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    mmigration and Acculturation

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    Immigration and Acculturation

    Use the readings of this unit regarding the concerns confronting Asian Americans/Pacific Islanders and Hispanic/Latino Americans in the United States to complete this discussion activity.

    Explain how institutional racism could result in internalized oppression for members of marginalized populations. Provide an example.

    Immigration and Acculturation Discussion

    Discuss how historical and current views on immigration result in challenges. Provide an example.

    In your own words, define acculturation and provide an example of how this may impact ethnic minorities and their families.

     

    Immigration and Acculturation Discussion

    COUNSELING ASIAN AMERICANS AND PACIFIC ISLANDERS

    Chapter Objectives

    1. Learn the demographics and characteristics of Asian Americans and Pacific Islanders.

    2. Identify counseling implications of the information provided for Asian Americans and Pacific Islanders.

    3. Provide examples of strengths associated with Asian Americans and Pacific Islanders.

    4. Know the special challenges faced by Asian Americans and Pacific Islanders.

    5. Understand how the implications for clinical practice can guide assessment and therapy with Asian Americans and Pacific Islanders.

    Among traditionally oriented Chinese Americans, depression is described with terms such as discomfort, pain, dizziness, or other physical symptoms, rather than as feelings of sadness. Many feel that a diagnosis of depression is “morally unacceptable.” (Kleinman, 2004)

    Asian parents hold dearly to the centuries-old culture of shame and honor so that when they arrive to the United States, it often gets passed down to the next generation. So much so that if their children need help for issues related to low self-esteem, depression, anxiety, or any personal struggles, they can be seen as tarnishing the family’s prestige. (Louie, 2014a)

    Calling Asian Indians the new “model minority” isn’t a compliment. It’s an attempt to fit them into a box for political purposes. . .The phase “model minority” inherently pits one minority group against others . . . After all, if one community is the “model, “ then the others are problematic and less desirable. (Srivastava, 2009, p. 1)

    The Asian American population is growing rapidly and, as of 2013, was close to 18 million, representing 5.3% of the total population. Native Hawaiian and other Pacific Islanders number 1.2 million and comprise 0.4% of the total population (U.S. Census Bureau, 2015). The largest Asian groups in the United States include

    (Pew Research Center, 2013)

    · over 4 million Chinese,

    · 3.4 million Filipinos,

    · 3.2 million Asian Indians,

    · 1.7 million Vietnamese,

    · 1.6 million Koreans, and

    · 1.3 million Japanese.

    Nearly three-quarters of Asian American adults were born abroad and about two-thirds speak a language other than English at home; approximately half do not speak English “very well.” Between-group differences within the Asian American population are quite large, since the population is composed of at least 40 distinct subgroups that differ in language, religion, and values. Counselors should not assume that Asian Americans are all the same. Individuals diverge on variables such as ethnicity, culture, migration and relocation experiences, degree of assimilation or acculturation, identification with the home country, facility in their native language and in English, family composition, educational background, religion, and sexual orientation (Nadal et al., 2012).

    Characteristics and Strengths

    In the following section, we present some of the cultural values, behavioral characteristics, and expectations that Asian Americans might have about therapy and consider the implications of these factors in treatment. The level of accuracy of these group generalizations for each individual client or family must be determined by the therapist.

    Asian Americans: A Success Story?

    The contemporary image of Asian Americans is that of a highly successful minority that has “made it” in society. Indeed, a close analysis of census data (U.S. Census Bureau, 2011a) seems to support this contention. Of those over the age of 25, over half of Asian/Pacific Islanders have a bachelor’s degree, versus 30% of their White counterparts; 20% have an advanced degree, compared with 10% of Whites (U.S. Census Bureau, 2011b). Words such as intelligenthardworkingenterprising, and disciplined are frequently applied to this population (Lim, 2014). The median income of Asian American families was $66,000 as compared with $49,800 for the U.S. population as a whole (Pew Research Center, 2013).

    However, a closer analysis of the status of Asian Americans reveals a somewhat different story. First, in terms of economics, references to the higher median income of Asian Americans do not take into account (a) the higher percentage of Asian American families having more than one wage earner, (b) between-group differences in education and income, and (c) a higher prevalence of poverty despite the higher median income (12.5% for Asian Americans and 15.1% for Pacific Islanders, versus 9.4% for non-Hispanic Whites) (U.S. Census Bureau, 2010). Rates of poverty are particularly high among Hmong, Guamanian, Indonesian, and Cambodian immigrants (Ramakrishnan & Ahmad, 2014).

