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Family Therapy with Asian Americans: Principles and Practice

Conference Paper · October 2014

DOI: 10.13140/RG.2.1.4271.4649

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20th Annual Asian American Mental Health
Training Conference
Family Therapy with
Asian Americans:
Principles and Practice
Stephen Cheung, Psy.D.
Department of Graduate Psychology
Azusa Pacific University
Azusa, CA 91702
Email: scheung@apu.edu
Phone: 626-815-5008 ext. 5206
1
 Family Therapy with Asian Americans:
Principles and Practice
Why do we provide family therapy to Asian
Americans (AA)?
n  Collectivist cultural worldviews.

n  The family and the family relationships are

important and so are the interpersonal and
community relationships.
n  Family therapy is effective with them—Whether
we see only one person in the room, or the whole
family at a time, we could employ a systems
perspective. 2
 Overview of Family Psychology:
Systemic Paradigm of Family Psychology

Intra-Individual

Environmental Interpersonal
Macrosystemic

3
 Systemic Paradigm
One way to look at a person or a family system is to
n  Examine the interrelationship among the
intrapersonal, interpersonal, and environmental
variables of that person.
n  It involves investigating the different contexts in
which a person is embedded and the circular/
reciprocal relationships among them.
n  One will look at the interrelationships, problems
and resources in the multiple layers of the context
of that person.
4
 Therapeutic Principles
n  Multicultural competence
n  A Some-knowing and a Not-knowing therapeutic
stance
n  Pacing and leading

n  Credibility and gifts-giving

n  Triple A:

-Assessment of Acculturation and

-Adaptation of Western Family Therapy
Concepts and Skills to AA
(Cheung, 2009a, 2009b, 2011, 2013) 5
 Multicultural Competence

n  Awareness
n  Knowledge &

n  Skills

6
 Awareness
n  Self and others and the relationship between them.

n  To avoid
personal, cultural, and theoretical counter-
transference.

7
 Knowledge
n  *Asian American’s collectivist cultural worldviews,
values, customs and practices, etc.
n  Impact of migration and the family life cycle

n  Socio-emotional reality of AA (Cheung, 2009a,

2013).
n  Acculturation and acculturative stress.

n  Expectations of therapy, the therapist and

themselves in therapy.
n  More culturally congruent therapeutic approaches
and how to adapt them in a culturally competent
manner. 8
 Impact of Migration on
Family Life Cycle

n  “At the heart of the family life cycle construct is the
notion that members of a family will most likely
navigate interconnected life cycle events
together.” (Falicov, 2011, p. 336).
n  Migration/immigration interrupts/disrupts this process
(Sluzki, 1979, 2008).

9
n  According to Sluzki (1979), the migration process
includes these stages:
Preparatory stage
Act of migration
Period of overcompensation followed by
Period of Decompensation
Transgenerational impact

n  *Migration transition stages intersect with how

predicted and unexpected life cycle events are
experienced (Falicov, 2011).
10
 Specific Impact of Migration on
Family Life Cycle Experience for
Asian Americans
n  Due to migration, the family life cycle tasks and
challenges of immigrant Asian American families are
much more complex than those of their counterparts in
Asia, or those of non-immigrant/European Americans
in the States.
n  Why are they so?

11
n  When Asian immigrants immigrate to the U.S., they
experience multiple material and emotional losses. Just
to name a few of these losses: they have to leave
behind their loved ones, possessions, familiar lifestyle,
and cultural norms and practices, etc.
n  Upon arrival in the U.S., while adjusting to the socio-
cultural reality of the U.S. society without their
customary social support network, immigrant Asian
American families encounter multifarious forms of
acculturative stress (e.g., linguistic challenges, cultural
shock, under-employment, or even unemployment,
role redefinition in one’s family, identity, etc.) (Cheung,
2009a, 2013). 12
n  Simultaneously, they continue to make transitions in
their family life cycle with much less social support and
cultural validation.
n  While progressing in their family life cycle with more
cultural dissonance, immigrant Asian American families
are often confronted with a two-fold challenge:
-What part of their cultural heritage to keep and
-What part of the U.S. social customs and cultural
values to adopt.
n  This ongoing challenge plus other adaptations to
expected and unexpected life cycle events can be
enormously overwhelming and taxing.
13
 Socio-emotional Reality of
Asian American Immigrants
n  Multiple losses
n  Pre-, actual, and post-migration experiences

n  Multiple and enormous adjustments to the U. S.

n  Interpersonal and macro-systemic dynamics

n  The differences among AA:

AAI (Asian American Immigrants)

UAAI (Undocumented Asian American
Immigrants)
ABAA (American-born Asian Americans), etc.
(*Certainly there are individual differences.)
14
 Acculturative Stress
n  Language and cultural barriers
n  A myriad of adjustments to school, work, daily life,
relationships, etc. (Cheung, 2001, 2009a, 2013).

