Culture-specific information for working with Asian families

(The information in this section is sourced from Lee (2002), and Au (2010).

Because of the central role of the family in Asian cultures, and because of the multi-dimensional approach to health, assessments should be holistic and systemic. Family dynamics and how these work in the larger network need to be understood from both an internal and external perspective:

Internal

Family members, family sub-systems, family hierarchy, leadership, communication, behavioural styles and norms and roles, developmental stage of members at the time of migration.

External

Impact of migration, war, possible racism, housing, financial and environmental stressors.

Protocol

In joint family sessions it is important to respect and safeguard cultural protocol and etiquette. This would mean not putting clients in a position where they have to transgress expected roles. For example fathers may be reluctant to show feelings as this might be considered a display of 'weakness', and thereby a 'loss of face'. Similarly children may find it difficult to 'criticise' parents as this would be disrespectful. Sensitive questioning and reframing will be essential.

Boundaries and dependency

What might be considered as 'enmeshment' or lack of boundaries in a Western family may be 'normal' for Asian families where parents regard themselves as entitled to information about their children; the bounds of confidentiality and understanding about privacy may be different. Similarly, expectations for family to provide emotional and practical support for members recovering from mental illness should not be regarded as dysfunctional or pathological. The dependent relationship is a cultural norm under these circumstances and clients themselves may see that family is obliged to support them. TCM also treats clients with chronic illness as dependent (Tse, 2004).

Crisis Referral

Because of the pattern of help-seeking behaviour, the preference to safeguard family 'secrets', and issues of shame and stigma, families are often in crisis by the time they present for intervention. Because there may be insufficient time for a thorough assessment, good rapport and trust become critical to the success of the first session. How to greet clients, who to address first, and showing respect for protocol, will be paramount.

Common problems presented in family sessions

• Astronaut families.
• Triangular relationships between mother-son against father, mother-son against daughters-in-law, family of one parent against the other parent, and father-son against daughter-in-law (especially if father-in-law is the main source of financial support).
• Role reversals.
• Solo parent families.
• Extra marital affairs.
• Custody and access issues.
• Division of heritage and marital properties.
• Pre-existing marital problems (more time spent together after migration often intensifies pre-existing problems).
• Step-parenting and blended families (historically step parents do not treat step children well).
• Migration as an escape route for problems and to save face.
• Different acculturation rates amongst members.
• Family of origin issues. This is summed up by the adage 'a bamboo door matches a bamboo door, while a wooden door matches a wooden door'.
• Mental health problems due to social isolation and shame.
• Grief.

Implications for practice 

In the absence of a thorough understanding of cultural values and practices, the meta-skills of compassion, empathy, neutrality and a willingness to work through a different lens, will be the clinician's best approach.