“Doing the Gratitudes” – Jessica Leza, MA, MT-BC

September 9, 2019
Jessica Leza, MA, MT-BC

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Dismantling Anglo-centric assumptions of the universal utility of gratitude

Dear music therapists,

We need to talk about gratitude.

In many circles, “doing the gratitudes” has become a popular exercise intended to increase happiness. This can manifest in several ways. Clients may be asked at the beginning of the session to share something they are grateful for, or they may be asked to write about something they are grateful for in a list, journal, or by writing a letter. On social media, people are asked to post once a day for 100 days about something they are grateful for with hashtags like #100DaysOfGratitude.

Sounds innocent enough, doesn’t it? The marketing materials that accompany the products selling this idea sure sound cheery! “Change your life forever!” “Gratitude is a happiness booster!” “Become 25% happier!”

The problem is when therapists accept these marketing claims after only the most superficial and cursory examination, based entirely on the frameworks of their own culture.

Cultural competency and its younger, more demandingly nuanced sibling, cultural humility, both require that we acknowledge our own culture and the fact that our clients may not belong (or be fully assimilated) to our culture.

I will get to the chase: If you are a white, neurotypical therapist asking your non-white or neurodivergent clients to participate in gratitude exercises and you have not bothered to investigate cultural differences in the meaning and expression of gratitude, you are not providing culturally competent services.

The reality is that the popularity of public performances of “doing the gratitudes” is a very white American (and neurotypical) cultural act. I intentionally use the word performance because these manipulations are not done privately but in front of others – the therapist, teacher, or boss, as well as other group therapy participants, students, or employees; and because these manipulations ask participants to express gratitude publicly regardless of whether they currently experience that emotion in an authentic manner. Considered this way, one might even digress by questioning the ethics and utility of asking those you hold power over to express a specific emotion – whether they authentically feel the emotion or not. One might question whose needs are truly being met by such an exercise. Is the therapist performing this manipulation because it easily allows them to check off a box in the patient’s chart that says “increased emotional expression?”

If you are asking others to perform gratitude for you, are you doing so under the assumption that because the practice benefits you and fits within your worldview that it will also benefit your clients and that this exercise necessarily matches your client’s cultural values? Are you assuming that your good intentions at promoting (assigning) “positivity” are adequate simply because you personally enjoy reading the proliferation of “hundred days of gratitude” posts on social media in the days running up to Thanksgiving and never really considered whether others might feel differently?

This is one of the dangers and harms of unchecked and unquestioned PPIs (Positive Psychology Interventions). Gratitude manipulations are deeply founded on a set of cultural assumptions, and through the colonialist power of white supremacy it is assumed that because some neurotypical white people benefit from this that all people will benefit. It is telling that PPIs are referred to in the research literature as “manipulations” (Titova, Wagstaff, & Parks, 2017).

The fact is that gratitude PPIs can cause negative emotional reactions in your clients and if you are not attuned to the possibility, the power dynamics might lead nonwhite and neurodivergent clients to mask their discomfort in order to comply with demands and satisfy the requirements of authority.

Gratitude is something that is conceptualized and expressed different ways amongst different cultures. Neurotypical, white American culture is not the gold standard of what other cultures aspire to be and therapists should not act as if it is. In this light, asking a client to express gratitude in a way that is not compatible with their culture runs a high risk of being a colonialist act. A white, American, neurotypical therapist who requires clients to assimilate to white culture while participating in therapy by expressing gratitude in a manner that disregards the variations in cultural understandings and expressions of the emotion is an example of one way that therapeutic modalities can preserve and strengthen the pillars of white supremacist colonialism.

Therapists should be especially sensitive to note that there are spiritual dimensions to the cultural differences in expressions of gratitude. Expressing gratitude may be seen as something that occurs primarily in a religious context, and religious figures such as saints or gods may be the only acceptable parties to whom to express thanks. For people who believe in this fashion, asking them to verbally express gratitude in a session may be asking them to bring their religion into a healthcare space, which may or may not be in the client’s best interests when their spiritual beliefs are not respected as equally valid. This ask from the therapist may become especially complicated when the client belongs to a minority faith compared to other group members. Clients may feel it is inappropriate to bring their religious views into therapy in that manner, or they may feel unsafe in revealing minority religious affiliation or discussing religious views with those from outside their religion. Therapists must be actively considering these complexities in order to ensure they are creating a safe environment in which a client’s religious values are respected.

Cultural differences in gratitude may also include different styles of expression. A white American neurotypical therapist may personally feel comfortable verbally performing gratitude because, in white American neurotypical culture, people normatively express gratitude verbally by saying “thank you” and similar phrases throughout the day to both strangers and familiar people. White therapists should not assume that this cultural convention is the same across the globe.

In other cultures, such and Iran and Malaysia, interpersonal expressions of gratitude may differ according the status of each party as well as the impact of the favor being performed. Iranian people, for example, are more likely to apologize for requiring assistance or to ask that God reward the person for their kindness (Mendonça, Merçon-Vargas, Payir, & Tudge, 2018).

