1. Introduction

According to the announcement of the newspaper Welt (2010), almost %20 of the population has migration background. Turkey constitutes the biggest migrant population with the number of 2,9 million migrants with Turkish background, in Germany. (see Weltonline 2010) This diversity creates major difficulties and the growing need of multicultural counselling. This counselling process is affected by the counsellor’s own culture, attitude, theoretical perspective and also by the client’s culture, values and it creates a multiplicity of variables. Therefore cultural and lingual communication difficulties between counsellors, therapists and clients from different cultural backgrounds often exist. Misunderstandings, uncertain diagnostics, misinterpretations of values, rules or attitudes can be the result of miscommunications. The problems owing to working people with migration background, may affect negatively the functionality of working with them. (see Uçar 2005:3) For that reason making provision against such problems is necessary. Ibrahim (1985) indicated that a major assumption for culturally effective counselling and therapy is that we can acknowledge our own basic tendencies, cultures and the limits of our cultural perceptions. It is essential to understand our own cultural heritage and world view before starting to set about understanding and assisting other people. (see Ibrahim 1985:627) This understanding emphasizes the awareness of one’s own life style and capabilities and the recognition of several structures, world views and developing an understanding for several cultures. To counter cultural differences counsellors should investigate their cultural background and be open to flexible definitions of “appropriate” or “correct” behaviour (see Bolton 1987:1) By the affect of increasing need for multicultural counselling and therapy several corporations, institutes have been founded in Germany with the aim for developing multicultural counselling and therapy. DTGPP (Die Deutsch-Türkishe Gesellschaft für Psychiatrie, Psychotherapie und psychosıziale Gesundheit) is one of them which was helpful to me while writing this essay.

Although the variety of culture is vast, I will try to explain some important components of Turkish culture. The examples in this essay will include the types of cultural issues and their effects on the counselling situation. While universal categories are necessary to understand various cultures and human experiences, losing sight of specific individual factors would lead to ethical issues (see Ibrahim 1985:629). The danger of stereotyping clients and other influences such as provenance or socioeconomic status may affect counsellors.

Bolton (1987) indicated that the most common danger in counselling is to oversimplify the client’s social system by emphasizing the most obvious aspects of their background. Individual clients are influenced by several factors, such as ethnicity, national origin, life stage, educational level, social class and sex roles. Counsellors should consider all factors of the client’s personal history, family history, social and cultural orientation. (see Bolton 1987:2-3)

With the help of examples I will examine the influence of culture-specific factors on the counselling of migrants with Turkish background. First, I will define and explain the cultural differences and misunderstandings. After that, I will take a closer look at different approaches to psychological illnesses and cultural values such as several family structures and nation of honour. Affects of Islam and the language problem of migrants are also the issuesthat I will explain. At the conclusion, I will finish my essay by discussing the issues that arise from cultural differences and possible resolution advisories.

2. Cultural Differences and Misunderstandings

Culture is a term that has different meanings. According to Harris “ total socially acquired life-way or life-style of a group of people. It consists of the patterned, repetitive ways of thinking, feeling, and acting that are characteristics of the members of a particular society or segment of a society. Commonly culture is attributed to the senses such as, shared attitudes, values, goals, beliefs, life styles, behaviours that are learned. Cultures have their own rules, norms, values, myths,

traditions, rituals, identities etc. We are affected by culture as members of them and culture shapes our behaviours, beliefs and world view. (see Birukou et al. 2009:4-8) It is clear that people who do not share a common background, behave differently.Cultural factors play an important role in the counselling of individuals. It is important to consider cultural differences and various cultural concepts in counselling. Individualismcollectivism is a basic dimension of cultural variability in cross cultural research. Several studies have suggested that individualism-collectivism are contrasting cultural syndromes and they are linked with differences in people’s social perceptions and social behaviour and in the style of social interactions (see Han, Shavit 1994:327). In individualistic cultures people are tend to prefer independent relationships to others and they have less in-group goals and more personal goals. In collectivist cultures people are more likely to have interdependent relationships to others and in-group goals are more important than personal goals. Collectivist cultures are associated with interdependence, harmony, family security, social hierarchies, and cooperation (see Han, Shavit 1994:328-329). According to the individualism-collectivism approach, it is possible to say that Turkish culture is more collectivist and German culture ismore individualistic. In reality, these terms cannot be acceptable for all German people and for all Turkish people but they are helpful to understand and generalize some cultural differences. For example there are some cultural differences in the relation with time.

