- to second-order paradigm shift during the late 1970s–early 1980s (Goolishian & Anderson, 1992; Hoffman, 1985). Such theoretical developments highlighted the critical significance of cultural context on social relationships with increasing attention to the self of the therapist, social inequalities, and power differentials in the therapeutic endeavour, including ‘race,’ culture, and social class (Krause, 1995; McIntosh, 1998; Waldegrave & Tamasese, 1993; White & Epston, 1990). Critical race theory recognises ‘race’ as a political and social construct (Delgado & Stefancic, 2000) with inverted commas used throughout this article to note this contention.

To date, cross-cultural practice has largely been addressed via the evolution of several key frameworks. The first major theoretical response was the development of the concept of ‘cultural competence,’ first highlighted in social work literature in the United States (Green, 1982; McKenzie, 2008) and adopted by the systemic community to describe an important training goal whereby cultural awareness is taught through acquiring knowledge about the traditions and practices of various cultural groups (Hardy & Laszloffy, 1995). This framework was subsequently criticised as failing to capture cultural complexity, portraying Black and minoritised communities as largely homogeneous (Kourgiantakis & Bogo, 2017) and defining inequality simply as ‘difference’ without raising critical consciousness about the origins and maintenance of discriminatory systems (Kelly et al., 2020; Krause, 2022). In addition, the dominant ethnic group (usually White³) tended to be represented as not having an ethnicity, thus rendering the achievement of cultural competency to be about learning about other cultures rather than exercising self-reflexivity (Kumas-Tan et al., 2007). This ‘othering’ of Black and minoritised ethnic people was thought to risk becoming a colonising practice, inadvertently strengthening, reinforcing, and reproducing societal power differentials (Lago, 2006; Nolte, 2007; Ryde, 2009). In response to these critiques, a second concept, ‘cultural sensitivity,’ emerged to describe the therapist's affective ability to respond ‘emotionally to stimuli with respect and delicacy’ (Hardy & Laszloffy, 1995, p. 228). Collaborative practice models emphasised the critical need for therapist self-awareness to enable the exploration of cultural differences from a position of self-reflexivity (Halevy, 1998; Hardy & Laszloffy, 1995; McGoldrick & Hardy, 2008). Indeed, therapist self-reflexivity is deemed critical to recent conceptualisations of cultural sensitivity demanding therapists ‘turn to [themselves] in an attempt to get an orientation in how to position towards others’ (Krause, 2012, p. xxii). Gabb and Singh (2015, p. 210) propose therapists exercise ‘critical reflexivity’ about similarity and difference, while Daniel (2012) calls for ‘cultural reflexivity’ to enable engagement with ‘aspects of “otherness” and difference’ (p. 92).

Burnham's social GGRRAAACCEEESSS framework (Burnham, 1993, 2012) has been embraced by the UK systemic community to consider the multiple social dimensions of lived experience of both client and therapist. These include issues such as gender, geography, ‘race,’ religion, age, ability, appearance, culture, class/caste, education, employment, ethnicity, spirituality, sexuality, and sexual orientation which interweave to shape identities and act as sources of marginalisation or privilege in people's lives, referred to as intersectionality in sociological literature (Crenshaw, 2017). The continued abuse of power and privilege within society however has led recent systemic theorists to argue that more is needed (Krause, 2022) with the expression of a third-order transformative approach where an aspiration towards social justice is explicitly integrated within the therapeutic discourse via heightened sociocultural attunement (McDowell et al., 2017, 2019).

SYSTEMIC RESEARCH AND CULTURAL SENSITIVITY

While these debates give an indication of the attention afforded to the theory and practice of cultural sensitivity in systemic psychotherapy, electronic database searches demonstrate a notable dearth of empirical research in the UK. Only 10 published research studies were located via an initial scoping review (Arksey & O'Malley, 2005) using three concept groups (‘family therapy’; ‘culturally sensitive therapy’; ‘ethnic minorities’) over a 15-year period (2007–22) (Collins, 2022; Cottrell-Boyce, 2022; Fox et al., 2017; Pakes & Roy-Chowdhury, 2007; Pandya & Herlihy, 2009; Singh, 2009; Teh & Lek, 2018; Ugazio et al., 2022; Wallis & Singh, 2014; Yon et al., 2018). Notably, all studies took place in England, with no empirical research identified in Wales, Scotland, or NI. In addition, one or more of the authors of 9 of the 10 studies were from a Black and minoritised ethnic background themselves, begging the question as to whether these issues remain a minority concern. Included studies were all qualitative in nature and tended to be small scale (maximum of 11 participants), with three single case studies. The majority of the papers focused broadly on how therapist–client cultural difference affects therapeutic alliance and engagement, while two examined the constructions and enactments of Whiteness and White privilege in therapy (Cottrell-Boyce, 2022; Wallis & Singh, 2014). Analysis of the included papers identified a range of pertinent themes (see Table 1 for summary).

