CHAPTER 16CHAPTER 16

ASIAN AMERICIAN ASIAN AMERICIAN FAMILIESFAMILIES

PRESENTED BYPRESENTED BY

OverviewOverview

The term “Asian Pacific American” refers to the The term “Asian Pacific American” refers to the collective set of Asian American and Pacific collective set of Asian American and Pacific Islander American populations.Islander American populations.

Although many Asian Pacific groups share certain Although many Asian Pacific groups share certain common cultural characteristics, appearance common cultural characteristics, appearance similarities, and migration experiences, use of similarities, and migration experiences, use of this term is in no way meant to imply that these this term is in no way meant to imply that these populations or communities are homogeneous in populations or communities are homogeneous in nature.nature.

The term Asian Pacific Americans has been in The term Asian Pacific Americans has been in common use since the 1960s.common use since the 1960s.

Asian Pacific Americans applies to 43 ethnic Asian Pacific Americans applies to 43 ethnic groups, including 28 Asian groups and 15 Pacific groups, including 28 Asian groups and 15 Pacific Islander groups.Islander groups.

This population has increased from less than 1 This population has increased from less than 1 million in 1960 to over 7 million in the United million in 1960 to over 7 million in the United States by 1990.States by 1990.

The Asian Pacific Americans represents the fastest The Asian Pacific Americans represents the fastest growing ethnic community in the United States growing ethnic community in the United States today.today.

This presentation will give you a brief overview of This presentation will give you a brief overview of Asian Americans:Asian Americans: Similar cultural values;Similar cultural values; ExperiencesExperiences Major differences. Major differences.

This presentation will primary focus is on major This presentation will primary focus is on major groups such as:groups such as: ChineseChinese JapaneseJapanese KoreansKoreans PilipinosPilipinos East IndiansEast Indians Southeast AsiansSoutheast Asians

Differences Among Asian Differences Among Asian American GroupsAmerican Groups

Asian American groups differ in terms of Asian American groups differ in terms of migration history, population, language, religion, migration history, population, language, religion, education level, occupation, income, degree of education level, occupation, income, degree of acculturation, preferred residential location, acculturation, preferred residential location, political involvement.political involvement.

PopulationPopulation

According to the 1990 U.S. Census, the six largest According to the 1990 U.S. Census, the six largest Asian American groups are Chinese (23% of the Asian American groups are Chinese (23% of the Asian American population), Pilipino (19%), Asian American population), Pilipino (19%), Japanese (12%), Asian Indian (11%), Korean Japanese (12%), Asian Indian (11%), Korean (11%), and Vietnamese (9%). Groups with less (11%), and Vietnamese (9%). Groups with less than 2% include Thai and Hmong.than 2% include Thai and Hmong.

Residential PreferencesResidential Preferences

About 70% of the total population reside in five About 70% of the total population reside in five states:states: California (35%)California (35%) Hawaii (16%)Hawaii (16%) New York (9%)New York (9%) Illinois (5%)Illinois (5%) Texas (4%)Texas (4%)

The cities with high concentration of Asian The cities with high concentration of Asian Americans are Honolulu, Los Angles, San Americans are Honolulu, Los Angles, San Francisco, New York, Chicago and San Jose.Francisco, New York, Chicago and San Jose.

Chinese favor San Francisco, Boston, New York, Chinese favor San Francisco, Boston, New York, and Washington, D.C.and Washington, D.C.

Japanese like Honolulu, Los Angeles, and Seattle.Japanese like Honolulu, Los Angeles, and Seattle. Pilipinos favor San Diego, San Francisco, and San Pilipinos favor San Diego, San Francisco, and San

Jose.Jose. Vietnamese concentrate in Orange County Vietnamese concentrate in Orange County

(California), San Jose, Houston, and Minneapolis.(California), San Jose, Houston, and Minneapolis.

Immigration HistoryImmigration History

Chinese Americans were the first Asians to Chinese Americans were the first Asians to immigrate to the US.immigrate to the US.

The 1965 Immigration Act brought a large The 1965 Immigration Act brought a large number of Chinese, Koreans and Pilipinos.number of Chinese, Koreans and Pilipinos.

