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Cultural influences on the formation of the therapeutic alliance : a case study with western-trained… Arrand, Penny Coral 1995

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C U L T U R A L INFLUENCES O N T H E FORMATION O F T H E THERAPEUTIC A L L I A N C E : A C A S E STUDY WITH WESTERN-TRAINED CHINESE C O U N S E L L O R S by PENNY (CORAL) ARRAND B.A., University of Victoria, 1974 Dip. Ed., University of British Columbia, 1992 A THESIS SUBMITTED IN PARTIAL F U L F I L L M E N T O F T H E REQUIREMENTS F O R T H E D E G R E E O F M A S T E R O F ARTS in T H E F A C U L T Y O F G R A D U A T E STUDIES (Department of Counselling Psychology) We accept this thesis as conforming to the required standard T H E UNIVERSITY O F BRITISlJ C O L U M B I A December, 1995 © P e n n y (Coral) Arrand, 1995 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. The University of British Columbia Vancouver, Canada Department DE-6 (2/88) ABSTRACT i i The underlying assumptions of Western counselling and psychotherapy are based on Western European values such as individualism and autonomy. How applicable then are the goals and practices of Western counselling and psychotherapy when applied to non-Western cultures? This research study interviews eight Western-trained Chinese counsellors/psychotherapists who have experience with counselling both Western European c l i e n t s and Chinese c l i e n t s . I t was found that the establishment of rapport using t r a d i t i o n a l Western counselling theories has varying amounts of success depending on a. the f a m i l i a r i t y of the c l i e n t to Western values, b. the f a m i l i a r i t y of the counsellor/psychotherapist with Chinese values, c. the awareness to not apply knowledge of a c l i e n t ' s culture i n a stereotypical way, and d. the willingness of the counsellor/psychotherapist to be open, f l e x i b l e , and patient i n negotiating a process that f i t s comfortably with BOTH the p a r t i c u l a r counsellor/psychotherapist's c u l t u r a l bias and the pa r t i c u l a r c l i e n t ' s c u l t u r a l b i a s . n i ACKNOWLEDGMENTS I would l i k e to thank my thesis supervisors (Dr. Marv Westwood, Dr. Jean Barman, and Dr. Ishu Ishiyama) fo r t h e i r on-going guidance and invaluable input into the planning, writing and e d i t i n g of my t h e s i s . I would also l i k e to express my appreciation and respect f o r the men and women who agreed to be interviewed f o r t h i s study, and who shared so generously with me t h e i r c u l t u r a l knowledge and t h e i r counselling experiences. TABLE OF CONTENTS Chapter 1: Introduction Description of Problem • Assumptions of Western European Counselling . Purpose of the Study Chapter 2: L i t e r a t u r e Review History of M u l t i c u l t u r a l Counselling and Therapy Current Theory and Research i n M u l t i c u l t u r a l Counselling The Therapeutic A l l i a n c e Chapter 3: Research Design Theoretical and Methodological Perspectives Research Instrument P i l o t Interview • Selection of Participants Interview Procedure Data C o l l e c t i o n Data Analysis Chapter 4: Chinese C u l t u r a l Context History of Chinese Immigrants i n Canada .•. T r a d i t i o n a l Chinese Values and B e l i e f s .... Chapter 5: Results » Chapter 6: Discussion P r a c t i c a l Implications 161 Theoretical Implications 162 Research Implications 176 Limitations of Study 180 Conclusions 181 R e f e r e n c e L i s t 1 8 2 A p p e n d i c e s : A Interview Schedule 194 B Consent Forms 196 C Data Analysis: Topics, Categories, and Themes 198 D Correspondence with Interviewees 212 E Canadian Po l i c y of Multiculturalism 217 F Background information of Interviewees 223 I CHAPTER ONE The f i r s t act of a teacher i s to introduce the idea that the world we think we see i s only a view, a description of the world...But accepting it seems to be one of the hardest things we can do; we are complacently caught in our particular view of the world...(C. Castaneda, 1974, p . 230) R i g i d l y adhering to the c u l t u r a l l y - s p e c i f i c diagnostic practices and intervention strategies of Western-European models of counselling i n the face of increasing c u l t u r a l d i v e r s i t y w i l l i n e v i t a b l y lead to feelings of d i s s a t i s f a c t i o n with, and alie n a t i o n of, c l i e n t s who are of a non-Western European background. I t i s i n c u l t u r a l l y ethnocentric to assume Western-European models of counselling/therapy are " r e a l " counselling/therapy and other, perhaps more h i s t o r i c a l and c u l t u r a l l y - s p e c i f i c forms of healing, are "fo l k therapies." As counsellors, understanding our own c u l t u r a l biases and respecting ways of thinking and behaving that may d i f f e r from our own view are the esse n t i a l f i r s t steps i n meeting the expectations and needs of a c u l t u r a l l y diverse population. Only when we come to r e a l i z e the context-determined roots of our values can we s h i f t to a systemic view of ourselves as part of a helping context (McGoldrick, Pearce & Giordano, 1982, p. 25). 2 The c u l t u r a l development of a worldview i s inseparable from our personal development. From the moment of b i r t h we i n t e r a c t with our environment i n relationships of mutual influence. Chess, Thomas and Birch's studies of personality p r o f i l e s i n babies ( i n D i l l e r , 1991) concluded that the average baby i s born with a set of temperamental c h a r a c t e r i s t i c s which make him or her an active participant i n the family dynamics from the very beginning. "Goodness F i t " was the term they used to describe the p o s i t i v e l y matched c h a r a c t e r i s t i c s of the baby with the temperament, energy, and c a p a b i l i t i e s of the parents. From infancy onward, ind i v i d u a l s revise t h e i r i d e n t i t y based on t h e i r recurrent relationships with others, including the s o c i a l and c u l t u r a l forces that d i c t a t e much of t h e i r contextual understanding of themselves, t h e i r r elationships and t h e i r view of the world. A l l e n Ivey ( i n Marsella & Pedersen, 1981), i n a s i m i l a r vein, places the therapeutic encounter i n counselling and therapy into the c l a s s i c interpersonal model (Lewin, 1935) i n which behavior i s expressed as the function of both the person influencing the environment and the environment influencing the person: B=f(P,E). Such a "person-environment i n t e r a c t i o n " i s extremely complex and becomes even more so when the therapist i s of a culture d i f f e r e n t from that of the c l i e n t . Many writers on m u l t i c u l t u r a l counselling emphasize the importance of being aware of the biases and assumptions of one's 3 own culture. This i s , however, not an easy process as many of these ingrained c u l t u r a l values are unknown consciously to ourselves. Luft and Ingham (Luft, 1984, p. 2) designed a model c a l l e d the Johari Window (see Figure 1) which describes the process of r e l a t i o n s h i p i n t e r a c t i o n as one i n which each person, the s e l f and the other, have parts of themselves which are "known" and parts which are "unknown." Through the process of s e l f - d i s c l o s u r e (sharing what we know) and feed-back ( l i s t e n i n g to the other's response to our s e l f - d i s c l o s u r e ) a t r u s t i n g r e l a t i o n s h i p , as well as self-awareness, develops and grows. Information i s exchanged through s e l f - d i s c l o s u r e and subsequent feedback which leads to the creation of a new, expanded s e l f -awareness. A four-quadrant g r i d i l l u s t r a t e s the exchange and flow of information i n any interpersonal contact. Given t h i s t h e o r e t i c a l conceptualization, the r e l a t i o n s h i p between c l i e n t and counsellor i n a therapeutic s e t t i n g follows the same patterns as other interpersonal r e l a t i o n s h i p s : information from the c l i e n t to the counsellor and feed-back from the counsellor to the c l i e n t create a t r u s t i n g environment i n which the r e l a t i o n s h i p can grow and develop. 