THIS STUDY

The study at the centre of this article aimed to address these noted research limitations by exploring therapist perspectives of culturally sensitive systemic psychotherapy in NI, a region within the UK where no previous studies had been conducted and with a history of sustained political conflict, ongoing sectarian division, and limited immigration. It was anticipated that this unique context might bring new learning, given its large White majority and where cultural identity remains a contested issue. The study was undertaken as the lead author Christiana Young's final dissertation of the MSc Systemic Psychotherapy at Queens University Belfast (Young, 2018). The second author, Suzanne Mooney, is a member of the systemic faculty at Queen's University Belfast and acted as study supervisor.

Study context: Northern Ireland

In NI, religious, national, and cultural identities are often conflated. NI, as a distinct jurisdiction within the UK, was created in 1921 by British law in response to the Irish War for Independence (1919–21) which sought to end British rule in Ireland. The border was drawn around six north-eastern counties, the most industrialised part of Ireland with a Protestant/unionist majority who identified as British as a result of 17th-century colonisation (Bardon, 2011). These counties however also had a sizeable Catholic/nationalist/republican minority who identified largely as Irish and aspired towards a united Ireland (Bardon, 2011). The formation of NI was therefore always contested and accompanied by violence, both for and against partition, and informal mutual segregation persisted between the two primary communities (McKittrick & McVea, 2002, p. 18). Successive devolved unionist governments were accused of systematic discrimination in housing, employment, and voting against the Catholic/nationalist/republican minority (McKittrick & McVea, 2002). Rising tensions culminated in a violent conflict which escalated and deteriorated into 30 years of protracted violence referred to as ‘the Troubles’ which cost more than 3,500 lives and injured over 50,000 people (Fay et al., 1999; Schiaparelli et al., 2015), with the greatest proportion of deaths located in areas with the highest levels of segregation and deprivation (Cunningham & Gregory, 2014; Mesev et al., 2009). A US-brokered peace process led to the Belfast/Good Friday Agreement of 1998 between the British and Irish governments and most NI political parties. However, despite major paramilitary disarmament and NI police reform, sectarianism, political disagreements, and community violence (albeit at a reduced level) persist in post-conflict NI (Goeke-Morey et al., 2009; McAlister et al., 2013; Nolan, 2018).

However, there are changes afoot in the NI social demographic landscape with the Catholic population for the first time overtaking the Protestant majority in the recently reported 2021 Census (NISRA, 2022). Census findings however indicate more nuanced issues related to cultural and national identity with three major distinct groupings identified: 32% identifying as British only; 29% Irish only; and 20% as Northern Irish only (NISRA, 2022). These statistics resonate with the findings about people's self-ascribed community/religious identity and unionist/nationalist political attitudes from the Northern Ireland Life and Times Survey (NILT, 2021) with evidence of flux, particularly in the younger age ranges (e.g., 51% of 21–34-years-olds think of themselves as neither nationalist nor unionist). Nonetheless, segregation on religious grounds (as well as social class) remains a significant feature of NI society, most pronounced in education and social housing (Hughes et al., 2007; McClements, 2018; Roulston & Hansson, 2021) with high rates of social deprivation and associated problems such as substance use, mental illness, suicide, and violence (domestic, paramilitary, criminal) (Black, 2021; Bunting et al., 2012, 2013; Cummings et al., 2009; Doyle & McWilliams, 2018; McAlister et al., 2013; Muldoon, 2004). High walls known as ‘peace lines’ separating Catholic/nationalist/republican and Protestant/unionist/loyalist neighbourhoods in mainly urban interface areas, erected in the 1970s as a result of disorder or attacks, still exist and have indeed increased in number more than 20 years since the 1998 Belfast Agreement (Irish Times, 2022; Shirlow & Murtagh, 2006).

In relation to NI's Black and minoritised ethnic populations, NI did not experience levels of immigration akin to the rest of the UK post the Second World War. However, in the years since the Belfast Agreement, and in particular since the Baltic states joined the European Union (Gilligan, 2019), NI's 1.9 million population has increased in diversity from a very low base. Although 96.6% of the population identify as White, there has been a doubling of minoritised ethnic populations from 1.8% in 2011 (32,400 people) to 3.4% (65,900 people)⁴ in the 2021 Census (NISRA, 2022) with a corresponding increase in recorded racist incidents (Gilligan, 2019). Census 2021 saw the highest recorded number of people living in NI who were born outside the UK and Ireland, an increase from 4.5% to 6.5% of the population (NISRA, 2022) with births to mothers born outside the UK and Ireland now accounting for over 13.3% of all NI births (NISRA, 2020). It is argued that Black and minoritised ethnic communities have been overlooked in NI, with the political system set up under the Belfast Agreement to ensure that the two main communities share power in government and a lack of ethnic monitoring contributing to the invisibility of these populations in policymaking (House of Commons NI Affairs Committee, 2022).

