Asian Americans: Practice Interventions
Abstract and Keywords
This entry describes the diversity among Asian American populations, setting the context to understand the need for different practice interventions. It explains the role of cultural values in the underpinnings of the selection of theoretical frameworks that guide chosen practice interventions. Indigenous and biculturalizations of interventions (Fong, Boyd, & Browne, 1997) are discussed as they relate to general and specific problems relevant to this population. Challenges and dilemmas are raised as ethical decisions are made among practitioners, who serve the Asian American native born, immigrant, and refugee populations.
Asian Americans are a diverse population of East Asians (Chinese, Japanese, Korean, Filipino), South Asians (Asian Indians, Pakistani, Bangladeshi, Sri Lankan, Nepalese, Bhutanese), and Southeast Asians (Vietnamese, Cambodian, Laotian, Hmong, Thai, Burman, Malaysian, Indonesian). Consequently, Srinivasan (2001) observes that, “The concept of ‘Asian American’ subsumes under one heading various cultures, social histories, and experiences of immigration and is, therefore, ambiguous, having consequences for health, mental health, legal and social service access, delivery, and development” (p. 155).
Lee, Lei, & Sue (2001) also note Asian American heterogeneity and the “differences in cultural backgrounds, native countries of origin, circumstances for coming to the United States, generational statuses, and native language spoken” (p. 160). While “Asian American” usually refers to a native-born American of Asian descent, multiracial children and adults with some parents of Asian heritage may also be included. Others may self-identify as Asian American, such as 1.5 generation persons, which refers to those who come from Asia to the United States at an early age, and individuals from Asia adopted by non-Asian parents. (Fong, 2007). Undocumented immigrants and refugees from Asian countries may also be included under the rubric of Asian American despite their political status, requiring that their political statuses and migration experiences be differentiated when discussing practices and interventions related to this population (Fong, 2004).
Asian American diversity is reflected in the different cultural values held by each group. Traditional cultural values usually include respecting elders, valuing and focusing on family instead of self, maintaining protocol, and valuing education (Lee, 1997; Uba, 1994). However, mixed race children or 1.5 generation individuals commonly hold mixed Asian and non-Asian values. Ascertaining the role of cultural values to the Asian American individual and family is key when creating and selecting practice interventions for work with Asian Americans (Fong, 2007; Rhee & Huynh-Hohnbaum, 2007).
Theoretical Frameworks for Practice
Social work practice with Asian Americans is driven by theory, which in turn needs to support the client's particular ethnic, cultural, and religious values (Ross-Sheriff & Husain, 2001). American-born Asians may share many American cultural values while also incorporating traditional values from their countries of origin. Traditional cultural values should be viewed as strengths. These strengths should be utilized when selecting interventions. For example, an intervention that focuses exclusively on self, but neglects the role of the family, may thwart healing and growth. Practice interventions must match the individual and his or her cultural values.
Cultural values as strengths are protective factors but they can also be risk factors. Lee et al. (2001) state, “Cultural values such as the emphasis on maintaining interpersonal and social harmony cause individuals to be more cautious and sensitive to others and the external environment” (p. 163–164). However, this cautiousness can also prevent action and confrontation when needed, in cases of physical abuse or family violence.
Because of the diversity among Asian American populations and practice interventions used, the strengths perspective as a theoretical framework captures the variety of issues dealt with in assessments and treatments in working with these groups of people.
Assessments and Practice Interventions
Before a practice intervention can be used with Asian Americans it is critical that a thorough assessment be done in terms of their cultural backgrounds, immigration experiences if applicable, cultural meanings to physical and mental illnesses, and modes of expression of illnesses. A presenting problem may not be the actual problem and the intervention set up may have cultural barriers.
Assessment issues among Asian Americans may be tied into shame and not reporting the actual problems, despite the generational differences and practices in the United States. The tendency to somaticize problems instead of verbally sharing them may exist among some Asian American family members. For example, “the teachings and philosophy of a Confucian, collectivistic tradition discourage open displays of emotion in order to maintain social and familial harmony or avoid exposing personal weakness. Thus either consciously or unconsciously, Asians are taught to deny the experience and expression of emotions” (Lee et al., 2001, p. 165). Yet those Asian Americans who are born in the United States or 1.5 generation persons may live in multigenerational households where family members are in conflict with cultural values, and practice interventions are difficult to determine to meet all the members' needs.