4 Known Unknown to Self l'> Soil' Known to Others Unknown to Others 4 I Open A % III Blind (Feedback) Risk " 1 II Hidden 1 (Self-Disclosure) IV Unknown (Potential) Figure i s The Johari Window In order to give accurate, empathetic feed-back, however, counsellors need to understand how t h e i r own c u l t u r a l biases a f f e c t both the information that they share with the c l i e n t and the interpretation of the information that the c l i e n t shares with them. Awareness of the "hidden" aspects of our c u l t u r a l biases and a willingness to discover and share "hidden" aspects of our c u l t u r a l i d e n t i t y can create a pos i t i v e and collaborative environment i n which counselling and therapy can take place: Counselling and psychotherapy must be recognized as c u l t u r a l phenomena. Methods of helping another person vary from culture to culture and se t t i n g to setting. An increasing awareness that culture i n i t s broadest d e f i n i t i o n pervades and undergirds the helping process i s imperative (Ivey, Ivey & Simek-Morgan, 1993, p. 303), 5 Furthermore, i t i s often only i n r e l a t i o n s h i p to others who hold a d i f f e r e n t perspective that we become c l e a r about our own assumptions and biases. Many c u l t u r a l values are so ingrained that they come into focus only i n contrast to another value system. Quadrant IV of the Johari Window g r i d i l l u s t r a t e s t h i s "unknown" area, and represents the potential f o r growth that i s inherent i n i t . Edward H a l l (1976) eloquently expresses the dynamic of the fourth quadrant: ...the great g i f t that the members of the human race have for each other i s not exotic experiences but an opportunity to achieve awareness of the structure of t h e i r OWN system, which can be accomplished only by int e r a c t i n g with others who do not share that system (p. 44). There are aspects to any culture which are known to an i n d i v i d u a l from that culture, and aspects which are as yet undiscovered or "hidden" from our self-awareness. Assumptions and Bias i n Western European Counselling Theory and Practice, We have no ins i g h t into our own c u l t u r a l l y learned ideas and values. They s i t within us qu i e t l y , unconsciously, providing the baseline against which we make value judgments but never themselves coming into judgement...What needs to be stressed i s how 6 important our c u l t u r a l l y learned ideas and values are in forming an unconscious mold, shaping l a t e r ideas and values. When we f u l l y r e a l i z e t h i s as therapists, then we w i l l r e a l i z e that we are indeed culture-bound (Torrey, 1972, p. 20). Many writers on m u l t i c u l t u r a l counselling (Ivey,Ivey & Simek-Morgan, 1993? Pedersen, 1988; Sue, 1977; Sue & Morishima, 1982; Sue & Sue, 1990) have attempted to expose some of the "known" Western European c u l t u r a l values and b e l i e f s . One of the strongest and most pervasive of these values i s the emphasis on individualism. Most Western European theories of human development eguate maturity with autonomy, individuation and rather than with interdependence. Erickson's eight stages of development, f o r example, describe progressive steps which move the i n d i v i d u a l towards the desired goal of independence and autonomy. S e l f - i d e n t i t y i s achieved APART from one's family (Ivey, Ivey, & Simek-Morgan, 1993, p. 148-150). Erickson's emphasis on autonomy as c h a r a c t e r i s t i c of a healthy adult has been extensively c r i t i c i z e d by feminist t h e o r i s t s (McGoldrick, Anderson, & Walsh, 1989; Greenspan, 1993) f o r i t s lack of recognition of the value of more "female" q u a l i t i e s such as emotional/intuitive reasoning and interdependence with others. Erickson could also be c r i t i c i z e d f o r being ethnocentric i n omitting other c u l t u r a l l y - d i f f e r e n t models of human development, as the po s i t i v e a t t r i b u t e s given to i n d i v i d u a l i t y are c e r t a i n l y 7 not universal (Sue & Sue, 1990): ...not a l l cultures view individualism as a p o s i t i v e orientation; rather, i t may be perceived i n some cultures as a handicap to att a i n i n g enlightenment, one that may d i v e r t us from important s p i r i t u a l goals. In many non-Western cultures, i d e n t i t y i s not seen apart from the group orientation (p. 35) Of course there are many other "culture-bound" values, and Sue and Sue (1990) have derived a comprehensive l i s t of prevalent Western European values to be considered by Western-trained counsellors and therapis t s : - use of Standard English - individual-centered - verbal/emotional/behavioral expressiveness - insight (introspection),leading to behaviour change - s e l f - d i s c l o s u r e , leading to openness and intimacy - ambiguity and abstraction across contextual s i t u a t i o n s - cause-and-effeet, l i n e a r orientation - c l e a r d i s t i n c t i o n between mental and physical functioning Western European culture's focus on the i n d i v i d u a l - either on the intrapsychic emotional and cognitive experiences, or on the interpersonal interactions with the environment or with others -as well as the other culture-bound values l i s t e d above, have been r e f l e c t e d i n the developmental h i s t o r y of Western counselling/psychotherapeutic theories and are r e f l e c t e d , 8 often i m p l i c i t l y , through the process of counselling. Sigmund Freud (1856-1939) created a psychotherapeutic model i n which he emphasized intrapsychic motivations behind each in d i v i d u a l ' s behaviour and emotions (Cormier & Cormier, 1991; Cor s i n i & Wedding, 1989). According to psychoanalysis, i t i s not others who influence us but our own ideas about those others, our own projections (Zohar, 1990). Self-awareness of underlying intrapsychic dynamics and innate human drives would, Freud believed, enable an in d i v i d u a l to begin making " r a t i o n a l " responses to objective r e a l i t y rather than responding "automatically." The therapist was the impassive "expert" who decided on what r a t i o n a l , normal behaviour was, and who interpreted the c l i e n t ' s experience i n r e l a t i o n to t h i s norm. Adler (1870-1937) took a s l i g h t l y d i f f e r e n t turn i n h i s psychoanalytic theory by deemphasizing the importance of unconscious influences and stress i n g that "people cannot be studied i n i s o l a t i o n , but only i n t h e i r s o c i a l context" ( C o r s i n i , 1989, p. 73). "Social Interest" was the expression Adler gave to the concept that "happiness and success are large l y related t o . . . s o c i a l connectedness" (Corey, 1991, p. 140). Successful in t e r a c t i o n with family and society was considered e s s e n t i a l to mental health. However, Adlerian Psychotherapy was s t i l l b a s i c a l l y an i n d i v i d u a l l y focused approach to understanding human behaviour, and i n f a c t has been also c a l l e d Individual Psychology (Corey, 1991), which stresses the in d i v i d u a l taking 9 r e s p o n s i b i l i t y f o r t h e i r own f e e l i n g s , thoughts and actions. Humanistic psychology, as defined by C a r l Rogers (1902-1987), introduced somewhat of a change i n the therapeutic re l a t i o n s h i p . I t took away the idea of the therapist as the "expert," with the intent of allowing c l i e n t s to access t h e i r own capacities to heal themselves given a supportive and nurturing climate. The only necessary and e s s e n t i a l ingredient was the therapist's a b i l i t y to provide empathy, unconditional p o s i t i v e regard, and congruence ( C o r s i n i , 1989; Corey, 1991). Roger's psychotherapeutic model, sometimes c a l l e d "person-centered", obviously also r e f l e c t s the Western European values of individualism, autonomy and s e l f - a c t u a l i z a t i o n and adds that of e g a l i t a r i a n democracy. According to F r i t z Perls (1893-1970), the i n i t i a t o r of the Gestalt therapy movement, the goal of therapy was "to make you understand how much you gain by taking r e s p o n s i b i l i t y f o r every emotion, every movement you make, every thought you have - and shed r e s p o n s i b i l i t y f o r anybody els e " (Perls, 1969, p. 65). Gestalt therapy focused not on unconscious intrapsychic c o n f l i c t s but on here-and-now feelings and behaviour. Responsibility was now delegated s o l e l y to the i n d i v i d u a l , and any attempt to look at wider influences was seen as avoidance, or resistance ( C o r s i n i , 1989; Perls, 1969). Such an approach again r e f l e c t s Western European culture's reverence for autonomy and s e l f -a c t u a l i z a t i o n ; as well, the intense release of emotions 10 (catharsis) encouraged i n Gestalt therapy r e f l e c t s the Western European