Maintaining Flexibility

There is a general agreement that the clinician should maintain flexibility with respect to the traditional "rules" of Western psychotherapy when treating Asian American individuals and families. For instance, not accepting small gifts from clients may be perceived as rude by some Asian Americans. In working with Asian American elderly clients, Kao and Lam (1997) suggest that clinicians practice "mental reservation," which involves deferring the detailed explanation of some Western psychotherapy practices until the client is well engaged in treatment. For example, when an Asian American elderly client initially invites the clinician to lunch, the clinician may respond with a statement such as "I've already eaten" rather than to respond with a detailed explanation of why such actions are inappropriate in psychotherapy. In addition, a clinician working with Asian Americans may need to serve as a cultural broker and provide some concrete assistance (e.g., locating legal aid) or serve functions traditionally not associated with the role of a therapist (e.g., assisting the Cambodian American community in establishing a local Buddhist temple or in initiating a community garden).

There is no one agreed treatment approach or a theoretical orientation that is recommended for treating Asian American clients, just as there is no one treatment approach that is suggested for treating all White clients (Shiang et al., 1998). In treating Asian American clients, the clinician may find it useful to invoke techniques from various schools of psychosocial treatment while still having a coherent framework for understanding the impact of culture and organizing clinical intervention. The treatment recommendations with Asian Americans tend to fall into two categories: (a) an adaptation or a modification of an existing treatment approach, or (b) an integration of various approaches into a new treatment framework. Representative of the former type, a number of clinical writers have described specific modification of theory and techniques of psychoanalytic treatment approach (Bracero, 1994; Wu, 1994; Yi, 1995) or of cognitive-behavioral treatment approach (Chen, 1995) with Asian American clients. For example, Chen (1995) discusses the compatibility of Chinese culture with some aspects of Rational Emotive Therapy (e.g., logical thinking as a principle of life, cognition as the origin of emotion, the counselor as a teacher) while cautioning the clinicians to moderate the Socratic questioning technique for disputing irrational beliefs with Chinese clients. Wu (1994) discusses how her psychoanalytic stance of being a blank slate (i.e., having a "stone face") by not answering a Chinese immigrant client's question about her own background led to a loss of therapeutic rapport and to that client's premature termination.

Taking a more integrative approach, Jung (1998) describes his CAFT model as "an eclectic, multidimensional, comprehensive family therapy model in which family integration theory, general systems theory, and case management act as foundational theories, combined with crisis intervention and social learning theory" (p. 57). Adding to the strategic use of various Western family therapy models and techniques, Jung asserts that "family integration," which is the central goal in the CAFT, is based on the Taoist premise that everything in nature is relative and has an opposite, that life is neither all good nor bad, and that we can all learn from both difficulty and success. The overarching goal for CAFT is for the family members to find peace with each other and with the cultural differences between their country of origin and the country of settlement, and to live harmoniously and ethically with each other. Thus in order to find emotional, psychological, and spiritual harmony within the family, Chinese American families are led to appreciate and accept both the American and Chinese cultural influences on the family.

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