    Second, in the area of education, Asian Americans show a disparate picture of extraordinarily high educational attainment among a few and a large, undereducated mass. Among the Hmong, only 40% have completed high school. Fewer than 14% of Tongan, Cambodian, Laotian, and Hmong adults and only 18% of Pacific Islanders have a bachelor’s degree (Aronowitz, 2014). When averaged out, this bimodal distribution indicates how misleading statistics can be.

    Third, there is now widespread recognition that Chinatowns, Manilatowns, and Japantowns in San Francisco and New York represent ghetto areas with prevalent unemployment, poverty, health problems, and juvenile delinquency. People outside these communities seldom see the deplorable social conditions that exist behind the bright neon lights, restaurants, and quaint shops.

    Fourth, although Asian Americans underutilize mental health services, it is unclear if this is due to low rates of socioemotional difficulties or cultural values inhibiting self-referral (Zane & Ku, 2014). It is possible that a large portion of the mental illness, adjustment problems, and juvenile delinquency among Asians is hidden. The discrepancy between official and real rates of adjustment difficulties may be due to cultural factors, such as the shame and disgrace associated with admitting to emotional problems, the handling of problems within the family rather than relying on outside resources, and the manner of symptom formation, such as a low prevalence of acting-out disorders.

    Fifth, Asian Americans have been exposed to discrimination and racism throughout history and continue to face anti-Asian sentiments. Even fourth- and fifth-generation Asian Americans are sometimes identified as “foreign” (Tsuda, 2014). In a survey of Chinese Americans, 58% reported being subjected to verbal harassment such as being made fun of, called names, or threatened; disrespectful or unfair treatment; unfairness in career advancement; stereotyping; and physical harassment (Larson, 2009). Perceived racial discrimination is associated with higher psychological distress, anxiety, depression, and suicidal ideation (Hwang & Goto, 2009).

    It is important for those who work with Asian Americans to look behind the success myth and to understand the historical and current experiences of Asians in America. The matter is even more pressing for counselors when we realize that Asian Americans underutilize counseling and other mental health facilities. The approach of this chapter is twofold. First, we attempt to indicate how the interplay of social and cultural forces has served to shape and define the lifestyle of recent immigrants/refugees and American-born Asians. Second, we explore how an understanding of Asian American values and social experiences suggests a need for modifications in counseling and psychotherapeutic practices when working with some members of this population.

    Collectivistic Orientation

    I was born and raised in Korea and came to the United States in 1968. . .I must move back to Seoul to take care of my aging mother. I am a man of Asian values (filial piety), and my children are young college graduates of American values (career advancement and development). (Choi, 1999, p. 7)

    Instead of promoting individual needs and personal identity, Asian families tend to have a family and group orientation. Children are expected to strive for family goals and not engage in behaviors that might bring dishonor to the family. Parents believe they should have influence on their children’s career choices (Pew Research Center, 2013). Asian American parents tend to show little interest in children’s viewpoints regarding family matters. Instead, the emphasis is on adherence to “correct” values, family harmony, and adapting to the needs of family members, especially elders (P. H. Chen, 2009). Asian American adolescents are often expected to assist, support, and respect their families even when exposed to a society that emphasizes adolescent autonomy and independence (Fuligni et al., 1999).

    Whereas EuroAmerican parents rated being “self-directed” as the most important attribute in children’s social competence, Japanese American parents chose “behaves well” (O’Reilly, Tokuno, & Ebata, 1986). Chinese American parents also believed that politeness and calmness are important childhood characteristics (Jose, Huntsinger, & Liaw, 2004). Asian American families do differ, however, in the degree to which they place individual needs over family needs. For example, in the case just given, the client accepted the fact that his adult children would not return home to stay with his wife (their mother) while he was in Korea taking care of his mother. Although he decries American society, in which individualism prevails over collectivism, he acknowledges that his children have honored the family by being successful and that they define family obligations in a different manner.