Systemic psychotherapy in Ireland

Systemic psychotherapy has been provided on the island of Ireland since the mid-1970s with the NI branch of the association of family therapy (AFT UK) and the Family Therapy Network of Ireland (FTAI) established by 1980, north and south of the border, respectively (Carr, 2013). Currently, there are three systemic psychotherapy training institutes in total, two accredited by FTAI (University College Dublin; Clanwilliam Institute) and one by AFT (UK) at Queen's University Belfast (Boland et al., 2020). While there are approximately 70 registered systemic psychotherapists in NI and 300 in the Republic of Ireland (RoI), many registrants are employed as nurses, social workers, and psychologists due to the lack of designated posts (Boland et al., 2020; Carr, 2013). In NI, the largest employer of systemic psychotherapists is the public sector Child and Adolescent Mental Health Services (CAMHS) with a small number of third-sector organisations employing systemic psychotherapists on a sessional, part time, or full-time basis.

Study motivation

Born to Sierra Leonean parents who migrated to the UK in the 1970s, Young was raised in North London with lived experience of racism. The juxtaposition of Sierra Leonean heritage, but British-born, resulted in her experiencing minority status in both Sierra Leone and England, viewed as part of the Sierra Leonean diaspora and thus called English when in Sierra Leone, while viewed as a Black woman in England. The complexity of living between two cultures is one she grappled with from an early age, helping to shape her notion of identity. On moving from London to Belfast, Young encountered a very different community context where she was the only Black trainee with all other course participants from a White Irish or British background having grown up in either NI or RoI. As part of her qualifying-level systemic training in NI, she reflected upon her lived experience and initially struggled to understand where Black and minoritised people ‘fit’ within the current NI context with its history marked by sectarian divisions, political conflict, and complex identity issues. She was conscious of her minoritised status in NI, her British nationality, and colour, leaving her unsure how to sensitively approach conversations around ‘race’ and ethnicity in this new cultural context. As training progressed, Young found that a tentative holding of the therapeutic stance of curiosity (Cecchin, 1987) alongside cultural reflexivity (Daniel, 2012) and relational risk-taking (Mason, 2018) afforded the opportunity to create the space to bring forth the racial, ethnic, and cultural aspects of her ‘self’ with good effect in therapeutic encounters with families and within her training group. These cumulative experiences of giving ‘voice’ to her lived experience as a Black British woman of Sierra Leonean heritage in NI galvanised Young's interest in exploring the practice of cultural sensitivity as the central topic for her final Master's dissertation. The second author, Mooney, acted as study supervisor and brought an in-depth understanding of the NI social demographic context to the project. She too had experience of complex identity challenges. Raised in a White Protestant/unionist/loyalist/British community background in NI, she studied in Scotland (where she was perceived as Irish) before returning to NI and becoming involved in her young adult life in cross-community projects and therapeutic trainings which sought to explore and expand anti-sectarian dialogue and exchange, with an aspiration towards a new Ireland. She now self-identifies as a White Irish atheist woman. Research supervision was utilised to initiate conversations about researcher and supervisor positionality (Wilson et al., 2022) and the intersection of their social identities as they relate to the NI context (‘race,’ culture, religion, ethnicity, nationality), thus enabling a critical, self-reflexive, and socially located stance throughout the research process.

