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Asian Indian, Pakistani, and Middle Eastern Families in Psycho-Therapy
One family assessment treatment issue is about the differences in rates of acculturation of family members. The general rule of thumb says that the degree of acculturation depends on: how many years were spent in the US, age at migration time, exposure to local culture and people, professional affiliations, work setting, spiritual and religious beliefs, health, and speaking English. Different family members may use different resources for coping, including resilience and internal hardiness. An example for this treatment issue is a family migrating from Eastern Europe.
The family is composed of a single grandfather, his only pregnant daughter and a grandson (son of the daughter). The grandfather hardly speaks English and has been through wars and oppression in his life. The daughter has a chance to get some education and learn some English. The retired grandson is about 2 years old and is now learning to speak. The unborn child is about to be born in the US. The four family members differ with their past history of oppression, their ability to speak English, their age at migration time, the possibilities of resources, exposure to the US, chances and speed of adaption, work and education status, and personality.
Another issue is the impact of migration on family and individual life cycles. The adjustment to the new world is a developing process, which affects family members differently, depending on their age and overall life cycle. For example, Asian parents who migrate with their 18-year-old twins, have to deal with separating from them, or living separately, while the twins move way to go to college and, at the same time, adjust to a completely new world.
One more issue is the family’s spiritual and religious beliefs, which could be anything from Christianity to Buddhism, or from Shinto to Muslim. The beliefs influence the behavior. Asians highly respect their religious affiliations. Monks, priests or ministers help solve family problems. The therapist should find out how much support the family is receiving from the religious organizations. The youth, who is exposed to Western religious beliefs, may challenge parents and grandparents. The clinician should ask the clients to share their spiritual beliefs to help with the problem solving strategies. Acknowledging the differences in spiritual beliefs can help the family make clearer decisions.
Again, another issue is the family’s physical health because some Asians psycho-somatize their emotions. Some physical problems could come from the malnutrition that refugees have had to endure. Asian immigrants are unfamiliar with Western medicine and may make mistakes with medicines. They often use both, Western and Eastern medicine. Asians usually appreciate the therapist or clinician’s concern about their health. Networking with other skilled providers can help the clinician be credible, trusted, intentional and altruistic.
One more treatment issue is the cultural strengths. Besides assessing family pathologies and stresses, it is necessary to assess family and individual strengths in coping, adjusting and problems solving. Their challenges from their country of origins are strengthened by powerful cultures, philosophies, spirituality, and survival stories. Voicing rituals can help transgenerational connection. Asians prioritize education, hard work, family, friends and communities, which support them in crises. The therapist must encourage and explore network resources and examine crises (Chang, 2003).
Chinese American families are diverse but all have gone, and are still going, through many changes within their family dynamics. The clinician must be aware of those family dynamics and strategize accordingly to guaranteed positive changes. The therapist must empathize with compassion and establish mutual trust. Also, the therapist must be aware of cultural identities, communication styles and counter transference. The biggest challenge is to benefit from the strong Eastern philosophies, spiritualism, history and medicine and integrate them effectively with Western sciences, including psychology, not only for the clients, but for society overall.
Filipino Americans in history have had to adapt and coexist with conflicting values and behaviors. Filipinos still need help with acculturation and trust. Due to their challenging country history, Filipino families have had to congregate. They have been very resilient in balancing individual, family and community needs.
Japanese American families are diverse. Some families are acculturated and others retain their original culture. Some value their original traditions and some minimize them. The therapist must assess any cultural issue and problem. Again, if family members have different level of acculturation, intergenerational conflicts may arise. All Japanese Americans experience insults and micro-aggression as people of color. They are part of a minority group and the challenges that go with it.
Korean Americans are recent immigrants. They are used to changes but they have not had a history in the rapidly changing US. Language can be a challenge. Korean families can express cultural stress. Therapists must differentiate between culture generated and situational conflicts and inner conflicts. Therapy must be accompanied by specialized ethnic resources and sensitizing mainstream institutions.
Southeast Asian families, including Vietnamese families, have language barriers, and different expectations of therapy, based on their culture. They do not have enough health, mental health and human resources. More research and attention is necessary to help this population.
Again, Asian Indian families are different. Indian families in the US often maintain strict cultural boundaries to protect them against racism and assimilation. The therapist could explore family connections and their financial investments. Also clinicians could ask questions to clarify culture and traditions. Because Pakistan and India have numerous regional differences between them, it is important to determine where the families are from, to identify values and rights. Families come from different classes and castes. Families’ experiences with Western colonization and families’ migration history could be different. Exploration of family structure is important to assess parenting styles and money management styles. It is also important for the therapist to coach family members, who usually come from arranged marriages and arranged financial negotiations, to be generous, loyal, respectful, and still empowered. Therapists must explore any family’s social and emotional issues. Depending on the family’s life stages, loss of cultural identity causes anxiety to the family members.
With Indian Hindu families, therapists must explore the many facets of this culture. Obviously it is even more crucial in these cases for therapists to carefully listen and ask meaningful questions. Indian Hindu families have different customs. Once Hindus trust someone, they become open communicators. More research for Hindu Indians would be helpful.
Arabs, as non-Westerners, are a culturally diverse minority. They are new to psychotherapy and seek it for learned behavior. Arabic clientele in psychotherapy has been the topic of several recent researches. Arabs and their service providers must be educated about the benefits of psychotherapy, especially the benefit of reducing stress. It is important to find out their expectations. Given the current large anti-Arab movements in the US, therapists may be challenged by themselves. There are several direct resources for learning more about Arab’s culture.