15
 Expectations of Therapy
n  Therapy goal, process, and outcomes
n  The therapist and

n  Themselves

16
Case Discussion 1

17
 Culturally Congruent Therapy
Models for Asian Americans
n  Cognitive-behavior Therapy (CBT)
n  Strategic and Structural Family Therapy (SSFT)

n  Solution-focused Brief Therapy (SFBT)

(Cheung, 2001, 2009a, 2009b; Kim, 1985; Lee

1997).

18
 Skills
n  How to use oneself and one’s relationship with
one’s AA client.
n  Perspective-taking.

n  To achieve a working relationship and results for

them.

19
 A Some-knowing and Not-knowing
Therapeutic Stance
n  To apply one’s multicultural awareness, knowledge,
and skills

20
 Some Knowing
n  “Some-knowing” refers to our knowledge and skills
in *multicultural psychotherapy and the family life
cycle, etc.
n  Specifically, it helps us to conceptualize

-Migration as a developmental process with four

stages as depicted by Sluzki (1979, 2008). This
process intersects with the family life cycle.
-Migration as analogous to unexpected life
events such as divorce, illness, loss of loved
ones, etc. (Falicov, 2011).
n  To be aware of

-The socio-emotional reality of immigrants 21

-The added complexity of facing family
developmental tasks and challenges in a
different linguistic, sociocultural, and
psychosocial contexts with less cultural
validation and social support
-Possible differences in cultural worldviews,
communication styles, expectations of the
therapeutic process, the therapist, and
themselves, etc.
-How the reactions of the host country to their
migration impact their adjustment/
acculturation to the U.S., etc. (Cheung, 2009a,
2011, 2013). 22
n  To help us to use our “some-knowing” in
migration, individual human development, family
life cycle, and multicultural psychotherapy
-To engage our immigrant families
-To empathize with, normalize, validate and
psychoeducate AA immigrant families about their
dilemmas as they experience their developmental
tasks and challenges in their critical life stages
(e.g., becoming a couple, being a parent, and
later stage of life, etc.).

23
 Understand the Complexity of
Asian Americans’ Family Life
via a Simple Family Typology
n  Traditional families
n  Family in culture conflict

n  Bicultural families

n  Americanized families

n  New Millennium families

24
 Not-Knowing Stance
n  To use one’s “not-knowing” stance to discover and
validate their unique circumstances and to highlight
and amplify their resources and successful solutions
(by asking the miracle, exception-finding, scaling,
coping, and relationship questions plus providing
indirect compliments, etc.).
n  All these interventions help the clients to envision a
more satisfying future and become more aware of
their strengths and resources that they can use to
turn their vision into reality (De Jong & Berg,
2013).
25
 General Therapeutic Strategies
n  Teamwork
n  Hypothesizing

n  Examine the functions and the restraints of the

presenting problems…
n  The strengths, protective and risk factors that
predispose, precipitate, and perpetuate the
problems
n  Credibility and Gifts-giving

n  Pacing and leading

n  Meeting the client’s expectations of therapy

26
 Specific Therapeutic Strategies
n  Assess the client’s acculturation and cultural
identity (Cheung, 2009a)

n  Credibility & gifts-giving.

n  Pacing & leading.

n  Perspective-taking: Understand your immigrant

families’ worldview by viewing their dilemmas from
their vantage point, and meet their cultural
expectations of therapy.
n  A balance between problem-solving and solution-
building. 27
 *Assessment of Acculturation
Assessment of your client’s acculturation and
cultural identity:
n  Preferred food

n  Preferred language(s) used at home

n  Preferred TV programs watched at home

n  Festivals and holidays observed

n  Childrearing practices

n  Ethnic and cultural pride

n  Cultural identification

28
n  Pre-immigration history as well as the actual and
post-immigration experiences.
n  Other factors including host country’s reactions to
them and their migration (Cheung, 2009a).

29
 *Adaptation of Therapy to AA
n  Requires *knowledge of the therapy approach (a
some-knowing stance).
n  *Knowledge of your client (a some-knowing
stance).
n  In collaboration with your client, discover some
effective ways to adapt the approach to your
client (a some-knowing and not-knowing or a
not-knowing and some-knowing stance).

30
n  With some clients, willingness to share about
yourself.
n  Flexibility in taking on *multiple roles (e.g., case
manager, coach, counselor, therapist, teacher,
adviser, advocate, service broker, cultural broker, &
community worker, etc.).
n  Patience and humility in learning from, and
growing with, your clients (Cheung, 2009a, 2009b,
2011).
31
Case Discussion 2

32
 Therapeutic Skills

n  Therapy begins with a phone call; engage the

concerned family member.
n  Personally invite over the phone the family
members who have the power to bring the family
back for therapy to the sessions and engage them
in the initial sessions.
n  Review existing information and formulate
hypotheses to guide the initial sessions.