Especially in western cultures timing, punctuality and temporal liabilities are very important. In many eastern cultures, punctuality and being late is not an important issue. When a Turkish client comes late to her/his appointment, it does not always mean that the client does not care about her/his appointment, it is because of the different understandings of punctuality. (see Wogau 2004:131) A German psychologist, Kielhorn, who worked 12 years in Kreuzberg with migrants, describes Turkish clients as follows:

A culture is the” (see Harris 1975 cited from Birukou et al. 2009:3).

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


(Kielhorn 1984, cited from Kentenich et al. 1984:15)

This description of Kielhorn shows us how strongly cultural differences are linked with the perception of others. It also serves an example of miscommunications and misunderstandings due to culture. It is clear that language incompetence is an important reason of cultural miscommunication. Many migrants are not able to speak and understand German sufficiently or they prefer to speak in their mother tongue while counselling because they believe that they can express themselves better in their mother tongue. But language incompetence is not the single reason of communication problems. Various understandings of illnesses (especially the psychological ones) also affect individual’s behaviour through  counselling or therapy.

3. Different Cultural Approaches to Psychological illnesses

In some Mediterranean countries, illness is frequently regarded as something that comes from outside, invades the body and takes control if it. Sometimes clients do not know what the problem is and they can not differentiate physical and psychological illnesses. They feel themselves overall sick and they feel anxious because of their psychological problems but they do not know the relation between their physical health and their psychological health.

Especially Turkish client’s approach towards psychological symptoms is interesting. For example women with Turkish migration background tend to describe their illnesses by explaining pain in their bodies. A German woman could say that she has depression, but in such situations Turkish women say that they feel pain. (see Ucar 2005:11-12) They focus on body pains in psychological illnesses more than feelings. Ucar gives an example for this situation:

“Im Falle von Yasemin, 9 Jahre alt, Schülerin der 3. Klasse wurde vom Schulpsychologischen Dienst eine Entwicklungsverzögerung diagnostiziert und deshalb eine psycho-motorische Therapie empfohlen. In Absprache mit den Eltern begann ein Deutsche Therapeut mit der Behandlung. Nach 3 Sitzungen haben die Eltern die Behandlung abgesprochen. Als ich nachgefragt habe, warum die Behandlung nicht fortgeführt wurde, antwortete Mutter ‚Eine solsche Behandlung bringt für meine Tochter nichts. Der Psychologe spielt nur mit meinem Kind oder macht einige Bewegungen mit ihr. Aber mein Kind hat Bauchschmerzen, auch öfter Kopfschmerzen und kann nicht schreiben und lesen. Der psychologe gibt ihr kein Medikament gegen Schmerzen. Das Kind muss für die Schule lesen lernen, nicht spielen, das bringt nichts.’.“

Ucar 2005:7

This example shows us, some parents with migration background do not know child therapy and they are not able to differentiate psyche and body. Therefore they prefer using medicines in psychological disorders. Believing that psychologists are the doctors of batty people (delidoktoru) is also common in Turkish culture. People who get psychological support are accepted as abnormal and unreliable in Turkish society. Therefore counselling or therapy is the final solution for them. Sometimes they tend to hide that they get psychological support because of the concern that they would be perceived and judged as batty and unreliable. This pressure is strong. Indeed patients with somatic symptoms tend to be shown more toleranceand understanding by the community than those with psychological symptoms which is regarded as personal failure (see Schouler 2008:653).

