Culturally Sensitive Counseling of Asian Americans
Culturally sensitive counseling is integral especially in a multicultural and multilingual society such as the United States. Scholars and researchers alike have been trying to identify the reasons for the underutilization of psychological services and premature discontinuation of therapy among ethnic groups in the U.S., particularly Asian Americans, and one of the major reasons they found out is the lack of available Asian American counselors and culturally sensitive mental health providers and staffs. This paper therefore explores these issues and provides an explanation of the importance of culturally sensitive counseling. The analysis focuses on the common psychological issues of Asian Americans and how counselors could best address these concerns using a culturally sensitive counseling paradigm.
Earlier studies have reported that Asian Americans usually avoid seeking psychological support. They also have a tendency to discontinue therapy impulsively and prematurely. No specific explanations were given about the reason Asian Americans should have a lower risk of mental disorders compared to other cultural/ethnic groups. It could be that this avoidance of and unfavorable attitude toward psychological interventions among Asian Americans is associated with Asian cultural values and belief system. Asian Americans who are weakly acculturated are predisposed to have greater adverse perception of seeking psychological treatment compared to those who are strongly acculturated (Schoen, 2005). This paper discusses the importance of culturally sensitive counseling, particularly with regard to Asian Americans, to the field of psychology. The discussion includes an analysis of the cultural challenges in counseling Asian Americans and the possible measures that counselors may adopt to become more culturally sensitive.
Research have demonstrated that with regard to ‘enculturation’—defined as the steady acquisition of the customs and attributes of a social group or culture— much compliance to Asian cultural ideals was related to both less eagerness to consult a counselor and less positive perception of pursuing psychological support (Ellis & Carlson, 2009). Therefore, counselors, therapists, and other mental health professionals must take into consideration carrying out more client-oriented programs such as raising awareness about the possible advantages of psychological interventions. Mental health institutions must make an effort of hiring a larger number of Asian American counselors to encourage Asian American patients to seek psychological support. When counseling Asian American clients who are securely acculturated, counselors must be attentive to and responsive of shared self-image needs and talk about matters concerning humiliation and disgrace embedded in the act of seeking psychological support.
Counseling Asian Americans: The Importance of Culturally Sensitive Counseling
Mental health professionals should exert their best effort in understanding and appreciating the history, customs, gender stereotypes, religious values, and family-related roles and obligations of Asian Americans. The unavailability of culturally sensitive and culturally experienced counselors can be a hindrance to the willingness of Asian Americans to receive psychological help is demonstrated by numerous studies that suggest that culturally sensitive, multicultural, or multilingual counselors are favored by Asian Americans as a whole and are deemed more effectual by Asian American patients.
One factor that may explain underutilization of mental health services among Asian Americans is the absence of cultural understanding and empathy on the part of mental health providers. Kurasaki and colleagues (2002) argue that lack of knowledge and appreciation for Asian-American traditions and values could lead to inaccuracies in treatment and diagnosis on the part of the counselor. Moreover, Asian American patients could sidestep or refuse to go back to a therapist who is not responsive to their cultural beliefs. The greater availability of culturally sensitive mental health professionals may represent a decrease, over the recent decades, in the evident frequency at which Asian Americans discontinue treatment hastily (Kurasaki et al., 2002). However, even though there has perhaps been an improvement in the availability of culturally sensitive counselors and therapists, there are still an insufficient number of staffs who are bicultural, bilingual, and responsive to cultural attributes of numerous Asian Americans (Liu, Iwamoto, & Chae, 2011). Not being able to hire and allocate sufficient numbers of culturally sensitive staffs has been an obstacle to effective psychological services outcome.
Historically, Asian Americans have suffered discrimination, intolerance, and racial prejudice. This was especially the case throughout the mid-19th century through the Second World War, when a huge number of Chinese settlers migrated to the U.S. to look for employment in railroad construction and mining. Other Asian groups – Koreans, Filipinos, and Japanese—also migrated to the U.S. (Gim, Atkinson, & Kim, 1991). Discrimination was evident in educational, employment, and housing opportunities granted to these Asian immigrants (Sandhu, 1999). Counselors who work with Asian American patients must be knowledgeable of and responsive to the history of prejudice, bias, and racial intolerance that Asians have encountered in the U.S., avoiding as much as possible any nonverbal or verbal language and attitudes that Asian patients may see as indications of bias and discrimination.
It is crucial for counselors to remember that the racial and ethnic individualities of Asian Americans cannot be treated as a single uniform individuality, but instead should be thoroughly evaluated and appreciated in collaboration with the patient. In spite of the difficulties that the paradigms of Asian American racial and ethnic individuality create, they could be useful instruments to build a channel of communication and enhance approach to patients’ problems (Tewari & Alvarez, 2012). Due to the historical experience of racial prejudice, which has weighed down Asian Americans with biased practices and unjust treatment in the U.S., any examination of the racial and ethnic individuality of an Asian American must involve consideration of the effect of racial domination (Liu et al., 2011). Because racial discrimination is an element of the historical experience of Asian Americans, mental health professionals have to acknowledge how Asian Americans try to cope with repressive and unjust situations.