Most Japanese Americans today are descendants Most Japanese Americans today are descendants of Japanese who migrated to Hawaii or the U.S. of Japanese who migrated to Hawaii or the U.S. mainland before 1924.mainland before 1924.

LanguageLanguage

Among Asian American groups, there are at least Among Asian American groups, there are at least 32 different primary languages spoken.32 different primary languages spoken.

There are sometimes many dialects.There are sometimes many dialects.

ReligionReligion

Religious belief vary greatly among the different Religious belief vary greatly among the different Asian Americans groups.Asian Americans groups.

Among the Chinese Americans, the most popular Among the Chinese Americans, the most popular religions include Buddhism, ancestor worship, and religions include Buddhism, ancestor worship, and Christianity.Christianity.

Over 70% of Korean Americans are Protestant Over 70% of Korean Americans are Protestant Christians and attend church regularly.Christians and attend church regularly.

Pilipinos, under past Spanish influence, are Pilipinos, under past Spanish influence, are heavily Catholic.heavily Catholic.

Japanese Americans follow Shintoism, Buddhism Japanese Americans follow Shintoism, Buddhism (especially the Zen sect), and Christianity.(especially the Zen sect), and Christianity.

Vietnamese practice Buddhism, and, from their Vietnamese practice Buddhism, and, from their French colonial past, Catholicism.French colonial past, Catholicism.

The religions of both Cambodians and Laotians The religions of both Cambodians and Laotians are strongly influenced by the Brahmanism of the are strongly influenced by the Brahmanism of the Hindus as well as by Buddhism.Hindus as well as by Buddhism.

The Hmong and the Mien are usually animistic The Hmong and the Mien are usually animistic and believe strongly in supernatural causes.and believe strongly in supernatural causes.

It is important to not that in many Asian countries It is important to not that in many Asian countries under Communist rule, religion was essentially under Communist rule, religion was essentially abolished.abolished.

Consequently, many immigrants from those Consequently, many immigrants from those countries may not practice any religion at all.countries may not practice any religion at all.

Exposure to War TraumaExposure to War Trauma

Many Asian countries suffered from war or Many Asian countries suffered from war or political turmoil.political turmoil.

Many immigrants were exposed to losses, Many immigrants were exposed to losses, separation, torture, and other forms of trauma separation, torture, and other forms of trauma before immigrating to the United States.before immigrating to the United States.

Common Traditional Common Traditional Characteristics of Asian FamiliesCharacteristics of Asian Families

Asian family values are very different from Asian family values are very different from Western family values.Western family values.

The agricultural background and the teachings of The agricultural background and the teachings of Confucianism and Buddhism have had a profound Confucianism and Buddhism have had a profound influence on Eastern philosophical approaches to influence on Eastern philosophical approaches to life and family interactions.life and family interactions.

In Western cultures the nuclear family stresses In Western cultures the nuclear family stresses independence and autonomy of the individual independence and autonomy of the individual members.members.

A family life cycle begins when two individuals A family life cycle begins when two individuals meet, fall in love, marry, and have children.meet, fall in love, marry, and have children.

In traditional Asian families, the family unit – In traditional Asian families, the family unit – rather than the individual is highly valued.rather than the individual is highly valued.

The individual is seen as the product of all the The individual is seen as the product of all the generations of his or her family.generations of his or her family.

This concept is reinforced by rituals and customs This concept is reinforced by rituals and customs such as ancestor worship, family celebrations, such as ancestor worship, family celebrations, funeral rites, and genealogy records.funeral rites, and genealogy records.

Personal action reflects not only on themselves Personal action reflects not only on themselves but also on their extended family and ancestors.but also on their extended family and ancestors.

Obligations and shame are the mechanisms that Obligations and shame are the mechanisms that traditionally help to reinforce societal traditionally help to reinforce societal expectations and proper behavior.expectations and proper behavior.

An individual is expected to function in his or her An individual is expected to function in his or her clearly defined roles and positions in the family clearly defined roles and positions in the family hierarchy, based hierarchy, based

on age, gender, and social class.on age, gender, and social class.