The official teachings of Islam prohibit the belief in supernatural powers. God’s will is the explanation of disease and God’s will, should be accepted. Notwithstanding, believing in magic is common in Turkish culture. The influence of traditional healing methods, such as the Muslimpossible that such healers represent a link to their culture of origin for immigrants. In this meaning, it plays an emotional role in the context of illness. (see Schouler 2008:655) It is common to perceive disasters as something magical which comes from outside and cover the body (see Ucar 2005:9). Especially when they can not heal with therapy or counselling, they tend to head towards superstitious beliefs back.Another common belief is the evil eye (nazar) which is often associated with feelings of anxiety. The evil eye of an envious person can bring bad luck. In this meaning evil eye is also regarded to broken interpersonal relationships. For prohibiting bad luck a blue bead (nazar boncugu) is attached on clothes. If anyone becomes ill, it is common to believe that the illness exists because of evil eye. For example it is common to advice a person who has actually depression, to cast lead (kursun dökmek) in order to break the negative affect of evil eye. (see Schouler 2008:656) Such cultural interpretations of health and illness may have a particular psychological function, making it easier for people to deal with illnesses. On the other hand they delay getting psychological support.

hoca (Muslim teacher or healer) should not be minimized. It could be alsohoca. A Turkish worker had not has the opportunity forhoca. Therefore he sent his worn clothes via post therewith the smell of his illnesshoca. (see Ucar 1982:5-6)

4. Effects of Different Cultural Values

Groups, societies, or cultures have values that are largely shared by their members. These values are considered as important and valuable by the members of society. The values of a society can often be identified by noting which people receive honour or respect. Values identify what should be judged as positive or negative. Different cultures reflect different values. These values reflect the goals, morals, and wishes of a group, such as the way of living, important priorities one should have. Cultural values can be influenced by various features of the environment and history, including socioeconomic status, gender, race/ethnicity, geographic location, acculturation level, and religion. Members of cultural groups often share common values, attitudes, and behaviours. However, within any group there are differences in the amount to which an individual adheres or espouses a particular value. (see Ibrahim 1985:631-634)

In this chapter I want to mention about some common values in Turkish culture, which

I find helpful to understand clients with Turkish background, such as family structure, notion

of honour. Before discussing them, I think it is important to indicate that these explanations

can not include all Turkish families, such cultural definitions are changeable due to region.

These generalizations may be more common in families from Turkish villages, which

constitute the major Turkish community in Germany. This does not mean that the families

which live in cities do not have such values but there may be differences in the strength of

cultural values.

4.1. The Notion of Honour

The notion of honour plays a special role in Turkish culture and it is strongly related

with family life. It is more closely associated with family and social life, for example a wrong

behaviour of a family member may cause loss of family’s honour. A Turkish proverb tells us

that “

three main categories:

honour. (see Schouler 2008:655)


it is better to lose your life than your honour”. The notion of honour can be divided intonamus, seref and onur. In English all three terms are translated as


behaviour, and

violates the moral rules. The term

is related with sexuality, chastity and modesty. The

with virginity and their chaste behaviours. But remain virgin until marriage is not expected

from men. If the unmarried girl is not virgin, it damages the honour of men in her family. Men

are responsible from the

married women there are also some restrictions. It is expected from women to be shy and

silent at the presence of men. They should also take care of their behaviour and dressing.

Sometimes it is not allowed to shake other men’s hand for women but men are allowed to

shake women’s hand. Girls learn to take care of their clothes, since childhood. After puberty

they start to wear head scarf. Clothes should cover all body parts except hands and face.

Dressing is different due to region, for example in cities mostly, girls do not get dressed like

this and they do not wear head scarf. According to the term

home, they should not beautify, they should do their sacred duties and household duties, they

should respect to men. It is expected to be powerful, strong and courageous from men, while

it is expected to be shy and passive from women. According to Islam male children should be

circumcised. Circumcision means to be belong to male community and becoming a man.

