Asian Clients Research Articles

The Guijin Therapist and the Nature of Therapeutic Truth: A Relational Perspective

The professional literature is replete with examples of the benefits of the client–clinician dyad being of the same ethnic group. Noted advantages include a perceived implicit understanding of the client’s subjective experience and a furthering of the therapist’s personal and professional growth as a result of the therapeutic interaction. This paper suggests that there are also benefits to the clinician being considered a guijin or “outsider” to the client’s culture of origin. Utilizing a relational perspective with an emphasis on multiple self-state theory, this paper will discuss the advantages of being perceived as an outsider when working with an Asian bicultural client.

The way of being a social worker: Implications for Confucianism to social work education and clinical practice

Studies examining therapeutic work with Asian clients frequently refer to Buddhism, Taoism, and Confucianism as central elements in the work. The clinical implications of Confucianism have been less studied than the implications of Buddhism and Taoism. This paper introduces five main features of Confucian learning and discusses how a Confucian approach to social work education and practice may contribute to understanding theoretical, social and cultural changes in the social work field. The paper examines the development of the professional self, and the increasing interface of spirituality and professional self. I argue that social work requires an educational framework that clarifies values, fosters personal growth and spirituality, and provides an outlook for lifelong education.

Working with Southeast Asian Clients: Suggestions from the Field

Working with Southeast Asian Clients: Suggestions from the Field

Working with elderly asian clients

This article describes an art therapy group at an Asian Day Centre which caters for Asian elders who are isolated, depressed or suffering adverse family circumstances. The group was set up to see if art therapy could help with the expression of thoughts and feelings, and to involve those with mental health problems in a non-stigmatising way. The group met weekly for two-and-a-half years and involved men and women from a variety of Asian backgrounds. After describing the work and reviewing the small amount of related literature, the author raises questions about cultural issues concerning art therapy and Asian culture.

Understanding and treating the ethnically Asian client: a collectivist approach.

Asian clients represent a growing population of clients seeking professional assistance for a variety of social and emotional difficulties. Ethnically Asian clients often have a collective notion of "self" which is highly influenced by family and culture. Clinical work with Asian clients requires very different treatment strategies than those used in work with western clients whose notion of "self" is far more individualistic. The cultural issues at play in the development of a "Collective Self" are described in the article along with common crisis situations which often require the Asian client to seek treatment.

The use of traditional and Western medicine among Korean American elderly.

With the current wave of Asian immigration to the United States, awareness of their use of traditional medicine, often in combination with Western medicine, is an increasingly salient issue for health care professionals. This paper describes the use of traditional and Western medicine by Korean American elderly and factors that are associated with their health-seeking behaviors and health service utilization. Data were obtained from a convenience sample of 205 Korean elderly immigrants through interview. The findings revealed that health service utilization among Korean American elderly covered a broad spectrum of health resources, including the use of Western medicine, the traditional Korean medicine (hanbang), or both Western and traditional clinics. In addition, health insurance status and the source of health care were found to relate to the types of health service that Korean American elderly chose to utilize. Better understanding of patterns of health service utilization may improve the quality of health care by increasing health providers' cultural sensitivity and facilitating adequate communication between Asian immigrant clients and their care providers. Implications for research and practice are discussed.

Patterns in use: a study on routes of administration of Asian drug users

Current evidence suggests that more people from ethnic minorities are accessing substance misuse services than before. However, research in this area is sparse and much of the work has been done outside London. Data gathered from the Thames regional database (1999) would suggest that the Asian community is an emerging sub-group that is accessing drug services. Anecdotal evidence suggests that the assessment process demonstrates marked differences when comparing data of Asian drug users with those of white users, the main differences being length of drug-using history, route of administration and amount of heroin being used. The drug of choice of the Asian community was heroin and their route of administration was by smoking (95% had never injected). In comparison, the British white population has a history of injecting drug use (95%). An audit was completed in Brent to verify the anecdotal evidence mentioned above. This audit was repeated in South Camden, where there is a similar Asian client group who are accessing the specialist service, to see if similar patterns in route of administration, length of drug history and amount of heroin used emerged. The audit was completed for 500 clients, with the two services provided approximately 250 clients each for the audit. The main evidence found differences in length of use, drug of choice, route of administration, age, social class and gender. The next step is to design suitable research to look at the possible reasons for this difference upon presentation, and whether this should shape drug service provision.

