Intervention with families

Because of the central role families play in Asian cultures, it is important that they are involved in the process. However, the definition of 'family' may vary in different cultures and for particular families. For example, a child who has been taken in by extended family at an early age, but re-united with biological parents later, may feel more affiliated with the extended family.

Pointers for working with families:

• Get the client's agreement to involve the family.
• Get the client to define who is in their family (and who they leave out will also be useful assessment information).
• Engage the family if family and client's goals are similar.
• Mediate between family/extended family and client if goals differ.
• Prior to sessions, meet each family member separately.
• Be respectful of traditional hierarchies and address adult members and decision-maker or elders first.
• Start by using titles and ask if first names are acceptable.
• Work sensitively with family dynamics to accommodate traditional Asian family values and concepts.
• Disclose sufficient personal information to establish credibility and professional affiliation whilst also showing warmth and empathy. Being able to create some social or personal connection will also be helpful towards rapport building.
• Irrespective of modality, maintain the role of the expert, teacher and negotiator, and only work collaboratively once this role is well established.

Wong and Au, 2010 suggest using the 5 Ps:

• Psychoeducation- provide an explanation for the situation/symptom.
• Positive reframing - finding a way to compliment the client/family for some aspect of the problem will be important.
• Pragmatic solution - focus on concrete problems (exploration of feelings may lead to failure).
• Projective strategies - family sculpture (role plays are not effective because of shyness and having to perform in front of children and strangers).
• Paradoxical approach- suggesting divorce or giving up children as a possible solution.

Implications for practice

It can be useful to present benefits of therapy to decision-makers using culturally congruent values to get their support. For example, interventions that will serve family obligations and the maintenance of status, as well as 'saving face', may be more motivating than 'solving problems'. The value of parenting and importance of children can be motivators to resolve couple issues.