After circumcision the child should not cry and he should not show weakness. A Turkish

proverb tells us that “Men do not cry.” Being sensitive, fragile and showing emotions are not

encouraged for men. Behaviours such as crying, being weak are attributed to women. (see

Ucar 1999:4-9) Briefly,

lose. Men are responsible the

restrict women’s activities.

describes a person’s feelings towards moral rules. Namus is the honourablenamusssuz refer to dishonourable behaviour of a person who disregards andnamus is differentiate due to gender. The namus of womannamus of unmarried girls is evaluatednamus of their female family members and their relatives. Fornamus, women should stay atnamus refers to gender specific roles, it is not winnable but it can benamus of the women in their family, therefore they are tend to


which means being respected by others.

not play a big role in family. It is related to men’s prestige in society and associated with

masculinity, strength, education, religiousness, hospitality, economical power. (see Schouler

2008:656) Ucar gives some examples, how migrants with Turkish background describe

„Gut arbeiten, gut verdienen.“

„Mit guter Ausbildung gewinnt man Ansehen“

„Kluge Leute haben immer Ansehen.“

is a virtue ascribed to women. In contrast, seref (Ansehen) is a male ascriptionSeref plays an important role in society, but it doesseref:


„Erführung der religiösen Pflichten.“

„Eine Hochzeitsfeier von 3 Tagen und 3 Nächten.“

„Einen Wolf zu jagen.“

Ucar 1999:10

Finally the term

honoured and respected. For example the parents can feel honourable because of their child’s

success. In traditional rural Turkish families concepts such as

important role. Family’s honour is upheld by the chastity and modesty of its female members

which causes seeing women in family as subject to especial scrutiny and control. All members

of family are obliged to bear themselves with dignity and avoid compromising their family’s


onur describes the sense of being proud of something and feelingonur, seref, namus play an

4.2. Affects of Islam

Muslims constitute the largest religious group in Turkey. Therefore Turkish culture

has been heavily influenced by Islam. Especially in rural areas religiousness is an important

fact. Allah is the God, the creator of the World, he effectuate life and death, health and illness,

he directs the past and the future. The Islam is not a “monolithic block”, it exists from several

types such as Sunnite, Shiah (see Ilkiliç 1998:63). In Turkey the major population is Sunnite.

Each Muslim has five duties that he should fulfil during his lifetime: the profession of faith,

ritual prayer, alms tax, fasting during Ramadan, and the pilgrimage to Mecca and Medina.

Observing these duties lead to social esteem, respect and acceptance within the community

(see Schouler 2008:655).

Religious wedding (imam nikahi) is an important traditional ceremony towards

Muslims. It means a special wedding which is blessed by God. (see Sharifova 2006:310) In

Turkish culture it is common to do both civil marriage and religious marriage. Sometimes,

especially in rural areas couples do only religious marriage. This type of marriage is not

recognized by law, it is a traditional necessity. It may also causes having more than one wife

with religious marriage. Some Muslims believe that Islam allowed man to have more than one

wife, but it is a controversial issue. Most of Muslims do not accept it.


According to Islam women should use head scarf to hide their hair. Some Turkish

women cover their hair with head scarf relaxedly, more religious ones use it to hide all of

their hair. In Islam women are seen as dangerous, they have the capacity to tempt men

because of their sexual attraction. Therefore they should hide their sexual attraction with their

mode of dressing and behaviour. Another aim of covering body is protection from the glance

of others. To this it is written in Koran:

„Sag den gläubigen Männern, sie sollen ihre Augen niederschlagen, und sie sollen

darauf achten, dass ihre Scham bedeckt ist (wörtlich sie sollen ihre Scham bewahren).