Methodology

As evidenced above, discussions around what constitutes culturally sensitive practice are complex, nuanced, and socially situated. Thus, a social constructionist research epistemology, with its critical stance towards received knowledge and attention to language and social context (Burr, 2015; Gergen, 1985), was adopted to explore the practice of cultural sensitivity by systemic psychotherapists in NI. Qualitative semi-structured interviews with targeted participants were selected as the most appropriate data collection method in order to generate richly detailed data (Braun & Clarke, 2013) and facilitate in-depth, contextualised understanding of unique perspectives based on lived experience (Kvale, 1996). Ethical approval was granted by the School of Social Sciences, Education and Social Work, Queen's University Belfast. A purposive sampling strategy (Campbell et al., 2020) sought to recruit systemic psychotherapists employed in the third sector as a means to access eligible participants within the restricted dissertation timeframe, given the extended ethical approval process required for public sector recruitment. The chief executive officers of the primary third-sector agencies in NI known to employ systemic psychotherapists were approached to distribute study recruitment materials. Five participants fitting the inclusion criteria provided informed consent. Following completion of a brief sociodemographic profile, the researcher utilised a bespoke interview guide (Patton, 2002) (see Appendix S1) to invite participants to reflect on their own racial, ethnic, and cultural backgrounds; describe experiences of working therapeutically with Black and minoritised ethnic families in NI; deconstruct the term ‘culturally sensitive practice’; and explore the affordances and constraints of culturally sensitive therapeutic encounters. All interviews were audio-recorded and described verbatim. An ‘inductive’ thematic data analysis was undertaken (Frith & Gleeson, 2004) informed by Braun and Clarke's six-phase guide to thematic analysis (2006). Transcripts were read and re-read to enable data immersion, followed by manual coding to identify potential patterns and themes (Hardy & Bryman, 2004). Visual mapping was utilised to explore emerging superordinate and sub-themes apparent across the data sets. A recursive process between the data and the thematic mapping progressed, with themes and sub-themes re-named accordingly in efforts to provide a concise and coherent analytic narrative which sought to capture the essence of participant perspectives (Braun & Clarke, 2006). In these ways, themes were uncovered rather than fitting ‘into a pre-existing coding frame’ (Braun & Clark, 2006:83). As noted above, careful effort was expended to enhance the study's credibility, transferability, dependability, and confirmability (Lincoln & Guba, 1985), including critical engagement with supervision (Severinsson, 2015) and a process of self-reflexivity (Berger, 2015) throughout.

Reflections on ‘race’ and ethnicity in the research process

Young was conscious of her Black British identity when conducting interviews, concerned that participants might question her motivation. To mitigate the likelihood of her identity inadvertently acting as a barrier to participant engagement, she was explicit during the recruitment process that she was not seeking to uncover prejudicial views or be unduly critical of participants' practice. Despite these efforts, her Black identity is recognised as inevitably having some influence on participant responses, potentially limiting the information shared (Gerson & Horowitz, 2002). It is however also possible that Young's visible difference enhanced conversations. Interestingly, all participants made reference to her identity as a Black British woman during the respective interviews. Her Black identity and NI ‘outsider’ status may have prompted participants to become more aware of their Whiteness and offered a unique opportunity to reflect on cross-cultural practice in the NI context.

STUDY FINDINGS

In total three females and two males over 45 years old were interviewed. Although all had grown up in NI, two participants self-identified as White Irish and three as White British. Two had completed their qualifying-level systemic training in NI, two in RoI, and one in England with post-qualification experience ranging between 8 and 15 years in public, third-sector, and private practice in social care, mental health, and justice settings (not always as designated systemic psychotherapists). At the time of recruitment, participants were employed as systemic psychotherapists (on a sessional or full-time basis) in four separate third-sector organisations which offered therapeutic services in relation to mental health, substance use, and relationship support. Two also reported a private practice. Despite this extensive clinical experience, three participants reported very limited cross-cultural practice (estimated at less than 2% of clients), most probably due to the relatively small Black and minoritised ethnic population in NI. Only one had worked with translators. The participant with most cross-cultural experience (estimated at 30%–40% of clients) had worked in areas known to be home to larger numbers of Black and minoritised ethnic communities due to migrant employment opportunities (NISRA, 2020). Four interlocking superordinate themes emerged from detailed analysis of participant interviews: the ‘culture of silence’ in NI; ‘Whiteness as an invisible norm’; theoretical paradoxes influencing therapist reticence; perceived benefits of exploring cultural differences, and lived experience of racism (see Table 2 for summary of themes and sub-themes).

Theme 1: the ‘culture of silence’ in NI

Given NI's protracted history of political conflict, sectarian violence, and discrimination, all participants commented on a cultural norm of protecting one's religious and cultural identity due to a prevailing sense of threat to one's personal safety or equitable treatment, concerns which are noted to still exist in the present day despite the Belfast Agreement (1998) and the ostensible end of the conflict (Morrow, 2019). As a result, four out of the five participants questioned whether the endurance of a ‘culture of silence’ and feeling ‘guarded’ around their own cultural and ethnic identity left them reticent and ill-equipped to initiate conversations about ‘race,’ culture, and ethnicity with Black and minoritised ethnic clients:

… how much do we feel that we can start talking about multi-ethnic work and things, whenever we're still so guarded and divided about our sectarian issues. (Participant 1)