There is a emphasis in harmonious interpersonal There is a emphasis in harmonious interpersonal relationships, interdependence, and mutual relationships, interdependence, and mutual obligations or loyalty for achieving a state of obligations or loyalty for achieving a state of psychological homeostasis or peaceful psychological homeostasis or peaceful coexistence with family or other fellow beings.coexistence with family or other fellow beings.

Marital SubsystemMarital Subsystem

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

The dominant relationship is more likely to be The dominant relationship is more likely to be placed on the parent-child dyad, rather than the placed on the parent-child dyad, rather than the husband-wife dyad.husband-wife dyad.

The husband assumes the role of leadership and The husband assumes the role of leadership and authority, and is the provider and protector of the authority, and is the provider and protector of the family.family.

The wife assumes the role of homemaker and The wife assumes the role of homemaker and childbearer.childbearer.

Physical and verbal expressions of love are Physical and verbal expressions of love are uncommon.uncommon.

When things go wrong, the difficulties may be When things go wrong, the difficulties may be repaired by other adult mediators or confidants.repaired by other adult mediators or confidants.

Divorce is not a common practice.Divorce is not a common practice. The wife is usually dominated by the authority of The wife is usually dominated by the authority of

her husband, her father, her in-laws, and her husband, her father, her in-laws, and sometimes her son.sometimes her son.

Parent-Child SubsystemParent-Child Subsystem

The traditional role of a mother is to provide The traditional role of a mother is to provide nutrients and support.nutrients and support.

The father’s role is to discipline.The father’s role is to discipline. The father and mother’s functions tend to be The father and mother’s functions tend to be

complementary, rather than symmetrical. complementary, rather than symmetrical. The strongest emotional attachment for a woman The strongest emotional attachment for a woman

is sometimes not her husband, but her children.is sometimes not her husband, but her children. Most parents demand filial piety, respect, and Most parents demand filial piety, respect, and

obedience from their children. obedience from their children.

In many extended families, children are not solely In many extended families, children are not solely raised by their parents, but are cared for by a raised by their parents, but are cared for by a wide range of adults (grandparents, uncles, wide range of adults (grandparents, uncles, aunts, cousins, wet nurses).aunts, cousins, wet nurses).

Parents expect to be cared for in their old age.Parents expect to be cared for in their old age.

Sibling SubsystemSibling Subsystem

Because of the large number of children in many Because of the large number of children in many Asian families, the parents usually delegate child-Asian families, the parents usually delegate child-care functions to older siblings.care functions to older siblings.

Cooperation and sharing among siblings are Cooperation and sharing among siblings are expected.expected.

The emotional ties among siblings are especially The emotional ties among siblings are especially strong for those who survived war and escapes.strong for those who survived war and escapes.

Dual to historical practices of sexism, sons are Dual to historical practices of sexism, sons are favored.favored.

Sibling rivalry is not uncommon.Sibling rivalry is not uncommon.

Asian American Families in Asian American Families in TransitionTransition

Repeated contacts with American values over a Repeated contacts with American values over a prolonged period of time have changed their prolonged period of time have changed their outlook on such issues as gender role, child outlook on such issues as gender role, child rearing, and family structure.rearing, and family structure.

The values, norms, and role behavior learned in The values, norms, and role behavior learned in the home country are modified when a family the home country are modified when a family adjusts to the new culture.adjusts to the new culture.

Family members struggle to hold on to the old Family members struggle to hold on to the old way while trying to develop new coping skills.way while trying to develop new coping skills.

Some eventually accomplish this task, whereas Some eventually accomplish this task, whereas others develop symptoms of stress when others develop symptoms of stress when attempting to force a blend two contradictory attempting to force a blend two contradictory sets of rules.sets of rules.

Asian American families in transition can be Asian American families in transition can be divided into five major types:divided into five major types: Traditional familiesTraditional families Cultural conflict familiesCultural conflict families Bicultural familiesBicultural families Americanized familiesAmericanized families Interracial familiesInterracial families

Traditional FamiliesTraditional Families

Traditional families usually consist entirely of family Traditional families usually consist entirely of family members born and raised in Asian countries.members born and raised in Asian countries.