value of emotional, behavioral expressiveness. The premise of Cognitive-Behavioral therapies, such as Rational-Emotive therapy developed by Albert E l l i s (1973), i s that "our emotions mainly stem from our b e l i e f s , evaluations, interpretations and reactions to l i f e s i t u a t i o n s . " An i n d i v i d u a l i s "taught" by the counsellor how to change i n t e r n a l i z e d b e l i e f s which lead to emotional upset or depression by using l o g i c and s e l f - t a l k and/or Behavioral s t r a t e g i e s . Cognitive therapies discourage dependency and urge c l i e n t s to become s e l f - r e l i a n t and to use s e l f - d i s c i p l i n e (Corey, 1991, p. 362). However, not a l l cultures respect i n d i v i d u a l decision-making as does Western European culture. In some cultures the group (family or community) i s the unit of i d e n t i t y and i s , therefore, inextricabley involved i n any i n d i v i d u a l decision. Therapists who are unaware of or who do not respect a l t e r n a t i v e c u l t u r a l d e f i n i t i o n s of i d e n t i t y may create extreme c o n f l i c t f o r a c l i e n t by placing deeply-held c u l t u r a l values into question. Furthermore, a counselling emphasis on i n d i v i d u a l r e s p o n s i b i l i t y can disregard wider s o c i e t a l pressures, such as economic hardship and discrimination, which may face an i n d i v i d u a l from a p a r t i c u l a r c u l t u r a l group (Sue & Sue, 1990). Even family therapies, although taking a more systemic view of the i n d i v i d u a l by placing them within the family context, have generally tended to ignore the larger c u l t u r a l system i n which IX family systems are embedded. Emphasis i s s t i l l on the i n d i v i d u a l obtaining a " d i f f e r e n t i a t e d " i d e n t i t y , which i s defined as having a sense of s e l f apart from one's family and being able to "transcend" not only one's own emotions but also those of the family system. O v e r i d e n t i f i c a t i o n with the family, on the other hand, i s defined as "undifferentiated family ego mass" or "fusion" (Becvar & Becvar, 1993, p. 148). Family therapy also focuses on the t r a d i t i o n a l family l i f e - c y c l e of Western European culture i n which adults separate from t h e i r family of o r i g i n , choose to marry and s t a r t a new nuclear family (usually within the same Western-European c u l t u r e ) . Children from t h i s marriage then grow up and "launch" t h e i r own new, separate family leaving the e l d e r l y parents alone at home. As Ivey, Ivey, and Simek-Morgan (1993) point out: I t i s p a r t i c u l a r l y important that you be aware of your own c u l t u r a l expectations regarding these developmental stages. For example, imagine the issues of a counsellor of Swedish background imposing h i s or her values on the I t a l i a n or Chinese, or v i c e versa. Healthy family functioning i n one culture may be viewed as p o t e n t i a l l y pathological by another (p. 336). The Western European counselling model which focuses most predominantly on the c o u n s e l l o r - c l i e n t r e l a t i o n s h i p , or the therapeutic a l l i a n c e , i s Rogers' non-directive, or person-centered, theory. As Rogers approach i s currently embedded i n 12 roost Western European models of counselling, i t i s useful to look s p e c i f i c a l l y at how Rogers p o t e n t i a l l y incorporates a c u l t u r a l l y biased perspective, Rogers i s discussed i n an a r t i c l e by C l a i r e Usher (1989) as an example of "potential p i t f a l l s when embracing any t h e o r e t i c a l perspective used i n c r o s s - c u l t u r a l counselling s i t u a t i o n s " (p. 62). Usher's analysis places Rogers' t h e o r e t i c a l orie n t a t i o n within the framework of Paul Pedersen's well-known a r t i c l e Ten frequent assumptions of c u l t u r a l bias i n counselling (1987). 1. Assumptions regarding normal behaviour: A common measure of "normal" behaviour, t y p i c a l of Western European counselling theories, assumes that "normal" means the same thing regardless of s o c i a l , economic, or p o l i t i c a l backgrounds. Rogers, by eliminating the "expert" r o l e of the therapist, places the locus of evaluation within the c l i e n t to make t h e i r own diagnosis and decisions around counselling d i r e c t i o n , thus allowing "normal" to be defined by the c l i e n t ' s own c u l t u r a l context. 2. Emphasis on Individualism: As previously discussed, Western-trained counsellors most often place the focus of counselling on the i n d i v i d u a l rather than on family, community or society. This focus can go so f a r as ignoring the p o l i t i c a l , h i s t o r i c a l , or c u l t u r a l factors that may impact on an in d i v i d u a l and devaluing possible strong interdependent t i e s with family and community i n favour of autonomy and in d i v i d u a l i n t e r e s t s . Rogers' person-centered approach to counselling strongly r e f l e c t s t h i s Western 13 c u l t u r a l bias. An e f f e c t i v e therapeutic r e l a t i o n s h i p i s described as one i n which the development of the person i s paramount (Rogers, 1980, p. 115). Rogers not only devalued a c l i e n t ' s potential sense of obligation to family and community, but believed that dependency on the family was a p o t e n t i a l b a r r i e r to i n d i v i d u a l growth (Rogers, 1980). 3. Fragmentation by academic d i s c i p l i n e s : Although Rogers was trained as a Minister and a Social Worker, perhaps g i v i n g him a somewhat broader perspective on human psychology, h i s main influences as a counsellor were nevertheless drawn from WesternEuropean psychology (for example, Freud and Adler). Pedersen recommended that counsellors attempt to go beyond t h e i r l i m i t e d perspective of counselling or psychology and "examine the problem or issue from the c l i e n t ' s c u l t u r a l perspective" (p. 18). By t h i s he i s r e f e r r i n g again to the counsellor gaining enough knowledge to be able to place the i n d i v i d u a l and the i n d i v i d u a l ' s psychological/emotional state within the context of that i n d i v i d u a l ' s culture (including s o c i a l , economic, s p i r i t u a l and p o l i t i c a l f a c t o r s ) . Knowledge from a s o c i o l o g i c a l , p o l i t i c a l or economic perspective could help to broaden the counsellor's understanding of the impact of an i n d i v i d u a l ' s c u l t u r a l association. 4. Dependence on abstract words: Pedersen expressed the b e l i e f that Western-trained counsellors are dependent on abstract words which r e f l e c t the "low-context" culture i n which they l i v e . A 14 low-context culture, described by H a l l (1976), i s one i n which abstract concepts carry t h e i r own meaning with them from one context to another, whereas i n a high-context culture abstract words and concepts depend f o r t h e i r meaning on reference to a s p e c i f i c context. Rogers' counselling theory incorporates many abstract words and concepts that could be e a s i l y misunderstood, or even considered offensive, from another c u l t u r a l perspective: f o r example, " s e l f , " " s e l f - a c t u a l i z a t i o n , " "self-awareness," and " s e l f - d i r e c t i o n . " Many of these words r e f l e c t not only the previously-mentioned Western emphasis on the i n d i v i d u a l , but a d e f i n i t i o n of Self which i s not present i n a l l cultures. For example, the personal pronoun " I " i n the Japanese language does not seem to e x i s t ; the notion of "altman" i n India defines i t s e l f as p a r t i c i p a t i n g i n unity with a l l things (Sue & Sue, 1990, p. 35). 5. Over-emphasis on independence: An extension of Western European emphasis on the in d i v i d u a l i s the b e l i e f that the ind i v i d u a l should be autonomous, that i s " d i f f e r e n t i a t e d " (not dependent on others) as opposed to "enmeshed" (intertwined emotionally with others). Rogers' counselling theory does not provide an exception to t h i s Western European c u l t u r a l bias, and i t s premise i s to encourage the c l i e n t to move towards autonomy and s e l f - d i r e c t i o n (Rogers, 1961, p. 170). Furthermore, according to Rogers, family and community t i e s could prevent the i n d i v i d u a l from moving i n t h i s d i r e c t i o n and thereby achieving insight 15 ("self-awareness"). The goal of insight i s i n d i r e c t opposition to many cultures' values i n which the strength of the family and community i s promoted above the s e l f , and attachment to the family and community i s maintained at an intimate and involved l e v e l throughout an indiv i d u a l ' s l i f e - t i m e . 