    Implications

    Because of a possible collectivistic orientation, it is important to consider the family and community context during assessment and problem definition. A therapist should be open to different family orientations and to avoid automatically considering interdependence as a sign of enmeshment. After doing a client-centered analysis of the problem, counselors can ask, “How does your family see the problem?” For traditionally oriented Asian Americans, a focus on individual client needs and wishes may run counter to the values of collectivism. Goals and treatment approaches may need to include a family focus (e.g., “How important is it for you to consult your family before deciding how to deal with the problem?” and “How would achieving your goals affect you, your family, friends, and social community?”). Questions such as these allow the therapist to assess the degree of collectivism in the family. Acculturated Asian Americans with an individualistic orientation can often benefit from traditional counseling approaches, but family issues should also be considered, since acculturation conflicts are common.

    Hierarchical Relationships

    Traditional Asian American families tend to be hierarchical and patriarchal in structure, with males and older individuals occupying a higher status (Kim, 2011). Communication flows downward from parents to children; children are expected to defer to their elders as a matter of obligation and duty (A. Lau, Fung, & Yung, 2010). Sons are expected to carry on the family name and tradition. Even when they marry, their primary allegiance is to the parents. Between-group differences do exist. Japanese Americans are the most acculturated. The majority are third- or fourth-generation Americans. Filipino American families tend to be more egalitarian, whereas Korean, Southeast Asian, and Chinese American families tend to be more patriarchal and traditional in orientation (Blair & Qian, 1998). Modern Chinese societies are moving toward more egalitarian relationships between husband and wife and between parents and children (E. W.-C. Chen, 2009).

    Implications

    Clients should be aware that Asian Americans may respond to the counselor as an authority figure, be reluctant to express true feelings and concerns, and say what they think the mental health professional wants to hear (Son & Ellis, 2013). In family therapy, it is important to determine the family structure and communication pattern. Does it appear to be egalitarian or hierarchical? If the structure is not clear, addressing the father first and then the mother may be most productive.

    If English is a problem, use an interpreter. Having children interpret for the parents can be counterproductive because it upsets the hierarchical structure. For very traditionally oriented families, having communication between family members directed to the therapist may be more congruent with cultural values than having family members address one another. It is also important to assess possible status changes within the family. It is not uncommon among Asian immigrants for women to retain their occupational status while men are either underemployed or unemployed. Such loss of male status may result in family conflict, particularly if males attempt to maintain their status by becoming even more authoritarian. In such cases, it may be helpful to cast societal factors as the problem that needs to be addressed.

    Parenting Styles

    Amy Chua, author of the book Battle Hymn of the Tiger Mom, raised a storm of criticism when she described her child-rearing strategies, including banning sleepovers, play dates, watching TV, or playing computer games and considering any grade less than an “A” as unacceptable. Her children are required to complete all of their school work and must practice their musical instruments three hours each day. (One daughter, Sophia, played at Carnegie Hall at age 14 and the other daughter, Lulu, is a gifted violinist.) (Corrigan, 2011)

    Asian American parenting styles tend to be more authoritarian and directive than those in EuroAmerican families (Kim, 2011), although a relaxed style is often used with children younger than the age of 6 or 7 (Jose et al., 2004). For example, Chinese parenting is based on the concepts of chiao shun (to train) and guan (to govern and to love) (Russell, Crockett & Chao, 2010). Shame, the induction of guilt, and love withdrawal are often used to control and train the children (J. S. Lau, Fung, Wang, & Kang, 2009). Problem behavior in children is viewed as a lack of discipline. While praise is frequently used in the majority culture to reinforce desired behaviors, many Asian families consider instruction to be the main parenting strategy (Paiva, 2008). As one parent stated, “I don’t understand why I should reward things they should already be doing. Studying hard is a normal responsibility. Listening to parents is a must. Why should they feel proud when they are merely meeting a basic obligation?” (A. S. Lau et al., 2010, p. 887). Criticism rather than praise is believed to be effective in changing behaviors. However, differences in parenting style between Asian American groups have been found. Japanese and Filipino American families tend to have the most egalitarian relationships, whereas Korean, Chinese, and Southeast Asian Americans are more authoritarian (Blair & Qian, 1998).

    Implications

    Egalitarian or Western-style parent-effectiveness training strategies may run counter to traditional child-rearing patterns. Traditional Asian American families exposed to Western techniques or styles may feel that their parenting skills are being criticized. Instead of attempting to establish egalitarian relationships, the therapist can focus on identifying different aspects of parenting, such as teaching and modeling. The therapist can help refocus on the more positive aspects of Asian child-rearing strategies, framing the change as helping the children with problems rather than altering traditional parenting. It is also important to commiserate with parents regarding the difficulties they encounter raising children in a society with different cultural standards (A. S. Lau, 2012).

