Child Study Center Grand Rounds 01.18.2022

March 21, 2022

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Engaging with Racism and Xenophobia in Psychoanalytic Psychotherapy

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00:00Great great hello everyone.
00:03Welcome to grand rounds.
00:05I'm so glad to be able to see
00:07how many people are here.
00:09I have the pleasure the good fortune
00:12of introducing our speaker doctor
00:14Tummala Narra before I get started,
00:17Doctor O'Donnell wanted me to remind
00:19everyone that next week we're going
00:22to have doctor Jonathan Willmert
00:24Harte from Kings College, London.
00:27His talk is entitled modeling Normal
00:29in the developing brain using MRI.
00:32And this is based on his work from the
00:35developing Human Connectome Project,
00:38so that's for next week.
00:39And that sounds pretty exciting,
00:41so I'm going to talk a little
00:45bit about Doctor Tummala Narra.
00:47But first I wanted to say she's
00:50going to be speaking as you know,
00:52on understanding racism and xenophobia
00:54through the lens of a psychoanalytic
00:57psychodynamic perspective.
00:58The Child Study Center has a long history of.
01:03Understanding child, adolescent,
01:05and adult development through
01:07a psychoanalytic context.
01:09Whether we're addressing
01:11neurodevelopmental disorders, trauma,
01:13other psychiatric impairment.
01:15So I'm really glad we're going to have
01:19a speaker who's going to address the
01:22current challenges that we're having.
01:27Through this lens through this lens
01:29and just before this meeting started,
01:31we were talking as a group about.
01:35Commentary written in the Orange
01:37Journal by Michael Shapiro.
01:39It just came out,
01:40and that commentary really emphasized
01:42the need for more intense and
01:45focused training in psychodynamic,
01:47child and adolescent psychotherapy
01:49for fellows in child psychiatry.
01:52So I think that's a good way to
01:55contextualize what we're talking about today.
01:59So doctor molinara.
02:00So she is a clinical psychologist,
02:03and the director of Community
02:05based education at the.
02:06Danielson Institute and Research
02:08which is at Boston University.
02:11She's also research professor in
02:13the Department of Psychological and
02:15Brain Sciences at Boston University.
02:17Most recently she was professor
02:19of counseling,
02:20developmental and educational psychology
02:21and the director of training and
02:24the doctoral program in counseling
02:26psychology at Boston College.
02:28Her research and scholarship
02:30focused on immigration,
02:32trauma,
02:33race and culturally informed
02:36psychoanalytic psychotherapy.
02:38Her publications include over
02:3990 peer reviewed articles and
02:42books and chapters in books.
02:44She's also in independent
02:45practice and works primarily with
02:47survivors of trauma from diverse
02:50socio cultural backgrounds.
02:52Doctor to Molinaro serves on that Home's
02:54Commission on racial equality of the
02:57American Psychoanalytic Association,
02:59and on the Board of directors
03:01of the American Psychological
03:03Association Division 45 as a diversity
03:06immigration member at large.
03:08Division 45 is a society for
03:10psychological study of culture,
03:11ethnicity and race.
03:13I'm doctor tomorrow serves as a
03:15member at large on the Board of
03:18directors in a PA Division 39.
03:20The Society for Psychoanalysis
03:23and Psychoanalytic psychology.
03:25She's chair of that Appa Division
03:2839 Multicultural concerns committee,
03:30and she's a member of the AP,
03:32a committee on ethnic minority affairs,
03:36the AP,
03:36a presidential Task force on
03:38immigration and the AP a task.
03:40Force on revising multicultural guidelines.
03:43She's a fellow of the American
03:46Psychological Association and have
03:48a PA Divisions 3945 Doctor Tummala.
03:50Narra is an associate editor of the
03:52Asian American Journal of Psychology.
03:55Associate editor of psychoanalytic
03:57dialogues and senior psychotherapy.
04:00Editor of the Journal of Humanistic
04:02Psychology,
04:03she serves on the editorial boards of
04:05the AP Ejournals Psychoanalytic psychology.
04:08And psychology of men and masculinities.
04:11She's the author of psychoanalytic theory
04:14and cultural competence and psychotherapy,
04:16which is published in 2016.
04:18And she's the editor of trauma
04:21and racial minority immigrants.
04:22Turmoil, uncertainty, and resistance.
04:26Published in 2021.
04:27Both of these volumes,
04:30published by the American
04:32Psychological Association.
04:33I want to say that the most recent volume,
04:37trauma and racial minority immigrants.
04:39Turmoil, uncertainty,
04:40and resistance is a fabulous volume.
04:43I was fortunate enough to be able
04:47to read several of the chapters,
04:49and I think it ought to be required
04:52reading for all our trainees.
04:53So without further ado,
04:55I'm going to introduce Doctor
04:58tomorrow to you.
05:01Thank you so much Kathy.
05:02Can you hear me OK? Audio is good.
05:05OK, thank you so much for your
05:08introduction and for the invitation
05:09to be with all of you today.
05:11I really appreciate that.
05:14I I know this topic of addressing racism
05:17and xenophobia is a very broad topic.
05:20It's a huge topic of course and cannot be,
05:23you know, I can't do justice to this
05:24topic in the the time that I have today,
05:26of course, so I'm going to.
05:29I'm going to focus on trying to give
05:32it some focus and attention to the
05:34experience of racial minority immigrants.
05:37For for the sake of today's talk,
05:40and I'm going to just begin with a
05:42personal story, a personal anecdote,
05:43and then move.
05:44Into some psychoanalytic perspectives
05:48on the issues of racism and xenophobia,
05:51and then share with you some clinical
05:54small clinical vignettes that I'm hoping
05:56that will translate some of what I
05:58say conceptually into practice and in
06:01the psychotherapeutic relationship,
06:02and in particular.
06:05So with that, let me get started.
06:08To the personal I arrived with my
06:10family to the United States from
06:12India when I was seven years old.
06:14This was back in 1977 in the Bronx
06:17in New York City.
06:19I brought with me the burden
06:21of colonialism caste, Hindu,
06:23Muslim conflict, gender based violence,
06:26sexism, and heterosexism.
06:27I was born in Hyderabad, India.
06:30A large multicultural city with a
06:32long history of tensions between
06:35Hindus and Muslims and among people
06:37of diverging Hindu castes.
06:39In subcaste as a Hindu in India,
06:42I had belonged to a majority religious group.
06:44Although I belonged to a Hindu subcaste
06:47which was frequently victimized
06:50by verbal harassment and physical
06:52violence in particular region India.