6. Neglect of c l i e n t ' s support systems: Pedersen points out that Western European culture compartmentalizes the counselling re l a t i o n s h i p , and seldom works i n collaboration with the natural support systems such as family and community which may surround the c l i e n t . Not only does t h i s , once again, ignore the contextual influences on the c l i e n t , but i t devalues and does not take advantage of the natural support systems r e a d i l y available to the c l i e n t . Rogers tended, as d i d other Western-trained counsellors, to avoid focusing on outside influences except as they may a f f e c t the c l i e n t ' s move towards separation and adjustment. According to Usher, however, Rogers i n hi s l a t e r years began to encourage community support groups as a way of leading to "a greater sense of cooperation, of community, of a b i l i t y to work together f o r the common good, not simply f o r personal aggrandizement" (Rogers, 1980, p. 332). 7. Dependence on l i n e a r thinking: The l i n e a r , cause-and-effeet, thinking of Western European culture stems from Western h i s t o r i c a l development i n which l o g i c and reasoning were placed on a pedestal of wisdom (Socrates and Descartes, f o r example epitomized the search f o r "truth" through l o g i c a l reasoning). As 16 Pedersen (1987) points out, the s c i e n t i f i c method f o r measuring and evaluating things stems from Western European c u l t u r a l h i s t o r y , and became embedded i n the counselling process through the t e s t i n g and measurement of constructs such as "depression" or "adjustment." Rogers held a high regard f o r research and s c i e n t i f i c methods as applied to human development and behaviour. However, i n practice, according to Usher, Rogers demonstrated an openness to non-linear (or what she c a l l s " c i r c u l a r " ) thinking. He chose to follow the c l i e n t ' s lead i n terms of f e e l i n g s and reasoning, f o r example, v i a paraphrasing and r e f l e c t i o n , rather than d i r e c t i n g the c l i e n t ' s process, and he allowed f o r free association and i n t u i t i v e i n s i ght during the counselling process. 8. Focus on changing the i n d i v i d u a l , not the system: By focusing on the i n d i v i d u a l and neglecting the c l i e n t ' s surrounding p o l i t i c a l and c u l t u r a l systems, Pedersen (1987) asserts, Western-trained counsellors can be accused of "taking the side of the status quo i n f o r c i n g i n d i v i d u a l s to adjust or adapt to the i n s t i t u t i o n s of society" (p. 68). If the i n s t i t u t i o n or society i s oppressive to the c l i e n t and the counsellor ignores the impact of t h i s and continues to focus on the c l i e n t ' s adjustment, the counselling process could i n f a c t be acting against the c l i e n t ' s best i n t e r e s t . Rogers perpetuated the b e l i e f that i t was the i n d i v i d u a l , not the system, that needed to change i f there was a c o n f l i c t . By doing so Rogers, a l b e i t unintentionally, perpetuated attitudes that allowed the continuation of r a c i a l and 17 s o c i e t a l constraints against p a r t i c u l a r groups within our society. 9. Neglect of h i s t o r y : An h i s t o r i c a l context of an i n d i v i d u a l i s often necessary to c o r r e c t l y determine motivation and expectations underlying the i n d i v i d u a l ' s behaviours and f e e l i n g s . For example, as Usher points out, cultures such as the American Indians may "perceive themselves to be intimately connected to t h e i r ancestors, and thus t h e i r current problems cannot be f u l l y understood without consideration of t h e i r h i s t o r i e s " (p.69). Counsellors who focus only on the "here-and-now" may furthermore be seen to lack respect f o r t r a d i t i o n a l , time-tested ways i n which a p a r t i c u l a r culture has dealt with personal problems and to see Western counselling as the "only" way to provide help f o r the c l i e n t (Pedersen, 1987, p. 23). Rogers was t y p i c a l of Western-trained counsellors i n t h i s regard. He focused on the immediate s i t u a t i o n , and not the i n d i v i d u a l ' s personal or c u l t u r a l h i s t o r y (Rogers, 1942, p. 29). 10. Dangers of c u l t u r a l encapsulation: Pedersen's f i n a l example of Western-European bias i s a plea for counsellors to not assume that they are aware of a l l t h e i r c u l t u r a l values and biases, but to remain open to challenges to t h e i r own assumptions. Rogers (1951) believed that h i s person-centered approach could be used with i n d i v i d u a l s regardless of culture because i t s focus on the i n d i v i d u a l could "transcend to some degree the l i m i t a t i o n s or 18 influences of a given cu l t u r e " (p. 5). Perhaps the challenge and l i m i t a t i o n s of a desire to "transcend" culture by ignoring i t altogether are best expressed by Edward H a l l (1976): ...the future depends on man's being able to transcend the l i m i t s of i n d i v i d u a l cultures. To do so, however, he must f i r s t recognize and accept the multiple hidden dimensions of unconscious culture, because every culture has i t s own hidden, unique form of unconscious culture (p. 2). In conclusion, a major premise of Rogers' person-centered counselling i s the b e l i e f i n i n d i v i d u a l s e l f - a c t u a l i z a t i o n and r e s p o n s i b i l i t y for self-growth. The counsellor r o l e i s to focus on the c l i e n t ' s perspective with "unconditional acceptance" so as to be able to understand and r e f l e c t the c l i e n t ' s experience and feelings accurately (Corey, 1991; C o r s i n i & Wedding, 1989; Egan, 1986). However, i t i s not possible to understand the i n d i v i d u a l c l i e n t ' s perspective without f i r s t understanding the culture which surrounds and permeates the c l i e n t ' s i n t e r p r e t a t i o n of themselves and others. An understanding of how c u l t u r a l bias permeates a l l counselling theories i s necessary i n order to be able to begin to challenge the u n i v e r s a l i t y of the basic assumptions underlying Western European counselling. A l l counselling i s , to a greater or lesser extent, c r o s s - c u l t u r a l . As counsellors increase t h e i r contact with other countries and other cultures they can expect 19 to learn a great deal about themselves. They can expect to challenge more of t h e i r unexamined assumptions about themselves and the world around them. They can expect to move beyond the parochial concerns and perspectives of a c u l t u r a l l y l i m i t e d perspective to look at the world i n a new, more comprehensive perspective (Pedersen, 1987, p. 23). Purpose of the Study The objective of t h i s research study i s to look at the r e l a t i v i t y of Western European values and assumptions i n counselling, as expressed through the i n i t i a l therapeutic a l l i a n c e formation, when contrasted with a non-Western European c u l t u r a l perspective. I have attempted to do t h i s by t a l k i n g to counsellors who are themselves attempting to bridge the gap between a non-Western European c u l t u r a l background (and accompanying world-view) and a Western European t r a i n i n g i n counselling, who are experienced and f a m i l i a r with working with c l i e n t s of a non-Western European c u l t u r a l background, and, more s p e c i f i c a l l y , who are of the same c u l t u r a l background as the counsellor. The reason f o r "matching" c u l t u r a l backgrounds i s to concentrate the stra t e g i e s , c o n f l i c t s , and approaches on the gap between t r a d i t i o n a l Western European approaches and a s p e c i f i c non-Western-European culture - i n t h i s case, Chinese cult u r e . I have chosen to focus on one p a r t i c u l a r culture p a r t l y due to time considerations and also to reduce the complications of 20 data analysis and r e l i a b i l i t y / v a l i d i t y concerns created by too many in t e r a c t i n g f a c t o r s . However, the intent i s not to describe an approach to working with a s p e c i f i c c u l t u r a l group, but to open up c u r i o s i t y and enthusiasm f o r the discovery of c u l t u r a l v a