From Winnicott’s potential space to mutual creative space: A principle for intercultural psychotherapy

Introduction

Donald W. Winnicott defined his concept of “potential space” as follows:

I refer to the hypothetical area that exists (but can not exist) between the baby and the object (mother or part of mother) during the phase of the repudiation of the object as not-me, that is, at the end of being merged in with the object. (Winnicott, 1971, p. 107)

Intriguing as they are, Winnicott’s ideas concerning potential space and the related formulations of “transitional object” and “transitional phenomena” were not developed in a way that would make them readily accessible to psychotherapists. Indeed, “Winnicott’s ideas are entrapped, to a far greater degree than is ordinarily the case, in the language in which they are presented” (Ogden, 1985, p. 130). Following Ogden, we can clarify Winnicott’s concept in the following way: “Potential space is the general term Winnicott employed to refer to an intermediate area of experiencing that lies between fantasy and reality” (Ogden, 1985, p. 129; Winnicott, 1971). Specific forms of potential space include the play space, the area of the transitional object and phenomena, the analytic space, the area of cultural experience, and the area of creativity. Neither Winnicott nor Ogden considered the “intercultural setting” in their conceptualizations. In this paper, I present some ideas about how “potential space” can be elaborated and developed in a way that contributes to psychotherapy in intercultural contexts. I explore this issue by focusing on cross-cultural therapy with Ethiopian immigrants in Israel.

In the first part of the paper, I will discuss the general problematic of intercultural psychotherapy. I then give a short account of the migration of Ethiopian Jews and some aspects of their integration in Israel. Following that, I describe the significant gap that exists between the Ethiopian cultural codes relevant to psychotherapy and those of the typical Israeli therapist, who is normatively trained in the Western psychotherapeutic tradition. That gap constitutes a problem and a challenge to cross-cultural psychotherapy. In the second part of the paper, I put forward a possible solution for this problematic situation by developing Winnicott’s concept of potential space. I suggest that a meaningful and effective therapeutic process can take place only if psychotherapist and client are able to cocreate what I have termed a “mutual creative space.” The paper will conclude with a discussion of the notion of mutual creative space in light of Winnicott’s original ideas.

The intercultural problematic

According to Jerome Frank (1973) the practice of psychotherapy, like other forms of symbolic healing, depends on tacit knowledge shared by patient and clinician. Since Frank’s now classic work, many authors have supported this observation in the literature. For example, Torrey (1973) claimed that one major condition needed for a psychotherapeutic process is the existence of a “shared worldview” between client/patient and therapist. Ibrahim (1985) contends that when counselor and client share similar (though not identical) worldviews, communication between them is likely to be clear. Sue and Morishima (1982) observe that the greater the similarity between clients’ and therapists’ ethnic and racial backgrounds, the more effective the therapeutic relationship. Accordingly, a culture match between therapists and clients is expected to facilitate a common understanding of symptom attribution and treatment, self-disclosure and expressive styles, and the importance of the family in states of illness and treatment. Atkinson and his colleagues believe (Atkinson, 1983; Atkinson, Morten, & Sure, 1989) that cultural match can minimize problems in assessment, avoid group stereotypes, and enhance rapport.

When the client and therapist come from different cultural backgrounds they lack a shared “assumptive world,” or “worldview.” Ibrahim contends that “when differences exist [between client and therapist] counselors and psychotherapists can fall prey to making negative judgements about their client’s concerns, behaviors, perceptions, attitudes, and values” (Ibrahim 1985, p. 321). As Kirmayer argues, “intercultural work challenges this shared ‘assumptive world’ and poses problems of translation and positioning, working across and between systems of meaning and structures of power that underpin the therapeutic alliance and the process of change” (Kirmayer, 2006, p. 163). Kirmayer adds that

the encounter of patient and clinician from two different cultures is not simply a matter of confrontation or exchange between static systems of beliefs and values. Once viewed as self-contained worlds of meaning, cultures are now seen as systems of knowledge and practice – sustained by cognitive models, interpersonal interactions, and social understanding and rhetorical possibilities for self-presentation and social positioning. (Kirmayer, 2006, p. 163)

This raises a serious question: is psychotherapy possible in such a context? Can a patient and a therapist have a meaningful and effective psychotherapeutic encounter in the cross-cultural setting?