Health-Seeking Behaviors and Barriers to Health Care of Southeast Asian Immigrants: Implications for the Home Health Nurse

Grounded in first-hand experience, research, and published literature, this article provides an emic view of the health-seeking behaviors and barriers to health care of Southeast Asian immigrants. Implications for the home health nurse are also examined. Such an understanding is the foundation for building the cultural and linguistic competencies for taking care of Southeast Asian clients. In addition, in light of the changing demographics of the U.S. population reflected in Census 2000 and the recently released national standards for culturally and linguistically appropriate services, the article also discusses the challenges and implications of implementing the national standards to reduce and eventually eliminate racial and ethnic disparities in health care.

Characteristics of an Accident and Emergency liaison mental health service in East London.

To analyse the work of a liaison mental health service at the Accident and Emergency (A & E) department of a hospital in East London. The English National Service Frameworks (NSF) for Mental Health recommend that A & E departments provide liaison mental health services and this study reports how a service in East London is responding to this challenge. Data were collected during a 14-month period using a specially designed audit form. The typical referral was aged 36, of either sex, United Kingdom (UK) non-White with a diagnosis of depression. The majority of referrals were in the afternoon and seen immediately. A slight majority were known to mental health services; many were new referrals. Older and male clients were more likely, and Bengali and other Asian clients were less likely, to be registered with a psychiatrist. There were seasonal variations in referral type. Emergency referrals tended to have a diagnosis of schizophrenia; urgent and non-urgent referrals were more likely to be depressed. The outcome for the majority of referrals was referral to appropriate community services. The majority of non-clinical referrals were for advice, information and support. The service seems a useful resource for A & E staff, and clients with mental health problems. The service is a channel through which people access mental health services and appears to address the NSF for Mental Health.

Cross-Cultural Group Counseling with Asians: A Stage-Specific Interactive Approach

This article provides an approach offering culturally responsive interventions for Asian members in ethnically mixedgroups led by Caucasian leaders. The theoretical foundation is based on a developmental paradigm focusing on two compounding factors: the Asian clients' and the Whitegroup leaders'ethnic identity development. The approach addresses potential problems and interventions for clients of various identity development phases at each specific group stage Special attention is given to the differences in culture-bound values, cultumlly encapsulated attitudes and beliefs, verbal I nonverbal communication styles, and the nature of interpersonal dynamics at each group developmental stage.

A Re-Conceptualization of the Working Alliance in Cross-Cultural Practice with Non-Western Clients: Integrating Relational Perspectives and Multicultural Theories

This article will addresses a gap in the literature regarding the working alliance in cross-cultural treatment. The paper draws on references from current relational theories and multicultural conceptual and empirical sources to re-conceptualize the definition of the working alliance to include cross-cultural dynamics between Asian clients and European-American therapists as a case in point. The paper includes an overview of the working alliance, and a proposal for the inclusion of specific relational domains that this author has found to be important for the definition of the working alliance. These domains are empathy, mutuality, the dynamics of power and authority, the use of self, and the process of communication. A case vignette is included to illustrate these discrete domains. The paper opens new directions for clinical practice and research in the area of the working alliance in cross-cultural counseling.

Self-evaluation of unintended biases and prejudices.

A scale for measuring self-assessment of factors, which might lead to unintended biases and prejudices, was tested with 39 professionals working with adolescents on probation. The scale has 10 items (e.g., "Would feel comfortable providing clinical services to [e.g., African Americans]." Each item was rated on a 3-point scale so as summated scores increase across items the probability of unintended biases and prejudices against five culturally diverse groups (African American, American Indian, Asian, Hispanic, and White) would also increase. The coefficient alpha was .87. Participants' mean unintended bias and prejudices across items were always lower toward clients from their own racial or ethnic group. For example, Hispanic and White participants tended to be more prompt to display these attitudes against African Americans, relative to African-American participants. White participants, however, reported lower scores leading to unintended biases in the case of White clients, relative to African-American and Hispanic participants. Overall, participants' mean unintended bias and prejudices against American Indian and Asian clients tended to be higher with these groups, relative to clients from the African-American, Hispanic, and White communities. Results are discussed in terms of further development of the scale in the design of cross-cultural training in various working environments with culturally diverse clients.

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.

