Asian American Clients Research Articles

Examining Health-Related Factors Among an Ethnically Diverse Group of Asian-American Mental Health Clients

As currently developed, health policies and practices consider Asian Americans as one homogenous group, ignoring the unique differences of each group regarding its own healthcare needs. In fact, the healthcare needs of mental health clients have received little attention in the professional literature. The purpose of this article is to investigate the diverse healthcare needs of Asian Americans seeking mental health services. The authors reviewed the literature on healthcare for ethnic minority groups while focusing primarily on Asian Americans and analyzing these needs as they relate to mental health-seeking clients. The results indicate that Korean Americans are faring less well than either Japanese or Chinese Americans. The authors discuss the implications for health policy, practice, and education.

Intersections of Identities

ABSTRACT This paper addresses several key issues related to counseling lesbian, gay, bisexual, and transgender (LGBT) Asian-Americans. An understanding of the intersections of these identities is important, yet can be complex because of the diversity within Asian-American cultural groups (i.e., ethnicity, generation, skin color, religion, levels of minority stress, and acculturation) and within LGBT communities. These factors may influence counselors' selection of developmentally appropriate and culturally sensitive counseling approaches for LGBT Asian-American clients. We propose a framework for understanding the intersection of racial/ethnic and sexual identity development, the Racial Ethnic and Sexual Orientation Identification Chart (RSIC), which is designed to assist therapists in determining relevant counseling issues and strategies. A case study is included along with a discussion of multidimensional assessment and clinical implications.

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.

Differential referral patterns to ethnic-specific and mainstream mental health programs for four Asian American groups.

This study examined the referral patterns of Chinese, Japanese, Filipino, and Korean Americans at ethnic-specific versus mainstream programs in a public mental health system. As predicted, social/ community-based services and family/friends to a lesser degree referred each Asian American group to ethnic-specific programs more than other referral sources (e.g., criminal justice and health services). Referrals by social/community-based programs to ethnic-specific versus mainstream programs were the most significant for Chinese Americans, followed by Japanese and Filipino Americans, and the least significant for Korean Americans. These findings suggest Asian American clients themselves and their social networks may view ethnic-specific programs as more culturally responsive than mainstream programs.

Therapeutic Dilemmas in Cross-Cultural Practice with Asian American Adolescents

The following study proposes that differences in traditions and values between Western clinicians and Asian American clients manifests in therapeutic dilemmas, and offers recommendations for cross-cultural practice with Asian American adolescents and their families. The themes that will be examined are independence vs. acculturation/individuation, equality vs. hierarchy/authority, and supportive vs. dynamic treatment.

Effects of counsellor race on racial stereotypes of rehabilitation counselling clients

Purpose: This study investigated perceptions of European American, African American, and Asian American rehabilitation graduate students in rehabilitation counselling by assessing their clinical impressions of African American, European American, and Asian American clients. This investigation is a continuation of several studies investigating clinical perceptions and client race.Method: Rehabilitation graduate students in rehabilitation counselling participating in this study were randomly assigned to one of three groups and were asked to review case materials for a client portrayed either as African American, European American, or Asian American. In pursuit of the main effect of client race, three separate MANOVA analyses were conducted: one for African American graduate students in rehabilitation counselling, one for Asian American graduate students in rehabilitation counselling, and one for European American graduate students in rehabilitation counselling.Results: Contrary to previous findings from comparable research, MANOVA results did not reveal a significant main effect of bias by European American, Asian American, and African American graduate students in rehabilitation counselling against any of the three groups.Conclusions: Understanding of the conditions in which racial biases and subsequent judgmental errors are likely to occur (or not occur) should allow clinicians to recognise tendencies for their assessments to be influenced by client characteristics that elicit stereotypes and thereby to make more accurate judgements.

Neuropsychological Assessment of Asian Americans: Demographic Factors, Cultural Diversity, and Practical Guidelines

Asian Americans belong to 1 of the most rapidly growing ethnic minority groups in the United States. Clinical neuropsychologists unfamiliar with Asian American peoples and cultures may not be able to perform an adequate evaluation with an individual of Asian descent because of lack of understanding of how cultural variables might affect the assessment. This article attempts to provide some basic knowledge and principles by which to guide neuropsychologists who might work with an Asian American patient by (a) familiarizing the reader with basic information and descriptions of some of the major specific Asian subgroups, (b) providing a context within which neuropsychological test selection and interpretation can be adjusted to account for cultural and linguistic factors, and (c) providing practical suggestions for working with Asian American clients in a neuropsychological setting.

Understanding Asian American Clients

Asian Americans are the fastest growing ethnic minority in the United States today. Therefore, the Asian American population greatly needs the services of qualified cross-cultural counselors. An ethnic match between an Asian American client and his/her counselor is generally recommended. However, due to the limited number of qualified Asian American counselors and problems sometimes encountered with an ethnic match, an ethnic match between the counselor and client is very often not realistic nor always preferred. However, Western counselors who work with Asian Americans need to understand their clients' acculturation problems. They also need to understand the preventable mistakes often made in counseling Asian American clients.