In what follows, I explore this question in the context of Israeli society, focusing on the intercultural encounter between Ethiopian Jewish immigrants as clients and veteran Israeli psychotherapists. ¹

The migration of Ethiopian Jews to Israel

There are about 120,000 Ethiopian Jews now living in Israel. Around 80,000 arrived from Ethiopia, whereas 40,000 were born in Israel (Israeli Central Bureau of Statistics, 2011; Ministry of Immigration and Absorption, 2010). Although, the mass migration started in 1977, the great majority of the immigrants came during Operation Solomon in 1991 and in the following years. Most, therefore, have lived in Israel 20 years or less. ² Most of the Ethiopian Jewish population now living in Israel are children or young adults up to 35 years old.

About 20,000 Ethiopian immigrants experienced a traumatic walking trail of suffering and heroism on their migration journey via Sudan between 1977 and 1985. This has become the main “formative event” for all Ethiopian Jews in Israel (BenEzer, 2006a). Four thousand did not survive the walk within Ethiopia or the refugee situation in Sudan. Not a single family arrived in Israel intact. Once in Israel, the immigrants were first put in “absorption” (reception) centers and then settled in different towns and villages. The adaptation process of these newcomers ³ was complicated by their “anomalous” Jewish identity. While Halachic (Rabbinical) scholars of the 16th century and later, ruled that this group was certainly Jew, religious authorities of the 1960s and 1970s in Israel questioned the authenticity of their Jewish identity, and their physical appearance (e.g., skin color) set them apart from “mainstream” Israeli society. These experiences were interpreted by the Ethiopian immigrants in relation to the walking journey. They felt that during this difficult journey their Jewish identity was tested and strengthened, and their “social visa” to Israel had been earned by the experiences of suffering and heroism (BenEzer, 2006a). Unfortunately, Israeli reality contradicted these self-conceptions.

As a result, the central issue on which the community focused was, and still is, that of identity and belonging: that is, receiving recognition as Jews in its full and most inclusive meaning and acquiring a sense of belonging to Israeli society. In the social struggle that has developed, two key events challenged this sense of belonging. One was connected to the demand to symbolically convert to Judaism, which resulted in a prolonged sitting strike of Ethiopian Jews against the Chief Rabbinate in 1985 (known as “the big strike”); the other was “the spilling of the blood scandal” of 1996, in which it was discovered that the blood of soldiers of Ethiopian origin, who had donated blood like other Israeli soldiers, was secretly being thrown away in the fear that they might be infected with HIV. The protest of the community, when this was revealed in the press, was unprecedented, probably because of its symbolic meaning as a profound “act of rejection and alienation” by Israeli society (BenEzer, 2005). In many respects, this struggle over identity and belonging, continues to be the central issue in the eyes of people from the Ethiopian Jewish community, and continues to influence their integration. ⁴

Problems of housing, employment and education have been added to those of identity and belonging. The dispersal of the Ethiopian immigrants to the most underdeveloped towns in Israel (ayarot pituah), or the worst neighborhoods within larger cities, has limited options for education and employment and sometimes provoke negative reactions in the local population, who resent the new competitors for already scarce resources. Finding employment has also been a major problem because the vast majority of the Ethiopian Jews came from agricultural backgrounds, thus being equipped mainly for unskilled, poorly paid work of low status in Israel. Employment is a crucial factor in integration since it determines whether a family can muster the resources needed to move to a neighborhood where children can have better opportunities for education, and hence a chance for social mobility. It is equally important as a constituent of self-respect and the feeling of worth, which is so significant in times of migration, as well as a crucial ingredient in family cohesion. Lastly, the encounter with the Israeli education system has also been problematic. The children were directed to the religious state education system (Weil, 1988) and most of the adolescents were sent to boarding schools. The majority of these educational institutions were of lower academic level than their secular parallels (Schwartzwald, 1990) thus putting Ethiopian immigrant children at a disadvantage. In addition, various social problems developed in the educational settings where Ethiopian children became a significant minority or even a majority. The social tensions surrounding their integration in these schools increased, with many parents expressing resentment about their presence in the school (probably ensuing from racist attitudes to skin color but also in response to the debate about their Jewishness which was more important for religious parents). Even though issues of identity and belonging are still operative 30 years after the beginning of the mass migration to Israel, there have been many successes in the integration of Ethiopian youth. In particular, there has been a substantial rise in matriculation certificates (from 7% in 1994 to 42% in 2007) and in the number of students in academic institutions (estimated today at 3,000 students). At the same time, the number of drop-outs from the educational system, and youth who drift into delinquent criminal activity and other antisocial behaviors, and into substance abuse (mainly alcohol and drugs), increased in the last 7 years and is still rising. At the root of these worrying phenomena is the failure of Israeli society to create amongst these children a strong sense of belonging to society.