They include families from agricultural backgrounds, They include families from agricultural backgrounds, recent arrivals with limited exposure to Western recent arrivals with limited exposure to Western culture, uncultivated immigrants who are older at culture, uncultivated immigrants who are older at time of immigration, and families who live in ethnic time of immigration, and families who live in ethnic Asian communities, with limited contact with Asian communities, with limited contact with American mainstream society.American mainstream society.

Family members hold strong beliefs in traditional Family members hold strong beliefs in traditional values and regularly speak in their native languages values and regularly speak in their native languages and dialects.and dialects.

Family members still practice traditional rituals Family members still practice traditional rituals and customs.and customs.

Many are members of family associations and Many are members of family associations and social clubs consisting of people from similar social clubs consisting of people from similar heritage.heritage.

““Cultural Conflict” FamiliesCultural Conflict” Families

Families have American-born children or arrived Families have American-born children or arrived more than a decade ago, when the children were more than a decade ago, when the children were young.young.

The family system usually experiences a great deal The family system usually experiences a great deal of cultural conflict between the acculturated children of cultural conflict between the acculturated children and the traditional parents or grandparents.and the traditional parents or grandparents.

Intergenerational conflicts and role confusion are Intergenerational conflicts and role confusion are common problems.common problems.

Other families have conflicts because one spouse is Other families have conflicts because one spouse is more acculturated than the other.more acculturated than the other.

Conflicts may be caused not only by different Conflicts may be caused not only by different degrees of acculturation, but also by religious, degrees of acculturation, but also by religious, philosophical, or political differences.philosophical, or political differences.

Bicultural FamiliesBicultural Families

These families consist of well-acculturated parents These families consist of well-acculturated parents who grew up in major Asian cities and were exposed who grew up in major Asian cities and were exposed to urbanization, industrialization, and Western to urbanization, industrialization, and Western influences.influences.

Many came as young adults.Many came as young adults. Some were born in the US but raised in traditional Some were born in the US but raised in traditional

families.families. These parents often hold professional jobs, come These parents often hold professional jobs, come

from a middle or upper class family background, and from a middle or upper class family background, and are bilingual and bicultural.are bilingual and bicultural.

The power structure has moved from a patriarchal to The power structure has moved from a patriarchal to an egalitarian relationship between parents.an egalitarian relationship between parents.

Decision making is not solely the father’s task.Decision making is not solely the father’s task. Family decisions are allowed between parents Family decisions are allowed between parents

and children.and children. Such families do not live in ethnic neighborhoods. Such families do not live in ethnic neighborhoods. The nuclear family members usually visit their The nuclear family members usually visit their

extended family members on weekends and extended family members on weekends and holidays.holidays.

Americanized FamiliesAmericanized Families

Some Asian families have become largely Some Asian families have become largely Americanized.Americanized.

These families usually consist of parents and These families usually consist of parents and children born and raised in the United States.children born and raised in the United States.

As generations pass, the roots of the traditional As generations pass, the roots of the traditional Asian cultures begin to slowly disappear, and Asian cultures begin to slowly disappear, and individual members do not express their interest individual members do not express their interest in or make any effort to maintain their ethnic in or make any effort to maintain their ethnic identities.identities.

Family communicate in English and adopt a more Family communicate in English and adopt a more individualistic and egalitarian orientationindividualistic and egalitarian orientation

Interracial FamiliesInterracial Families

Interracial Asian American families are increasing Interracial Asian American families are increasing rapidly, currently constituting about 10-15% of rapidly, currently constituting about 10-15% of marriages.marriages.

Japanese Americans lead in this trend, with more Japanese Americans lead in this trend, with more than half marrying outside their group, followed than half marrying outside their group, followed by Pilipino, Chinese, Vietnamese, and Korean by Pilipino, Chinese, Vietnamese, and Korean Americans.Americans.

Some interracial families are able to integrate Some interracial families are able to integrate both cultures with a high degree of success.both cultures with a high degree of success.

Others often experience conflicts in values, Others often experience conflicts in values, religious beliefs, communication style, child-religious beliefs, communication style, child-rearing issues, in-law problems, and so forth.rearing issues, in-law problems, and so forth.