Predictors of nonattendance of intake appointments among five Asian American client groups.

The authors examined the relationship of demographic, clinical, and service program factors with preintake attrition rates, or the nonattendance of intake appointments, among 5 Asian American groups at an ethnic-specific program. The results show that younger age, earlier appointment, Asian language match with the prescreening interviewer, and assignment of the prescreening interviewer as the intake therapist increased; however, gender match with prescreening interviewer decreased-the likelihood of intake attendance. As hypothesized, Southeast Asians (Cambodian, Iu Mien, and Vietnamese Americans to a lesser degree) reported higher intake attendance rates than more established East Asian groups (Chinese and Korean Americans). Specific implications of these results to program evaluation and to development and improvements in service delivery to Asian American groups are discussed.

Counselor Ethnicity, Counselor Nonverbal Behavior, and Session Outcome With Asian American Clients: Initial Findings

Five Asian American and 5 European American female counselors each saw 3 Asian American volunteer clients for 1 session of career‐focused individual counseling. Examination of counselor nonverbal behaviors revealed that European American counselors displayed significantly greater frequency of adaptors, postural shifts, and smiles than did Asian American counselors. The frequency of smiles was significantly positively correlated with client‐rated session positivity and session arousal, and the frequency of postural shifts was significantly positively correlated with client‐rated session arousal. Limitations and implications of the findings are described.

Counselor self-disclosure, East Asian American client adherence to Asian cultural values, and counseling process.

After completing a measure of adherence to Asian cultural values, 62 East Asian American clients talked about personal issues in a counseling session with a European American counselor who either disclosed personal information or refrained from disclosing personal information. Disclosure condition and client adherence to Asian values did not predict session outcome. However, type and intimacy of disclosure were related to immediate process and session outcome. Disclosures of strategies were perceived by the clients to be more helpful than disclosures of approval/reassurance, facts/credentials, and feelings, with disclosures of insight perceived as intermediate in helpfulness. Disclosures of strategies occurred more frequently in highly rated sessions than in sessions rated low. Also, client-and counselor-perceived intimacy of disclosures was significantly correlated with client- and counselor-perceived helpfulness of disclosures, respectively. Several naturalistic studies have found that counselor selfdisclosures have immediate positive effects on counseling process (Hill, Helms, Spiegel, & Tichenor, 1988; Knox, Hess, Petersen, & Hill, 1997; Ramsdell & Ramsdell, 1993). In a study with actual clients and counselors, Hill et al. (1988) reported that the clients gave the highest ratings of helpfulness and exhibited the highest experiencing levels (i.e., involvement with their feelings) in response to counselor self-disclosures compared with other verbal response modes. In a qualitative study, Knox et al. (1997) found that clients viewed counselor self-disclosures as leading to insight, making the counselors seem more real and human and making clients feel normal and reassured. Ramsdell and Ramsdell (1993), based on a survey of former clients who had at least six sessions of counseling, reported that the counselor’s sharing of personal information was perceived by clients as having a beneficial effect on counseling. Furthermore, in an experimental study in which counselors either disclosed more or less than usual in four sessions of counseling, Barrett and Berman (2001) found that clients in the high-disclosure condition had less symptom distress and liked the counselors more than did clients in the low-disclosure condition. Although very interesting and relevant to practice, there are two major problems with the previous studies. First, no distinctions were made between different types of clients. The participants in most of these studies were comprised of members of various ethnic groups, with most participants from the European American group. Hence, the extent to which the findings directly apply to nonEuropean American ethnic group members, particularly Asian Americans, is not clearly known. Moreover, given the diversity within the Asian American group, particularly in terms of their levels of adherence to the Asian cultural norms, there is a need to study the possible effects of within-group differences. Therefore, the first purpose of the present study was to examine at session outcome how Asian American clients of differing cultural values would react to counselor disclosures during the session. The second problem with previous studies is that no distinctions were made between different types of disclosures. In these studies, counselor disclosures tended to be treated as a unidimensional construct and specific effects of various kinds of disclosures were not studied in depth. Hence, the second purpose of the present study was to examine on a moment-by-moment basis the immediate effects of type and intimacy of disclosure on Asian American clients’ perception of each disclosure made during the session.

Review of Psychotherapy and counseling with Asian American clients: A practical guide.

Review of Psychotherapy and counseling with Asian American clients: A practical guide.

Psychotherapy and counseling with Asian American clients: A practical guide: Book review.

Psychotherapy and counseling with Asian American clients: A practical guide: Book review.

Predictors of help seeking for emotional distress among Chinese Americans: Family matters.

Using data from the Chinese American Psychiatric Epidemiological Study, the authors examined longitudinal predictors of help seeking for emotional distress in a community sample of 1,503 Chinese Americans. Specifically, they assessed the relative contribution of family relational variables (e.g., levels of family support and family conflict) in predicting help seeking for medical, mental health, and informal services. After traditional need, predisposing, and enabling factors were controlled for in hierarchical logistic regression analyses, family conflict predicted both mental health and medical service use, whereas family support was not predictive of help seeking. In addition to family conflict, mental health service use was predicted by negative life events, emotional distress, and insurance coverage. Implications of the findings for assessing and treating Asian American clients are explored.