06:55And when I say violence against the
06:59people who belonged in my subcaste,
07:02are our families home was actually
07:04burned down,
07:05and that was set on fire and burned down.
07:08So this was very significant
07:10early in my life.
07:11And and that the life of my family.
07:15The experience that I'm describing,
07:17the experience of being an
07:19insider and an outsider,
07:20were familiar to me even before
07:22migrating to the United States.
07:24The internalization of these events in
07:27my early childhood was met with a new
07:30set of experiences of discrimination,
07:32xenophobia and racism in the United States.
07:35I had not identified as an Indian
07:37person or a person of color until
07:40after migrating to the US in India.
07:42I was a Hindu of a particular
07:44subcaste that was our.
07:46Family identity in the US.
07:48We adopted different labels.
07:50Asian American, South Asian,
07:52Indian American, Person of color and so on.
07:55In the US,
07:56race takes a particular form.
07:58When you're not categorized black
08:00or white indigenous,
08:02you are often seen as on the outside.
08:05Yet I know that I'm not on the
08:07outside of American race politics.
08:10Indians in the US,
08:11more broadly S Asians have
08:13like every other cultural group
08:15that is raised upon migration,
08:17have a framework for understanding race.
08:19More often than not,
08:21these frameworks are less visible and more
08:23likely to be dismissed by notions of.
08:25Immigrants, as people who choose to
08:27come to the US, and indeed immigration
08:30often entails a choice, we know,
08:33however, that immigration is certainly
08:35not a choice for all people,
08:37and certainly not a choice for children,
08:39and it is also not a choice
08:41to become racialized.
08:42Many adults who immigrate to the US
08:45are actually quite unaware of the deep
08:48entrenchment of racial politics in the US,
08:50and its impact on their lives and their
08:53children and grandchildren's lives.
08:55Moving on from that early immigration
08:59story or pre migration story in
09:02my early adolescence in the 1980s
09:04I lived in northern New Jersey,
09:06so we had moved from the Bronx
09:08to a a white suburb,
09:10an almost all white suburb
09:12suburban northern New Jersey,
09:14and this was an era that later
09:16became known for the dot Busters.
09:18I don't know if people are familiar
09:20with who the dot Busters are.
09:22Most people are not.
09:23So let me just briefly tell
09:25you who they were.
09:26The dot Busters were a a street gang,
09:29a white St gang that victimized
09:31people of South Asian origin during
09:33this era in the 1980s and into
09:36the early 90s there was an influx
09:39of South Asian immigrants in the
09:42in New Jersey as well as northern
09:45Pennsylvania in the Philadelphia region,
09:47and so.
09:48This was a gang that would sort of
09:51go around and harass kids adults and
09:54it was and from verbal harassment
09:56all the way to murders.
09:59So this was not something however that
10:01was covered in the national press.
10:04We did not see media coverage of these
10:07these incidents and they were quite frequent.
10:11And interestingly South Asian immigrants
10:13who have arrived more recently to
10:16the US are unaware of this history.
10:19Of the dot Busters,
10:20because the history has not been passed on
10:23through any kind of formal systemic sense.
10:28But to give you a sense of the impact
10:30of the dot Busters on my family,
10:32my brother and I often walked home
10:34from our predominantly white school,
10:36feeling anxious about whether or not
10:38we would be followed and harassed
10:40by white kids from a neighboring
10:41town who would seek us out on
10:43The Walking path from school.
10:45Our home was vandalized with
10:47racial slurs at into the snow
10:49in our front yard in do go home.
10:52It's painful events made it very
10:53clear that being seen as different
10:55meant that one is an outsider,
10:57even though on the outside we were
10:59seemingly acculturating to mainstream
11:01culture and learning how to participate
11:03from the inside at school and at work,
11:05we spoke English fluently,
11:07wore Western dress 8 Western food.
11:10However,
11:11these changes does not did
11:12not secure insider status,
11:14but instead created feelings of otherness
11:17and hopelessness about belonging.
11:18The problems of xenophobia and
11:20racism as we know continue from
11:22one generation to the next.
11:24Well, you could say.
11:25Well that was back then.
11:26It was the 1980s and so on.
11:28But of course I know,
11:29and as so many others that these problems
11:32persist and I have two sons now,
11:35one who is a young adult
11:37and adolescent son as well,
11:39so knowing their experiences and
11:41seeing the kinds of stereotypes
11:43and discriminatory behavior that
11:45they've had to grow up with
11:48since they were in preschool,
11:49we know that this is an
11:52intergenerational problem.
11:53So I'm sharing these personal
11:54experiences I'm starting.
11:55Off with this as a way of recognizing
11:58explicitly that we each bring our own
12:00experiences of racism and xenophobia
12:02with us to the clinical encounter.
12:04So today I want to explore
12:06with you the dynamics of race
12:08and racism in recent years,
12:09with a particular focus on racial
12:11minority immigrants and how these
12:13dynamics impact psychotherapy from
12:15a psychoanalytic perspective.
12:17We're all aware that more explicit
12:19forms of racism have heightened since
12:22Trump's presidential campaign and in
12:23the midst of the COVID-19 pandemic.
12:26As racial minorities have been
12:28targeted with harassment and
12:29violence and victimized by the
12:31virus as disproportionate rates,
12:33and blamed for causing and
12:35or spreading the virus.
12:38To situate the context of
12:39racial minority immigrants,
12:40it's important to consider the growth
12:43of immigrant populations in the US.
12:45In 2017, there were about 44,
12:47a little over 44 million immigrants
12:49in the US,
12:50so that's about close to 14%
12:53of the population.
12:55This number reflects an increase of over
12:57four times as many immigrants since 1960,
13:00and so we have a growing number of
13:03first and second generation immigrants.
13:05And just for terminology,
13:07first generation.
13:08I'm referring to those people
13:10who arrive to the US as adults
13:12in the second generation.
13:14As US born children of immigrants
13:17and the 1.5 would be people like me,
13:19who are who arrived as children are
13:22very early in adolescence since 2016,
13:25there's been a rise in explicit
13:27forms of racism.
13:28In fact,
13:29the term Trump effect has been used
13:31by psychologists like Phil Zimbardo
13:34to describe the notable increase in
13:37racializing of phobic misogynistic.
13:39Homophobic and transphobic bullying
13:41in schools since the election
13:43and the murder of George Floyd
13:46has awakened many to the violence
13:48and brutality directed against
13:50black people and more broadly,
13:52other people of color are the
13:53bipac folks at the hands of police.