A profile of mental health problems

The great majority of Ethiopian Jewish immigrants in Israel seen in therapeutic settings are young people—adolescents and young adults in particular. This reflects the fact that most Ethiopian Jews in Israel are of young age (70% under the age of 35, 50% between 10 and 29 years). Secondly, young people are those who acquire the Hebrew language quite fast—many of them could actually start conversing at a reasonable level in this language following months in Israel. In fact, quite a few are losing their proficiency in Amharic, especially those who were born in Israel, and it is estimated that about 60% of the children have lost their Amharic altogether, thus having serious communication problems with their parents. ⁵ A third reason may be that the young are in more “directive” settings, where they are observed and referred to therapy by the school authorities. Lastly, older people may find it more difficult to change systems of belief and tend to resort more to traditional healers, or else are too busy struggling for survival to seek help. Accordingly, I shall focus in this section on the profile of mental health issues of adolescents and young adults (up to 35 years old).

Ethiopian immigrant adolescents (like most other Israeli adolescents) are usually referred to therapy by others, including teachers, boarding school educational counselors, or social workers from “outreach” programs. Only a few adolescents apply for therapy on their own initiative. The same is the case for young adults, whether during their army service (age 18 to 20–21, depending on gender) or between ages 20 and 21–35, while at university or vocational training institutions, or already at the workplace. The pattern of resort to therapy in this age group does not resemble that of other native-born Israeli young adults, who do apply to therapy on their own initiative.

Looking at the grey literature on the last 30 years of integration, as well as my own experience as a consultant to policy makers in various settings, I have been able to delineate a profile of expressions of distress in Ethiopian adolescents and young adults. The profile includes (a) problems expressed through bodily ailments and pains, in particular, headaches, stomach and chest pains, and a kind of asthmatic attacks/breathing difficulties; (b) “eating arrests” that would endanger the life of the individual even though it did not resemble anorexia nervosa (BenEzer, 1990); (c) problems in mental concentration and other symptoms that could be related to PTSD (PTSS or PTSD, as defined by the DSM-IV-TR); and, (d) a great number of suicide threats and (possibly “demonstrative”) suicide attempts.

While the ways of expressing emotional distress today are, surprisingly, quite similar to the pattern 30 and 20 years ago, the stressors have changed. During the first 15 years or so the main stressors “sending” the youngsters to treatment were separation from family members left behind in Ethiopia, and the after-effects of the traumatic migration journey via Sudan. The obstacles to belonging to Israeli society exacerbated the impact of these stressors (BenEzer, 2006a). Over the last 15 years or so, the stressors that were directly connected to the journey have been resolved, whether by the reunification of families (mainly in 1991) or the processing of the trauma occurring on the horrific journey. However, the difficulties related to the lack of sense of belonging to Israeli society have not been relieved. Indeed, they were exacerbated with time. I shall not go into details of the complex processes leading to this predicament in affiliation, but mention that for those who arrived very young or who were born in Israel, the sense of not belonging is also reflected to them through the condition of their older brothers and sisters and their parents.