So halten sie sich am ehesten sittlich (und rein). Gott ist wohl darüber unterrichtet,

was sie tun. Und sag den gläubigen Frauen, sie sollen ihre Augen niederschlagen, und

sie sollen darauf achten, dass ihre Scham bedeckt ist, den Schmuck den sie tragen,

nicht offen zeigen, soweit er nicht sichtbar ist, ihren Schal sich über den Schlitz ziehen

und den Schmuck, den sie am Körper tragen, nieman offen zeigen, ausser ihrem Mann,

ihrem Vater (…)“

Ilkilic, 1998:65

Talking about sex is not allowed, it is seen as taboo. When Turkish women have sexual

problems, they tend not to talk about these problems even if with doctors or counsellors. The


word is used to emphasize incorrect behaviour. For example it is

things to foreign people. Especially the non-educated Turks are respectful to educated people

such as doctors and teachers. They show their respect by being quiet and shy. This situation

may cause communication problems between doctors/counsellors and clients with Turkish

background. Explaining their problems to them is also accepted as

about their problems, especially the sexual ones. (see Ucar 1999: 5-14)

Understanding of illness is also affected by Islamic beliefs. The term illness (marad)

has different 24 relevancies in Koran. The first and the most frequent one means hypocrisy,

faithlessness, suspicion from the existence of God. The second meaning includes somatic well

being and doing the physical religious tasks such as fasting, praying. According to Islam the

most important thing is being able to do religious tasks and being prayerful. When impairment

of health prevents doing religious tasks, than the person accepted as ill. Ilkiliç gives an

example in his article about the understanding of health in Islam:


ayip plays an important role on child rearing. Ayip means shameful behaviour. Thisayip to explain personalayip. They abstain to talk

“Frau Geiger, wissen Sie, was Gesundheit für uns Muslime ist?“

Etwas irritiert antwortete ich: „Nein“

dass wir das Gebet –vorschriftmäßig- durchführen, dass wir unsere Familie gut

versorgen können, das wir eine Begegnungsmöglichkeit für die Gemeinde haben, und

dass wir einen wohnortnahen Platz zum sterben wissen.

Ich werde Ihnen sagen, was unsere Gesundheit ausmacht: Zur Gesundheit gehört,

Aus einem Gesprach mit Herrn C. im Gesundheitsamt, 1996 cited from Ilkiliç 1998:66

According to Islam, God’s will is the most important factor of illness or health.

Biological, chemical or psychological treatment can be helpful, but they can not change God’s

will. In Sure (Koran chapter) 26 is named “When I am ill, God will heal me.” Thereby

Muslims are obligated to endure and resign illnesses. To be in enjoyment of good health

means not to have pain, physical handicap. If a person is able to do religious and social tasks,

this person is healthy. The terms destiny and resignation also influence the understanding of

illnesses. These terms are important in Islam, according to them patients should consent their

illnesses. Therapeutic methods should not contradict with Islam. Muslims often ask the

legitimacy /validity of counseling according to Islam. When contradictive situations with

Islam exist, they ask for help to Muslim schoolmasters (hodja), if hodja allow to continue

counseling, they carry on with counseling. (see Ilkilic 1998: 63-71)

Islam defines illness and getting well in relation with God’s wish. But it is important

to consider individual differences and degree of religiousness. Religious influence life view

and life style but it is necessary to draw attention to mistake of generalization. We need to

keep individual differences in mind when we learn about any group. In each case, including of

Turks/Muslims, we learn about what characterizes the group and what differentiates it from

other groups. In addition to these between-group differences, we need to keep seeing the

within-group and individual differences, because the religion is often interpreted differently

and religiousness of individuals is changeable. (see Dwairy 2004:133) Counsellors should

focus on both problem-orientate and client-orientate solutions. It is important to take care of

shaping conversation with respect to client’s belief.