Examining the effects of ethnic-specific services: An analysis of cost-utilization and treatment outcome for Asian American clients

Ethnic-specific mental health services have developed to meet the unique cultural and linguistic needs of the ethnic client. It has been assumed that this type of service configuration provides more accessible, culturally-responsive mental health care, which in turn, encourages utilization and enhances outcomes. Previous studies have found that ethnic-specific services (ESS) increase utilization of mental health services, but there has only been inconsistent evidence that ESS results in better outcomes. This study compared patterns of the cost-utilization and outcomes of Asian American outpatients using ESS to those Asians using mainstream services. Consistent with earlier studies, cost-utilization for ESS Asian clients was higher than that for mainstream Asian clients. Better treatment outcome was found for ESS clients compared to their mainstream counterparts, even after controlling for certain demographics, pretreatment severity, diagnosis, and type of reimbursement. Moreover, there was a significant relationship between cost-utilization and outcome for ESS clients, whereas for mainstream clients, this relationship was not significant. The findings strongly suggest that mental health services with an ethnic-specific focus provide more effective and efficient care for at least one ethnic minority group. Implications for the delivery of culturally-competent mental health services are discussed. © 2000 John Wiley & Sons, Inc.

Applications of Group Career Counseling Techniques in Asian Cultures

In this article, applications of group career counseling techniques to Asian cultures are discussed. The article first identifies how group‐oriented cultures differ from individually oriented cultures, reasons that group career counseling is especially appropriate for group‐oriented cultures, and relevant issues in group career counseling with Asian populations. Interventions that illustrate the use of group career counseling with Asian clients are prescribed.

THE SOUTH ASIAN CLIENT

THE SOUTH ASIAN CLIENT

Strategic Pragmatism: The Culture of Singapore's Economic Development Board. By Edgar H. Schein. Cambridge, Mass.: The MIT Press, 1996. xvi, 275 pp. $27.50.

Singapore's economic development board - three perspectives. Part 1 The EDB's perspective on itself - historical and cultural legacies: some historical roots of the EDB culture variations on a theme: the major strategic eras the founding chairman: Hon Sui Sen (1961-1968) the deal makers: I.F. Tang and Chan Chin Bock building and consolidating: Ngiam Tong Dow and P.Y. Hwang redefinition and renewal: the EDB under Philip Yeo. Part 2 The EDB from a client/investor perspective: the EDB as perceived by U.S. investors European and Asian client perspectives. Part 3 The EDB culture from an analytic perspective: the core assumptions of the EDB's cultural context the cultural paradigm of the organization: assumptions about organization and management in the EDB. Part 4 Problems, issues, and lessons: problems and issues: the contextual culture problems, issues, and opportunities in the EDB's operational and managerial culture lessons and conclusions.

A Process Evaluation of the Cultural Compatibility of Psychoeducational Family Group Treatment with Ethnic Asian Clients

Effective ethnic-sensitive social work practice requires an understanding of the cultural compatibility between an intervention model and the client group. This study evaluated the cultural fit of psychoeducational family group treatment with ethnic Chinese and Malay families in Singapore. Process evaluation of five treatment groups determined that incompatibilities in beliefs, world views, and treatment expectations between the model and the clients resulted in difficulties in client role behavior. Cognitive-behavioral interventions were partially successful in facilitating members' participation in group activities and goal achievement.

The use of video-film to discover cultural baiases in trainee counsellors

Two empirical studies were conducted with innovative methodologies to inquire into the influence of video-films on respondents' biases. The experiments included a construction of vide-films which displayed simulated counselling sessions with foour clients from different cultures and a counsellor from te indigenous population. The scripts, Directive and Non-directive counseling apporaches, were validated. The evidences indicated that, appart from the one favourable exception in the fires study where significant positive attributions and awareness of the appropriate counseling approach were directed to the Asian client, the respondents, White trainee counsellors, found no significant differences between the other clients. The video-films in the second study evoked responses that were positive to all four clients with no significant differences. The preduction that favourable responses would be made for te White (in-group) client, was disputed. Furher research should include discussions into the efficacy of video-film as a reliable teaching tool for trainee counsellors.

Adapting Mainstream Substance-Abuse Interventions for Southeast Asian Clients

Southeast Asians are experiencing increasing problems with alcohol and other drug abuse. Because few culturally specific treatment models are available, mainstream substance-abuse programs will increasingly be called on to provide services to clients and consultation to Southeast Asian human service agencies. The authors describe ways that existing mainstream treatment methods may be ineffective and recommend program modifications to increase cultural relevance.