In the last 10 years, the profile of mental health problems seen in this population also includes (e) antisocial behavior, such as violence, crime, and alcohol or substance abuse, and (f) “delayed” PTSD symptoms among people in their late 30s/early 40s, especially women, for whom the traumatic experiences of the journey, especially rape and other sexual assaults, surface to disturb their functioning or quality of life. Another mode of distress involves (g) culture-specific phenomena, Zar spirit possession in particular, which has troubled some of the adolescents and young adults and brought about their referral to therapy over these 30 years. These cases, however, have been commonly treated by traditional healers (Balazar), once they started to arrive in Israel, or by combined efforts with a mental health professional. Lastly, (h) in recent years, some young people have started to come to therapy on their own initiative for reasons similar to other Western Israelis. These are mainly students at colleges and universities who have developed similarities in values and modes of expression with the rest of Israeli society, or who face conflict between social dictums and codes. For example, there have been instances where love relations between young adults, leading to a wish to get married, are confronted with traditional sanctions of incest taboo relating, in Ethiopian traditional Jewish culture, that require a seven-generation gap between the candidates for marriage, thus leading to the cancellation of the plans when closer links were discovered just prior to their marriage.

The Ethiopian–Israeli cultural gap

A full analysis of the differences between Ethiopian and Israeli worldviews is beyond the scope of this paper and I thus will focus on some aspects that are relevant to psychotherapy. Following Jerome Frank, these aspects include coping styles and the forms of expression and ways of addressing authority figures used in the therapeutic situation.

Of course, referring to “Israeli” or “Ethiopian” culture is not meant to imply that these are homogenous cultural “entities.” Israeli society is very heterogeneous, with many cultural groups, including a 20% Palestinian–Arab minority, and with people of the Jewish majority who come from diverse cultural backgrounds. The same can be said for Ethiopians (Levine, 2000). Groups of people living in the Omo Valley are certainly different than the Amhara of northern Ethiopia. Notwithstanding, there are certain codes and modes of coping that are shared by most members of the Ethiopian subgroups in the areas where Ethiopian Jews lived. The same applies to Jewish Israelis. Young people of both cultures are in constant change, opting in or out of their cultural backgrounds, adopting multiple affiliations and global signifiers of protest or integration, and hybridizing their emotional expressions which affect the therapeutic situation. Therefore, while we should consider their cultural backgrounds, we should always remember that psychotherapy is an encounter with specific individuals, who have made their own choices, and must always be treated as individuals.

The intercultural context in psychotherapy: The principle of mutual creative space (MCS)

What I have presented to this point makes it clear, I hope, that we are dealing with two very different worldviews. The people holding these worldviews are trying to make meaningful communication in the therapy context. If we return to Jerome Frank’s idea of “a shared assumptive world,” the basic question to be asked is: How can we bridge the gap between the two worldviews in the Ethiopian–Israeli relationship context to enable a therapeutic process?

I contend that for meaningful intercultural therapy to take place therapist and client must create a “mutual creative space.” This “space” is not entirely Ethiopian, yet not entirely Israeli, or Western. It is something new which is based on negotiation of perceptions, beliefs, attitudes, and behaviors, including mutual learning of mental coping styles and patterns of cure. Put differently, this is a way of creating a common therapeutic language. The creation of this space should grow out of the “pain” that is shared by both therapist and client: both are at a loss, neither of them knows how to interpret and understand central aspects of the therapeutic situation. On the basis of this lack of orientation, they can initiate something new that is shared by both sides.

I shall now present a few ideas for the formation of such a “creative space” drawn from many years of clinical work with Ethiopian Jews. The first few ideas concern technical devices related to the framework of the therapeutic process. Other ideas involve more fundamental changes in the therapeutic work ensuing from the cross-cultural setting.