r i a b i l i t y inherent i n the counselling process. I have chosen the Chinese culture for my research study because i t i s one of the largest and most ra p i d l y growing immigrant groups i n Western Canada. According to research on immigration trends by S t a t i s t i c s Canada, the Chinese since the 1960's have been one of the largest streams of immigrants in t o Canada. Over the past two decades, the country of o r i g i n of immigrants to Canada has s h i f t e d from mainly European countries to Asian countries: "Hong Kong was the major country of b i r t h of landed immigrants who came to Canada between 1981 and 1991, followed by Poland and the People's Democratic Republic of China." The most recent s t a t i s t i c s ( F i r s t Quarter, 1995) show the same trend: "The majority (76.5 per cent) of immigrants came from Asia" and "Hong Kong is . . . t h e leading source of immigrants to B r i t i s h Columbia." Even more s p e c i f i c a l l y , the Vancouver area has been the focus for the migration to Canada from Asia. In 1994, 33,609 immigrants landed i n the Vancouver area as opposed to 3,807 i n the r e s t of B r i t i s h Columbia; and i n the f i r s t quarter of 1995 (January-March) 6,426 immigrants landed i n the Vancouver r e l a t i v e to 857 immigrants i n the re s t of B r i t i s h Columbia. Such a large increase r e f l e c t s , according to Chiu (1994) 21 both the changing of Canada's immigration regulations and the p o l i t i c a l and economic s i t u a t i o n s i n Asia (p.24). The coming take-over of Hong Kong, currently a B r i t i s h colony, by China i n 1997 has created uncertainty and a strong incentive f o r many Hong Kong Chinese to immigrate. Canada's new five-year Immigration Poli c y was released on November 1, 1990, with the intent that from 1991 to 1995 the intake of immigrants would be increased to a t o t a l number of 250,000, and i n the expectation that many of these immigrants would a r r i v e i n Vancouver and many would be from Hong Kong (Chui, 1994, p. 10). The new Immigration P o l i c y eliminated the previous "point" system f o r q u a l i f i c a t i o n to immigrate, and instead allows immigrants to enter under the class of "family," "refugee," or "independent." This, i n e f f e c t , eliminates r a c i a l c r i t e r i a as immigrants are instead selected on the basis of q u a l i f i c a t i o n s such as education, work experience, and family connections. Canada has also encouraged the immigration of professional entrepeneurs or business people from Hong Kong who, through t h e i r investments, can stimulate the Canadian economy. In the l i g h t of increasing immigration from Asian countries, i n p a r t i c u l a r Hong Kong and the People's Democratic Republic of China, i t makes sense to look at possible impacts on the i n t e r a c t i o n between a Western European (as r e f l e c t e d i n t r a d i t i o n a l psychotherapy) and a Chinese worldview. Previous research has shown the therapeutic a l l i a n c e to be an e s s e n t i a l feature of Western counselling/psychotherapy (Truax 22 & Carkhuff, 1967; Horvath & Greenberg, 1994) without which e f f e c t i v e counselling/psychotherapy cannot proceed. I have, therefore, narrowed the focus of t h i s research study further by concentrating on the i n i t i a l formation of the therapeutic a l l i a n c e . My research study examines Western counselling assumptions regarding the formation of the therapeutic a l l i a n c e i n r e l a t i o n to t r a d i t i o n a l Chinese culture. The value of looking at Western counselling assumptions i n r e l a t i o n to another c u l t u r a l set of b e l i e f s and assumptions i s that i t i s often only through c u l t u r a l i n t e r a c t i o n and comparison that the r e l a t i v e l y of c u l t u r a l values and assumptions become c l e a r . As Edward H a l l (1976) explains: ...the great g i f t that the members of the human race have f o r each other i s not exotic experiences but an opportunity to achieve awareness of the structure of t h e i r own system, which can be accomplished only by i n t e r a c t i n g with others who do not share that system (p. 44). I have, therefore, chosen to interview Western-trained Chinese counsellors/psychotherapists who are themselves, both personally and professionally, attempting to bridge the gap between two cultures. 23 CHAPTER TWO REVIEW OF LITERATURE History of M u l t i c u l t u r a l Counselling and Psychotherapy Any counselling/psychotherapeutic model in e v i t a b l y incorporates the values and assumptions of the culture from which i t stems. However, Western European counsellors often appear to assume that there was never such a thing as "counselling and psychotherapy" u n t i l i t was "invented" by Western European culture, and do not recognize the a b i l i t y of therapeutic helping to take many forms which, although they may appear quite d i f f e r e n t , are no less e f f e c t i v e ^ o r legitimate (Sue & Sue, 1990, p. 8). This c u l t u r a l bias i s ^ eloquently described by Torrey (1972), i n his comprehensive analysis of c u l t u r a l healing and therapeutic approaches: A p s y c h i a t r i s t who t e l l s an i l l i t e r a t e A f r ican that his phobia i s related to a fear of f a i l u r e or a witchdoctor who t e l l s an American t o u r i s t that his phobia i s related to possession by an ancestral s p i r i t w i l l be met by equally blank stares. And as therapists they w i l l be equally i r r e l e v a n t and i n e f f e c t i v e , (p. 16). Mu l t i c u l t u r a l counselling does not have a long h i s t o r y . Karen Horney was one of the f i r s t Western European psychoanalysts, as early as 1937, to recognize that the indi v i d u a l and the ind i v i d u a l ' s problems were "incomprehensible 24 apart from t h e i r c u l t u r a l context" (McGoldrick, Pearce, and Giordano, 1982): Thus the term neurotic...cannot be used now without i t s c u l t u r a l implications...One would run great r i s k i n c a l l i n g an Indian boy psychotic because he t o l d us that he has visi o n s i n which he believed...The conception of what i s normal varies not only with the culture, but also within same culture i n the course of time." (Horney, K., 1937, p. 14). Early nineteenth century anthropologically-oriented accounts of "native healing," such as Devereux's (1951) account of h i s attempt to do psychoanalysis with American Plains Indians, tended to view healing processes i n other cultures as " c u r i o s i t i e s " (Marsella & Pedersen, p. 14) and to compare diagnosis of mental i l l n e s s e s and treatment processes to Western European practices. C u l t u r a l l y - o r i e n t e d p s y c h i a t r i s t s (Kiev 1964/66? Prince 1976/80) also began documenting c u l t u r a l healers as "instances of e f f e c t i v e psychotherapy i n d i f f e r e n t c u l t u r a l milieus" (Marsella & Pedersen, 1981, p. 14) and demonstrated a willingness to go beyond c u r i o s i t y with indigenous healing methods and consider integrating some of these c u l t u r a l l y - d i v e r s e practices and s k i l l s into Western European counselling and psychotherapeutic p r a c t i s e . In 1972 E. F. Torrey, i n what has been described as a "whimsical and engaging formulation of therapeutic universals" 25 (Draguns, 1981, p. 14), described and compared concepts of mental health and healing of various cultures around the world. Torrey suggested that Western psychotherapy may have something to learn from the healing methods of "witchdoctors" (native healers), and further pointed out that cultures themselves frequently change across time. ("It was only a few years ago i n Western cultures that mental i l l n e s s was thought to be caused primarily by witches." Torrey, 1972, p. 23). However, i n general, research on psychotherapeutic healing i n cultures other than Western European culture has proceeded from the generic framework which assumed that a l l counselling theories could be e f f e c t i v e l y used with a l l i n d i v i d u a l s regardless of c u l t u r a l v a r i a t i o n (Ridley, et a l , 1994). There was strong resistance to the notion that t r a d i t i o n a l Western European counselling theories may not be generalized across cultures. This resistance hinged on the strong b e l i e f that t r a d i t i o n a l Western European theories (for example Rogers's Person-centered model and Erickson's Stage development model) transcended culture because they were based on un i i v e r s a l experiences common to a l l human beings, and that these experiences were stronger and more relevant than c u l t u r e - s p e c i f i c experiences (Scott & Borodovsky, 1990). Such an approach echoes the concept of the "melting pot" which overemphasized the common or universal aspects which indivi d u a l s share at the expense of acknowledging unique c u l t u r a l perspectives. 