13:56At the present time,
13:57are out the pandemics outbreak
13:58is rife with racist sentiment and
14:01attacks against Chinese Americans and
14:03those who perceive were perceived to
14:05be Chinese or East Asian descent.
14:07I want to just say a couple
14:09things about Asian Americans,
14:11since this is an area that I focus
14:14pretty heavily on in my research
14:17and and a group that is highly
14:19invisible and visible at the same
14:21time just to sort of elaborate
14:23on this impact of racism,
14:25particularly for youth.
14:27Following the Atlanta Spa shootings.
14:30If you recall this and back in March of 2021,
14:33the Pew Research Center conducted a
14:35survey in April just the following month.
14:37The month following those shootings,
14:40and they focused a survey on anti
14:42Asian discrimination and what they
14:44found was that 32% of Asian adults said
14:47that they had feared someone might
14:49threaten or physically attack them.
14:51The vast majority of Asian adults like 81%,
14:54also say violence against them is increasing.
14:57Far surpassing the share of all US adults,
14:59which is about 56% who say the same.
15:03Another study with Chinese American
15:05parents and kids between March 2020 and
15:09May 2020 indicated that nearly half of
15:12parents and children were targets of
15:15online COVID related discrimination.
15:17So as you all may know,
15:20we Asian Americans constitute a
15:22highly heterogeneous population with
15:24regard to national origin, ethnicity,
15:26and among many other things and.
15:28And we also differ with regard
15:30to physical markers of racial
15:32categorization and our families carry
15:34very unique histories with colonization.
15:36Depending on our parents or
15:39grandparents birth countries.
15:40However, if we look at any kind of
15:44psychological research or practice, really.
15:46We are often homogenized.
15:48We're sort of lumped together as
15:50one category of Asian Americans,
15:52and this pure this.
15:54This sadly dismisses the distinct
15:58experiences of culture, race,
16:00among other aspects of social location,
16:03and so socio cultural differences
16:05tend to become routinely erased.
16:07We're simply Asian or South Asian to
16:10those outside of our communities.
16:12We also hold a unique position in
16:15broader racial hierarchy in the US,
16:16where minoritized objects,
16:18when it is convenient and we are also
16:21viewed as privileged and model minorities.
16:23Also,
16:24when it's convenient either way,
16:26our subjectivities are largely
16:28diminished and ignored,
16:29and even within our mental health
16:31professions we are seen as racial minorities,
16:34often when it suits other people.
16:37So I want to share with you an
16:38example of this invisibility.
16:40Recently I began working with a
16:42high school senior.
16:43Who's an Asian American boy?
16:45He's a young man now he's Chinese
16:47American and I he he reached out to
16:50me because he was interested in a
16:52research project focused on raising
16:54awareness of mental health concerns
16:56among Asian American adolescents
16:58in his school.
16:59And so when I met him and I asked
17:01him about his experience of being a
17:04Chinese American boy in his school.
17:06He told me that he didn't quite fit
17:08into the stereotype of Asian boys.
17:10He's a football player.
17:12He loves academics.
17:13And developed a program in his school
17:15to support Asian kids deal with mental
17:18health distress and then he proceeded
17:20to tell me that the White and Black
17:23teammates that he has been playing
17:25football with for a very long time.
17:27Now for a number of years
17:29don't really understand him.
17:30One of his white teammates in fact
17:32told him I like Asians because you
17:35guys don't complain about racism.
17:38So you can imagine what that might
17:40have felt like for this young man
17:42to hear that I like you because
17:44you don't complain about racism and
17:47what that means about who he is.
17:51My mentee was taken aback at this
17:53moment and once again felt invisible.
17:56One of the most striking things
17:57to me about this incident is that
17:59his teammate is fully aware of the
18:01fact that Asians experience racism,
18:04but made it clear to him that
18:05he didn't want to hear about it.
18:07And expected his friend his teammate,
18:10to comply with his demand.
18:12In contrast to this experience of
18:15invisibility, Asian Americans can
18:16become hyper visible when there's a
18:19perceived threat to non Asians in the
18:21US and other regions of the world.
18:23For example, Asian American kids are
18:24bullied based on their physical features,
18:27the shape of their eyelids,
18:28their skin color,
18:29and in the aftermath of the Trump election,
18:32we're routinely told that they would be
18:34rounded up and sent back home by both
18:37peers and teachers across American schools.
18:39They're told that they're innately
18:41smart and their peers randomly
18:43asked them to do their homework,
18:44particularly their math homework.
18:46They're told that they're
18:48terrorists and dangerous exotic,
18:50smelly, asexual, and passive.
18:52Think about all of the terms that I
18:55just used, and the contradictions.
18:59And the contradictory messages that
19:01kids hear from a very very early age.
19:06So I want to move to sharing some
19:09perspectives from psychoanalysis on
19:11the xenophobia and the racism that I
19:14had just described and beyond that.
19:16Of course, xenophobia manifests in
19:19intrapsychic and interpersonal realms,
19:21and as such psychoanalytic perspectives,
19:23in my view, can elucidate understandings
19:26of prejudice and aggression.
19:28So analysts have written about the role
19:30of early life experiences like separation
19:33anxiety as fundamental to developing benign.
19:36Prejudice as a way of differentiating
19:39specific objects of attachment
19:41like parents from other objects
19:43with regard to the development of
19:46malignant or harmful prejudice.
19:48Henry parents underscored the role of
19:51ambivalence towards objects of attachment,
19:53implicating the use of defenses
19:56like projection and denial.
19:58The role of childhood trauma and neglect,
20:00and the demands for children
20:03to identify with their parents.
20:05Relatedly,
20:05Vamik Volkan emphasized the role of
20:09parents transmitting traumatized self
20:11and object images related to traumatic
20:14dislocation into a child self representation,
20:17and he described a process called depositing,
20:20and he pointed out that depositing
20:23is distinct from identification,
20:25and that depositing involves an adult,
20:27mostly unconsciously using a child to
20:30become a reservoir for certain self and
20:33other images belonging to that adult.
20:36So what he's talking about here is the
20:39ways in which parents can unconsciously
20:42transmit prejudice beliefs to their children,
20:45but not only sort of pass on beliefs,
20:48but in fact believing the child
20:51believing the same beliefs as the
20:53parents actually is a contingency
20:56for an attachment with that parent.
20:58So it's not just about sort of
21:01intergenerational transmission
21:02of cognitive beliefs,
21:03but what he's describing as
21:05an affective component.
21:06Where in fact the parent is making an
21:10unconscious effective demand that you
21:12must believe these things that I believe
21:15in order to maintain an attachment to me.
