Blog

Counseling Uzbek-speaking and other clients from ex-Soviet Central Asia

Counseling Uzbek-speaking clients and others from the ex-Soviet Central Asian region is not something I planned for when I started my career in the mental health and social services arena more than twenty years ago. 

However, this is the work that I have primarily been doing for the past twelve years - and I thoroughly enjoy it, even in the moments of therapeutic-cultural impasse.   

I am not an ethnic Uzbek. I have, however, traveled extensively throughout Central Asia on more than one occasion and had the opportunity to learn the Uzbek language to a functional degree, along with other languages of Central Asia including Tajik, Judaic Bukhori, Afghan Dari, and some Turkmen.  

As a good social worker, I was repeatedly taught to "meet the client where the client is at." To this day, that is still a mantra in most graduate social work schools and departments. If you want to be able to meet Central Asian clients in their psycho-social environ, you have to be willing to question some assumptions about the order of things - that is, if you grew up within the cultural backdrop of the contemporary Western world.

Many of the issues and themes that most psychotherapists likely encounter in their work with clients often take on a deeper understanding when it comes to working with Uzbek-speaking and other Central Asian clients, and especially with men. Issues of communication, relational engagement, emotional regulation - not to mention other traditional mental health concerns - will require the clinician to process Western theories of behavioral change via the prism of historical adaptation and cultural sedimentation. This work is intrinsically dynamic as it carries a dialectic all its own; the interplay between Western rationality along with an appreciation of Eastern sensibilities. 

Working with Uzbek-speaking clients as a psychotherapist/counselor will demand nothing short of therapeutic and personal authenticity. It also requires a good amount of creativity and comfortability in translating concepts of therapeutic/behavioral change into "culturally appropriate" and linguistically relevant words, phrases, and ideas that resonate with the heart and collective conscious of the (ex)Soviet Central Asian body collective.  

The work will also require a good amount of patience and ability to engage in truly client-centered counseling of the pure Rogerian kind - not that of vacuous sloganeering made popular by regulatory bodies removed from the intricacies of psychotherapeutic interchange. True client-centered counseling is actually well-suited for the Central Asian client who wants to change, but does not quite have the current emotional vocabulary to set forth a positive behavioral change. This is where we can help, and the place from which I usually offer my help.  I believe it is a benefit that I have an affinity with the mountain ranges, environmental sensations, and pace of the (ex)Soviet Central Asian heart.

Understanding modern-day problems and issues of relational engagement, "work-life balance", adjustment, and acculturation takes on a unique flavoring for the clinician who is situated in the West - and working with Uzbek-speaking and other clients hailing from the (ex) Soviet regions of Central Asia, the Caucuses (Kafkaz), and other parts. Both the traditions of Western psychotherapeutic schools of thought along with the wisdom of the ancient Orient have much to offer the clinician seeking to facilitate truly adaptive change for clients living and loving in these spaces in between.  

"Living bodies are qualified to conceive mentally grasped things only by and through certain powers that are put within them."  Bakhtiar, Laleh. (2013). Avicenna on the Science of the Soul. Chicago IL: Great Books of the Islamic World.  

Uzbek Respectfulness and Mental Health Implications; Traditions of Hurmatchiliq

What if what is missing from some of our most cherished theories of personality assessment and behavioral change is the idea of respect? A respect that is based on a deep and authentic sense of the appreciation of another person. Not one connected to exterior signifiers of worth or passing fads of the day, but one in which there is a real reaching out of welcome and a striving for understanding.

Uzbek traditions - and by and large the (ex) Soviet Central Asian experience - are steeped in notions and sentiments of respect. If one takes a literal interpretation of many common Uzbek greeting phrases and turns of expression, it becomes abundantly clear how much good will is expressed in these sayings. 

I believe starting from a place of authentic respect (how much work does this require on the part of the treating therapist first!) when "treating" Uzbek-speaking clients does more good than compiling a history of symptoms, complaints, and problems. Although, those latter issues will certainly come into the framework of holistic understanding, and absolutely should as well.  Authentic and fully embodied respect will often set and carry the tone of a mutual endeavor of understanding...a will to understand, and then more. 

This is what is often not addressed in popular schools of psychological thought from the analytic traditions to the more humanistic camps of enlightenment. Respect should not be something taken for granted; there is no ?????, x'op, mayli, maylash, ok, or whatever in the same sentence where you find respect - or hurmat. There cannot be, if a clinician is attempting to enter into the experiential world of an Uzbek-speaking client with care and attention. 

"While we usually think of quotidian existence as routine, habitual, and designed to satisfy our basic biological and psychological needs...we might also take a moment to see how everyday life actually is not so routine, but something that we constantly re-make and reorganize as we go through various phases in our lives" Sahadeo, Jeff, and Zanca, Russell (eds.). 2007. Everyday Life in Central Asia Past and Present. Bloomington, IN: Indiana University Press. 