An example of a technical device which I use in forming a “creative space” is the way I shake hands with the client. This act is the first thing I do, before uttering a word. I always meet an Ethiopian client with an Ethiopian handshake (the palm of the left hand holding the right lower arm forming a ninety degree angle). By enacting an Ethiopian cultural element within the Western situation of therapy I leave the safe grounds of my own professional culture and step into a new unknown territory. The patient is also stepping out of his/her culture in the very fact that they come to a psychologist, sit in a room with two armchairs and a low coffee table with a box of tissue paper. We have thus created a new and different situation for both of us. ⁸

Another technical device, which I use quite often, is related to the way people in different cultures encourage other people to go on telling a story, to continue talking about something. In most Western cultures, when we wish to encourage someone to go on talking, to convey that we are listening attentively to what they say, we usually say “ehm,” “aham,” and so forth. In Ethiopian culture, this attentiveness is signalled with the sound “hh!” made by a sudden sharp inhalation. Therefore, when I work with Ethiopian immigrants, I replace my usual “ehm” with an Ethiopian “hh.” In that way I again “meet them half way,” show them, even if subliminally in the communication process, that I am familiar with their culture and encourage them to use their cultural codes. ⁹

A third example concerns using the Ethiopian buna (coffee) ceremony. In the buna ceremony, unlike most encounters, people sometimes share personal stories. The ceremony consists of three rounds of coffee. In Ethiopia, men used to do it when they returned from their daily work, in the evenings, whereas women would assemble together three times a day for buna. It would also be the customary ceremony for guests. Traditionally, it would be conducted by age groups, mainly with grown-ups and the elderly, sometimes divided by sex as well. Children would not participate but could sometimes be present, either keeping silent or holding candles for light and serving the guests. The ceremony begins with the “woman of the house” roasting the coffee beans and bringing them for the guests or other participants to see and smell, with some additional scent. She goes out to grind the beans and cook the coffee in a special jug and then she comes and pours the coffee into special small white ceramic glasses. With each round the coffee becomes less bitter, since water is added to the jug. In the first round, people customarily ask each other only general questions that concern the health and whereabouts of relatives and friends. Towards the end of this round of coffee, and with the second round, the “warming up” has ended, and the participants may share personal stories, sometimes disguised as if it happened to someone else. At this stage, consultation may take place, in an explicit or implicit manner, in the form of similar stories of trouble and misfortune that happened to others and their “solutions,” or discussion of good and bad options within the situation, and so on. The third round is the closing part of the ceremony. The whole process usually takes 45–60 minutes, but will sometimes be prolonged. It is considered bad manners to agree to a buna ceremony and then leave after the first round of coffee.

I use the buna ceremony in cross-cultural therapy offering coffee at the beginning of our meeting. If the person prefers tea I would of course bring that. However, even if they respond with the customary polite refusal (after my offering at least three times), I would still bring two cups, for myself and the patient/client, and put them on a little table between us. My intention here is to signify that the situation resembles the Ethiopian coffee ceremony in that it is one of sharing experiences. In this way, I hope to achieve more openness and willingness to share trouble and misfortune.

In addition to contextual cues, therapists use the explicit communication to make it clear that the therapeutic encounter is different from ordinary social situations like speaking to a friend, a relative or other nonprofessional. Using the coffee ceremony is just one more way to create a special situation. However, because Israelis generally do not pay much attention to rituals or codes of etiquette as in the Ethiopian culture, this distinct gesture of acknowledgment makes the context unique and contributes to establishing the mutual creative space where therapist and patient can communicate and work effectively. ¹⁰

These three examples relate to the first level of mutual creative space, that of the therapist’s willingness to change his or her standard practice to include certain codes and behaviors of the patient to indicate they are accepted as they are. The second level in developing mutual creative space involves changes in both therapist and patient/client. From the therapist’s point of view, this level may include more fundamental changes in therapeutic technique. This can be illustrated by cross-cultural therapeutic work with dreams. In Ethiopian culture dreams foretell the future. The interpretation of a dream thus involves figuring out what is going to happen. In psychodynamic theory, the dream is usually an expression of an inner wish which was not actualized, or a forbidden drive which came up to the surface of conscious awareness. In other words, it reflects the past or present rather than the future. In my cross-cultural therapeutic work, I do not try to change the Ethiopian viewpoint about dreams and what they tell us, but instead, weave it into the mutual creative space. This was the case in therapy with a young Ethiopian person in Israel who related the following dream:

In my dream, I have seen my father and all the rest of my family standing behind him in the city of Addis Ababa. I stood on one side of the road while they stood on the other side. We did not hug each other. What does it mean? Does it mean that something bad will happen?