    Emotionality

    Patients may not be willing to discuss their moods or psychological states because of fears of social stigma and shame. In many Asian cultures, mental illness is stigmatizing; it reflects poorly on family lineage and can influence others’ beliefs about the suitability of an individual for marriage. (Louie, 2014b)

    Strong emotional displays, especially in public, are considered signs of immaturity or lack of self-control; control of emotions is considered a sign of strength (Kim, 2011). Thus, in many Asian families, there is generally less open display of emotions. Instead, care and concern are shown by attending to the physical needs of family members. Fathers frequently maintain an authoritative and distant role and are not generally emotionally demonstrative or involved with children. Their role is to provide for the economic and physical needs of the family. Mothers are more responsive to the children but use less nurturance and more verbal and physical punishment than do EuroAmerican mothers (Kelly & Tseng, 1992). However, mothers are expected to meet the emotional needs of the children and often serve as the intermediary between the father and the children. When the children are exposed to more open displays of emotions from Western society, they may begin to question the comparative lack of emotion displayed by their parents.

    Implications

    Counseling techniques that focus directly on emotions may be uncomfortable and produce shame for traditional Asian Americans. Emotional behavior can be recognized in a more indirect manner. For example, if a client shows discomfort, the therapist could respond by saying either “You look uncomfortable” or “This situation would make someone uncomfortable.” In both cases, the discomfort would be recognized. We have found that many Asian Americans are more responsive to the second, more indirect acknowledgment of emotions. Feelings of shame or embarrassment may interfere with self-disclosure and need to be addressed in counseling. The process may be facilitated by affirming that the sharing of personal information, although it may be uncomfortable, is a natural process in therapy (Zane & Ku, 2014). It is also helpful to focus on behaviors more than emotions and to identify how family members are meeting each other’s needs. Among traditional Asian American couples, care and concern may be demonstrated by taking care of the physical needs of the partner rather than by verbally expressing concern. Western therapies that emphasize verbal and emotional expressiveness may not be appropriate in work with traditional Asian couples or families.

    Holistic View on Mind and Body

    A female Asian American client described her symptoms, including dizziness, loss of appetite, an inability to complete household chores, and insomnia. She asked the therapist if her problem could be due to “nerves.” The therapist suspected depression, since her symptoms included many of the physical manifestations of the disorder. She asked the client if she felt depressed and sad. At this point, the client paused and looked confused. She finally stated that she feels very ill and that these physical problems are making her sad. Her perspective was that it is natural to feel sad when sick. When the therapist followed up by asking if there was a family history of depression, the client displayed even more discomfort and defensiveness. Although the client never directly contradicted the therapist, she never returned. (Tsui & Schultz, 1985)

    Because the mind and body are considered inseparable, Asian Americans may express emotional difficulties through somatic complaints (Grover & Ghosh, 2014). Physical complaints are a common and culturally accepted means of expressing psychological and emotional stress. It is believed that physical problems cause emotional disturbances and that symptoms will disappear once the physical illness is treated. Instead of mentioning anxiety or depression, Asian clients often mention headaches, fatigue, restlessness, and disturbances in sleep and appetite (Wong, Tran, Kim, Kerne, & Calfa, 2010). Even psychotic patients typically focus on somatic complaints and seek treatment for these physical ailments (Nguyen, 1985).

    Implications

    Treat somatic complaints as real problems. Inquire about medications or other treatments that are being used to treat the symptoms. To address possible psychological factors, counselors can ask questions such as, “Dealing with headaches and dizziness can be quite troublesome; how are these affecting your mood or relationships with others?” This approach both legitimizes the physical complaints and allows an indirect way to assess psychosocial factors. It is beneficial to develop an approach that deals with both somatic complaints and the consequences of being “ill.”

    Academic and Occupational Goal Orientation

    I want to write. I have to write. . . This is not the choice my parents would make, and surely not the choice they would wish me to make. . .I must not let it deter my progress or shut down my dreams, my purpose. (Ying, Coombs, & Lee, 1999, p. 357)

    There is great pressure for children to succeed academically and to have a successful career, since both are indicative of a successful upbringing. As a group, Asian Americans perform better academically than do their EuroAmerican counterparts. Although Asian American students have high levels of academic achievement, they also have more fear of academic failure and spend twice as much time each week studying as their non-Asian peers (Eaton & Dembo, 1997). Their achievement often comes with a price. Asian American adolescents report feeling isolated, depressed, and anxious, and report little praise for their accomplishments from their parents (Lorenzo, Pakiz, Reinherz, & Frost, 1995). Asian American parents often have specific career goals in mind for their children (generally in technical fields or the hard sciences). Because choice of vocation may reflect parental expectations rather than personal talent, Asian college students are sometimes uncertain about realistic career options (Lucas & Berkel, 2005). Deviations from either academic excellence or “appropriate” career choices can produce conflict with family members.