There are many practice interventions from which to choose when working with Asian American individuals and families; however, factors affecting selection include the age, gender, and role of the family member and immigration status. Those practice interventions that are family oriented may need to have theoretical frameworks that support cultural values of respecting males, and honoring hierarchal family systems if the Asian American family holds true to adhering to any traditional cultural values. Theoretical frameworks of practice interventions should match the cultural values so that they are supportive of each other rather than in conflict. For example, if some Asian American clients may not be able or willing to talk in therapeutic interviews about their emotions, but tend to somaticize their problems, to insist that the practice intervention only focus on communication skills may miss the whole point of the need of cultural translations in interpreting cultural meanings in the communication transpiring between the client and the therapist. Author Marshall Jung (1998) of Chinese American Family Therapy talks about “adjusting the Western lens and using the best clinical model of therapy that “best suits the clients' needs” (p. 89). He discusses how Structural Family Therapy, Strategic Therapy, Planned Short-term Treatment, Rational-Emotive Therapy, Solution-Focused Therapy, and Contextual Family Therapy “provide therapists with a multidimensional and comprehensive framework for diagnosing and treating Chinese families” and because these models allow therapists to “adapt to the expectations of [Chinese] clients and the style in which they work best” (p. 89). For example, Structural Family Therapy (SFT) reinforces the traditional Asian cultural value of the importance of acknowledging the male and female roles in the structure of the family and is compatible in working with Chinese families who still adhere closely to traditional values and behaviors. Thus, using SFT in practice would be adapting to the Chinese family's familiar belief system.
Adapting to clients' preferences may also include not just Western models but also indigenous practices. Some elders living in Asian American families may prefer traditional healing methods such as acupuncture, cupping or oxybustion, a form of treatment using suction for healing, or herbal medicines. Some may refuse Western medicines or prescriptions because they disturb the chi, or the yin and yang. Asian American immigrant and refugee families may come from countries of origin that use traditional healers like shamans or acupuncturists. When they migrate to the United States they often seek to continue with these familiar ways of treating physical and mental ailments. There needs to be a better integration of Western interventions with indigenous methods of healing. This is done through adopting an approach of selecting and implementing both kinds of practice interventions.
Biculturalization of Interventions
The biculturalization of interventions is the practice of combining an indigenous intervention with a Western intervention (Fong, Boyd, & Browne, 1997). It has five steps: (a) The practitioner identifies the relevant values in the ethnic culture that are important to the client and can be used to reinforce therapeutic interventions; (b) The practitioner selects a Western intervention whose theoretical framework and values are compatible with the ethnic cultural values of the client system; (c) The practitioner and client analyze and select an indigenous intervention familiar to the ethnic client system in order to determine what techniques can be integrated and reinforced with a Western intervention; (d) The practitioner develops an approach that integrates the values and techniques of the ethnic culture with the Western intervention; and (e) The practitioner applies the Western intervention while at the same time explaining to the client system how the Western intervention reinforces the ethnic cultural values and supports the indigenous intervention.
Indigenous interventions are important and need better integration into the Western methods that currently dominate the choices of treatment. To insist that only Western interventions are the prescribed treatment not only may ignore culturally competent practice but also may promote greater challenges by alienating Asian American clients who may then become reluctant to seek treatment. For example, acupuncture, which is a common indigenous treatment in Asia, is becoming a more acceptable form of practice intervention in some managed care systems, used by Asians and non-Asian clients.
Challenges and Dilemmas
There could be several dilemmas for the practitioner in working with Asian American families. Some may be related to language and translation difficulties; others may be related to shame and fear of losing face. It is commonly found that many Asian Americans do not seek treatment because of shame factor (Lee, 1997; Uba, 1994). However, if a problem is severe and creating major stressors to the family, members will be more likely to seek treatment (Fong & Furuto, 2001; Lee, Lei, & Sue, 2001, Lum, 2007). Therefore, silences in treatment sessions may be common if the client is forced to come for treatment as the family's last resort to obtain help. Discomfort and unfamiliarity with terms or practices need careful time spent in the problem-solving process.
The use of children or youth as cultural and language translators for immigrant and refugee parents or other family members creates special dilemmas. This may cause tension and miscommunication because of the inappropriate burden on children put in this role. This may also pose an ethical dilemma for the practitioner because language interpreters are not easily found and cultural practices are not easily understood by persons who are not part of that cultural community. Cultural protocols frequently need some interpretation and the tendency to use Asian American children and youth because they are conveniently available may cause tensions and role reversals in the family system and additional stressors for the young people.
While there is a need to integrate indigenous interventions with Western treatments, problems may arise with issues related to evidenced-base practices.
In using indigenous interventions or biculturalization of interventions, there may be problems with agencies offering practice interventions whose measures of effectiveness in evidence-based practice may be in conflict or not as supportive of the indigenous and traditional healing practices. These dilemmas point to challenges and the need to identify and remove those obstacles preventing the offering of best practices to Asian American individual and family clients.
Our changing demographics with the increase of multicultural and multigenerational Asian American families, forces practitioners to examine the theoretical approaches and kinds of treatments offered to this population. The offering of culturally competent biculturalization of practice interventions needs to become an integrated part of treatment, replacing the tendency to solely use Western interventions, which do not always best fit this culturally heterogeneous population. A changing paradigm is needed in the larger context of practice to meet the complex needs of these diverse Asian American populations.
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