4.3. Family Structure and Marriage

The family occupies a key position in the Turkish society and culture. In Turkish

families the father represents the family to the outside world. The father is the head of the

family, and he makes decisions for the family. Older brothers may share this role with the

father or take it over if the father dies. The mothers are portrayed as passive housewives who

are controlled and oppressed by their husbands. Within the home, mother plays often a

predominant role. Their lack of contact with the outside world causes that they have weak

German language skills and little knowledge of German society and culture, which could be

seen as the way of ensuring the honour of the family is preserved. (see Schouler 2008:656)

Children are obliged to respect, obey and remain royal to their parents. Unmarried

female family members are expected to retain their virginity before marriage. Female family

members are responsible to do household duties. In some families female girls are not allowed

to go to school. It is believed that they do not need education, they should just be able to do

household duties because they will marry and they will supported by their husbands. The girls

are prepared that she will leave her family after marriage and she will start to live with her

husband’s family. Showing respect to her husband’s family is another responsibility of

women. Several conflicts could occur between daughter in law and the man’s family. When

the father of the family goes abroad to earn money, his wife and children stay with his family.

His relatives take care of his wife and his children and protect them, in return for this he sent

money to his relatives. In some regions daughter in law is not allowed to read the letters that

her husband sent and she can not get the money. She should be respectful and silent, she can

not express her feelings and longing. Ucar indicated that a woman, whose husband was

working in Germany, said that:

“Ich habe Angst, obwohl ich weiß, daß mein Mann nicht für immer in Ausland beleibt.

Ich wohne hier bei Verwandten. Du kannst als Frau nichts machen, was du willst. Du

kannst deine Bedürfnisse und Wünsche nicht äußern.“

Ucar 1986:52

When such conflicts increase, some women prefer to live alone with their children. In such

cases the women must undertake both the roles of man and woman. In rural areas of Turkey,

it is hard to live alone as a woman because of the strong social control. Sometimes, her


husband must come back to Turkey to take care of his family. Such long term separations may

cause psychological illnesses and attempts to suicide. In fact, there is a special name for

psychological illnesses of those women in common speech; the migrant’s wife illness

(almanci karisi hastaligi). Psychological problems of these women may last after arriving

migration country. The conflicts also influence men who live alone in a foreign country. By

comparison with men, women are affected more intensively because of their social status. (see

Ucar 1986:49-59)

In rural areas a newly married couple is expected to live with the husband’s family.

Since marriage meant the wife’s entrance into her husband’s family, it neither changed the

residence of the husband, nor did it have any significance in terms of the transfer of property

rights. They could set up an independent household after the husband’s father died. In this

system of residence it was the patriarch’s responsibility to provide a dwelling for the new

couple, either under the same roof or in close proximity (see Duben 1985:82).Sometimes

families are afraid of that their girl will be bad treated, therefore they seek a husband for their

daughter in their neighbourship. Male members will always belong to the family but

unmarried female members are often seen as guest members of the family. (see Kronsteiner


The consent and permission of the family members for the marriage is also an

important issue. Some families allow choosing their husband/wife freely to their children. But

forced marriages also occur. Men are freer to choose their wife. In some Turkish villages, the

tradition “bride price” (baslik parasi) is still in force. According to this tradition, son in law

must pay to girl’s family to be able to marry with her. Some migrant families choose

wife/husband from Turkey for their children. Because they believe people in Turkey are

cleaner. They mean being decent and upright for girls. In some regions in Turkey cousin

marriage is common. According to Tuncbilek and Ulusoy’s research frequence of cousin

marriage was 20,92 % in Turkey, in 1983 (see Tuncbilek, Ulusoy 1983:7-26 cited from Ucar

2006:5) Each year this rate have decreased. Ucar indicated that the inter cousin marriage has

some social and economical reasons. The relatives develop a collective identity with cousin

marriage, social control of women could be easier, the bride could be controlled both as

cousin and daughter in law. It is also seen as a good way to make getting residence and work

permit possible for the relative who lives in Turkey. Cousin marriage causes some health

problems. The biggest risk is that the children of such couples have more hereditarily, genetic


illnesses. The risk of being handicapped of children is doubled. Therefore it is important to

inform people about the risks of cousin marriage. Counsellors who work people with

migration background should be aware of the risk and if necessary, they should warn and

inform their clients. (see Ucar 2006:3-11)


