Asian Families: an overview

-Asian American has collectively referred to Americans whose families originated in many different Asian countries.

-Geographically, Asia includes counties encompassing the Far East, Southeast Asia, the Indian subcontinent (including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam).  Pacific islanders sometimes get put into this group as well.

-There are about 32 primary different languages spoken.

-In 2000, Asian Americans were more likely than whites to have earned at least a college degree…but they were also more likely to have less than a ninth grade education.

-Asian families are different than western culture in the way the family unit is highly valued and emphasized throughout the life cycle. Asians embrace an “We” identity instead of an “I” identity.

-A lot of Asian countries have suffered trauma from war, political upheaval, etc.

-Asians are stereotypically seen as the “model minority” in that they are viewed to be high academic achievers and a group that doesn't create problems in society. This stereotype may actually increase family pressure and individual stress.  Asian women are stereotypically viewed as passive. Men are stereotypically seen as being controlling and physically attractive.

-The expression of mental health problems in Asian families seems to depend on the family’s level of acculturation.

-Some research has underscored six predictions of mental health problems among Asian Americans 1) employment or financial insecurity, 2) gender- Asian women seem more vulnerable, 3.) older age, 4) social isolation, 5) relatively recent immigration, and 66) refugee remigration experiences and post migration adjustment.

-Asian Americans have some of the lowest rates of utilization of mental health services. These low rates have been attributed to shame and stigma about using the resources, lack of financial resources, difference conceptions of illness and health, and lack of culturally competent services.

-Research shows that when they seek services, it is only when the problem is very severe and has stretched the family system to its limit.

-Asian Americans may turn to alternative treatments in the community (spiritual leaders, healers, natural remedies)

-The family unit—rather than the individual—is the most values. The individual is seen as the sum of all the generations of his or her family. What an individual does is a reflection on the larger family and ancestors.

-The Chinese have a saying. “The nail that sticks up will be pounded down”

-The dominant influence of patriarch still remains. Historically in China, a woman’s value is related to her giving birth to sons in order to preserve the family name.

-in 1979 the leadership in China instituted the “one-child family” policy (if you only had one child, you received better benefits from the government). Those who had daughters would often hide them with relatives and wouldn’t even name them.

In traditional Asian families, marriages are arranged by parents or grandparents to ensure the family prosperity and propagation of the husband’s family line.

-the primary relationships is likely to be the parent-child dyad rather than the husband-wife.

-Physical and verbal expression of love is uncommon.

-Divorce is relatively uncommon.

-the traditional role of the mother is to provide nurturance and support. The father’s role is to discipline.

-The strongest emotional attachment for women is usually to her children.

-Parents are expected to be cared for in their old age.

Asian American families in transition can be described into several major categories:

-Traditional families (usually consists entirely of individuals born and raised in Asian countries)

-Families in “cultural conflict” (usually has American-born children or children who were very young when they moved to the US)

-Bicultural families (well-acculturated parents who grew up in major Asian cities and were exposed ot urbanization, industrialization, and western influence. Many of these people come to the US as young adults. Some were born in the US but raised in traditional families)

“Americanized” or highly acculturated families (mostly parents and children who were born and raised in the US…may not identify with their Asian roots as much.)

-New millennium families (previously referred to as interracial.

Treatment

-The clinician needs to assess 1) the internal family system which includes understanding the individual members and family subsystems, and 2) external factors, which include the impact of community and other environmental stressors.

-Asian families undergo rapid social change and cultural transition, so it is important to get a full/relevant history.

-The clinician will need information on the neighborhood and larger community, including the availability of role models, housing conditions, economic climate, job ability, and education system for children and adults, etc.

-Family stress may be caused by Role Reversal in which the Asian parents become dependent on their English-speaking children, which can lead to anger and resentment.

-Asian American families value hard work, and economic stress has been significantly associated with depression

-Many traditional Asians do not accept western explanations of mental health. On page 280, there is a list of good questions to ask in the assessment phase in which the clients can discuss their cultural and religious perspectives on the presenting problem, past coping styles, and health seeking behaviors.

Phases to follow in therapy:

Beginning phase: engage the family

• 1.       Initial appointment should be made with the family’s “decision maker”
• 2.       A brief explanation of the clinician’s role and training background
• 3.       Address the family in a polite, somewhat formal manner.
• 4.       They may ask the clinician personal questions. The clinician must feel comfortable answering such questions
• 5.       Disclose familiarity with that culture to make the cultural connection. For the clinician who is not familiar, it is important to show interest.
• 6.       Ask non-threatening personal questions. Avoid direct confrontation, demands for greater emotional disclosure.
• 7.       Empathize with the client’s feelings of shame and encourage them to verbalize such feelings. Assure them of confidentiality.
• 8.       Establish credibility right away to ensure the client will return (use professional titles when making introductions, displaying diplomas awards, etc. , obtaining sufficient information about the client before seeing them the first time, offering a possible explanation of the cause of the problem, showing familiarity with the cultural background)
• 9.       Help the client understand the reasons behind questions in the assessment/evaluation process
• 10. For the first session, allow more than the usual 1 hour…especially if an interpreter is being used.
• 11. Some discomfort may occur around certain topics (sexual orientation, sexual intimacy, etc). After credibility is established, acknowledge that some difficult areas may need to be discussed.

Second phase: involving Family members in therapy.

-mutual goal setting  

Third Phase: Problem solving.

-focusing on the problems as presented by the family

-apply a psychoeducational approach

-assuming multiple helping roles

-indirectness in problem solving

-employing the reframing technique

-capitalizing on family strengths and community support

-utilizing intermediary/go-between functions

-understanding the family’s communication style

Termination Phase