Mental health professionals may most successfully deal with Asian American patients when they consider examining the level of coping mechanism, flexibility, and resilience that they possess in dealing with the demands of acculturation. Resilience is described as the ability to cope with difficulties effectively (Uba, 2003). The collectivistic attitude of Asian Americans can be a defensive mechanism against such discrimination and underestimation of their culture in the U.S., as they may look for social sustenance from their close social networks in trying to cope with experiences of discrimination (Kurasaki et al., 2002). Nevertheless, such resilience appears to be also influenced by the ethnic identity growth of Asian Americans and the level of prejudice that the individual experiences. For instance, Schoen (2005) discovered in a research of perceived resilience and perceived prejudice for Korean Americans that confidence in their ethnic individuality functioned as a defensive mechanism against discrimination. Nonetheless, loyalty to ethnic identity yielded less helpful outcomes and protective effect as the extent of discrimination escalated.
Generally, Asian Americans do not think that disclosing family problems to strangers or even to counselors is a good idea. All concerns, as well as psychological issues, are to be disclosed only among the members of the immediate family. Guilt and shame are two components that Asian American families exercise to impose rules and standards in the family (Ellis & Carlson, 2009). These components serve a critical function in discouraging Asian Americans from unveiling or confessing their problems to other people outside the family circle. If an Asian American fails to act as expected outside and inside the family unit, s/he could lose the loyalty, support, and esteem of the family members, which may create an intense feeling of guilt and shame (Schoen, 2005). Such feeling of guilt and shame could result in severe depression and anxiety.
A number of Asian researchers have proposed that Asian Americans’ need to prevent this feeling of guilt and shame may shed light on the intense self-discipline usually observed among individuals in this ethnic group. Hence an essential recommendation for counselors working with Asian American patients is to identify and examine with them this feeling of guilt and shame so as to make sense of how challenging is for Asian Americans to share their problems to other people (Tewari & Alvarez, 2012). A counselor should not anticipate that an Asian American patient will talk about his/her mental issues the moment s/he asks, “What difficulties are you having?” Two communication-related habits that could raise difficulties during the evaluation and treatment of Asian American patients are failure to establish eye contact and silence (Schoen, 2005). As asserted by Liu and colleagues (2011), counselors must be conscious that silence among Asian Americans is an act of courtesy, good manners, and respect; it also suggests a person’s need to keep on talking after disclosing or stressing something during a session.
In Western societies, lack of eye contact during a face-to-face conversation is interpreted as lack of interest in and courtesy toward other people. On the other hand, among Asian Americans eye contact is regarded an act of disrespect and apathy, especially to older people and those in authority (Uba, 2003). A counselor who is not sensitive to or appreciative of the significance or implications that Asian Americans attribute to eye contact and silence during face-to-face interaction may feel awkward or ill at ease when talking to an Asian American patient and could alter the whole direction of the conversation based on the impression that the patient is not attentive to or focused on what the counselor is saying (Uba, 2003; Schoen, 2005). Such misconception may discourage an Asian American patient from either explaining a previous concern or expressing respect and attentiveness to the counselor in the way s/he believes is suitable, such as through preventing eye contact and keeping silent.
Culturally Sensitive Counseling Based on Clinical Practice
In order to offer more culturally sensitive counseling, therapists should be conscious of the expectations of their client, their counseling approach, and style of communication. A wide array of nonverbal and verbal cues will be useful. Language obstacles could be moderated by innovative and patient-centered treatments (Tewari & Alvarez, 2012). For instance, actual exercises like role play could encourage patients to communicate their ideas and undertake self-realization of subliminal assumptions, emotions, or thoughts (Liu et al., 2011). These patient-centered activities may be developed to complement a patient’s proficiency in language.
Kim and colleagues (2003 as cited in Schoen, 2005, 257) studied the correlation between the nonverbal cues of counselor and the effectiveness of counseling sessions. Therapists who exhibit more pleasant nonverbal behavior like smiling often or regularly making postural changes obtained positive feedback from volunteer clients. However, Zhang and Dixon (2003 as cited in Schoen, 2005, 257-8) came up with opposing results, suggesting the Asian American students favored therapists of the same cultural background.
Based on empirical studies, the following steps are useful in counseling Asian Americans and in developing a more culturally sensitive approach to counseling. First, place emphasis on academic and somatic problems as a means to create and strengthen relationship with patients and concentrate on more mentally related concerns (Ellis & Carlson, 2009; Sandhu, 1999; Kurasaki et al., 2002). Second, adoption of counseling techniques that are more directive and problem-oriented than self-centered and unrestricted. Third, balance of awareness and understanding of Asian American belief and value system with an emphasis on individuality and diversity (Schoen, 2005; Gim et al., 1991). And, lastly, recognition of one’s own beliefs, prejudices, and biases.
Counseling Asian Americans is a challenging task that requires a great deal of conscious effort on the part of the counselor and the client. Asian Americans were historically discriminated and oppressed in the United States, and this experience made them distant and reserved. Their pride in their racial and ethnic individuality serves as their defensive mechanism and protection against such harsh circumstances. Thus they prefer counselors of the same ethnicity as role models and source of social support. In view of this, mental health institutions should try to recruit and hire more Asian American counselors in order to resolve the problem of underutilization of psychological services and premature discontinuation of treatment among Asian Americans.
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