5. Language Problem and the Term “Culture Interpreter”

Language differences may be the most important stumbling block to effective

multicultural counselling and assessment. Language barriers hinder the counselling process

when clients cannot express the complexity of their thoughts and feelings or abstain from

discussing affectively charged issues. Counsellors may also become frustrated by their lack of

bilingual ability. At the worst, language barriers may lead to misdiagnosis and inappropriate

placement. (see Bolton 1987:1)

Especially the first generation, who was born in Turkey and came to Germany in

adulthood, have more incompetence with German language than second, third generation. It is

common that their relatives or someone else translate their problems when they have health

problems. According to the research of Universitaetsfrauenklinik in Wedding, half of the

migrants needed a translator while treatment, between 1993-1995. Mostly their husbands,

relatives or personnel of the clinic translated their complaints. A professional translator was

used only %2. Owing to the need of professional translators and multilingual information

materials, more personal, whose mother tongue is Turkish, have been taken into service in

clinics, hospitals in Germany. The executive director of Ethnomedicine Centrum Hannover,

Salman indicated that, “Vorhandene Dolmetscher sind haufig aufgrund fehlender

psychologischer, medizinischer und sozialer Kompetenzen kaum in der lage, die Bedarfslücke

zu schliessen.” This centrum has synthesized the first medial translation service in 1990. The

workgroup “Armut und Gesundheit” has also been dealing with this problem since January

2000. The aim of “Armut und Gesundheit” is encouraging intercultural competence of the

medical personnel and increasing the number of foreign doctors, psychotherapists,

psychologists and facilitating getting work permit for these personnel. They struggle to

generalize multicultural counseling and multilingual information brochures and to found

translation centrums like Hannover example. (see Richter 2001:54)

In the counselling and therapy process translation by relatives, friends can not be

expected. Individual counsellors can also not be expected to have a command of all languages

that are spoken by their clients or counsellors are familiar with all of the culture specific

factors. It is important to offer counselling in a migrant client’s native language, few clinics

have the personnel resources needed to provide such services or professional translators. (see

Schouler 2008:665) J. Bot indicated that there is increasing need for culture sensitive


counselling and therapy in Germany. Therefore the question appears: Is therapy with

interpreters possible? The cooperators of the clinic, Phoenix, have evaluated the therapy with

interpreters. According to this evaluation, the danger, that the interpreter may add his

comment by interpreting, is big. Sometimes interpreters translate by sieving and knowing

both languages gives them a superior position. Therefore choosing interpreters and training

interpreters has a special meaning. Another danger is that the therapist could loose his

leadership roles in therapy at the presence of interpreter. For that reason it is important to

define clearly the roles of interpreter and therapist in therapy process. The presence of

interpreter causes a new three-person-situation. (see Koch 2001:7-8) Moreover, talking about

personal problems may be more difficult at the presence of third person and the clients may

feel themselves under pressure.

Schouler (2008) gives an example which includes many issues that I mentioned in this

essay. A female patient who came from an Anatolian village had depression. When she was

12 years old, she was raped by her uncle. She came to Germany when she was 15 years old.

Following these traumatic events, she withdrew increasingly into herself. A was taken by her

family to see several traditional healer or hodjas. At first it was thought that attractive young

patient had been afflicted by the evil eye, than her relatives thought this situation existed due

to lack of a husband. But she did not want to marry because of the fear that her relatives

would understand she is not virgin. After her several suicide attempts, finally her relatives

decided to bring her psychiatry clinic. During her first sessions, the patient spoke about how

happy she was to be able to talking with a woman about her problems without needing her

relatives to act as interpreters. Her command of German was poor. She noted that she had

been unable to talk freely without her brothers’ translation. (see Schouler 2008:656-658)

Intercultural communication is necessary for the effective care of clients with

migration background. Acquisition a general picture of client’s psychological situation

requires sufficient knowledge of her or his cultural background, personal biography.