Interestingly, each participant hesitated and took considerable time when defining their own cultural and ethnic background as if these were issues not often requested or explicitly voiced. Being unused to and ‘guarded’ about disclosing one's own cultural and ethnic identity was identified as a constraint to the development of culturally sensitive practice. For one participant, this difference became most apparent when confronted with a perceived willingness to explicitly name one's cultural and ethnic identity when attending systemic training events in England:

if you've gone over to England to meetings where people … introduce themselves as White middle class … We're all like what are they going on about, all you do is give your name, but it's also well … maybe we're uncomfortable with that upfront identity of this is what I am because you might have to name things that we don't in that culture of silence. (Participant 1)

Participant responses therefore begged the question whether in the sociopolitically contested context of NI, it was necessary for trainees and therapists to ‘break the silence’ and start with exploring their local sociopolitical history, context, cultural identities, and inequalities as a means to orientate to engaging with other peoples and wider inequalities.

Theme 2: ‘Whiteness as an invisible norm’

It was notable that the word ‘insular’ was used by all five participants to describe the NI context and illustrate how it had been impacted by a lack of immigration:

We have been insular here … we are a very insular community … we are off the coast of England and Britain and nobody ever really … came here. (Participant 4)

The relative absence of immigration was thought to have contributed to NI being an ‘inward-looking country’ with the focus on sectarian and political divisions as opposed to issues of ‘race’ and ethnicity. Four of the five participants reported that living within a society dominated by consideration of religious and national identities had actively discouraged reflections upon their ethnic identity with Whiteness perceived as an overarching ‘monoculture,’ thus echoing Wallis and Singh's finding of ‘Whiteness as an invisible norm’ as a dominant theme in therapist discourse (Wallis & Singh, 2014, p. 46). The more recent increase in Black and minoritised ethnic people in the broader NI community had reportedly led one participant to reflect upon their racial identity and specifically their Whiteness, eliciting a novel sense of exploration:

I suppose I see myself as Caucasian … that kind of American-sense White … it's only recently I've taken stock of that … because being in a monoculture, you don't have to really think about yourself in those terms. It's whenever you're … interacting with other people from different cultures, that you then begin to reflect well, where am I, where am I at. (Participant 5)

Participants took the opportunity to note the experiential limitations of their respective trainings with only one participant explicitly mentioning the term ‘self-reflexivity’ when asked to deconstruct the term ‘cultural sensitivity.’ Qualified between 8 and 15 years earlier, four participants were of the opinion that systemic training in Ireland (North or South) inadvertently acted as a barrier to developing culturally sensitive practice as learning groups were reported as not ethnically diverse enough to provoke discussion:

in my [training] group we were all White and there was no one from another country or another race so I don't think you get a rich conversation. (Participant 5)

One participant who completed their training in RoI commented that no Black or minoritised ethnic families had presented for therapy during this period, which was perceived as limiting the opportunity to develop their skills for working with cultural difference. In contrast, the one participant who had undertaken their training in England believed their learning had been enhanced by the ethnic diversity represented in both the training group and families attending for therapy. More broadly for this participant, the premises of systemic psychotherapy needed to be re-considered in light of its White origins:

… family therapy was in large part developed as a White, Caucasian model … based on White ideas of who we are, what we are … how we communicate and what's good and what's helpful communication, and what's not helpful, so the challenge is to kind of try and set that aside. (Participant 3)

Continuous professional development (CPD) opportunities were also generally perceived as limited in the NI context with attendance at training events in more ethnically diverse geographical contexts considered essential for professional development.

Theme 3: theoretical paradoxes influencing therapist reticence

Although exploring client lived experience was reported as important for effective therapeutic practice by all participants, it was apparent that different emphasis was placed on the inclusion of cultural considerations and social inequality with participants articulating contradictory positions revealing some therapist reticence in raising this subject matter. When deconstructing the term ‘culturally sensitive practice,’ participant responses emphasised attending to how client cultural beliefs and practices affected their lives:

Culturally sensitive practice means me having an awareness or sensitivity to the fact that another person's culture is theirs and affects how they live their life, how they see the world and therefore you need to be aware of that fact and then try to … sensitively work with it. (Participant 2)

Despite this ostensible acknowledgment of the critical importance of culture and ethnicity to a person's lived experience and worldview, paradoxically four of the five participants expressed reluctance to raise the issue of cultural, racial, or ethnic experience or beliefs with families, seeing this as exercising power over clients by determining the therapeutic agenda. Instead participants highlighted their preference to take a ‘one down position’ and an ‘informed not-knowing’ approach (Anderson & Goolishian, 1992; Laird, 1998) in their therapeutic engagement with minoritised ethnic families as a means to balance expertise and uncertainty (Mason, 1993). Three participants went on to express concern that having a focus on culture could also lead to an unhelpful ‘reification of culture’ (Pakes & Roy-Chowdhury, 2007 p. 286) in the therapeutic context with one stating:

… [the family] are not there because they have a certain ethnicity … they are there because they need help to reflect on what's going on in their lives and what needs to change … I take it from the point of view that they're here for a purpose … and that reason has nothing to do with where they've lived previously, or who they are or what they are in that sense … I'm much more aware of anxiousness coming into the room and fear coming into the room … rather than if the person is Croatian, Polish, Nigerian, or whatever really … that might not be the right answer but that's my first concern, but after that, yes, I'll try to get on the same page because there are differences and you don't want to be crass or saying something out of turn or stupid. (Participant 4)

Notably, all participants also expressed the view that difficulties experienced by families ‘transcend’ culture and reported how the concepts of universality and a ‘shared humanity’ (Rober & De Haene, 2014) acted as important guides when working therapeutically with families:

I do love the common humanity … it crosses and transcends culture … it means it can be easier to not worry about culture because it's just humanity and not a cultural issue. (Participant 2)

Clearly this approach risked relegating the importance of distinct issues related to ‘race’ and ethnicity, as participants appeared to be thinking of culture as related only to particular aspects of people's lives, as opposed to understanding racialised and minoritised identities as embedded in all lived experience and critically connected to society's dominant power structures. It may, however, also indicate a concern that an explicit focus on ‘race,’ culture, or ethnicity by the therapist might be perceived by the family as discriminatory. This may suggest a discourse of ‘political correctness’ identified by Wallis and Singh (2014) as constraining White practitioners raising issues of ‘race’ in the therapeutic domain due to feelings of ‘race anxiety’ and ‘self-policing’ (p. 51).

Theme 4: perceived benefits of exploring cultural differences and lived experience of racism

While the above quotations indicate a risk of negating the consideration of ‘race,’ culture and ethnicity in the therapeutic domain or relegating it to one of simple ‘difference’ (as opposed to inequality), four of the five participants nevertheless reported that they did not allow their consideration of people's ‘shared humanity’ to deter them from recognising how culture and ethnicity affects people's lived experience in numerous and often disadvantageous ways. Examples were provided of how a focus on cultural differences had been beneficial to the therapeutic endeavour:

… [prior conversation] nicely led into how the family could enrich itself by strengthening some of their own cultural practices within this [new NI] culture … [or] was there any ways the family could borrow from this [NI] culture to help other obstacles they were facing? … this brought in [to the therapeutic dialogue] very openly the whole question of culture … it made culture very much a part of the conversation. For me, this was one of the most enriching experiences. (Participant 2)

The lack of immigration to NI and focus on sectarianism as the primary discriminatory system was thought by some to have limited societal awareness of racism. Despite considerations of racism and structural inequalities being a relatively minor theme in the interviews as a whole, all five participants described a growing awareness of racism in NI, perceived to have increased as the presence of minoritised ethnic communities became more visible:

it's like the Polish community when they first came … there was no problem but once [the community] started to grow … suddenly there was this whole backlash against them … (Participant 3)

Such experiences, when presented in the therapy room, were thought to demand the therapist adopt an anti-racist stance:

if someone is presenting racism they are experiencing, you need that extra sensitivity to … work with that and to make it okay for them to understand that it's not them and it's the culture they find themselves in unfortunately. (Participant 2)

This stance was thought to enable consideration of clients' lived experience of racism, described as strengthening the therapeutic alliance and facilitating further dialogue:

I certainly felt that when we talked about [clients experience of racism] … there was a stronger therapeutic alliance, and that allowed us to talk about other things. (Participant 5)

Therefore, in spite of theoretical frameworks which might inadvertently discourage exploration of cultural difference and their relative lack of experiential training, the majority of participants in this study recognised the therapeutic benefits of exploring cultural differences and experience of racism.

DISCUSSION

Recent events such as the COVID-19 pandemic and the BLM movement have shone the spotlight on the impact of racism and structural inequalities on Black and minoritised people's everyday lives in the UK. A contemporary struggle to recognise and address racial and social injustice has been reinvigorated in the UK systemic community with AFT, the governance body for family and systemic psychotherapy in the UK, issuing a statement alongside the UK Council for Psychotherapy in support of anti-racist protests and stating their intention to use their ‘platform and resources to play a role in the fight to overcome deep-seated systemic challenges … amplify our campaign to highlight racial disparities in experience of mental health services and mental health outcomes’ (UKCP, 2022). Theorists too call for transformative models of practice which actively promote social justice (Krause, 2022; McDowell et al., 2017, 2019). But how do these aspirations actualise in therapeutic practice in contested sociopolitical contexts? And what might this mean for systemic training? This pioneering Master's study sought to answer these questions by exploring the practice of cultural sensitivity with systemic psychotherapists in NI. Three areas of primary interest emerged with implications for systemic theory, research, practice, and training.

