Cultural Knowledge

S. Sue and Zane (1987) argued that their recommendation for clinicians to establish credibility with Asian American client is more proximal to the achievement of the therapeutic goal than the recommendation for clinicians to be familiar with the client's cultural background. However, a knowledge of cultural values and behavior are indispensable for conducting cultural assessment and treatment planning. The essential concepts that would assist in the preparation of the assessment and treatment of Asian American clients can be broadly divided into three sets: (a) broad cultural concepts about common Asian values, (b) knowledge of how those broad cultural concepts manifest in Asian American client behavior surrounding mental health treatment, and (c) historical and demographic information about Asian Americans.

1. Broad Cultural Concepts

The defining psychological characteristics of individuals from non-Western cultures center around the integral relations between the self and others. Cross-cultural psychology literature provides a theoretical base on which the clinician can learn to conceptualize Asian American individuals' cognition and behavior through a cultural lens. There are a number of excellent texts on the central concepts put forth in cross-cultural psychology to explain broad cross-cultural differences between the Western industrialized nations (e.g., the United States, Canada, Western Europe) and non-Western nations (e.g., countries in Asian, South American, Africa, etc.). Examples of these concepts include individualism versus collectivism (e.g., Triandis, 1995) and independent versus interdependent self-construal (Markus & Kitayama, 1991). Central to these concepts is the notion that world cultures vary in the extent to which the individual self and its views, needs, and goals supersede the collective's views, needs, and goals. For example, the interdependent self-construal, which is thought to characterize the self-concept of individuals from Asian cultures, is fundamentally interrelated with others and cannot be separated from the surrounding social context. The behavior of those with interdependent self is governed by what he or she perceives to be the thoughts, feelings, and actions of others in the relationship, and people with interdependent self-construal derive their self-worth through their abilities to adjust themselves to the social climate, to restrain expressions of their individual wishes or feelings, and to maintain harmony with others. Asian Americans, on average, tend to hold more interdependent self-construal than White Americans (Okazaki, 1997). Other broad cultural concepts that may be useful for understanding the psychology of people from Asian cultures are what Ho (1982) calls "relational" concepts. Ho argues that concepts indigenous to Asian cultures (e.g., filial piety, face, amae) all pertain to the relational, reciprocal aspects of social behavior between individuals rather than the traditionally Western focus on individual characteristics (e.g., ego, self-esteem). Many descriptions of Asian psychology in the available clinical literature about Asian Americans make use of these fundamental concepts from the cross-cultural psychology literature; thus, the clinician does well to become familiar with these important works.

2. Behavior Surrounding Treatment

Interdependent self-construal has many behavioral consequences that extend to treatment settings. For example, one of the most cited characteristics of a traditional Asian values is that of modesty and humility in interpersonal contexts in the service of maintaining interpersonal harmony. The culturally normative behavior for many Asian cultures is to downplay one's own accomplishments in group settings, which should not be confused with poor self-esteem (Prathi-kanti, 1997). The cultural sanction against displaying strong emotions in some interpersonal contexts may manifest as client inexpressivity relative to mainstream American clients. Interdependence, which may be culturally normative for the Asian individual, may be perceived by Western standards as pathological dependency (Kobayashi, 1989).

Clinicians treating Asian American clients must be cognizant of the possible role that stigma plays in the help-seeking and treatment process. For example, an Asian American family may seek treatment in a distant location rather than seek treatment in their own community and risk being seen by someone who may recognize them (which in turn might brand family members as having a mental health problems and thereby lessen the marriageability of family members). Some Asian American parents may not agree to having their child assessed for learning disabilities in schools because they fear that an appointment with a psychologist would imply that the child has mental health problems.

In discussing Indian American families' resistance to seeking mental health treatment, Prathikanti (1997) argues that some Indian families may not wish to undermine the "model minority" myth (which asserts that Asian Americans and Indian Americans have no problems) and may fear that seeking treatment would damage the reputation of the entire ethnic group.

3. Diversity Within

There are many accessible, brief texts that summarize the population characteristics as well as the brief history of the major Asian ethnic groups in the United States (e.g., Cao & Novas, 1996; Kitano & Daniels, 1995). This background knowledge about the demographic characteristics and the history of various Asian ethnic groups serves as a necessary building block for performing culturally competent assessment and treatment. The knowledge of cultural diversity within the Asian American population will make it less likely for the clinician to make broad stereotypical assumptions about their Asian American clients. For example, although many traditional Asian cultures hold Confucian gender roles, the Filipino culture prior to the Spanish domination held much more egalitarian gender roles (Sustento-Seneriches, 1997). By knowing which Asian ethnic groups entered the United States at which points in the history, the clinician is able to narrow the questions needed to assess the particular client's cultural background. For example, a third-generation Japanese American client may be more likely to be English-speaking and have had significant exposure to the various aspects of the American culture, while a first-generation elderly Korean American client may be more likely to be a monolingual Korean-speaker with relatively less exposure to American cultural institutions. A post-1965 Japanese American immigrant may or may not identify with the history of Japanese American internment during the World War II. Knowing the pre-and postmigration history of the various waves of refugees from Southeast Asia will allow the clinician to assess not only the acculturative status of the client but also for possible psychological repercussions of traumatic events following the Vietnam War. Obtaining some basic information about the client (e.g., ethnic origin, generational status) prior to the first session will allow the clinician to review relevant resources about the historical and cultural characteristics of the prospective client.

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