Yes – you read that correctly – in other cultures expressing gratitude is a humbling act that may compel people to apologize! In Japan, this construct is contained by the word sumimasen, an expression that can serve to express both gratitude and an apology (Kimura, 1994).

Are you considering that when you ask your clients to perform gratitude in order to conform to white American culture that internally your client may be reflecting on the times they have inconvenienced others and their need to subsequently apologize, and the ways in which this may be contraindicated for the goals and objectives you have in mind? Are you considering that these cultural values are just as valid as yours and that you should not attempt to overwrite the client’s culture with your own white, American, neurotypical culture? Are you assuming that a performance of gratitude will make your clients happier without considering that the emotional experiences that white Americans value and feel entitled to (e.g., the “pursuit of happiness”) may not be experienced as enriching to those from different cultures?

If you are not carefully considering these issues then in these moments you are not executing culturally competent care.

Titova, Wagstaff, & Parks (2017) found that the gratitude-focused PPIs that are popular amongst white American clinicians can actually increase negative emotions such as sadness and guilt in study participants from India. The authors further point out that the perception that emotions fall into a dichotomy of good or bad and even the value of striving for increased personal happiness are white / western cultural constructs, as citizens of other nations may take a more dialectical view of emotions and derive satisfaction through collective harmony.

Layous, Lee, Choi, & Lyubomirsky (2013) also found that PPIs with a focus on gratitude had more positive effects for Americans than South Koreans, who experienced a more complicated emotional response that included feelings of indebtedness and a resulting lower impact on western-oriented measures of wellbeing. Meanwhile, Naito and Sakata (2010) found that gratitude amongst Japanese study participants was also associated indebtedness, as well as feelings of regret and remorse. These higher levels of indebtedness were associated with lower quality of life scores – showing that gratitude-focused manipulations may harm clients instead of helping.

In some cultures, such as China and Korea, gratitude is expressed less through the verbal performance of expressing thanks and more through interpersonal connectivity. In this case, someone may feel the best way to express gratitude is to connect with the person who helped them and provide them with those things they actually want. This may take form in a concrete gesture or tangible gift, but it also takes place through the strengthening of the relationship (Mendonça, Merçon-Vargas, Payir, & Tudge, 2018).

This is illustrated by the Confucian concept of 关系, or guānxi, a word that can be translated literally from Chinese as “relationship” or “connections” but functions more as an expectation of reciprocity within a non-familial relationship in which each person helps the other in an ongoing cycle of loyalty and trust. This is often explained to foreigners visiting China as “you scratch my back, I’ll scratch yours.” Within the parameters of guānxi, failing to reciprocate by performing a favor in turn is socially unacceptable. It is within this context of interlocking acts of goodwill with business partners and other stakeholders that Chinese people often observe that Americans living in China verbally communicate thanks rather excessively. And so it may be unsurprising to read in Boehm, Lyubomirsky, and Sheldon’s 2011 study that Anglo Americans benefitted much more from gratitude manipulations than foreign-born Asian Americans, many of whom were Chinese in this particular study.

These data points are not to suggest that music therapists should reactively eliminate gratitude-focused manipulations or other PPIs from their toolkits. Instead it is a call to increased critical analysis, reflection, and cultural humility, and a reminder that what benefits a white American therapist may not benefit – or may even cause harm – to their non-white / non-American clients.

Read more on this subject:

Boehm, J.K., Lyubomirsky, S., & Sheldon, K. M. (2011). A longitudinal experimental study comparing the effectiveness of happiness-enhancing strategies in Anglo Americans and Asian Americans. Cognition and Emotion, 25(7), 1263-1272. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394986/#

Kimura, K. (1994). The multiple functions of sumimasen. Issues in Applied Linguistics, 5(2). Retrieved from https://escholarship.org/uc/item/73q6b248

Layous, K., Lee, H., Choi, I., & Lyubomirsky, S. (2013). Culture matters when designing a successful happiness-increasing activity: A comparison of the United States and South Korea. Journal of Cross-Cultural Psychology, 44, 1294-1303.

Mendonça, S. E., Merçon-Vargas, E. A., Payir, A. & Tudge, J. R. (2018). The development of gratitude in seven societies: Cross-cultural highlights. Cross-Cultural Research, 52(1), 135-150. Retrieved from: https://journals.sagepub.com/doi/pdf/10.1177/1069397117737245

Naito, T., & Sakata, Y. (2010). Gratitude, indebtedness, and regret on receiving a friend’s favor in Japan. Psychologia: An International Journal of Psychological Sciences, 53, 179-194

Naito, T., & Sakata, Y. (2010). Gratitude, indebtedness, and regret on receiving a friend’s favor in Japan. Psychologia: An International Journal of Psychological Sciences, 53, 179-194.

Titova, L., Wagstaff, A. E., & Parks, A. C. (2017). Disentangling the effects of gratitude and optimism: A cross-cultural investigation. Journal of Cross-Cultural Psychology, 48(5). DOI: 10.1177/0022022117699278. Retrieved from: https://www.researchgate.net/publication/313114740_Disentangling_the_Effects_of_Gratitude_and_Optimism_A_Cross-Cultural_Investigation