26 Wrenn i n 1962 warned counsellors of the danger of c u l t u r a l "encapsulation," and the subsequent "imposition of c u l t u r a l l y a l i e n goals, values, and practices upon counsellees" (Draguns, 1981, p.15). Paul Pedersen (1991) i n a s i m i l i a r vein echoes that the danger of " r e l y i n g on one t r u t h " i s that the counsellor can become "trapped i n one way of thinking that r e s i s t s adaptation and r e j e c t s a l t e r n a t i v e s . " M u l t i c u l t u r a l counselling s i g n i f i e s a "condition or concern f o r understanding the i n t e r a c t i o n of people of d i f f e r e n t c u l t u r a l backgrounds - a deliberate attention to differences AND s i m i l a r i t i e s " (Sundberg, 1981, p. 30). The danger of t h i s approach i s that i t can create s t e r e o t y p i c a l responses to c l i e n t s based on generalized information about the c u l t u r a l background of the c l i e n t . " I n f l i c t i n g c u l t u r a l perspectives (stereotypes) on the c l i e n t based on membership i n a c e r t a i n group would be unethical" (Ibrahim, 1990). In f a c t , within-group (idiographic) v a r i a t i o n s can be as great, or greater, than between-group (nomothetic) v a r i a t i o n s . I t i s important, therefore, to stress that any attempt to delineate and compare group c h a r a c t e r i s t i c s within a culture does not over-ride the need fo r determining i n d i v i d u a l differences. However, each i n d i v i d u a l ' s unique s i t u a t i o n and perspective needs to be viewed within the context of t h e i r c u l t u r a l worldview. E f f e c t i v e m u l t i c u l t u r a l counselling s t a r t s with an awareness of c u l t u r a l differences (and within-culture differences) before considering i n d i v i d u a l v a r i a t i o n s on 27 those group c h a r a c t e r i s t i c s . Such an awareness has been termed " c u l t u r a l i n t e n t i o n a l i t y " (Allen Ivy, 1987). Paul Pedersen, whose work has been one of the major influences on the f i e l d of mu l t i c u l t u r a l counselling, acknowledges the complexity of c u l t u r a l i n t e r a c t i o n by proposing a broad d e f i n i t i o n of the term "culture" which would include within-group as well as between-group differences. To some extent, according to t h i s d e f i n i t i o n , a l l mental health counselling i s m u l t i c u l t u r a l (Pedersen, 1990, p. 94). This marks a r a d i c a l s h i f t from the t r a d i t i o n a l view of culture (Kroeber and Lusckhom, 1952; Sue and Morishiraa, 1982) which emphasizes ethnographic variables such as n a t i o n a l i t y , e t h n i c i t y , language and r e l i g i o n . A broad d e f i n i t i o n of culture adds additional demographic variables such as age, sex, and socioeconomic status, and recognizes that these factors also help to create, i n part, our c u l t u r a l values, biases and assumptions. A broad d e f i n i t i o n further recognizes that culture i t s e l f i s dynamic and can change over time i n response to environmental circumstances, and may even vary from i n d i v i d u a l to in d i v i d u a l ("The same c u l t u r a l l y -learned behaviour may have very d i f f e r e n t meanings for d i f f e r e n t people and even f o r the same person across time and s i t u a t i o n s , " Pedersen, 1991, p. 6). For example, although women i n Western society experience r e l a t i v e to other cultures a great deal of independence, opportunity and freedom of choice, i t i s well to remember that women were only l e g a l l y declared persons i n Canada 28 i n 1929. Measures of c u l t u r a l i d e n t i t y and influences are always, therefore, approximate. Kluchohm (1962) expressed t h i s continually transforming nature of culture when he wrote: "culture systems may, on one hand, be considered as products of action, and, on the other hand, as conditioning influences upon future action" (p. 73). Culture i s , i n other words, not a passive force acting upon us, but a r e a l i t y that i s constantly influencing and being influenced by the i n d i v i d u a l . Ivey, Ivey and Simek-Morgan (1993) further include i n t h i s construction of culture the " d i a l e c t i c r e l a t i o n s h i p " between c l i e n t and ther a p i s t : We are not just culture bearers, we also have the c a p a b i l i t y to create and change culture. Just as therapist and c l i e n t can change each other, so can both a f f e c t the environment and culture that led to our perceptions. We are part of a " m u l t i p l i c i t y i n One" (p. 129). There are several important factors which have influenced the counselling profession, over the past two decades, to increase focus on culture and i t s impact on the counselling process. F i r s t , " c u l t u r a l s e n s i t i v i t y " has become an imperative within the counselling/psychotherapy profession since 1974 when the V a i l Conference on C l i n i c a l Psychology, sponsored by the American Psychological Association, suggested that lack of c u l t u r a l s e n s i t i v i t y , knowledge and awareness were unethical i n 29 counselling practice (Draguns, 1981, p. 16). In 1986, the American Psychological Association meeting i n Washington, D.C. made s p e c i f i c recommendations fo r changing A.P.A. E t h i c a l Guidelines so they r e f l e c t e d the recommended " c u l t u r a l s e n s i t i v i t y . " The f i r s t two additions to the A.P.A. E t h i c a l Guidelines are of the most relevance to my research t o p i c , and are as follows: P r i n c i p l e One: R e s p o n s i b i l i t y - Psychologists have a r e s p o n s i b i l i t y to i n t e n t i o n a l l y , constructively, and appropriately adapt t h e i r methods to c u l t u r a l l y d i f f e r e n t populations, recognizing the d i f f e r e n t ways that c u l t u r a l factors shape human behaviour. P r i n c i p l e Two: Competence - Psychologists should indicate and further develop t h e i r competence about the cultures of persons they are studying or serving. Secondly, "Multiculturalism" became a p o l i c y of Canada i n 1973 when Prime Minister Trudeau and the L i b e r a l government introduced multiculturalism as a state p o l i c y . The concept of multiculturalism, as a p l u r a l i t y of cultures understanding and accepting one another i s i n dramatic contrast to concepts of c u l t u r a l unanimity, such as the United States "melting pot" metaphor. In 1981 Multiculturalism became enshrined i n the Canadian Constitution's Charter of Rights and Freedoms, and i n 1988 the Multiculturalism Act was affirmed as a national p o l i c y by an act of parliament (Chiu, 1994, p. 28). 30 In part, the Canadian Multiculturalism Act states: I t i s hereby declared to be the p o l i c y of the government of Canada to...recognize and promote the understanding that multiculturalism r e f l e c t s the c u l t u r a l and r a c i a l d i v e r s i t y of Canadian society and acknowledges the freedom of a l l members of Canadian society to preserve, enhance, and share t h e i r c u l t u r a l heritage (Berdichewsky, B., 1988, p. 28). And t h i r d l y , Canadian immigration p o l i c i e s have continued to increase the number of immigrants, and the d i v e r s i t y of c u l t u r a l groups, entering Canada. Canadians, therefore, w i l l i n e v i t a b l y come into contact with, and in t e r a c t with in d i v i d u a l s from many c u l t u r a l backgrounds other than t h e i r own. In regard to the counselling/psychotherapy profession, increasing c u l t u r a l d i v e r s i t y r e f e r s not only to the c l i e n t population, but to the counsellor/therapist population as well. The intent of t h i s thesis i s not to make c u l t u r a l generalizations about a s p e c i f i c culture based on li m i t e d information, but rather to confirm the relevance of our own values and b e l i e f s as Western-trained counsellors/therapists, and to i n s t i l l a c u r i o s i t y and enthusiasm regarding the complex c u l t u r a l v a r i a b i l i t i e s inherent i n the counselling process: What i s e s s e n t i a l f o r c l i n i c i a n s i s to develop an attitude of openness to c u l t u r a l v a r i a b i l i t y and to the r e l a t i v i t y of t h e i r own values (McGoldrick, 1982, p. 27). 