Rehabilitation Counseling For Asian Americans:
Psychological and Social Considerations
George K. Hong, Ph.D.
Associate Professor/Clinical Psychologist
California State University, Los Angeles
Abstract
This paper examines the psychological needs and the social environment of Asian American consumers. Factors considered include: the diversity and commonalities among different Asian American groups, concrete services versus psychological counseling, individuals versus family focus, and the obstacles to rehabilitation encountered in the social environment. Implications of these issues for culturally sensitive rehabilitation services are discussed.
Introduction
In order to provide effective services, rehabilitation counselors have to be aware of the psychological needs of their consumers and the social environment in which consumers live. These are crucial factors that should be taken into consideration in developing a working relationship with the consumer, as well as in realistic service planning. This paper aims to familiarize counselors with these two aspects of the Asian American populations so that culturally sensitive services can be designed.
Diversity & Commonalities Among Asian Americans
In the mass media as well as in the professional literature, Asian Americans are often presented as a homogeneous group. In reality, Asian Americans come from different countries in Asia which have different languages and cultures. They also have different histories of migration to the United States. A first generation Korean American and a Sansei, i.e., third generation Japanese American, will have different degrees of identification with mainstream American culture and their cultures of origin. A Chinese American coming from the rural parts of mainland China will be embracing a form of Chinese culture different from that of one coming from the cosmopolitan centers such as Hong Kong. All four of the above will have migration experiences that are in sharp contrast to Vietnamese Americans who came as refugees, and whose trauma from war and turmoil will likely have a lasting influence on their experience in the United States.
Thus, in providing rehabilitation to Americans, it is important for the counselor to be sensitive to the differences among groups of Asian Americans. One should also keep in mind that every consumer is an individual whose degree of identifica tion with his or her ethnic culture and with mainstream American culture might be different from others in the same ethnic group. Stereotyping, even when it is based on benign intentions, will lead to misunderstanding, frustration, and eventually hurt feelings for both the consumer and the counselor.
Given the diversity among Asian Americans, it is difficult for a counselor to learn the details about every group. So I will focus on the general characteristics shared by many of them. Many Asian cultures, namely Chinese, Japanese, Korean, and Vietnamese, share common world views which are based on the "Eastern" philosophies such as Confucianism, Taoism, and Buddhism, in contrast to mainstream American or western culture which is based on the Judeo-Christian orientation. Many discussions are focused on these Asian American populations. As noted by many authors, (Hong, 1988, 1993; Lee, 1979; Shon, 1979; Sue & Morishima, 1982; Wong, 1985) they can be considered as a group with shared cultural characteristics which warrant counseling techniques and service delivery models that are different from those designed for the mainstream population.
Concrete Services Versus Counseling
In order to provide effective rehabilitation counseling, a counselor often has to go beyond medical or concrete services to address the psychological needs of the consumer. For example, one cannot provide successful job training or placement until the consumer has the motivation and the emotional strength to go through with it. Issues relating to the loss of an ability, etc., are all to be addressed in the course of providing rehabilitation services.
When Asian Americans seek counseling, they often expect a quick resolution of their problems, such as trouble-shooting an issue, direct advice, or concrete services (Hong, 1988, 1993; Sue & Morishima, 1982). They are not familiar with the "emotional/psychological" type of counseling. In addition, Asian Americans have the tendency to somatize, or complain about physical discomforts such as poor appetite, insomnia, headaches, or other "pains," etc., when they experience emotional difficulties (Hong, 1993). In working with Asian Americans, rehabilitation counselors should be careful not to be misguided into focusing solely on medical and concrete services for Asian Americans and neglect their psychological and emotional needs. Similarly, one has to be sensitive to the consumer's interest in the "non-psychological" aspect of a disability. A good approach to this dilemma is to engage consumers by starting from the medical or concrete aspects of the disability, and gradually lead them to explore their feelings. The emotional issues can then be addressed in the context of how the psychological well-being might impact on the progress of one's rehabilitation.
Family Versus The Individual
Asian cultures are focused on the family as opposed to mainstream American culture which is focused on the individual (Hong, 1988; Shon & Ja, 1982; Sue & Morishima, 1982). In working with an Asian American consumer, it is important to take the family into consideration. When making a service plan, the rehabilitation counselor has to examine the impact of a disability on the individual consumer as well as on the whole family. For example, a vast majority of Asian Americans are immigrants and establishing economic security is a major concern for them. Therefore, the following questions should be considered by service providers: To what extent does the disability of a family member affect the family's collective goals? How does one address the guilt experienced by a consumer for being an additional burden on the family members? How does one help the Asian family locate culturally congruent resources?
Given the importance of the family, the rehabilitation counselor has to be careful to include relevant family members in the decision making process. At times, this might include extended family members, such as uncles or cousins (if they are in the United States). When a service planning meeting is held, it is useful to let the consumer know in advance that all concerned family members are invited to the meeting. If the counselor limits participation to the consumer and a significant other, the plan will often need to be re-negotiated because other members of the family have different ideas. Giving an open invitation to all will facilitate the process and enhance consumer cooperation.
Social Considerations
Cultural sensitivity on the part of the rehabilitation counselor by itself is often insufficient for effective services. The cooperation of other people in the public or private sector is essential. As such, Asian American consumers face a double jeopardy. They face discrimination as an ethnic minority individually, and they face discrimination as persons with disabilities (Broadwin, Hong, & Soriano, 1992; Cook, 1992; Fine & Asch, 1988). This is especially true for those of lower socioeconomic background or those living in the ethnic communities. They are typically less integrated into mainstream America than the middle and upper classes. Many are not fluent in English. Where can the counselor find appropriate job training for them? Are firms and agencies in mainstream settings willing to hire them? Will their potential colleagues accept them socially?