Effects of Asian American client adherence to Asian cultural values, session goal, and counselor emphasis of client expression on career counseling process.

Seventy-eight Asian American college students who were experiencing career uncertainty engaged in a counseling session with a European American female counselor who focused on either immediate resolution of the problem or insight attainment through exploration of the problem and who emphasized client expression of either cognition or emotion. Clients with high adherence to Asian cultural values perceived increased counselor empathic understanding and stronger client– counselor working alliance than did clients with low adherence to Asian values. Clients who were exposed to the immediate resolution condition perceived stronger working alliance than did clients exposed to the insight attainment condition. Among clients with high adherence to Asian values, those in the expression of emotion condition perceived greater counselor cross-cultural competence than did those in the cognition condition.

Asian American client adherence to Asian cultural values, counselor expression of cultural values, couselor ethnicity, and career counseling process.

Asian American client adherence to Asian cultural values, counselor expression of cultural values, couselor ethnicity, and career counseling process.

Effects of Asian American client adherence to Asian cultural values, session goal, and counselor emphasis of client expression on career counseling process.

Effects of Asian American client adherence to Asian cultural values, session goal, and counselor emphasis of client expression on career counseling process.

Asian American client adherence to Asian cultural values, counselor expression of cultural values, couselor ethnicity, and career counseling process.

This study investigated the relationships among client adherence to Asian cultural values, counselor expression of cultural values, counselor ethnicity, and career counseling process with Asian American college students. Clients who had high adherence to Asian cultural values evaluated Asian American counselors as more empathic and credible than did clients with low adherence to Asian values, and clients who had low adherence to Asian cultural values evaluated European American counselors as more empathic than did clients with high adherence to Asian values. Contrary to expectations, clients rated the session with a European American counselor as more positive and arousing than the session with an Asian American counselor. Limitations and implications of the results are discussed. Recognizing the growing number of ethnic minorities in the United States and their tendency to prematurely terminate from counseling services, multicultural counseling researchers have increasingly examined the relationships among cultural variables, such as acculturation and ethnic identity, and the quality of counseling process (Atkinson, Morten, & Sue, 1998; Sue, 1990). One particular group of people that has received attention in this endeavor has been Asian Americans. As of 2000, there were over 10.2 million Asian Americans in the United States, representing 3.6% of the total population (U.S. Bureau of the Census, 2001). These numbers represent an increase of 46% since 1990, making Asian Americans the second fastest growing ethnic group in the United States (after Hispanic Americans). Given these statistics, it is likely that there will be greater demands in the future from Asian Americans for culturally relevant and sensitive psychological services. In addition, because Asian Americans comprise individuals ranging from those whose ancestors immigrated to the United States in the 1850s to those whose parents immigrated to the United States after the passing of the Immigration Act of 1965 and those who have immigrated just recently, the need to account for within-group factors that are related to the quality of counseling process is especially salient. The goal of the present study was to investigate the relationships among three cultural factors, client adherence to Asian cultural values, counselor’s expression of cultural values and counselor ethnicity, and the quality of career counseling process.

Cultural Competency and Achieving Styles in Clinical Social Work

This paper attempts to build a cultural competency framework by reviewing the literature and laying a conceptual foundation for professional standards in clinical social work. It also explores the implications of cultural competency by relating some important factors to clinical decisions, alliance, and outcome in the mental health field. The pathways and directions of the relationships as well as the potential factors affecting cross-cultural clinical alliance are illuminated in a general model to guide hypothesis formulation in further research. Empirical data are presented on clinical social work practice with Asian American clients in light of a key factor in shaping cultural competency, i.e., clinicians' personal achieving styles. The findings suggest that such styles are culturally bound.

Ethnic match and client ethnicity effects on global assessment and visitation

The effects of client-therapist ethnic match and client ethnicity on therapist-evaluated Global Assessment of Function (GAF) and visitation were investigated. The sample consisted of several thousand outpatient clients of a Southern California community mental health center. Findings indicated that unadjusted GAF-intake and GAF-termination scores were higher for ethnically matched Latino and Asian Americans but not for African and White Americans. Unadjusted GAF-difference scores for ethnically matched Latino and White Americans were higher than for African American clients. Unadjusted visitation or total visits was lower for ethnically matched Asian and Latino American clients, while African and White American clients had relatively high visitation levels regardless of the ethnic match status. After adjusting for 12 other variables, ethnically matched Asian American therapists consistently evaluated clients higher than did ethnically matched African American therapists. Adjusted visitation revealed fewer total visits for ethnically matched Latino and African American clients, while White Americans garnered higher visit levels when ethnically matched, and Asian Americans evidenced relatively high levels of visitation regardless of ethnic match status. Separate diagnostic category analyses revealed higher GAF-termination scores for ethnically matched African, Asian, and Latino American (schizophrenic) clients and ethnically matched Latino and Asian(mood disorder) clients. Implications for future research are discussed. © 2000 John Wiley & Sons, Inc.