21:18And so this is where this is the
21:21distinction between identification
21:22and this idea of depositing.
21:25It's important to consider that the
21:28intergenerational transmission of traumatic
21:29stress and prejudice can encompass a
21:31wide range of defenses such as denial,
21:34projection and rationalization.
21:35For example,
21:36a parent who's experienced by a child
21:39as loving and attentive and who holds
21:42negative attitudes towards immigrants,
21:43may consciously or unconsciously
21:45communicate these attitudes and expect
21:47that the child carries similar negative
21:50attitudes as a content as a condition
21:52for maintaining a sense of connection.
21:55So in this way.
21:56A child becomes a container for hateful
21:59attitudes that are often dissociated
22:01from loving images of a parent.
22:04Illini Cogan,
22:05who is an Israeli analyst,
22:07further noted that xenophobia has roots
22:09in early childhood when an infant's
22:12fear of strangers can mark the quality
22:14of a relationship with a caregiver,
22:16and specifically whether the infant develops.
22:19A response of curiosity or that of fear.
22:22And what Cogan does is refer to
22:25a basic interpersonal survival
22:26mechanism in infant development,
22:28and she suggested that strangers represent
22:31an attack on our inner equilibrium,
22:34and that rather than tolerating
22:36this T stabilization,
22:37we hold the stranger responsible.
22:40Therefore,
22:40an inner conflict becomes externalized
22:43and aggressed upon someone
22:45who has less social,
22:46political or economic power.
22:48The stranger, then,
22:49is seen as the one who is dirty, lazy,
22:52stupid, exotic and violent, non human.
22:56It's important to consider that
22:58xenophobia and racism internalized
23:00in childhood and adolescent are not
23:03not only located in family dynamics
23:06and parent child interactions,
23:08but also in the schools,
23:09neighborhoods, workplaces,
23:11different communities, political groups,
23:13and social media communities.
23:16Uhm? Salman Akter,
23:18who is a well known
23:20analyst from Philadelphia,
23:22noted that defenses underlying
23:24prejudice become rigid as individuals
23:26show little or no interest in
23:28others who are different from them.
23:30With regard to religion,
23:32culture and race and socialize within
23:35their own socio cultural groups and
23:37what he described was something
23:39called unmet lcisd xenophobia,
23:41and this is sort of the consequence
23:43of the defensive structure that he
23:46talks about and what happens in.
23:48Fundamentally, xenophobia is that it impact.
23:50This impinges on our ability to
23:52develop a sense of cooperation,
23:54develop friendships with people
23:56who seem like strangers to us.
24:00Returning to Ilani Hogan for a moment,
24:02Kogan presents a very interesting question.
24:06Actually in her work.
24:08And this is a question regarding
24:10the inner life of majority
24:11status individuals and groups.
24:14So in the United States,
24:15we think from a racial perspective
24:18these are people who are
24:20white or perceived as white.
24:23She stated liberal thoughts and
24:25international human rights laws
24:26recognize the rights of minority groups
24:29to maintain their cultural identity,
24:31but assume that majorities have
24:33neither a need for similar rights nor
24:36a moral ground for defending them.
24:38Cogan's point can be extended to the
24:40invisibility of whiteness in the US,
24:42and more specifically within
24:44the clinical encounter.
24:45For example,
24:46when I've asked many of my white
24:48patients about their ethnicity and
24:49this is something I would do routinely
24:52tell me about your background,
24:54your describe your ethnic background,
24:55your racial background.
24:58Many of my white clients will say
25:01that they don't have enough ethnicity,
25:03but instead say I'm just white.
25:06So the transference dynamics in
25:08these moments with these patients
25:10at times reflects their anger and
25:13their envy about not having an ethnic
25:15identity that is visible to others
25:17and at other times reflects their
25:19guilt and shame about having the
25:22ability to choose whether or not
25:24to think about ethnicity or race.
25:27These dynamics can also indicate
25:28A wish to wait,
25:30a wish to maintain white privilege,
25:33as there's an implicit message in
25:35stating I'm just white that conveys
25:37the feeling that their Indian American
25:39therapist is the one that is different,
25:41unusual,
25:41and that their whiteness is the
25:44standard reference point against which
25:47might Indian background is perceived.
25:49In all of these cases,
25:51the clients wish to be seen is
25:53diminished by a disavowal of
25:55family migration and find,
25:57and really the family migration history
26:00and messages of white that standard,
26:02privileged and oppressive.
26:07I want to move to saying a few
26:09things about the experiences
26:11of racial minority immigrants.
26:13Xenophobia and racism have profound
26:15effects on how immigrant youth and adults
26:18experience themselves in relation to
26:20others and on their sense of belonging,
26:23immigrants and their kids negotiate conflict,
26:26identity, belonging and health
26:28within the parameters of constraint
26:31delineated by xenophobia and and racism.
26:34In his essay, the Mental pain of
26:37Minorities Salmen Dr pointed out that
26:40minorities are not just people who
26:43exist in smaller numbers but the but
26:46rather they're they become colonized.
26:48Subjects have less voice representations
26:51and often fewer resources.
26:53He suggests that being a minority
26:55reflects cumulative trauma where the
26:57protective and holding functions of the
27:00society at large accrue overtime and put
27:02a silent but palpable strain on the ego,
27:05both at the individual and collective level.
27:09An important paradox is put
27:11forth in his perspective.
27:13And this is the he asks.
27:16A really interesting question.
27:18Actually he poses the following question.
27:20Pointing out that the majority group
27:22tends to ignore the presence of the
27:24minority group and at the at the same time
27:27unconsciously desires the minority group,
27:29which becomes a target for externalizing
27:32paranoid and depressive anxieties.
27:34So he poses the question if one
27:36is not wanted but does exist,
27:39then what is 1 to do with one's existence?
27:42So let me repeat that.
27:45If one is not wanted,
27:46but does exist,
27:47then what is 1 to do with one's existence?
27:51It's often the case then,
27:52that racial minority immigrants
27:54experience anxiety,
27:55confusion,
27:55and despair related to not knowing how
27:58to be fully seen and present and at the
28:01same time invisible to the majority group.
28:04One has to then potentially sacrifice
28:06authenticity to be seen and accepted by
28:09the majority group and secure safety.
28:13I want to mention also in
28:16the context of development,
28:17a series of studies with immigrant children
28:22that really support the psychoanalytic
28:26literature that I've just presented.
