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Working With Asians and Cultural Considerations
Wendy Eng, LCSW,
Clinical Director, Hamilton-Madison House, Chinatown Family Consultation
Center
The struggles of immigrants are all too familiar to the social work profession. Historically, social work has had a significant impact on the lives of the various immigrant groups particularly during their assimilation process. This is no different for the Asian immigrant whose cultural, customs, values and language so differs from mainstream American society.
Coming to a New Country can be Life Altering
The harsh realities of adjustment in a new country can be a life altering experience having deep emotional impact. Long hours of work and multiple jobs, conflicts due to language barriers, discrepancies in values and expectations between generations, because of different levels of acculturation within a family, all affect the cohesiveness of the family structure. Over time, the cumulative effects from socioeconomic and psychological stress on the functioning of the individual and family can be quite overwhelming. Symptoms are often manifested in physical and behavioral complaints - a more culturally acceptable way of symptom expression. There is a strong social stigma associated with mental illness and other social ills and, consequently, most Asians would not readily and voluntarily seek help. It is not until they have reached an acute crisis and have exhausted alternate means of alleviating symptoms that they are referred for mental health services.
Academic and/or behavioral issues are common presenting problems in children and adolescents whereas adults often present with family problems, somatic complaints, interpersonal/relationship difficulties and inability to sustain employment due to mental illness. Having a family problem may invoke a sense of shame and inadequacy in the individual. Having a mental illness brings on additional stigma. Any presentation of mental or emotional distress and the seeking of help outside of the family are believed to bring shame and disgrace to the family. Asking for assistance is perceived as having failed oneself and one's family, and is viewed as a reflection on the family, causes one to lose face, resulting in shame and embarrassment.
The Work Is Challenging
Some of the challenges of working with this population include breaking through barriers of stigma, the client's readiness to accept treatment, resistance to treatment due to a lack of insight and understanding about their illness and treatment and medication compliance. Broad clinical implications and treatment considerations are raised when one takes into account the great diversity of the various Asian cultures, the culture-specific factors within each group which influence symptom manifestation and an individual's conception of illness. In depth exploration into an individual's cultural identification and journey, his/her migration experiences and personal histories are crucial in the formulation of a comprehensive, culturally- sensitive, bio-psycho-social assessment, appropriate diagnosis and relevant interventions.
Emphasis is placed on a client-centered approach, treating the person as a whole, with dignity and respect and not as a diagnosis. Assurance of confidentiality is vital in fostering an on going trusting therapeutic alliance. Psycho-education is essential in empowering the client to better understand and manage his/her illness and related problems. Last but not least, the clinical aspects combined with the fundamental social work ethos of compassion, empathy, advocacy and case management skills, knowledge of community systems and resources further support the client in addressing basic human needs and enhancement of quality of life.