33
n  Establish alliance with every family member in the
sessions by our therapeutic posture and our
interactions with them, and by our in-session and
end-session interventions:
1). Interact with each of them.
2). Stay with them on the presenting
problem.
3). Be empathetic and supportive.
4). Validate their feelings as well as their
efforts in the attempted solutions.

34
5). Provide psycho-education on the
mental disorders and give some kind of
explanations for the symptoms of the
disorders
6). When appropriate, *positively
reframe/relabel/connote their problems,
or emphasize the “restraints” of their
situation.
7). Together with the family define the
problems in specific terms and set
small and concrete goals in order to
improve the problems.
35
 8). Ask “circular questions” to assess the
interactional/interpersonal context of their
problems and feed new and useful information
back to the family.
9). *Give assignments/directives.
10). Evaluate progress in the agreed-upon
intervals with the family/client
(Cheung, 2001, 2005; 2009a; Haley, 1987, 1996,
2007; Madanes, 1981, 1991; Selvini
Palazzoli, 1985).

36
n  Be flexible in interviewing different family
subsystems, while respecting the family hierarchy
and the boundary of various family subsystems.
n  Help them discover their own resources, and
identify, amplify, and expand their positive
changes/successful solutions.
n  Empower them to remain to be solution-focused
(Cheung, 2009a, 2009b, 2013; De Jong & Berg,
2013).

37
Case Discussion 3

38
 Conclusion
To serve immigrant Asian American families well, one
needs to
n  *Be knowledgeable of Asian collectivistic cultural values
and practices as well as the family and individual life
cycle
n  *Respect and accept the cultural worldviews and values
of one’s clients
n  Strike a balance between “not knowing” and “some
knowing” in implementing one’s self-awareness,
knowledge, and skills in multicultural competence
39
n  Maintain a relational focus
n  Strike a balance between “problem talk” and “solution
talk.”
n  Strike a balance between giving directives and
facilitating growth in your Asian American client due to
the Asian American client’s cultural expectations of the
therapist, himself/herself and the therapeutic process
n  Consult when in doubt; grow as you go;

n  Also know when and where to refer (Cheung, 2009a,

2009b, 2013).

40
 Selected References
Cheung, S. (2009a). Asian American immigrant
mental health: Current status and future
directions. In Jean Lau Chin (Ed.), Diversity in
mind and in action (Vol. 1, pp. 87-104). New York:
Praeger Press.
Cheung, S. (2009b). Solution-focused brief therapy.
In J. Bray & M. Stanton (Eds.), The Wiley
Blackwell handbook of family psychology (pp.
212-225). United Kingdom: Wiley-Blackwell.
Cheung, S. (2011). Becoming a couple in the family
life cycle: Implications for education in family
psychology. The Family Psychologist, 27(1), 23-25.
41
Cheung, S. (2013, August). Solution-focused therapy
for immigrant families at critical life cycle
stages. Paper presented at the American
Psychological Association Annual Convention,
Honolulu, HI.
Cheung, S. (2013, August). Therapy with immigrant
Asian American families across the lifespan.
Paper presented at the American Psychological
Association Annual Convention, Honolulu,
HI.
Falicov, C. (2011). Migration and the life cycle. In M.
McGoldrick, B. Carter, & N. Garcia-Preto
(eds.), The expanded family life cycle: Individual, 42
 family, and social perspectives (4th ed., pp. 336-347).
Needham Heights, MA: Allyn & Bacon.
Falicov, C. (2014). Latino families in therapy (2nd ed.).
New York: The Guilford Press.
Hong, G., & Ham, M. (2001). Psychotherapy and
counseling with Asian American clients. Thousand
Oaks, CA: Sage Publications, Inc.
McGoldrick, M., Carter, B., & Garcia-Preto, N.
(Eds.). (2011). The expanded family life cycle:
Individual, family, and social perspectives (4th ed.).
Needham Heights, MA: Allyn & Bacon.
Sluzki, C. (1979). Migration and family conflict.
Family Process, 18(1), 379-392. 43
 Sluzki, C. (2008). Migration and the disruption of the
social network. In M. McGoldrick & K. V.
Hardy (Eds.). Re-visioning family therapy: Race,
culture and gender in clinical practice (2nd ed., pp.
39-47). New York: Guilford.
Zagelbaum, A., & Carlson, J. (Eds.). (2011). Working
with immigrant families: A practical guide for
counselors. New York: Taylor and Francis
Group, LLC.

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