28:29And one of the sets of studies was
28:31conducted by Corolla Suarez Orozco,
28:34who is an amazing researcher who is now at
28:37the University of Massachusetts in Boston,
28:40and she LED a huge set of immigration
28:44studies with children in elementary schools,
28:48and this was back in the early 2000s.
28:51And by the way, the the findings that I'll
28:53share with you have been replicated with
28:56children and adolescents since then into,
28:58you know, as as.
29:00Early as a couple years ago.
29:03But one of the things that she did was
29:05provide a sentence completion task.
29:06So again from a psychoanalytic perspective,
29:09using methodologies that sort of support,
29:13you know, open-ended kinds of questioning
29:16and responses on methodologies and research.
29:19She provided us some sentences
29:21to complete to these children.
29:23They were third and 4th grade
29:25children who are Mexican American,
29:26Chinese, American,
29:27and Haitian American and and the children
29:31were given sentences like the following.
29:33People in my family think that I am blank.
29:37The second sentence would read.
29:38Most Americans think that I am blank.
29:41In the first,
29:42in the in terms of the responses
29:44to the first sentence,
29:45people in my family think think
29:47that I'm blank.
29:48The kids would say things like people in
29:50my family think that I'm funny people in
29:53my family think that I'm smart people
29:55in my family think that I'm silly.
29:57So all the kinds of adjectives you might
29:59find in an elementary school aged kid.
30:01And then the second sentence,
30:04most Americans think that I'm blank.
30:07The kids would say things like
30:09most Americans think that I smell.
30:11Most Americans think that I am stupid.
30:14Most Americans think that I am lazy.
30:18The adjectives that were used by these
30:20children exactly matched the type of
30:23ethnic and racial stereotypes that
30:24you might expect of Mexican Americans.
30:27Haitian Americans and Chinese Americans.
30:29And so.
30:31What Corolla and her research did was
30:35coined this phenomenon as social mirroring,
30:39so she extended winnicott's idea of
30:41mirroring in the caregiving context
30:44between an infant and a caregiver
30:46or a toddler and a caregiver into
30:49a social context.
30:50A broader social context outside
30:52of the caregiving relationship.
30:54And so this concept of social
30:56mirroring has become incredibly
30:58important for us to understand,
31:00because in our typical intake
31:02forms and in our professions,
31:04we ask about the family context a great deal.
31:06But very until very recently we have
31:09not asked questions about social
31:11contacts and how that's impacting
31:14child development from an early age.
31:17And now, of course,
31:19what's happening on social media.
31:21In addition to what may be happening at
31:24school and other other physical locations
31:27that children and adolescents interact in.
31:30So I wanted to mention that as.
31:34The research,
31:35in conjunction with what we know
31:38from the psychoanalytic literature,
31:41is critical,
31:42in my view,
31:43to really understand the complexity
31:45of what is actually happening,
31:46what's being internalized from an early age
31:49for children and adolescents. In terms of.
31:53Negotiating socio cultural identity.
31:55In this context that I'm describing,
31:58there are a few things that I
31:59just want to point out and I
32:01want to share with you a case.
32:04A case vignette.
32:05Before I wrap up today.
32:07So when we think about negotiating
32:11socio cultural identity,
32:12whether we're talking about childhood,
32:14adolescence, or adulthood.
32:17Adapting to new and divergent
32:19cultural context can necessitate the
32:21compartmentalization of experience,
32:24or we call subjectivity in psychoanalysis
32:27and also form dissociated self states.
32:29There's a lack of sense of continuity
32:32and immigrant experiences that typically
32:35remains unconscious as efforts to meet
32:37the demands of survival in the new
32:40cultural context dominate everyday life.
32:42In fact, for many immigrants,
32:44securing economic stability
32:46and family structure.
32:48Attaining access to education,
32:50navigating language.
32:51These are some of the key
32:53aspects of survival.
32:54Immigrants also try to seek a better
32:57future for their children in relation
32:59to opportunities available in a country
33:02in the compared to the country of origin.
33:05So the psychological loss was inherent
33:07to cultural change or perceived
33:09as necessary sacrifices for full.
33:11For meeting these goals.
33:14Additionally,
33:14the conflicts associated with
33:16cultural shifts lie largely
33:18an unconscious experience.
33:20As immigrants forge on towards adapting
33:22while at the same time retaining
33:25heritage culture and minimizing
33:27the pain of loss and separation.
33:30Importantly,
33:30the second later generations have
33:34done experiences compared to
33:36earlier generations of immigrants.
33:38The second generation typically
33:39seeks to both retain aspects
33:41of their heritage culture and
33:44mercin mainstream society.
33:45Moving beyond the goal of this survival
33:48that I just described growing up in
33:50the US poses fundamental differences
33:53in second generation racial minority
33:55immigrants as they develop a sense
33:57of identity within a context of race,
33:59gender and sexuality that contrasts
34:02with that of their parents.
34:04Empirical studies in fact indicate
34:07that stress related to racism while
34:10experienced by immigrants of all generations,
34:14have has a greater negative impact on
34:182nd generation racial minority immigrants.
34:20And in fact,
34:22these findings parallel the
34:23immigrant paradox,
34:24which is a phenomenon that we
34:26find in immigration research where
34:28second generation racial minority
34:30immigrant origin people have been
34:32found to have worse mental health.
34:34In the educational outcomes when
34:37compared with the first generation.
34:40So.
34:41This is called the immigrant paradox,
34:44of course, because you would
34:45think this is counter intuitive,
34:47but in you know,
34:48and this is what immigrant parents assume
34:50that their children are better off than them.
34:53That in fact that they will be.
34:55They will develop a better
34:56sense of belonging.
34:57They won't carry my accent,
34:59they'll be able to communicate better.
35:01They'll understand the
35:02educational system better.
35:03They will blend in better,
35:05and that is the typical hope.
35:06But we're we're finding and mental health
35:09research is actually quite the opposite,
35:11but the longer you stay in the US.
35:13The worse your educational and
35:16mental health outcomes become,
35:18and this has been found across
35:21different racial minority immigrant
35:24samples, including Asian American
35:28Latinx and Africa Caribbean
35:32communities. And more recently,
35:35with African immigrants as well.
35:39The the studies you know this study is
35:42composing the immigrant paradox findings.
35:45They call attention to the divergent
35:48developmental experiences of 1st and
35:512nd generations and the dilemmas arising
35:54from acculturation gaps as well.
35:56If you are familiar with this
35:59concept of acculturation gaps,
36:00I'm not sure if this is something that.
36:05You've heard of or?