Psychopathology of Asian Psychopathology of Asian AmericansAmericans

Research suggests that Asian Americans have a Research suggests that Asian Americans have a rate of psychopathology equal to or higher than rate of psychopathology equal to or higher than of European Americans.of European Americans.

Immigrants can suffer any or all of the psychiatric Immigrants can suffer any or all of the psychiatric disorders or emotional problems that affect the disorders or emotional problems that affect the general public.general public.

Certain disorders are altered or influenced by the Certain disorders are altered or influenced by the migration process.migration process.

Certain premigration factors may precipitate a Certain premigration factors may precipitate a psychiatric disorder/psychiatric disorder/

The common presenting family problems are The common presenting family problems are usually parent child conflicts, marital discord, in-usually parent child conflicts, marital discord, in-law problems, and domestic violence.law problems, and domestic violence.

Individual presenting problems include Individual presenting problems include somatization, depression and anxiety, adjustment somatization, depression and anxiety, adjustment disorder, schizophrenia, alcoholism, drug disorder, schizophrenia, alcoholism, drug addiction, gambling, and suicide.addiction, gambling, and suicide.

Posttraumatic stress disorder and dissociative Posttraumatic stress disorder and dissociative disorder are fairly common among refugees disorder are fairly common among refugees traumatized by war.traumatized by war.

Children and adolescent problems include Children and adolescent problems include learning disorder, attention deficit disorder, learning disorder, attention deficit disorder, conduct disorder, and gang affiliation.conduct disorder, and gang affiliation.

A survey of Asian American Therapists revealed that A survey of Asian American Therapists revealed that depression, low self-concept, and relationship conflicts affect depression, low self-concept, and relationship conflicts affect at least 50% of their Asian American clients.at least 50% of their Asian American clients.

Between 40% and 50% of the clients were affected by Between 40% and 50% of the clients were affected by problems with parent child relationship, acculturation, problems with parent child relationship, acculturation, somatic complaints, and isolation.somatic complaints, and isolation.

There were interethnic differences among different Asian There were interethnic differences among different Asian American Groups.American Groups.

Japanese and Pilipino Americans presented more Japanese and Pilipino Americans presented more intrapsychic problems, such as identity conflict.intrapsychic problems, such as identity conflict.

Southeast Asians encountered more employment difficulties.Southeast Asians encountered more employment difficulties. Hawaiian, Pilipino, Japanese, and Samoan Americans Hawaiian, Pilipino, Japanese, and Samoan Americans

suffered from more alcohol and substance-abuse problems.suffered from more alcohol and substance-abuse problems. Research has revealed six predictors of mental health Research has revealed six predictors of mental health

problems among Asian Americansproblems among Asian Americans employment/financial statusemployment/financial status Gender- Asian women seem to be more vulnerableGender- Asian women seem to be more vulnerable Old ageOld age Social isolationSocial isolation Relatively recent immigrationRelatively recent immigration Refugee premigration experiences and postmigration Refugee premigration experiences and postmigration

adjustment.adjustment.

There are also interracial differences on There are also interracial differences on manifestations of psychopathology.manifestations of psychopathology.

Chinese and Japanese Americans have reported Chinese and Japanese Americans have reported more somatic complaints that European more somatic complaints that European Americans.Americans.

Asian Americans who use mental health services Asian Americans who use mental health services are more severely disturbed than non Asians are more severely disturbed than non Asians counterparts.counterparts.

The proportion of Asian Americans diagnosed as The proportion of Asian Americans diagnosed as psychotic was larger than the proportion among psychotic was larger than the proportion among European Americans.European Americans.

Asian Americans were also diagnosed as having Asian Americans were also diagnosed as having major affective disorders at a proportionately major affective disorders at a proportionately higher rate than African Americans or Latino higher rate than African Americans or Latino Americans.Americans.

Assessment and Data Assessment and Data CollectionCollection

Although Western psychological and biological Although Western psychological and biological understanding of emotional difficulties is understanding of emotional difficulties is important, we need to incorporate the Eastern important, we need to incorporate the Eastern holistic way of thinking into clinical practice.holistic way of thinking into clinical practice.