    Implications

    Counselors can inquire about and discuss conflicts between parental academic or career goals and the client’s strengths, interests, and desires. When working with parents, counselors can encourage the recognition of all positive behaviors and contributions made by their children, rather than just academic performance. For career or occupational conflicts, counselors can acknowledge the importance parents place on their children achieving success, while indicating that there are many career options that can be considered. Differences of opinion can be presented as a culture conflict. The counselor can help the client brainstorm ways to present other possibilities to the parents. Because Asian American students often lack clarity regarding vocational interests, they may need additional career counseling assistance (Lucas & Berkel, 2005).

    Cultural Strengths

    Asian Americans’ cultural values can provide resiliency and strength. The family orientation allows members to achieve honor by demonstrating respect for parents and elders and supporting siblings in their endeavors. These customs produce a collective support system that can shield the individual and family from sources of stress. Because the achievements and success of an individual are considered a source of pride for the family rather than the individual, group harmony is primary. Enculturation or identification with one’s racial and ethnic background can serve as a buffer against prejudice, discrimination, and family conflicts (Hwang, Woods, & Fujimoto, 2010; Kim, 2011). For Korean American adolescents, ethnic identity pride is positively related to self-esteem, especially when there is strong parental support (Chang, Han, Lee, & Qin, 2015).

    Pacific Islanders have faced a history of colonization and oppression. Despite these challenges and obstacles, cultural strengths such as collectivity, harmony in family relationships, and respect for elders have been an important source of resilience. Pacific Islanders can rely on the community and family during times of stress (Vakalahi, 2009). Korean American college students were found to have strong cognitive flexibility. In dealing with conflicts with parents, these individuals used creative means to prevent or resolve problems in a way that accommodated traditional cultural expectations and their own personal needs (Ahn, Kim, & Park, 2009).

    Specific Challenges

    In the following sections we describe the challenges often faced by Asian Americans and consider their implications in treatment.

    Racial Identity Issues

    White privilege was a concept I was unaware of, even though it was intricately woven into the fabric of my life. If someone had asked me then, I would probably have said that I have not experienced racism, and I did not feel oppressed in any way. This is not to say I had not experienced racism. I just never thought of those encounters as racism because, most of the times, they were subtle. I reacted to racial microaggressions with confusion, fear, and frustration, although I never understood my emotions. (Lo, 2010, p. 26)

    As Asian Americans are progressively exposed to the standards, norms, and values of the wider U.S. society, the result is increasing assimilation and acculturation. Bombarded on all sides by peers, schools, and the mass media, which uphold Western standards, Asian Americans are frequently placed in situations of extreme culture conflict and experience distress regarding their behavioral and physical differences (Kim, 2011). Asian American college women report lower self-esteem and less satisfaction with their racially defined features than do their Caucasian counterparts (Mintz & Kashubeck, 1999). C.-R. Lee (1995) described his experiences as “straddling two worlds and at home in neither” and tells how he felt alienated from both American and Korean cultures. As with other adolescents, those of Asian American descent also struggle with the question of “Who am I?” In the case above, Lo talks about the struggles encountered during his racial identity development. Individuals undergoing acculturation conflicts may respond in one of the following ways (Huang, 1994):

    1. Assimilation. Seeking to become part of the dominant society to the exclusion of one’s own cultural group

    2. Separation or enculturation. Identifying exclusively with the Asian culture

    3. Integration/biculturalism. Retaining many Asian values while simultaneously learning the necessary skills and values for adaptation to the dominant culture