Take for example a Chinese American consumer who, for most of his adult life, had been working as a cook in a Chinese restaurant. Due to a car accident, he suffered a permanent disability and could not perform work requiring physical labor. He could not sit or stand too long without incurring pain in his hips. The restaurant business became too strenuous for him. Being in his late forties, what employment opportunities did he have? He was denied disability benefits because the welfare caseworker indicated that he could work as a telephone operator, and there were corporations willing to hire people with disabilities for that position. What the caseworker did not consider was that this consumer had limited English fluency! The caseworker also said that he could be a cashier. Again, which place would hire a person in his forties who was not fluent in English and who needed frequent breaks as he could not stand or sit in the same position too long? What sounded good on paper for the "average" Anglo American consumer was simply not feasible for this consumer. Sure, having the consumer enrolled in adult English classes could be part of the rehabilitation plan. But this meant that the consumer would require a longer time for job training than the bureaucratic "formula" for rehabilitation allowed.
Considering the limited training and employment available to ethnic and linguistic persons from minority groups such as Asians, the rehabilitation counselor has to be especially resourceful and persistent. Very often, he has to be the advocate for his consumers, arguing their cases before government agencies, and locating legal assistance when needed. He also must serve as the liaison between different agencies, such as medical services, job training, and welfare services, to ensure that the consumer will not get lost in the shuffle between them. This is especially important for many Asian immigrants who are unfamiliar with the institutional system in this country (Hong, 1993; Shon, 1979; Sue & Morishima, 1982). Finding their way among the myriad of providers is a confusing and frustrating experience.
In order to perform the above functions, it is useful for rehabilitation counselors working with Asian Americans to network with community agencies and other culturally sensitive providers in allied professions (Chan, 1986). When a referral is needed, they can use their contacts to locate appropriate services for their consumers, and if necessary, to advocate for their consumers. In addition to working on individual cases, rehabilitation counselors should use their professional knowledge and status to identify the inadequacies and insensitivities currently present in both public and private agencies. They need to work together with other community groups to promote institutional change so that cultural services will be more easily accessible than at the present time.
Concluding Remarks
This paper has focused on the major psychological and social issues commonly experienced by Asian American consumers. It is not a comprehensive list of all of the problems. In working with a consumer from a particular ethnic group, it is important for the rehabilitation counselor to apply the suggestions advanced here selectively. Group characteristics can serve as guidelines, but indiscriminate applications will lead to over-generalization and stereotyping. The counselor should remember that, first of all, the consumer is an individual with his or her own unique circumstances, personal experiences, and needs. It is only with such attitudes that truly culturally sensitive services can be achieved.
References
Brodwin, M.G., Hong, G.K., & Sorian, M (1992). Discrimination, disability, and cultural considerations: Implications for counselors. California Association of Counseling and Development Journal, 12, 9-14.
Chan, S. (1986). Parents of exceptional Asian children. In M.K. Kitano & P.C. Chinn (Eds.) Exceptional Asian children and youth (pp.36-53). Reston, VA: Council for Exceptional Children.
Cook, D. (1992). Psychological impact of disability. In R.M. Parker & E.M. Szmanski (Eds.), Rehabilitation counseling: Basics and beyond (pp.249-272). Austin, TX: Pro-ed.
Fine, M. & Asch, A. (1988). Disabilities beyond stigma: Social interaction, discrimination, and activism. Journal of Social Issues, 44, 3-21.
Hong, G.K. (1988). A general family practitioner approach for Asian American mental health services. Professional Psychology: Research and Practice, 19, 600- 605.
Hong, G.K. (1993). Contextual factors in psychotherapy with Asian Americans. In J.L. Chin, J.H. Liem, M.D. Ham, & G.K. Hong, Transference and empathy in Asian American psychotherapy: Cultural values and treatment needs. (pp. 3-13). Westport, CT: Praeger.
Lee, E. (1979, May). Mental health services for Asian Americans: Problems and alternatives. In Civil rights issues of Asian and Pacific Americans: Myths and realities. A consultation sponsored by the U.S. Commission on Civil Rights. (pp. 734-756) (GPO: 1980 624-865/1772). Washington, DC: Government Printing Office.
Shon, S.P. (1979, May). The delivery of mental health services to Asian Americans. In Civil rights issues of Asian and Pacific Americans: Myths and realities. A consultation sponsored by the U.S. Commission on Civil Rights (pp.724-733) (GPO: 1980 624-865/1772). Washington, DC: Government Printing Office.
Shon, S.P., & Ja, D.Y. (1982). Asian families. In M. McGoldrick, J.K. Pearce, & J. Giordano (Eds.), Ethnicity and family therapy (pp. 208-228). New York: The Guilford Press.
Sue, S., & Morishima, J.K. (1982). The mental health of Asian Americans. San Francisco: Jossey-Bass, Inc.
Wong, H.Z. (1985). Training for mental health services providers to Southeast Asian refugees: Models, strategies, and curricula. In T.C. Owan (Ed.), Southeast Asian mental health: Treatment, prevention, services and research (pp.345- 390) (DHSS Publication No. ADM 85-1399). Washington, DC: National Institute of Mental Health.
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