Part 2 of a 2-Part Series
A cultural guide in working with Asian American families

Minh-Ha Pham, Psy.D.
Asian Traditional Family

Family, morality, loyalty, cohesiveness and unifying collectiveness are highly important and defined as pride of an Asian family and the self. Indirectness, implicitness, and complex nonverbal expressions for approval or non-approval messages strongly characterize the communication patterns among Asian Americans and family members. Trust is often placed with individuals who value cohesiveness or conform to the identification shared by group unity or with those in power, communicating and expressing for the family, group, or community.

Trends and Results of Research Studies
A year 2007 research study by Child Trends and the Center for Social and Demographic Analysis (CSDA) of the University of Albany, State University of New York, indicated that four in five children in U.S. immigrant families are American citizens, and three fourths of the children speak English exclusively or very well, while one half are fluent in English although they speak another language at home. This trend study across 50 states revealed that young children in immigrant families are becoming deeper rooted in the U.S. where they now call home.

A study done in 1995 by Sodowsky, Kwan, and Pannu suggested that parents who adopt a more rigid and conservative stance in enforcing the values of their native culture and apply excessive pressure and restrictions on their children being raised in the U.S. may actually drive the children away from their native culture. In a few studies that examined family environment and ethnic identity, Rosenthal and Feldman indicated in 1992 that the feeling of ethnic pride is more likely to emerge in families marked by warmth and independence. From their 1992 study, Phinney and Chivera reported that family relations are among the prerequisites for minority youth to explore their cultures of origin.

Accumulated data from studies done by Kinzie & Fleck, 1987; Kinzie & Leung, 1993, revealed high level of distress, post-trauma, psychiatric disorders, as well as depression and Post-Traumatic Stress Disorder (PTSD) among South East Asian Refugees (Kinzie & Mason, 1983; Kinzie, Boehnlein, Leung, Moore, Riley, & Smith, 1990; Mollica, Wyshak, & Lavelle, 1987). High incidence of depression and PTSD were also reported among refugee adolescents and youths (Kinzie, & Sack, 1991).

Cultural Sensitivity in Working with Asian American Families

• Greet the clients and their family with gentle eye contact.

• Use a quieter tone of voice with the client and with special respect toward older/elder clients and parents.

• Greet the client with title, last name versus first name.

• The first name of an Asian individual usually carries a dual meaning that was chosen by his or her parents to well wish that the child would have a certain character and/or destiny.

• Time line is a continuum with the past, present, future and the after life in another channel. The past signifies accumulated wisdom where one’s life lessons were learned. It is also viewed as an important integral part of life affecting the now and future.

• Because mental health care is a foreign concept to many Asian Americans and their families, it is important to take the necessary time to describe the client’s and care provider’s roles and the therapeutic process.

• Clients will need to be informed that due to the necessity of assessment, respectful inquiries will be made in terms of the self as an individual, family life change events, family multigenerational relationships and the ecosystem.

• Since Asian American clients tend to expect concrete goals and strategies focused on solutions to their issues, mental health care providers must exercise care not to impose solely techniques and strategies.

• Consenting procedure or interventions require clear and simple explanations without rushing or pressuring. It is also crucial to demonstrate a respectful stance by collaborating with the client and family in co-constructing solutions and interventions in the client’s family and world context.

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Fostering love for our patients

By: George Nguyen, patient.
Translated by: Hanh D. Truong, PhD

The things that my daughter hears and sees, I cannot see or hear. There are multiple conflicts between the world that my daughter lives in and the reality that I live by. These conflicts cannot be explained by reasons or logic but love is the only venue to tolerate and accept my daughter.

Please listen to your heart. At the onset, my daughter had many unusual symptoms which led to multiple conflicts in the family among the family members. As the head of the household, I worried so much to the point of being quite dysfunctional. I could not eat, I could not sleep. I faced so many problems dealing with my daughter and her issues.
Internally, I often worried. I did not know how to fix this problem. Perhaps, my daughter is either crazy or possessed by evil spirits. I was also worried that my relatives, friends, and neighbors would find out about my situation. Furthermore, I was afraid that society would look down on our family and ostracize us for being different. Finally, I wondered how my daughter would be able to find happiness through marriage and raising her own family like everyone else.

The problems got worse. My daughter wandered in the streets with no purpose in life; she did not care to eat, and she was markedly depressed leading to suicidal ideation. She was finally hospitalized.

There were challenges and conflicts in my cultural views, traditional values, and family beliefs. These are some of the reasons that discouraged me from seeking help for my daughter from the onset of the disorder.

I began to receive assistance and services for my daughter through the outpatient clinics. Through these clinics, I was able to connect with other families in similar situations with similar challenges. I decided to join the Community Services and Support group of Orange County to gain more support and guidance. Through the Mental Health Services Act, we have founded the Orange County Association for Vietnamese Mental Heath Awareness and Support (OC/AVMAS).

The association was formed in order to foster love and support for Vietnamese mental health patients and my daughter is one of those patients. The participation of both patients and family members through the Mental Health Services Act helps to improve the effectiveness of treatment for all patients. More than that, our participations and contributions will help the Vietnamese community learn about the issue of mental health so that we can detect the symptoms and intervene effectively from the onset of the disorder. There is a Vietnamese proverb that says “when a horse gets sick, the whole herd will not eat,” thereby when a family member is sick, the entire family suffers. The OC/AVMAS is our united family where love is fostered and nurtured for all (Vietnamese) mental health patients.

We welcome all other community members from other ethnic communities to collaborate with us in order to help bring happiness and support to our patients/family members. For more information, please call 714-531-1917.

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