The importance of attending to the local sociopolitical context and intersectionality in systemic trainings

Although study findings mirror themes discussed in existing UK research, perhaps unsurprisingly, given the systemic understanding of the vital importance of context, the study location in NI contributed some nuanced differences from studies undertaken in Greater London as well as potential parallels with other areas in the UK and Ireland with large White majorities. The absence of significant immigration to NI led to a perceived sense of White homogeneity expressed by study participants. A lack of interactions with people of colour and from different cultural backgrounds in training and clinical environments meant that even experienced therapists described limited cross-cultural therapy experience and a sense of under-explored Whiteness. Such gaps were compounded in the NI context with the dominant focus on religious/national identities as a result of NI's protracted political conflict contributing to a ‘culture of silence’ in naming and exploring cultural and ethnic identities per se. Study findings suggest there is additional experiential learning needed in contested sociopolitical contexts such as NI. Exploring one's intersecting identities through the lens of privilege/disadvantage necessitates an understanding of a community's social history and power relations which will inevitably elicit underlying tensions and challenges for training institutions in politically contested contexts where no such shared narrative exists.

Under-explored Whiteness and under-recognised structural inequalities

While acknowledging the specificities of the NI context, this study affirms and expands previous research findings about the critical under-exploration of Whiteness and White privilege in White systemic psychotherapists (Cottrell-Boyce, 2022; Wallis & Singh, 2014), with the majority of participants in this study describing ‘culturally sensitive practice’ as attending primarily to the cultural beliefs and practices of the client rather than being critically alert to their own constructions and relatively limited attention to the experience of inequality and racism in people's lives. It is difficult to understate the importance of considering systemic oppression in Black and minoritised people's lives with implicit and explicit racial prejudice and discrimination, powerful mutually reinforcing forces which create barriers that impede access to opportunity across critical life domains such as housing (Gulliver, 2017), education (Joseph-Salisbury, 2020), health (Salway et al., 2020), and criminal justice (Lammy, 2017) as well as the potential for ‘micro-aggressions’ in the therapeutic relationship (Sue et al., 2007). These findings suggest that White systemic psychotherapists in the UK, irrespective of location, remain in danger of acting upon ‘Whiteness as an invisible norm’ (Wallis & Singh, 2014, p. 46), further obscuring how racism is institutionalised and cannot be responded to by individuals alone (Patel, 2022). Such thinking points to the challenges for systemic training providers throughout the UK and Ireland to ‘make Whiteness visible’ (Wallis & Singh, 2014, p. 56) with Whiteness understood, not as an individual characteristic or identity, but rather as ‘a hegemonic lens which racialises the other, an ideology which is dynamic and reproductive in maintaining structural advantage and upholding particular structures, institutions and practices’ (Patel, 2022, p. 94). Thus, promoting culturally sensitive practice demands not only a critical consciousness of one's own White ethnicity (Barratt et al., 1999; Singh, 2009) but also an understanding of intersectional inequalities and explicitly how Whiteness operates as an invisible system of racialised advantage, the outcome of which is racism (Patel, 2022). This knowledge coupled with experiential capacities is a critical requirement for ethical cross-cultural, anti-racist engagement (Cottrell-Boyce, 2022; Knudson-Martin et al., 2019; Krause, 2012; Patel, 2022; Wallis & Singh, 2014). Embedding such anti-racism praxis demands therefore not only critical reflexivity from the individual practitioner, but also action by the training institution (Patel, 2022).

Beyond ‘cultural sensitivity’: the need for new theoretical frameworks

There are inherent contradictions in systemic theoretical discourses which both encourage and constrain the recognition and exploration of ‘race,’ culture, and ethnicity in clinical practice. While the exploration of ‘universalities’ is thought to positively impact the therapeutic alliance (Rober & De Haene, 2014), research also highlights the importance of feeling ‘culturally understood’ (Fox et al., 2017; Teh & Lek, 2018; Yon et al., 2018). Participant responses reflected some of these theoretical contradictions with a noted hesitancy in eliciting conversations about ‘race,’ culture, and ethnicity. Postmodern discourses about minimising the enactment of therapist power in determining the therapeutic agenda were cited as constraints as well as a propensity to veer towards a ‘shared humanity’ stance and (as a result) away from considerations of cultural difference and inequality. While well-intentioned, there are risks attendant with ‘colour evasiveness’ (Annamma et al., 2017) when utilised outside therapist awareness which may instead preserve the status quo leaving racism and intersectional inequality unacknowledged. Such a ‘colourblind’ approach is thought to risk obscuring and invalidating minoritised clients' lived experience through its inherent implication of equality (Cottrell-Boyce, 2022; Wallis & Singh, 2014), making White privilege and Black marginalisation invisible (Sue, 2010).