36:06This is something people
36:07are mostly familiar with,
36:08but this acculturation gaps,
36:10typically referred to the idea that
36:13the younger generations in an immigrant
36:16home tend to have worldviews that match
36:19more mainstream American attitude,
36:22so they're more Americanized.
36:23You know, sort of the the
36:25term that's used typically,
36:26and the older members of the family
36:28tend to have more traditional
36:30views that are oriented towards
36:32a heritage culture, which.
36:34Certainly captures one part
36:37of this acculturation issue,
36:39and what happens in psychotherapy is
36:41that there's this assumption that,
36:44OK, the older members and have these
36:46traditional views and the kids want
36:48to be more American and so that tends
36:50to be the location of the conflict
36:52that's typically explored in psychotherapy.
36:55However,
36:55one of one of the things.
37:00That is complicating and is not it's.
37:05It tends to be far less
37:06visible in our literature,
37:08which has huge implications
37:09for psychotherapy practice.
37:11Is the fact that acculturation
37:13acculturative stress is a process
37:15that happens outside the home,
37:17and what happens is that the parents
37:20might be experiencing racism or
37:22culture distress of other types.
37:25The children may be experiencing
37:26racism and other types of
37:28acculturative stress outside the home.
37:31But this these are these processes
37:34are occurring independent of the
37:36family dynamics and the parents
37:38and the children typically are not
37:41talking about this with each other.
37:43The kids typically don't want to
37:45burden parents with their stress
37:47and sometimes feel like their
37:49parents would not understand anyway,
37:51what they're going through and the
37:54parents may not be sharing everything
37:56that's happening to them because
37:58their key goal may be to survive to.
38:01To forge forward, keep going,
38:04move on,
38:04and so the disconnect happens in
38:07psychotherapy when the therapist
38:09assumes that the location of the
38:11problem is solely between family members,
38:14that this is a family issue.
38:16This is an intergenerational
38:19acculturation conflict.
38:20Rather than locating the social
38:22context as placing demands on each
38:25of the family members who are trying
38:28to acculturate in their own way.
38:30So there is this gap in.
38:31Understanding and communication
38:33that develops,
38:34but if we're not exploring social
38:36context and the demands that
38:38each member of a family face we,
38:40we really don't have an understanding.
38:42A complete understanding of what these
38:45conflicts might be and the sources
38:48of distress for each member of a family.
38:51So this is.
38:52This is why this research
38:54on acculturation and or the
38:56psychoanalytic conceptualizations of
38:58of acculturation can be so critical.
39:00Because a large part of this is unspoken,
39:03unspoken,
39:04and unconscious dynamics that
39:06are typically not tapped into.
39:11I think that I might have time to share.
39:16One quick case with you,
39:19before I just open this up for questions.
39:23This is of a of a a a man that I have
39:28worked with for in longer term psychotherapy
39:31for a couple of years that I wanted to
39:34share just to kind of illustrate some of
39:38the complexity of navigating identity.
39:40This is a a 43 year old Sikh,
39:44Indian American man, heterosexual cisgender
39:46man from a middle class background.
39:49His name is Arjun.
39:50I call him Arjun.
39:51He emigrated from an urban area of
39:54northern India to the US when he was three.
39:58And when I saw him,
39:59he had been coping with a depressed mood.
40:03Related to a divorce, A met,
40:05a separation and his divorce had just
40:09become finalized and he has joint custody
40:12of a 9 year old daughter at that time.
40:15And he was very worried when
40:16I met with him that he feels a
40:18strong connection to his daughter.
40:20He was very worried about the loss
40:22of a sense of family stability
40:25because of this divorce.
40:26Arjun and his parents left their
40:28extended family home in India,
40:30moved to the US in the 1980s after
40:32being sponsored by a relative and
40:34they moved to a rural area of the
40:37Midwest where his parents worked in
40:39a hotel business managed by Arjun's,
40:42relative and outside of this extended
40:45family which included his uncle and aunt,
40:48they had little access to an Indian or
40:50Sikh community in about 2 years later,
40:54Arjun's younger sister was born.
40:57The the parents became more and more
40:59involved in a community of Indian Americans.
41:01Much and much of his social life
41:04would center around this community.
41:06Afterward.
41:07At school,
41:07he was quite isolated,
41:09particularly during middle school
41:10and high school,
41:11where he felt different from the
41:14predominantly white students and teachers.
41:16And he was frequently bullied
41:18and in two incidents was beaten
41:20up by two different kids.
41:21In both incidents he had
41:23suffered physical injuries,
41:24although the school really
41:25didn't provide any protection.
41:27For support no,
41:28no repercussions for the boys
41:30who had assaulted him either.
41:32He also faced racial slurs such
41:34as sand and word and ***** ****
41:37throughout his adolescence.
41:38He rarely told his parents
41:39about these experiences.
41:41In fact,
41:42he didn't tell his parents about
41:43being physically assaulted until
41:45his mother noticed that he had been
41:47covering his face with his hair.
41:49And then when she learned about it,
41:51he begged her not to say anything because
41:54he didn't want face more ostracized.
41:57After more opposition from his peers.
42:02In addition to coping with
42:04racial violence at school,
42:05he endured significant stress related
42:06to his parents experiences of racism,
42:09in particular his father,
42:10who had worn a pug areora turban during
42:13his initial years of living in the US,
42:15faced verbal harassment from white
42:17people in their town on a regular basis,
42:20his father decided to stop wearing
42:22his thuggery and cut his hair
42:24when Arjun was eight years old,
42:26he described Arjun and our session with me,
42:29described this moment as both a relief and
42:32as one of the saddest times in his life.
42:35His his father told him that he too
42:37should not wear a bugri when he's older,
42:39as this would invite trouble
42:41quote invite trouble.
42:43In about 2 years after this incident,
42:45Arjun's family's home was vandalized
42:48as well and again no, no help.
42:51Sort of given to the family at this time.
42:54I work with Sergeant.
42:56For about three years and
42:58when I first met Arjun,
43:00he indicated that he wanted to
43:02meet with an Indian American
43:03therapist as he felt increasingly
43:06disconnected from his Indian American
43:08identity and his extended family.
43:10So by meeting with me,
43:11he thought that this he
43:13could explore this further.
43:15In his adolescence,
43:16Arjun Cope with his experiences
43:18of racial trauma,
43:20primarily by withdrawing from others and
43:22firing a variety of books he loved reading.
43:26He excelled at school.
43:27He went to college and and
43:29while he was in college,
43:31he at college he developed a close
43:33group of South Asian American friends
43:35and he fell in love with a young
43:38woman who was Sikh American and
43:40they dated for over three years.