31 Current Theory and Research i n M u l t i c u l t u r a l Counselling Recent research on c u l t u r a l differences i n mental health conceptualization and healing interventions has focused on recognizing the influence of one's own c u l t u r a l worldview on the counselling process and on the strength and uniqueness within a p a r t i c u l a r culture, rather than focusing on comparisons to Western-European models of health and healing (Tata and Leong, 1994). A fundamental objective f o r M u l t i c u l t u r a l Training i s for trainees to develop an awareness of the p a r t i c u l a r value system underlying t h e i r helping theory and corresponding intervention strategies (Sue et a l . , 1992, p. 5). Over the past two decades researchers and p r a c t i t i o n e r s have struggled with a s h i f t from the theory to the p r a c t i c e of se n s i t i v e c r o s s - c u l t u r a l mental health care (Ivey, 1987; Pedersen, 1991; Ponterotto, 1994; Sue, 1991). Kagawa-Singer and Chung's 1994 a r t i c l e , "A paradigm f o r c u l t u r a l l y based care i n ethnic minority populations" (Journal of Community Psychology, 22, p. 192-208), mentions the need f o r counsellors/therapists to broaden narrow concepts of mental health and r e s t r i c t i v e s t y l e s of intervention i n order to accommodate and incorporate interpretations of r e a l i t y affected by d i f f e r e n t cultures. The a r t i c l e emphasizes the negotiation process of therapeutic i n t e r a c t i o n , i n which the counsellor needs to understand and 32 respect the c l i e n t ' s objectives: "...the counsellor needs to use knowledge of his/her own culture AND information of the c l i e n t ' s culture to succeed" (p. 198). Kagawa-Singer and Chung never underestimate the complexity of the i n t e r a c t i o n between counsellor, counsellor's culture, c l i e n t , and c l i e n t ' s culture. They also stress emphatically as do others (Pedersen,1988,1981; Ponterotto, 1988; Sue & Sue, 1990, 1981) the danger of overgeneralizing to the i n d i v i d u a l from a s u p e r f i c i a l knowledge of culture. Pedersen (1990) adds a further dimension to the complexity of c u l t u r a l i d e n t i t y by suggesting that an i n d i v i d u a l may belong to as many as one thousand cultures, or r o l e s , at any given time (See Figure 2). He i s , of course, broadening the d e f i n i t i o n of culture to include the categories of race, marital status, parental status, gender, socioeconomic status, r e l i g i o u s a f f i l i a t i o n , and geographical a f f i l i a t i o n . These categories, according to Pedersen, i n t e r a c t and overlap with each other to create a complex and unique i n d i v i d u a l perspective. An example demonstrating the c u l t u r a l complexity of an i n d i v i d u a l ' s s e l f -conceptualization i s the case example of "Mrs. Clark" given by Ridley, Mendoza, Kanitz, Angermeyer, and Zenk (1994). Mrs. Clark i s not only African-American, but married, a mother, a Baptist, a woman, middle-class, a native of southern Alabama, and a product of her family and s o c i e t a l experiences. Each aspect of Mrs. Clark's i d e n t i t y interacts with the others to compose the t o t a l 33 individual i d e n t i t y and world perspective. Figure 2. A n idiographic approach to client Figure 2 African American Marriott Mothor of throo chlldron Baptist Woman MIddle-dass Native of southern Alabama Mrs. Clark's personal experience, Involving her collective membership In all of these groups, or tho idiographic center conceptualization: The case of Marian Clark. When one adds the complexity of the counsellor's c u l t u r a l context to that of the c l i e n t ' s , the task of establishing a common understanding and rapport between counsellor and c l i e n t becomes formidable: Client Therapist Client cultural/ historical background Counselor cultural/ historical background Figure 3 34 The counselling process i s a d e l i c a t e balance between awareness of c u l t u r a l differences and the a b i l i t y to transcend categorization i n order to focus on the uniqueness of the i n d i v i d u a l (Draguns, 1981; Ivey, 1981). The challenge f o r counsellors p r a c t i s i n g within a m u l t i c u l t u r a l context i s to "switch from one frame of reference to the other; to combine the two" (Draguns, p. 13) which requires knowledge and s k i l l . Current theory and research i n the area of m u l t i c u l t u r a l counselling i s focused on recognizing the d i v e r s i t y within a c u l t u r a l population (Sue, 1990; Pedersen, 1988); emphasizing the strengths and e x i s t i n g coping strategies or i n t r i n s i c healing systems of a culture (Ivey, Ivey & Simek-Morgan, 1993; McGoldrick, Pearce & Giordano, 1982; Marsella & Pedersen, 1981; and Sue, 1990); and developing adequate c r o s s - c u l t u r a l t r a i n i n g for counsellors ( B r i s l i n , 1990; Miranda & Kitano, 1986; and Pedersen, 1988). The research proposal presented here addresses i t s e l f to one of the s p e c i f i c aspects of the counselling process: the i n i t i a l r e l a t i o n s h i p - b u i l d i n g , or " j o i n i n g , " between counsellor and c l i e n t , with the intent of supplying useful knowledge fo r counsellors considering the influence of culture on the counselling process: Our future w i l l depend on the a b i l i t y to go beyond i n d i v i d u a l i s t i c assumptions i n co-ordinating the r e l a t i o n a l perspective of other cultures with our own c r i t e r i a of good mental health (Pedersen, 1981, p. 326). 35 The Therapeutic A l l i a n c e Theoretical and conceptual background. Greenson (1967/65) introduced to psychotherapy the term "Working A l l i a n c e , " which has since become a widely used therapeutic concept r e f e r r i n g to the " s k i l f u l aspects of the patient's collaboration that are directed toward the tasks of therapy." The working a l l i a n c e , as Greenson defined i t , included both "the patient's cognition capacity to self-observe" AND "his non-distorted, f r i e n d l y a t t r a c t i o n to the analyst" (Gaston & Marmar In Horvath & Greenberg, 1994, p. 86). The "therapeutic a l l i a n c e " r e f e r s more s p e c i f i c a l l y to the a f f e c t i v e aspects of the c l i e n t ' s r e l a t i o n s h i p with the therapist, and i s based o r i g i n a l l y i n Freud's early papers on Transference, where he wrote that the f i r s t aim of treatment was "to attach the person of the patient to the person of the therapist" (Gay, P., 1989, p. 375). Freud further stressed that therapeutic work could not begin u n t i l "proper rapport" had been established, and that "positive transference" would automatically happen i f the therapist showed sincere i n t e r e s t i n the patient (Hougaard, 1994). The effectiveness of t r a d i t i o n a l psychotherapy lay i n the therapist's s k i l l e d use of the interpersonal r e l a t i o n s h i p i t s e l f for the benefit of the c l i e n t ' s growth and change. Otto Rank, an early student and l a t e r colleague of Freud's, emphasized more s p e c i f i c a l l y the "therapeutic effectiveness of the therapist's warmth, empathy and genuineness" (Truax & 36 Carkhuff, 1967, p. 590), a d e f i n i t i o n remarkably s i m i l a r to the current d e f i n i t i o n s of the therapeutic r e l a t i o n s h i p . A l f r e d Adler, i n the same vein, talked about the therapist having to "temper his warmth and encouragement with understanding of the s p e c i a l problem of the patient" (Truax & Carkhuff, 1967, p. 509). Sullivan's theory of Interpersonal Introjection introduced to Western psychotherapy the idea that not only i s the creation of a strong therapeutic r e l a t i o n s h i p or a l l i a n c e an e s s e n t i a l aspect of therapeutic effectiveness, i t i s a s u f f i c i e n t agent for therapeutic change. Underlying t h i s statement i s the concept that i n d i v i d u a l s learn attitudes about themselves and others through interpersonal patterns and messages received early i n l i f e (Sullivan, H.S., 1953). Further, i f one accepts that the therapeutic r e l a t i o n s h i p i s an interpersonal i n t e r a c t i o n , then the primary therapeutic task becomes "the therapist's metacommunication with the c l i e n t about these messages, t h e i r impact, and t h e i r r e l a t i o n s h i p to