In response, I asked him: “What would you have done in the case of such a dream in Ethiopia?” He answered: “I would have gone to someone who is a specialist for that in the village, a ‘dream solver’ [an interpreter of dreams].” ¹¹ I then asked: “What would she have said if you brought her this dream?” And he answered: “If I knew that, I would have not come to you!” I was then forced to look for another way to work with him on that dream. Here I left the safe ground of the technique known to me and I told him: “Let us use the dream as a ‘jumping board,’ a venture point, and try together to predict what might happen according to your dream, what does the dream predict?” Together, we then entered the new territory, unknown and unmapped, of mutual creative space. On my part, I was ready to go with him to consider predictions of the future on the basis of a dream. I did not, however, leave behind my basic therapeutic assumption that his associations and predictions concerning what might happen would reflect what was bothering him currently and reveal aspects of his inner world. On his part, he had to give up the traditional Ethiopian way of dream-solving in which I was supposed to give him straight away a full and authoritative interpretation of the dream’s prediction. Instead, he was asked to invent possible (predictive) interpretations himself. Both of us left familiar territory, our cultural safe haven concerning dream interpretation, and engaged in negotiating a new space between us.

We were then able to realize, using the various predictions raised following the dream narration that he had been extremely worried about his family left behind in Ethiopia. And that he also experienced intense guilt feelings because he had left his seven younger brothers and sisters to face the dangers of the refugee situation in Ethiopia alone. His interpretations of the dream made it clear how much he missed his parents and a particular brother of his, and longed for the end of the four-year separation.

Another example of how to form a mutual creative space involves the case of an Ethiopian adolescent who was referred to me because he had stopped eating. On our first session, to describe his condition he told me the following story:

A monkey fell from a tree and rolled into a thorn bush. An old man passing on the road saw him and asked him how he could help. The monkey said “Take my thorns out.” But the old man did not have time and he said he could take out only one thorn, the one that hurt the most. “Which one is that?” he asked. The monkey pointed to his behind.

The boy then asked me: “Can you take that thorn out for me?” I understood that what he meant was, “You cannot bring my family from Ethiopia, so how can you help me?” I thought for a moment and responded in the following way:

You know, I wish to tell you a story as well: It happened that twin monkeys fell from a tree and rolled into a thorn bush. Their whole bodies were covered with thorns. An old man passing on the road saw them and asked how he could help. The twin monkeys said “take our thorns out.” But the old man did not have time to take all the thorns out and he said he could take out only one thorn, the one that hurts the most. “Which one is that?” he asked. Both monkeys pointed to the area under their fingernails. “Well,” said the old man, “these thorns I cannot take out. However, since this is the case, I am willing to stay longer and take all other thorns out.” One of the twin monkeys responded to this by saying: “If you cannot take out the thorn that hurts the most, I do not want any of your help.” The other of the twin monkeys then said: “Well, if you take out all the other thorns, maybe I could cope better with the pain of that one thorn which is most hurtful.” Now, I said to the youngster, “it is for you to make your choice.”

What I did in this instance is respond in the same cultural modality of the patient, that is, in the form of the parable. The use of parables, fables, and other kinds of stories in order to illustrate a point is very common in Ethiopian culture. By stepping into his cultural modality, I was able to help him put his current choices in perspective. He was then able to choose psychotherapy as an option and, after some months of therapeutic work, he had gained weight, and was no longer in life-threatening condition. He then completed therapy with the statement: “I saw my flesh above the fire—and almost fell into the fire myself,” meaning: I saw my family at risk and almost died by putting myself at risk as well.