Armenian families have high wariness of outsiders. They also have reflexive self-reliance. They need to find therapy meaningful. Armenians tend to think they already know everything about themselves. It is easier for therapists, then, to “remind” them of what they already know and have overlooked when busy. In other words, therapists must acknowledge their competence and knowledge. Family patterns must be emphasized as a strength and resource by the therapist. Many feelings may still be hunting Armenians as a result of their historical genocide. Therapists can also acknowledge ethnic values before problem solving solutions. It takes them awhile to accept Americans in, but, when they do, they do full-heartedly.
Lebanese and Syrian families have a hard time acculturating to Arabic or Western families. The family is central to them. Therapists must then encourage independence. Insight-oriented interventions must be avoided with traditional families. The best therapeutic interventions recognize family centrality, spirituality, and education regarding family roles.
Palestinian American families have a unique relation with Israelis and Jews. Unlike other Arab Americans, Palestinian Americans are the most impacted ones by the war like conflict between Palestine and Israel. Palestinian Americans do not receive any help from their country of origins so they must count on one another or on a therapist. It is the opposite with other Arab immigrants, who can count on Saudi Arabia.
Loss and trauma are the most popular treatment issues for Cambodian families. They have symptoms of Post-traumatic stress disorder, as a result of the massive destruction of families and Buddhism, during Khmer Rouge. Often, older Cambodians speak no English and have a hard time relating to young Cambodians, who have to translate everything for them and even miss school and work for it. A lot of old Cambodians do not believe in dating and for women to be alone with men and do not believe in children living by themselves, while in college. They used corporal punishment or used to hit kids until they found out Social Service could intervene. They revere elders so talking back or disrespect is not allowed.
Many Cambodians live in gang areas and the US can deport them to Cambodia if convicted of crime. Often parents never tell kids about their traumas occurred in Cambodia, so kids wonder why the parents are in so much distress and often they think they are the reason for it. Traditional therapy is ineffective because effective therapy for them involves case management, advocacy and outreach. Trust is a major issue for Cambodians, because during Rouge, there was systematic brainwashing, and Cambodians believed that, if they told the truth, they would be killed. They have also had to lie to get into the US. As a result, Cambodians tend to speak indirectly. Cambodians believe that the act of lying is not bad. Major community agencies, such as Buddhist monks and Mutual Assistance Associations, are very helpful. Cambodians are a tiny community that uses the word of mouth.
Due to the genocide, family and individual healing is not enough. There is a need to rebuild the entire culture in the community. Respecting the Cambodian New Year is also very crucial. Cambodians do not distinguish between physical and emotional pain. They mention the psychosomatic symptoms, and when prompted, they associate the beginning of the physical pain, with a painful and traumatic event. Their trauma may be interfering with the ability to learn English or new languages. It is important for the therapist to involve the entire family. For the English non-speaking members, it is important to hire a non family related translator, by implementing the bridging model. If a member is highly depressed, he or she may not admit it, as it is considered sinful in Buddhism.
Issues to consider when working with Indonesian families are: family closeness, hierarchy, parenting, difficulty in being direct, shame, the aftermath of September 11, gender roles and homosexuality, social class, political influences, and length of therapy. Their average number of sessions is 2. The therapist must discuss the process, concept and purpose of therapy, in order to elongate the sessions. The huge gap between Indonesian rich and poor people separated Indonesians from other Asians. During the 1998 riots, the president was taken out, the economy collapsed and conservative Muslims burned Christian churches and attacked thousands of Chinese Indonesians. This was similar to the 1965 genocide of 300,000 “communists”, which made the river near Jakarta red. Indonesians experienced colonization and oppression.
Because extended families are important to Indonesians, they should come to the therapy sessions, when necessary. Many issues are also considered private to Indonesians, so the therapist must remind clients that capable and caring people engage in therapy. Many Indonesians like direct advice, even via phone. Effective therapy utilizes their commitment to family, religion, and rich customs and culture. Genograms and I statements can be helpful. Some of them may appreciate feminism or differential gender power, but some others may not. Social constructionist family therapies, that co-construct reality through dialogue, are effective. Indonesians like choices. Home based sessions could help involve the family. The genuine therapist, who learns about the clients and enjoys working with them, always, goes a long way.
Treatment issues with Pakistani are: Immigration, especially after 9/11, people and government, religion, education, health and mental health care, socialization and cultural gestures, marriage, family and life-cycle dynamics, and homosexuality. Other treatment issues are matters related to unresolved feelings of loss around immigration. The therapist must then explore immigration history and circumstances. Most Pakistani families were affected by the 1947 division between Pakistan and India. Intergenerational and multiple immigrations are common. After 9/11, many Pakistani families, especially congregated on the East coast, have moved or will move to Canada or back to Pakistan. Acculturation experience must then be explored systematically. Substance and child abuse and domestic violence could be issues. Pakistani families believe in disciplining children. Loyalties and keeping secrets with extend families are prevalent. Stress of the male dominant family hierarchy is possible. In conclusions, therapists must validate, encourage and respect experiences of Asians, including Pakistani clients, within the context of their culture, norms, nuances and practices.
Chang, I. (2003). The Chinese in America: A narrative history. New York: Viking.
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