    4. Marginalization. Perceiving one’s own culture as negative but feeling inept at adapting to the majority culture

    Implications

    Although identity issues can be a problem for some Asian Americans, others believe that ethnic identity is not salient or important. Assessing the ethnic self-identity of clients is important because it can affect how we conceptualize the presenting problems and how we choose the techniques to be used in therapy. Those who adhere to Asian values have a more negative view toward seeking counseling (Kim, 2007). Acculturated Asian American college students hold beliefs similar to those of counselors, whereas less acculturated students do not (Mallinckrodt, Shigeoka, & Suzuki, 2005). Assimilated Asian clients are generally receptive to Western styles of counseling and may not want reminders of their ethnicity. Traditionally identified Asians are more likely to be recent immigrants who retain strong cultural values and are more responsive to a culturally adapted counseling approach. Bicultural Asian Americans adhere to some traditional values, while also incorporating many Western values. Being bicultural is associated with resilience in facing stressful situations (Sirikantraporn, 2013). Programs that help Asian American youth develop social awareness about ethnic identity issues and societal imbalance in power are associated with increased pride, self-efficacy, racial and ethnic esteem, and increased interest in contributing to societal change in its participants (Suyemoto, Day, & Schwartz, 2015).

    Acculturation Conflicts

    Children of Asian descent who are exposed to different cultural standards often attribute their psychological distress to their parents’ backgrounds and different values. The issue of not quite fitting in with their peers yet being considered “too Americanized” by their parents is common. Parent–child conflicts are among the most common presenting problems for Asian American college students seeking counseling (R. M. Lee, Su, & Yoshida, 2005) and are often related to dating and marriage issues (Ahn, Kim, & Park, 2009). Chinese immigrant mothers report a larger acculturation gap with sons than with daughters (Buki, Ma, Strom, & Strom, 2003). The larger the acculturation gap between parents and children, the greater the number of family problems. Parents may complain, “My children have lost their cultural heritage” (Hwang et al., 2010). The inability to resolve differences in acculturation results in misunderstandings, miscommunication, and conflict (R. M. Lee, Choe, Kim, & Ngo, 2000). Parents may feel at a loss in terms of how to deal with their children. Some respond by becoming more rigid.

    Implications

    To prevent negative interpersonal exchanges between parents and their children, therapists can reframe problems as resulting from acculturation conflicts. In this way, both the parents and their children can discuss cultural standards and the expectations from larger society. Although family therapy would seem to be the ideal medium in which to deal with problems for Asian Americans, certain difficulties exist. Most therapy models are based on EuroAmerican perspectives of egalitarian relationships and require verbal and emotional expressiveness. Some models assume that a problem in a family member is reflective of dysfunction between family members. In addition, the use of direct communication between child and parents, confrontational strategies, or nonverbal techniques such as “sculpting” may be an affront to the parents.

    Assess the structure of the Asian American family. Is it hierarchical or more egalitarian? What is their perception of healthy family functioning? How are decisions made in the family? How are family members showing respect for each other and contributing to the family? Focus on the positive aspects of the family and reframe conflicts to reduce confrontation. Expand systems theory to include societal factors such as prejudice, discrimination, poverty, and conflicting cultural values. Issues revolving around the pressures of being an Asian American family in this society need to be investigated. Describe the session as a solution-oriented one and explain that family problems are not uncommon. As much as possible, allow sensitive communications between family members to come through the therapist. The therapist can function as a culture broker in helping the family negotiate conflicts with the larger society.

    Expectations Regarding Counseling

    Because psychotherapy may be a foreign concept for some Asian Americans, it is important to carefully explain the nature of the assessment and treatment process and the necessity of obtaining personal information and insight into family dynamics. Asian American clients may expect concrete goals and strategies focused on solutions. Even acculturated Asian American college students prefer counselors to serve as direct helpers offering advice, consultation, and the facilitation of family and community support systems (Atkinson, Kim, & Caldwell, 1998). Mental health professionals must be careful not to impose techniques or strategies. Counselors often believe that they should adopt an authoritarian or highly directive stance with Asian American clients. What many Asian American clients expect is that the counselor take an active role in structuring the session and outlining expectations for client participation in the counseling process. It can be helpful for the therapist to accept the role of being the expert regarding therapy, while the client is given the role of expert regarding his or her life. In this way, clients can assist the therapist by facilitating understanding of key issues and possible means of approaching the problem (S.W.-H. Chen & Davenport, 2005).

    Implications

    Carefully describe the client’s role in the therapy process, indicating that problems can be individual, relational, environmental, or a combination of these and that you will perform an assessment of each of these areas. Introduce the concept of co-construction—that effective counseling involves the client and the counselor working together to identify problems and solutions. The therapist might explain, “In counseling we try to understand the problem as it affects you, your family, friends, and community, so I will ask you questions about these different areas. With your help we will also consider possible solutions that you can try out.” Co-construction reduces the chance that the therapist will impose his or her worldview on the client.