In both of these clinical examples, a common stressor, namely worries for absent family members, was at the forefront. This concern was particularly important for many young people and others in the community in the period following the journey through Sudan (1977–1985). Some 1,500 unaccompanied minors of Ethiopian origin suffered intense longing due to separation from their relatives left behind in Ethiopia. Operation Solomon (1991) ended this period for most of them and relieved their suffering, but did not solve the problem of separation for others, whose relatives were not registered previously as Jews by Israeli agencies, thus left behind in Ethiopia, to be taken to Israel in a slow process in the following 20 years, a process that is still going on to this day.

The two cases thus raise a political dimension: are these patients asking the therapist for personal help or addressing the host country through the therapist? Indeed, in both cases, the therapist did address the practical aspects of the predicament, setting aside the non-active approach, and trying to facilitate the migration of the patients’ relatives from Ethiopia. These political actions may be viewed as “committed psychotherapy,” or simply, as Anna Freud once said in a very different context, “taking care of the preconditions for therapy, in order to make therapy possible…” (Joseph Sandler, personal communication, November 27, 1982). ¹² Negotiation between therapist and patient may take place at multiple levels. This should be noted and addressed by the therapist, who must take into account that in specific migratory contexts, such as that of the Ethiopian Jews arriving to Israel via Sudan leaving their relatives behind, the cultural gap might not be the most painful aspect of their mental suffering.

Conclusion

In his concept of “potential space” Winnicott proposed a space that is not fantasy and not reality, where imagination, symbolization, and creativity are possible. In this space, transitional objects and phenomena, as well as play, can exist and meaningful communication is enabled. Similarly, in the intercultural situation, we can create a potential space between two (or more) cultures that is not identical to any of these cultures and does not represent their reality or fantasy accurately. The development of such a “mutual creative space,” as described in this paper, can enable significant communication and a meaningful encounter between people belonging to different cultures. In this potential space something new is created, and the participants may experience a kind of developmental growth.

Winnicott claimed that “only in playing is communication possible” (Winnicott, 1971). Taking Winnicott one step further, I suggest that this space is based on the willingness to “play the other,” in fantasy or reality, and to test ideas, beliefs, attitudes, or codes of behavior of the other culture, in imagination or in action. As Ogden put it: “Empathy is a psychological process (as well as a form of object relatedness) that occurs within the context of a dialectic of being and not-being the other. Within this context (Winnicott would say ‘within potential space’) one plays with the idea of being the other while knowing that one is not” (Ogden, 1985, p. 138). Taking this idea into the intercultural therapy situation, we may say that the creation of a mutual creative space allows both psychotherapist and patient to play with the idea of being the other. In this process, the “other” helps create, crystallize, and sharpen the identity of both participants in the encounter. As a result, both may experience personal growth. Playing the other enriches and expands the boundaries of the person/self while, at the same time, strengthening them by sharpening the differences between them. As Winnicott put it: “The mother creates the infant and the infant creates the mother” (Ogden, 1985, p. 131). I would suggest the same process for the intercultural situation, where communication and a meaningful relationship are dependent on establishing a mutual creative space.

To sum up, while Winnicott identified the importance of an “in-between undefined space,” to enable a meaningful relationship between mother and infant, as well as psychoanalyst and patient from the same culture, the notion of mutual creative space emphasizes the way that an in-between space can foster a meaningful relationship between patients and therapists working together a cultural divide. This mutual creative space can also help address the phase in the lives of immigrants and others in society facing transitions in which aspects of their existence must be addressed (and then readdressed over time as their adaptation process changes). In social constructivist terms, this might be rephrased as “a phase in the lives of people coming from different subgroups within society,” (or construed as such) who, in order to interact in a meaningful way, must negotiate aspects of their worldviews, as well as creating new forms to address their shared reality.

The principle of “mutual creative space” may be relevant not only in the therapeutic situation but in any cross-cultural encounter in other domains, including the world of educators, physicians, nurses, administrators, and other professionals, paraprofessionals, and laypersons. Striving to achieve a mutual creative space could assist in creating a meaningful and effective encounter in many cross-cultural situations. Indeed, this notion of in-between space may assist in working toward a more just, pluralistic, multicultural society, in which multiculturalism is not only a theory but a practical way of life for everyone.