A model that takes into account the A model that takes into account the psychological, social, biological, cultural, political, psychological, social, biological, cultural, political, and spiritual influences on the lives of families is and spiritual influences on the lives of families is recommended.recommended.

In addition to the traditional psychosocial In addition to the traditional psychosocial assessment or mental health status examination, assessment or mental health status examination, a holistic model in data collection and a holistic model in data collection and assessment.assessment.

Migration Stress and Degree of Migration Stress and Degree of War TraumaWar Trauma

Most Asian countries have suffered years of war and Most Asian countries have suffered years of war and political turmoil, the stress of which compounds the political turmoil, the stress of which compounds the migration strain that all immigrants experience.migration strain that all immigrants experience.

Many immigrants and refugees experienced Many immigrants and refugees experienced unwilling separations and exposure to trauma, both unwilling separations and exposure to trauma, both in the home country and in the search for sanctuary.in the home country and in the search for sanctuary.

The clinician can apply a chronological approach The clinician can apply a chronological approach focusing on two major aspects of the family focusing on two major aspects of the family migration history:migration history: Premigration historyPremigration history Immigration historyImmigration history

The use of genograms, oral history, and family The use of genograms, oral history, and family photographs can be helpful.photographs can be helpful.

Premigration history-city/village of origin, family Premigration history-city/village of origin, family composition, major political changes, composition, major political changes, socioeconomic status, employment status, socioeconomic status, employment status, support system and so forth.support system and so forth.

Immigration history – reasons for leaving, means Immigration history – reasons for leaving, means of escape, hardships endured during the trip, type of escape, hardships endured during the trip, type of losses, trauma experience, and so forth.of losses, trauma experience, and so forth.

Cultural Strengths Cultural Strengths

In addition to the assessment of family stress and In addition to the assessment of family stress and pathologies, and assessment is necessary with pathologies, and assessment is necessary with respect to individual and family strengths in respect to individual and family strengths in adaptation, coping, and problem solving.adaptation, coping, and problem solving.

Asian Americans bring along very highly developed Asian Americans bring along very highly developed cultures, religions, and philosophies.cultures, religions, and philosophies.

Asian cultures place great importance on hard work, Asian cultures place great importance on hard work, education, family, friend, and the ethnic community.education, family, friend, and the ethnic community.

During a crisis, Asian families can usually count on During a crisis, Asian families can usually count on support from extended family members, friends, and support from extended family members, friends, and ethnic community networks and organizations.ethnic community networks and organizations.

Culturally Relevant Treatment Culturally Relevant Treatment StrategiesStrategies

Traditional Western psychotherapeutic approaches Traditional Western psychotherapeutic approaches based on the assumptions of individuation, based on the assumptions of individuation, independence, self-disclosure, verbal expression independence, self-disclosure, verbal expression of feelings, and long-term insight therapy may go of feelings, and long-term insight therapy may go counter to Asian American values of counter to Asian American values of interdependence, self-control, repression of interdependence, self-control, repression of emotions, and short-term result-oriented solutions.emotions, and short-term result-oriented solutions.

It is recommended the use of an integrated family It is recommended the use of an integrated family therapy orientation drawn from Haley’s strategic therapy orientation drawn from Haley’s strategic and Minuchin’s structural therapies.and Minuchin’s structural therapies.

Bowen’s intergenerational perspective and Satir’s Bowen’s intergenerational perspective and Satir’s cognitive approach to “teach” family members to cognitive approach to “teach” family members to recognize the family’s rules.recognize the family’s rules.

Paniagua (1994) suggested several effective Paniagua (1994) suggested several effective treatment strategies, such as exhibiting expertise treatment strategies, such as exhibiting expertise and authority, maintaining formality and and authority, maintaining formality and conversational distance; providing concrete and conversational distance; providing concrete and tangible advice; and giving assurance that stress tangible advice; and giving assurance that stress will be reduced as quickly as possible.will be reduced as quickly as possible.