Therefore the culture-comparing competence of counsellors is an important issue in

counselling. The proliferation of biculturalism or multiculturalism, trauma and migration

affects individuals. One the other hand considering individual differences and gender specific

aspects are also important. (see Salman, Collatz 2001:48) Schouler (2008) emphasizes the

role of gender in the therapy process. For example a female client with Turkish background

who has been sexually traumatised should not be expected to relate the history of her trauma


through a male interpreter. Shame and taboos may also have a significant influence in this


Uçar (2005) defines the term “Culture Interpreter” to emphasize the problems between

migrants with Turkish background and German counsellors, psychologists. He defines the

terms as follows:

Ein Kulturdolmetscher ist ein Dolmetscher als mittler zwischen verschiedenen

kulturelllen Systemen. Dolmetschen in diesem Sinne ist mehr als eine blosse

Übersetzung der Sprache in eine andere Sprache. Es ist eine übersetzung der

kulturellen Normen, Werte und Verhaltensweisen der Menschen von einer Kultur, um

sie für Menschen anderer Kulturen verstandliche zu machen. Diese

Verstandigungstatigkeit oder mittlertatigkeit setzt voraus, dass der Dolmetscher nicht

nur die beiden Sprachen beherrscht, sondern beide kulturellen Systeme gut kennt.

Uçar 2005:3

He emphasizes the necessity of interpreting the norms, values, attitudes, terms from different

cultures to other cultures. Achieving this requires the sufficient competence of culture

interpreters. Not only verbal communication, but also non-verbal communication such as

gesture, eye-contact, closeness, distance, spacial-temporal perceptions may have different

cultural meanings and play an important role in communication. Thus an intensive eyecontact

may be interpreted as aggression or respect. For example in Turkish culture

aggressive attitudes of male children is tolerated, but German people tend to interpret such

attitudes negatively. (see Uçar 2005: 3-11) Therefore not only language problems but also

cultural differences may cause misunderstanding and miscommunication in the process of

therapy or counseling.


6. Conclusion

As the examples showed us cultural differences affect counseling process heavily.

Especially in the countries, which have a big migrant population, problems often exist.

Learning the information about a client’s psychological condition requires general knowledge

of his or her cultural background. Counselors cannot adopt the client’s ethnicity or cultural

heritage, but they can become more sensitive to these differences. Counselors who work with

migrants, should be able to avoid the problems of stereotyping and wrong expectations due to

their own culture and values. Clinical sensitivity, knowing the importance of values, beliefs

roles and attributions are necessary for effective outcomes. Examining own assumptions,

accepting the multiplicity of variables which constitute an individual’s identity, and

development of a client centered, balanced counseling method will support effective help.

(see Bolton 1987:3) The therapist needs to be willing to reflect on his or her stance, and to

learn as much as possible about the socio-cultural background of each patient.

Culture specific factors have a big role in counseling process. Recognizing and

accepting these factors without stereotyping them is important. The solutions discussed with

the patient should be compatible with his or her cultural background. It is important to keep in

mind that clients with migration background deserve the same degree of professional attention

as clients from same cultural background. While family members often are often asked to

translate in the absence of professional interpreters, such situations may lead other problems

such as the family members may add their command or they may have problems while

translating and they are generally not prepared or trained to deal with traumatic content.

Interpreters who come from same cultural background may remain the danger of identifying

with their experiences. Interpreters should therefore be offered assistance such as workshops,

supervision or special programs to help them deal with feelings that arise during counseling.

(see Schouler 2008:665-667)

The personnel, who is able to understand and interpret two different cultures, is

supported due to increasing need for multicultural psychologists, counselors, psychotherapist

and health care providers, in Germany. Moreover there are several corporations, institutes

which have been founded to support these developments. Precautions and developments are

not enough but they become widespread every passing day. Such promising improvements


should be supported by government. Thus the misunderstandings and miscommunications due

to culture differences would be accomplished.



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