43:42Tragically she passed away due to a terminal.
43:45Illness leaving her family
43:47and argente devastated.
43:49He told me in one session that he had
43:51never gotten over this and I don't think
43:53I ever will which to which I responded.
43:55I don't know how one would ever get over,
43:58and you know something like this,
44:00but he cope with this loss by focusing
44:04almost exclusively on his on his work,
44:07and he visited his family occasionally,
44:10but overtime became more
44:12disconnected from them.
44:14In his late 20s,
44:15he met a co-worker whom he later
44:17dated and eventually married.
44:19His former wife is a white SIS woman
44:22with Scottish and German ancestry,
44:24and he described her as someone who
44:26brought some vibrance in his life.
44:28Although he cared deeply about her,
44:29he felt as though something
44:32was missing in the marriage.
44:34In particular,
44:34he would say it was almost like she didn't
44:37want to talk about our differences.
44:39You know, like,
44:40let's just be colorblind.
44:42I think the differences were
44:44too much for her.
44:45And yet having a biracial child.
44:50Made it very complicated between the
44:52two of them because he felt that she
44:54was disinterested in his Indian and
44:56Sikh heritage and he would sort of
44:58take his daughter to the gurdwara
45:00by himself and over the course of
45:03time the gurdwara being a place of
45:05worship over the course of time.
45:07He felt as though.
45:09His wife was disinterested in it and
45:12so he became increasingly resentful.
45:17In the course of psychotherapy,
45:18he would share his sadness and
45:20grief at the end of their marriage
45:23and felt increasingly isolated,
45:25and he would say that that he didn't
45:29know that anybody could understand him.
45:31And then in about the third
45:33month of working together,
45:34he said,
45:34I don't know how much to say about
45:36what I went through with my
45:37girlfriend in college or with my wife.
45:39It's hard to know who will really
45:41understand and he would make comments
45:43like you probably have Indian friends and
45:46you probably connected to being Indian.
45:48And and in these moments,
45:50Sergeant expressed his experience
45:52of not being understood,
45:54and his fear that nobody,
45:55including me would really know him fully,
45:59and I would respond to him by saying,
46:00I'm wondering if you think
46:02if you think that I too,
46:03I'm not interested in knowing how you
46:05really feel about Indian and then he
46:08would say sometimes I worry that you
46:10might not see me as Indian enough.
46:12I'm I'm giving you an example of
46:15how these types of dynamics come up,
46:17but for the sake of time I'll
46:19wrap up and and leave it there,
46:21but but I wanted to just share with
46:23you an example just to give you a sense
46:27of the complicated dynamics that.
46:31I think so many first and second
46:34generation folks really contend with
46:36in the psychotherapeutic process,
46:38so I'll wrap up with that.
46:39I know we're short on time, so.
46:43Hey so questions, comments. It did.
46:50There was so much for your talk,
46:54it was just absolutely wonderful.
46:57You know, I was interested in
46:59this concept of depositing,
47:00and I wondered if you could elaborate
47:02on that a little bit. I mean,
47:04there's so much to say about this book,
47:07recent case that you described,
47:09and so much about psychotherapy.
47:11But can you say a little bit more
47:13about the concept of depositing I?
47:15I was very interested in
47:17understanding that, sure,
47:18so this idea of depositing I can share
47:21with you another brief example that
47:23might illustrate that a little bit more,
47:26and a case that I had.
47:27Written about and it was published
47:31last well actually now two years ago,
47:34but this is of of someone who
47:37is an Irish American man who was
47:40sexually assaulted by a priest as
47:43when he was a child and his parents
47:46initially didn't believe him.
47:48Then they did believe him and then
47:50they sort of disconnected from the
47:52church and they never spoke about
47:54the abuse again and they the.
47:57Parents held a very strong
48:00negative views about immigrants,
48:03racial minorities and and so I had seen
48:09this particular patient during the
48:11Trump election years and and during the
48:14Trump years and after the election he.
48:18We had a session and he was
48:20very excited and he said I'm,
48:23you know we won and he was thrilled.
48:25And so I was really taken aback.
48:28Up until this point in our work
48:30we had really been working on US
48:32trauma and processing his trauma.
48:34And so in that moment,
48:37there's this clear difference
48:39between the two of us.
48:42And over the course of time we've been
48:45exploring his feelings about racial
48:48minorities in general immigrants,
48:49and he would sort of make me an exception.
48:52You know, you worked hard for what you have,
48:54but these other people.
48:55They're the problem.
48:56You know.
48:57And increasingly,
48:58we had more explicit conversations
49:00about this.
49:01But for him,
49:03these these ideas that he was raised with.
49:07Were really embedded in maintaining
49:11an attachment to his parents,
49:14which was already problematic.
49:16He did not feel protected by the
49:19same people who he was desperately
49:21trying to hold onto in some way,
49:24and so those negative kinds of feelings,
49:27beliefs that he had about racist
49:31beliefs really were entangled
49:33were intertwined with this
49:35attachment that he had with his.
49:37Parents that were complicated.
49:40And so.
49:41To ask somebody to no longer
49:43believe what they believe is
49:45also asking them to detach from
49:47people they love or want to try
49:49to maintain some connection with.
49:51And we all can relate to this
49:53in some capacity or another,
49:54but for him it was quite profound,
49:56so this is an example of what Vamik
49:58Volkan has described as depositing.
50:03That's wonderful, great explanation.
50:05It's helpful for me as a therapist to
50:10think about that. In terms of the,
50:13you know I haven't thought about it
50:15in terms of attachment and that's
50:17really important to think about.
50:19Other comments and questions people have.
50:25I may I was, you know,
50:26I'm just thank you for that wonderful talk.
50:28Very interesting perspective and I just
50:31wondered they contacted the social
50:33mirroring studies that you discussed.
50:34At what age were those children
50:37who were giving those responses?
50:39Seems quite quite sad and tragic
50:41really, but I just wonder how early we like
50:43to see those kind of responses emerge.
50:45So those studies were done with
50:473rd and 4th grade students,
50:50so we're talking like you know 789
50:53year olds and and what we found
50:56though other studies we we see this
50:59kind of these kinds of reports
51:01coming much earlier than that.
51:03So those were just one set of studies
51:05that we see that these kinds of attitudes
51:07are internalized from the time that
51:09children step outside their homes and
51:11neighborhoods into a school setting.
51:13So you know,
51:14we're talking about preschool age kids.
51:16Uhm? Yes, and and also just
51:20learning awareness of differences,
51:21even if they're not evaluative.