Effective clinical strategies need to incorporate Effective clinical strategies need to incorporate unique Asian cultural values and family unique Asian cultural values and family characteristics.characteristics.

The following suggestions are divided into three The following suggestions are divided into three distinct stages: beginning phase, problem-solving distinct stages: beginning phase, problem-solving phase, and termination phase.phase, and termination phase.

Beginning PhaseBeginning Phase

Asian American clients are usually unfamiliar with Asian American clients are usually unfamiliar with family therapy.family therapy.

The clinician needs to pay special attention to the The clinician needs to pay special attention to the first contact phase of therapy in order to avoid first contact phase of therapy in order to avoid premature termination.premature termination.

Three areas are particularly important in this Three areas are particularly important in this phase:phase: Engaging the familyEngaging the family Assessing family readinessAssessing family readiness Deciding on family members involved in therapyDeciding on family members involved in therapy

Engaging the FamilyEngaging the Family

Initial appointment should be made with the Initial appointment should be made with the decision maker of the family, mostly the father.decision maker of the family, mostly the father.

A brief explanation of your role and training A brief explanation of your role and training background maybe helpful.background maybe helpful.

During the first session, the clinician should During the first session, the clinician should address the family in a polite and formal manner.address the family in a polite and formal manner.

The clinician needs to feel comfortable in The clinician needs to feel comfortable in answering questions. Appropriate self-disclosure answering questions. Appropriate self-disclosure may facilitate positive cultural alliance and a level may facilitate positive cultural alliance and a level of trust and confidence.of trust and confidence.

Forming a social and cultural connection with the Forming a social and cultural connection with the family during the first session is very important.family during the first session is very important.

Engage the client in small talk may help.Engage the client in small talk may help. Mental health problems can bring intense shame Mental health problems can bring intense shame

and humiliation. The clinician may counter those and humiliation. The clinician may counter those emotions by empathizing with them and emotions by empathizing with them and encouraging them to verbalize this feeling.encouraging them to verbalize this feeling.

It is helpful for the clinician to establish credibility It is helpful for the clinician to establish credibility right away, to assure that the client will return.right away, to assure that the client will return.

The clinician needs to help the client understand The clinician needs to help the client understand the reason behind such questions.the reason behind such questions.

The clinician should plan to allow more time than The clinician should plan to allow more time than an usual 1-hour session, especially when an an usual 1-hour session, especially when an interpreter is used.interpreter is used.

Assessing family readiness for therapy.Assessing family readiness for therapy. Involving family members in therapy.Involving family members in therapy. Mutual goal settingMutual goal setting

Problem-Solving PhaseProblem-Solving Phase

Focusing on the problems as presented by the Focusing on the problems as presented by the family.family.

Applying a psychoeducational approach.Applying a psychoeducational approach. Assuming multiple helping roles.Assuming multiple helping roles. Indirectness in problem solving.Indirectness in problem solving. Employing reframing technique.Employing reframing technique. Capitalizing on family strength and community Capitalizing on family strength and community

support.support. Utilizing intermediary/go-between functions.Utilizing intermediary/go-between functions. Understanding the family’s communication style.Understanding the family’s communication style.

Termination PhaseTermination Phase In this phase, it is unrealistic for the clinician to expect an In this phase, it is unrealistic for the clinician to expect an

Asian client to verbalize anger or separation anxiety.Asian client to verbalize anger or separation anxiety. A client may not be able to comment on the progress in A client may not be able to comment on the progress in

public.public. In showing appreciation, he or she may invite the clinician In showing appreciation, he or she may invite the clinician

for dinner or present him with a gift.for dinner or present him with a gift. If clinically appropriate, the clinician should accept such If clinically appropriate, the clinician should accept such

gestures with genuine appreciation.gestures with genuine appreciation. Many Asian Americans went through many losses due to Many Asian Americans went through many losses due to

war and migration.war and migration. A good relationship with the clinician is a permanent one A good relationship with the clinician is a permanent one

that is be treasured.that is be treasured. A client may include him or her in family celebrations. Such A client may include him or her in family celebrations. Such

culturally appropriate behavior should not be interpreted culturally appropriate behavior should not be interpreted as pathological.as pathological.