    The counselor should direct therapy sessions but should ensure full participation from clients in developing goals and intervention strategies. Suggestions can be given and different options presented for consideration by the client. Clients can also be encouraged to suggest their own solutions and then select the option that they believe will be the most useful in dealing with the problem. The opportunity for Asian American clients to try interventions on their own promotes the cultural value of self-sufficiency. The consequences for any actions taken should be considered, not only for the individual client, but also for the family. The client’s perspective is also important in determining what needs to be done if cultural or family issues are involved.

    Therapy should be time limited, should focus on concrete resolution of problems, and should deal with the present or immediate future. Cognitive-behavioral and other solution-focused strategies are useful in working with Asian Americans (S.W.-H. Chen & Davenport, 2005). However, as with other Eurocentric approaches, these approaches may need to be altered because the focus is on the individual, whereas the unit of treatment for Asian Americans may actually be the family, community, or society. Cognitive-behavioral approaches can be modified to incorporate a collectivistic rather than an individualistic perspective. For example, assertiveness training can be altered for Asian clients by first considering possible cultural and social factors that may affect assertiveness (e.g., minority status or personal values such as modesty). Then the therapist and client can identify situations where assertiveness might be functional, such as in class or when seeking employment, while recognizing other situations where a traditional cultural style might be more appropriate (e.g., with parents or other elders). Additionally, possible cultural or societal influences that affect social anxiety or assertiveness can be discussed. Finally, the client can practice role-playing to increase assertiveness in specific situations. This concrete alteration of a cognitive-behavioral approach considers cultural factors and allows clients to establish self-efficacy.

    Racism and Discrimination

    Katie also said she had not been “exposed to racism, personally,” defining racism as making fun of or discriminating against others because one feels superior . . . “except for those annoying little people that walk around the street and walk by me and go, ‘ching, chong, ching’ or whatever.” (Suyemoto, Day, & Schwartz, 2015, p. 130)

    Asian Americans continue to face issues of racism and discrimination (Hwang & Goto, 2009). However, some Asian American youth, such as Katie in the previous example, lack awareness of or minimize discriminatory behavior toward them, describing racial jokes and teasing as unintentional or “just for fun.” Exposure to racism or discrimination does affect mental health. In a sample of 444 Chinese American adolescents, it was found that discrimination in early adolescence was related to depression, alienation, and lower academic performance in middle adolescence (Brenner & Kim, 2009). Experience with discrimination in foreign-born and Asian American–born college students was not only related to depression but also to intergenerational conflicts, especially with the mother, probably because she is the one whom family members interact primarily with to navigate social problems (Chang, Chen, & Cha, 2015). Southeast Asian refugees who experienced racial discrimination reported high rates of depression (Noh, Beiser, Kaspar, Hou, & Rummens, 1999).

    Implications

    A therapist must assess the effects of possible environmental factors, such as racism, on mental health issues in Asian Americans and help ensure that clients not internalize issues based on discriminatory practices. Instead, the focus should be on how to deal with racism and on possible efforts to change the environment. If a problem occurs in school, the therapist can help assess the school’s social receptivity to Asian students. The same can be done with discriminatory practices at the client’s place of employment. Intervention may have to occur at a systems level, with the therapist serving in the role of advocate for the client.

    Implications for Clinical Practice

    [A] one-size-fits-all approach to clinical work with Asian Americans is potentially problematic. Instead, it is important for clinicians to identify within-group differences among their Asian American clients based on their mental illness, lay beliefs, and level of enculturation. (Wong et al., 2010, p. 328)

    There is a range of acceptable practices in working with Asian American clients. Qualities such as attitudinal similarity between the counselor and the Asian American client and agreement on the cause and treatment of a disorder are more important than racial match in promoting counselor credibility and a strong therapeutic alliance (Meyer, Zane, & Cho, 2011). Asian Americans view counselors who demonstrate multicultural competence by addressing the cultural beliefs of clients as more competent (Wang & Kim, 2010). Helping Asian American clients formulate culturally acceptable strategies can improve their problem-solving abilities and facilitate the development of skills for successful interactions within the larger society, including balancing conflicting values. Many of the counseling skills learned in current mental health programs, such as cognitive behavioral therapies, can be effective, especially if modifications are made for less acculturated clients (W.-Y. Lau, Chan, Li, & Au, 2010). Considerations in working with Asian American clients include the following:

    1. Be aware of cultural differences between the therapist and the client in the areas of counseling, appropriate goals, and process. Use strategies appropriate to thecollectivistic, hierarchical, and patriarchal orientation of Asian Americans, when needed.