Therapist reticence indicates the need for new practice frameworks that go beyond concepts such as cultural sensitivity and understanding of ‘race’ and ethnicity as issues of mere difference and make explicit reference to the social justice aspiration of contemporary therapeutic engagement to avoid perpetuating a colonising practice (Collins, 2022; Rober & De Haene, 2014). It is our view that the recently articulated third-order approach is a step in the right direction, moving from ‘knowing’ about sociocontextual issues to ‘doing’ socioculturally attuned practice via a process of: attunement to context and power – naming injustice – valuing what is minimised – intervening in power dynamics – envisioning just alternatives – and transforming to make the imagined a reality (Knudson-Martin et al., 2019, pp. 50–56). Such a framework calls on therapists to be accountable for how their practice replicates or helps transform social inequities (Almeida et al., 2007), moving from a commitment to diversity and social equity to taking action (Knudson-Martin et al., 2019, p. 47). As Krause (2022) asserts, while we may not be able to ‘teach race and equity,’ we can ‘highlight it, flag it up, commit to it, shout it, agitate, take political action … we can do all this in the way we … dare to be curious and enquire about what up until now we have taken for granted’ (p. 168).

STUDY LIMITATIONS AND THE NEED FOR FURTHER RESEARCH

This dissertation study has a number of important limitations which accentuate the tentative nature of the findings discussed and call for further research into cross-cultural practice in varied locations across the UK and Ireland. It is acknowledged that researcher and participant (and indeed supervisor) identities may have skewed findings and analysis, with future research no doubt benefiting from a larger sample of practitioners working in a wider range of contexts. While it is unknown whether public sector recruitment may have elicited participants with greater cross-cultural therapeutic experience, it is highly likely that NI would mirror the UK experience. A recent landmark report by the NHS Race & Health Observatory found that people from Black and minoritised ethnic backgrounds in England are less likely to access NHS talking therapies, experience longer waits for assessments, and are less likely to receive treatment following assessment (NCCMH, 2023). These racial disparities are also acknowledged across Scotland, Wales, and NI (UK Parliament, 2022) with the Westminster Government's Northern Ireland Affairs Committee finding that ‘people from marginalised community backgrounds are often overlooked in public policy decision-making. Furthermore, health services are found to not meet the needs of people from outside the two communities (‘Green and Orange’) that continue to dominate the political discourse in Northern Ireland’ (Weaver, 2022, p. 6). Further in-depth exploration of participant identities and a revised interview protocol might also have facilitated advanced analysis of the intersection of multiple identities and their influence on cross-cultural practice. In addition, given the recent rise in NI of non-affiliated persons on the usual religious/community/political/nationality dividers (NILT, 2021), a younger or more recently qualified participant cohort might have provided nuanced difference regarding the impact of the NI political conflict on the perceived need to guard one's ethnic and cultural identity and/or increased therapeutic attention to social inequalities.

CONCLUSION AND FINAL REFLECTIONS

We believe the current sociopolitical context presents an important opportunity for the systemic community to renew its commitment to anti-racism and social justice by reviewing how these critical issues are embedded within contemporary theoretical and practice frameworks and introduced in the training context. This article seeks to makes a contribution to this task, highlighting current debates and theoretical paradoxes and drawing on the findings of a small pioneering study in NI. Findings confirm and expand previous research, pointing to the need to more clearly embed an understanding of the pervasive impact of intersectional inequalities into systemic theory and training, with a greater emphasis on experiential learning grounded in the student's local socio-demographic context. At Queen's University Belfast's systemic faculty, we have sought to take the learning from this study and apply it to our own training courses with good effect noted to date. Foundation-level diversity and inequalities training is co-facilitated by the authors of this paper, with learning cascaded throughout all levels of training. Such developments are intended to assist students (all multidisciplinary professionals) from the outset of their systemic training, to explore their own cultural and ethnic backgrounds (inclusive of opening up conversations about NI identity), and offer a critical examination of Whiteness as a precursor of institutionalised racism. Moving beyond the concept of cultural sensitivity may facilitate the explicit integration of anti-racism and social justice as core components of ethical systemic practice. Such measures are, we believe, essential to enable practitioners to break ‘the culture of silence’ and directly address structural inequalities in their clinical practice, offering Black and minoritised clients therapeutic spaces which explore the possibilities for change rather than inadvertently reinforce oppression.