51:23You know, I remember my son when he was
51:26one of my kids who when he was three,
51:29coming home and saying like I, you know,
51:32I didn't know I was brown, you know.
51:34And so this was something that you know
51:37he recognized after he left our house.
51:39And you know, and it was,
51:42it became more of a blatant.
51:44Recognition,
51:44and you know when he was in
51:47school and also you know,
51:49since Corolla studies in my own
51:52research the the types of comments
51:55that kids were receiving were
51:57not only in the context of peers,
51:59they were also from the adults at school.
52:02So I've done some studies with
52:04adolescents that report that it's my
52:07teacher who would say things to me.
52:09That made me feel different,
52:12less than, or assumed that I was
52:14smart because I was Asian.
52:15Or stupid because I'm Haitian,
52:18you know.
52:20So these are the types of things that we've
52:22heard from kids in our studies as well.
52:30Martin, do you have a question?
52:34I know you do, I do. I do thank you.
52:38First of all, doctor Tim Allen R.
52:41Thank you so much.
52:42This was a terrific presentation
52:44and I give you extra kudos
52:46for the gift of no PowerPoint.
52:49Amazing, so that's the first
52:52thing I have a question.
52:53You cited a couple of times.
52:57Salmen actor who is one of the most beautiful
53:01writers and thinkers and psychodynamics and.
53:05Hi, I read years ago I haven't been up on it,
53:08but he speaks a lot about language
53:11switches and what that does in therapy
53:14in general and as a native Spanish
53:17speaker now mostly English speaker.
53:20But dealing with that I'm I'm
53:22just curious in how that has
53:24played out in your in your work.
53:26And again,
53:26thank you so much for a wonderful talk.
53:28Thank you so much.
53:30It's such a great point.
53:31And yeah, someone's work is.
53:36Incredible and they you know,
53:38his work on language and so many others
53:41who have thought about language and affect.
53:44This is very important because
53:47language sometimes you know it,
53:50it can be invisible and it can be visible.
53:52You know, through accents,
53:54for example, that that makes it
53:56most visible in psychotherapy,
53:58but I've had sort of my experience has
54:01been that unless we're actually asking
54:04a patient very directly about their.
54:06Language and for example what
54:09language one thinks in and dreams in.
54:13We don't have a good understanding of
54:16the internal life of a person and how
54:19language works in relation to how they
54:21think and feel about themselves and others.
54:24So for example,
54:25for me my first language is not English.
54:28I learned English in the United States,
54:30but I sound like someone who
54:32is a native English speaker.
54:33Because of this accent that I have.
54:36But.
54:36In fact, my first language is Telugu,
54:39which is in South Indian language and
54:42I still dream and Telugu I my nicknames
54:45for my kids are Telugu nicknames.
54:48They're you know so affect evli when
54:50I need to express certain things,
54:53they're very much and still
54:55in my first language.
54:56I cannot translate that into English.
54:58However,
54:58for somebody with an accent,
55:00they could be assumed one can
55:02assume that they only want to
55:03speak in that first language.
55:05This is a highly individual.
55:06Thing that is determined
55:08by a whole set of factors,
55:10including social context,
55:12migration histories,
55:13family dynamics that we don't tend
55:15to pay enough attention to, you know?
55:18So we ask the question,
55:19do you want to speak in this
55:20language or that language?
55:21Do you need an interpreter?
55:22But when we think about the dynamic
55:25issues that are involved with language,
55:27they're far more complex,
55:29including trauma histories as well
55:31that that language is also associated
55:34often with traumatic events and.
55:37Including childhood trauma
55:39and interpersonal violence.
55:44I see a question for from Christine Emons.
55:49She's asking, I think,
55:51how do you use information about
55:54social context as well as family
55:57dynamics in your work with clients?
56:00And I mean, I think you've been
56:02speaking to that to some degree,
56:03but maybe elaborating on that a little bit.
56:05Sure, one of the things that I've
56:08been learning to do more and more
56:11in my work is is to introduce it
56:13very early in the work and not as
56:15something that comes up later.
56:17You know. So right in the intake
56:19the first time I meet somebody,
56:21or the first several times,
56:23I'm getting to know somebody that I ask
56:26questions about contacts right away,
56:27because what that does is
56:29communicate to them very directly.
56:31But I think it's important and that it's
56:33relevant that it's not something outside.
56:35So for example, I will ask people
56:37about whether they were raised with
56:40a particular religious background,
56:41or, you know,
56:43tell me about what your school was like.
56:46Tell me about your neighborhood,
56:49tell me about your
56:50family's migration history,
56:51those types of questions that I want to
56:54immediately bring the relevance of that
56:56into our conversation, and our work.
56:58And and also to not assume that
57:01I know more than I do.
57:03For example,
57:03if somebody shares with me that
57:05they are Indian American or I see
57:07that they're Indian American,
57:08that they have a very different
57:10experience than me as an Indian American.
57:13That in fact their interpretation
57:15and their experience of being Indian
57:17is very distinct individually and so
57:20it's to recognize these differences but
57:22also to see I think the individuality
57:25and experience that heterogeneity of
57:27experience right from the beginning.
57:30So these are two quick things I could say
57:33you know in response to that question.
57:38Thank you, thank you Andreas.
57:40Just made the comment that he he
57:42curses in his native language because
57:46ingrained so deeply so deeply.
57:50And you know, I, I was thinking too.
57:52We do have the experience.
57:54Sometimes when family may not
57:55want to use an interpreter, but.
57:58Well, I I would I want to but the child is,
58:03you know, the interpreter for the parent,
58:05and that's not an optimal
58:07situation to my mind.
58:09But sometimes that's what we end up
58:12with and you wonder what you actually
58:16see the parents perspective through
58:18the child lens as they translate,
58:20and that makes a huge difference.
58:22And of course is implication for the child.
58:26You know, in terms of his or her
58:29own psychological functioning as
58:30being the interpreter as well, so.
58:35Thank you so much.
58:36This talk was just wonderful.
58:38I I'm.
58:40You gave us so many jumping off points in
58:42terms of references and things that we,
58:44as clinicians and researchers will
58:46definitely want to school and more so.
58:51There are no other questions I
58:53think will wrap up and let me.
58:56Is there anything else here in the
58:59chat and just people are just saying
59:01it's been so great it's been so great.
59:03Thank you so much.
59:04Doctor Tummala,
59:05Narra and we hope to see you again.
59:09Everybody having me and your
59:11questions appreciate it.
59:12Thank you very much. Take care.
59:15Bye bye. Thank you. Bye bye.