    2. Build rapport by discussing confidentiality and explaining the client role, including the process of co-constructing the problem definition and solutions.

    3. Identify and incorporate the client’s beliefs about the etiology and appropriate treatment regarding the disorder.

    4. Assess not just from an individual perspective but include family, community, and societal influences on the problem. Obtain the worldview, degree of acculturation, and ethnic identity of the Asian American client.

    5. Conduct a positive assets search. What strengths, skills, problem-solving abilities, and social supports are available to the individual or family? How have problems been successfully solved in the past?

    6. Consider or reframe the problem, when possible, as one involving issues of culture conflict or acculturation.

    7. Determine whether somatic complaints are involved, and assess their influence on mood and relationships. Discuss somatic as well as psychological issues.

    8. Take an active role, but allow Asian Americans to choose and evaluate suggested interventions. Asian Americans may prefer an immediate resolution to a problem rather than in-depth exploration.

    9. Use problem-focused, time-limited approaches that have been modified to incorporate possible cultural factors.

    10. Self-disclosure regarding strategies the counselor has used in the past to solve problems similar to those faced by the client can be helpful.

    11. With family therapy, the therapist should be aware that Western-based theories and techniques may not be appropriate for Asian families. Determine the structure and communication patterns among the members. It may be helpful to address the father first and to initially have statements by family members directed to the therapist. Focus on positive aspects of parenting, such as modeling and teaching.

    12. In couples counseling, assess for societal or acculturation conflicts, and determine the couple’s perspective on what an improved relationship would look like. Problems often occur when there are differences in acculturation between the partners. Determine the ways that caring, support, or affection is shown, including providing for economic needs.

    13. With Asian children and adolescents, common problems involve acculturation conflicts with parents, feeling guilty or stressed over poor academic performance, negative self-image or identity issues, and struggles between interdependence and independence.

    14. Consider the need to act as an advocate or to engage in systems-level intervention in cases of institutional racism or discrimination.

    Summary

    Asian Americans/Pacific Islanders are nearly 6% of the population, but are composed of 40 distinct subgroups, each with its own language, religion, and customs. The counselor should not assume that they are all the same. Asian Americans are often seen as a “model minority”; the myth has masked the historical and continuing prejudice and discrimination directed toward them. Counselors working with Asian American/Pacific Islanders must be cognizant of major cultural differences such as collectivism,hierarchical relationships, parenting styles, emotionality, holistic orientation, and academic/occupational goal orientations that contrast with EuroAmerican characteristics. A failure to acknowledge these differences may lead to inappropriate and ineffective treatments. Further, it is important to understand and work with the strengths of the group, and be knowledgeable about racial identity development, acculturation conflicts, and the different expectations Asian Americans may have of counseling. Fourteen clinical implications for counselor practice are identified.

    Glossary Terms

    Acculturation

    Assimilation

    Co-construction

    Collectivistic orientation

    Emotionality

    Hierarchical relationships

    Integration/biculturalism

    Model minority

    Saving face

    Somatic complaints

    References

    1. Ahn, A. J., Kim, B.S.K., & Park, Y. S. (2009). Asian cultural values gap, cognitive flexibility, coping strategies, and parent-child conflicts among Korean Americans. Asian American Journal of PsychologyS(1), 1, 29–44.

    2. Aronowitz, N. W. (2014). Proud heritage: Mentors teach Native students about their pasts. Retrieved from http://www.nbcnews.com/news/education/proud-heritage-mentors-teach-native-students-about-their-pasts-n184271

    3. Atkinson, D. R., Kim, B.S.K., & Caldwell, R. (1998). Ratings of helper roles by multicultural psychologists and Asian American students: Initial support for the three-dimensional model of multicultural counseling. Journal of Counseling Psychology45, 414–423.

    4. Blair, S. L., & Qian, Z. (1998). Family and Asian students’ educational performance. Journal of Family Issues19, 355–374.

    5. Brenner, A. D., & Kim, S. Y. (2009). Experiences of discrimination among Chinese American adolescents and the consequences for socioemotional and academic development.Developmental Psychology45, 1682–1694.

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