Respect, in my humble understanding, also implies an ability to take time and observe the presentation of the person/client entering the counseling relationship. There is much that passes in both verbal and non-verbal modes of communication, oftentimes faster than the workings of the comprehending brain. Respect can allow a receptacle to form, which receives and can focus attention on what needs to be seen, heard, felt, and then understood. This work is thoroughly collaborative, and forged in the matrix of mutual respect that can only be attained via the efforts of both the therapist and client - even if, and especially if, they hail from different backgrounds. However, demonstrated respect (hurmatchilik) is also a powerful tie that binds. 

The implications for improved mental health in a clinical setting for Uzbek-speaking clients is significant. As the old English adage states: people remember how you made them feel, not what you said. In my experiences of counseling hundreds of Central Asian and Soviet clients, the ability to foster an integration of intellect, personal insight, and affect is the zenith point of respect. This is also the model that you gift your clients, for them to bring into their own uy (home), mahalla (neighborhood) and choy-xonallar (tea-houses). 

Meeting the Uzbek Client Where He Is At, and Not At

Working predominantly with Uzbek-, Russian-, and Tajik-speaking men from the hinterlands of Central Asia over more than a decade has allowed me to refine some ideas on the concept of motivational interviewing via a "culturally competent" lens. I wish to make clear that I take the notion of cultural competence with utmost seriousness. However, the same idea begins to reek of predominant cultural imperialism (of the "modern world") when bandied about by most Western-oriented practitioners who often refer to these same casts of men as backward, aggressive, controlling, and a litany of other clinically-couched pejoratives.

Let's get back to the topic at hand. Group counseling can work wonders. Providing individual Central Asian clients with rather foreign ideas to entertain about relationships, gender roles, gender expectations, family systems, and other ideas of adequate behavioral adaptation will move the needle to a degree. At worst, it can result in a complete therapeutic impasse, most typically seen when such clients begin to work with clinicians that do not have an understanding of (or worse: antipathy toward) Central Asian culture and mentality. However, something truly magical (ajoyib) begins to occur when one Uzbek-speaking client sees another Uzbek-speaking client in the same therapy group on a weekly basis. In a controlled setting, with firm yet receptive boundaries. That is a must.

My weekly Uzbek-speaking group therapy sessions often feel as if I am sitting in a room (in-person or virtual) of Genghiz Khan descendants, and I love every second of it. The more individuals in the room, the better, and the more that I can see the magic of person-to-person benevolent influence begin to take shape. I do also take pride in the fact that I am planting "seeds of change" into the framework of my group therapy sessions with such men. It has become more noticeable of late that there is a dwindling of "men's spaces" in our society. This contemporary cultural critique is not lost on the vast majority of my Uzbek-speaking and other Central Asian clients. In fact - when we begin to talk - this idea is expressed unilaterally by such clients in their own words. Those are the same moments where I can meet them (the group as-a-whole) in their yearning, their desire, their forgotten memories of what it was once like to gather in the "may don" and speak openly about THEIR problems and concerns.

It is also the same place from which I can authentically and respectfully (although directly, if needed) introduce concepts and ideas that those same clients have never heard of before yet can begin to appreciate and think about. That is a major therapeutic and psycho-developmental milestone that can only be witnessed and experienced to truly understand.

More than ten centuries ago, one of the most prominent and prolific Persian/Central Asian academics, Abu Ali Ibn Sino, introduced the world to a common CBT (Cognitive Behavioral Therapy) principle - way before the world would ever hear of such therapies or Ibn Sino, would even dream of their popularity. "It is when the particular portion of the Breath of Life reaches the appropriate parts of the brain that it becomes impressed with the temperament of the brain and thereby becomes adapted for the operation of the soul's powers..." Bakhtiar, Laleh. (2013). Avicenna's Psychology: A Textbook on Perennial Psychology. Chicago IL: KAZI Publications, Inc.

When my Uzbek-speaking clients come back to me and begin to speak with their own minds and heart about the need to adapt their thinking and behaviors (not only in line with American standards of acceptability but also out of an authentic desire to have healthier familial relations), I listen to them with deep respect and curiosity about how they have come to such a place. Inevitably, they also reference their group therapy experiences (with comparisons and contrasts to the next "d'ost," friend) - and perhaps how they unconsciously see aspects of themselves in the others in the group and consciously wish to work on those very aspects of themselves, they know they can make their lives happier, healthier, and safer.

That is where I meet many of my Uzbek-speaking clients, and we begin to explore worlds never quite known or talked about in the public squares, but certainly in my private rooms. And then, hopefully, in their own homes, tea houses, places of worship, buzkashi matches, and hearts.