disordered interpersonal patterns" (Henry & Strupp In Horvath & Greenberg, 1994, p. 64). Taking the concept of interpersonal i n t e r a c t i o n i n psychotherapy a step further, Stanley strong (1968) suggested that The extent to which counsellors are perceived as expert, a t t r a c t i v e , and trustworthy would reduce the l i k e l i h o o d of t h e i r being d i s c r e d i t e d by the c l i e n t . . . I n the f i r s t stage, counsellors enhance t h e i r perceived expertness, attractiveness, trustworthiness, and c l i e n t s ' involvement 37 i n counselling. In the second stage, counsellors use t h e i r influence to p r e c i p i t a t e opinion and/or behaviour change i n c l i e n t s , ( i n Egan, 1986, p. 17). Interpreting the a l l i a n c e as interpersonal process suggests that both c l i e n t and counsellor/therapist contribute to the on-going re l a t i o n s h i p - and do so in, ways large l y dictated by each participant's interpersonal history (Henry & Strupp In Horvath & Greenberg, 1994), including the enormous influence of culture. Carl Rogers' (1957) model of Client-centred Therapy agreed with the concept of the a l l i a n c e as a necessary and s u f f i c i e n t factor i n therapeutic change, and went on to define the s p e c i f i c q u a l i t i e s of a therapist needed to create and maintain a p o s i t i v e a l l i a n c e . The a t t r i b u t e s which were considered by Rogers to form the core of the therapeutic r e l a t i o n s h i p were: genuineness, unconditional p o s i t i v e regard (or non-possessive warmth), and accurate empathetic understanding of the c l i e n t . (Corsini & Wedding, 1989, pp.155-189). These three q u a l i t i e s are complex concepts and w i l l be defined and analyzed l a t e r i n t h i s chapter, so that they can be operational!zed more e f f e c t i v e l y . Current psychotherapy confirms the importance of a p o s i t i v e therapeutic a l l i a n c e as a prerequisite f o r e f f e c t i v e counselling process. (Egan, 1982; Cormier & Hackney, 1993). Research seems to suggest that the i n i t i a l a l l i a n c e i s formed within the f i r s t few 38 sessions (sessions one to three) and that t h i s i s a " c r i t i c a l period" i n either forming or f a i l i n g to form a p o s i t i v e therapeutic a l l i a n c e (Henry & Strupp, 1994; Horvath & Greenberg, 1994); and, further, that forming a "good enough" a l l i a n c e i s necessary before the therapeutic work can proceed (Horvath & Greenberg, 1994, p. 3). For these reasons, I have narrowed the focus of my research study to the elements of the i n i t i a l a l l i a n c e formation, Bordin (1979) contributed a generic working model of the therapeutic a l l i a n c e . I t included three stages: agreement on the goals of psychotherapy; agreement on the tasks of psychotherapy; and the development of a r e l a t i o n s h i p bond between the therapist and c l i e n t (Duncan, Solovey, & Rusk, 1992, p. 40). According to Bordin these stages are central to a l l psychotherapies, yet might develop d i f f e r e n t l y i n d i f f e r e n t forms of therapy. I t i s the t h i r d stage of Bordin's model, the "bond," that i s the focus of my research study. Bordin went on to d i s t i n g u i s h c l e a r l y between the unconscious projections of the c l i e n t (transference) and the c l i e n t ' s "positive collaboration with the therapist against the common foe of the c l i e n t ' s pain and self-defeating behaviour," the l a t t e r being the therapeutic a l l i a n c e (Horvath & Greenberg, 1994, p. 110). The bond aspect of the therapeutic a l l i a n c e , according to Bordin, contains both the transference and the collaborative 39 aspects of the c l i e n t / t h e r a p i s t r e l a t i o n s h i p . The r e l a t i o n s h i p provides the context i n which successful therapy can occur. Therapeutic interventions ("goals" and "tasks") are only as e f f e c t i v e as the meaning that i s ascribed to them by the c l i e n t , and that meaning i s acquired i n the i n t e r a c t i o n a l context of the c l i e n t - t h e r a p i s t r e l a t i o n s h i p . "Intervention, then, becomes the behavioral manifestation of the r e l a t i o n s h i p " (Duncan, Solovey & Rusk, 1992, p. 32). Transference, i n Bordin's model, i s viewed as natural and not necessarily pathological. In t r a d i t i o n a l psychoanalytic theory the patient's e a r l y - l i f e c o n f l i c t s , p a r t i c u l a r l y parental r e l a t i o n s h i p s , are n e u r o t i c a l l y projected onto the current c l i e n t - t h e r a p i s t r e l a t i o n s h i p . More recent interpretations of transference r e f e r to i t as a natural phenomenon which occurs i n ALL psychologically meaningful r e l a t i o n s h i p s . "To the extent that relationships form the foundation f o r the s e l f , one might say that the therapist-patient r e l a t i o n s h i p would function as a c r u c i b l e of the s e l f " (Cashdan,s., 1988, p. 28). The "bond" aspect of the a l l i a n c e , therefore, includes both the a f f e c t i v e and psychodynamic aspects of the r e l a t i o n s h i p between the c l i e n t and the therapist. (Pinsof, i n Horvath & Greenberg, 1994). In terms of the a f f e c t i v e component of the "bond", Bordin r e f e r s to the c l i e n t ' s f e e l i n g trusted, respected, and cared about by the counsellor/therapist. Another important aspect of Bordin's d e f i n i t i o n of the 40 "bond" aspect of the therapeutic a l l i a n c e i s the emphasis on the "bond" being b i d i r e c t i o n a l . That i s , the therapist w i l l also a t t r i b u t e meaning to the c l i e n t ' s behaviour (Pinsoff, i n Horvath & Greenberg, 1994). The view of the a l l i a n c e bond as an in t e r a c t i v e process, or a "partnership," i n which c l i e n t and counsellor/therapist work together to achieve a common goal focuses on the mutuality of the re l a t i o n s h i p . Empirical evidence f o r an association between the a l l i a n c e and outcome. The d i r e c t association between the therapeutic a l l i a n c e and psychotherapeutic outcome has been supported by considerable empirical evidence (Bachelor, 1991; Hartley & Strupp, 1983; Horvath & Greenberg, 1986; Luborsky, C r i t s -Christoph, Alexander, Margolis & Cohen, 1983). The importance of the "common fact o r s " (warmth, empathy and genuineness) i n producing p o s i t i v e outcomes was also supported empirically by the f a i l u r e to f i n d d i f f e r e n t i a l outcomes i n studies comparing a number of d i f f e r e n t psychotherapies (Horvath & Symonds, 1991). In a detailed report on "Counsellor c h a r a c t e r i s t i c s : how they a f f e c t outcomes," Dorothy Fahs Beck (1988) compiled numerous research studies which together demonstrated overwhelming support f o r the c r i t i c a l importance of the co u n s e l l o r - c l i e n t r e l a t i o n s h i p . Her l i s t included: Gelso, C. and Carter, J . , "The rel a t i o n s h i p i n counselling and psychotherapy: components, consequences, and t h e o r e t i c a l antecedents," The Counselling Psychologist, 13, A p r i l 1985, pp. 155-243; Luborsky, L. & 41 Auerback, A., "The therapeutic r e l a t i o n s h i p i n psychodynamic research: the research evidence and i t s meaning f o r p r a c t i c e " i n Hales, R. and Frances, A., eds., Psychiatry update: American Psychi a t r i c Association Annual Review. 1 (Washington, DC: American Psyc h i a t r i c Association, 1985, pp. 550-561); Frank, J . Hoehn-Saric, R. Imber, S., Liberman, B., and Stone, A., E f f e c t i v e ingredients of successful psychotherapy (New York: Brunner/Mazel, 1978); Lambert, M., Bergin, A., and C o l l i n s , J . , "Therapist-induced deterioration i n psychotherapy," i n Gurman and Razin, eds., E f f e c t i v e Psychotherapy: Truax and M i t c h e l l , "Research on c e r t a i n therapist interpersonal s k i l l s i n r e l a t i o n to process and outcome;" and Truax, C. and Carkhuff, R., Toward e f f e c t i v e counselling and psychotherapy: t r a i n i n g and practice (Chicago: Aldine Publishing co., 1967). Lambert (1992) estimated that the therapeutic r e l a t i o n s h i p contributes as much as t h i r t y percent to outcome i n psychotherapy, making i t a"* f a r more c r i t i c a l factor than e i t h e r therapeutic technique or expectancy. Research studies have also reported that c l i e n t s ' retrospective accounts of t h e i r therapeutic experience focused on p o s i t i v e therapist q u a l i t i e s (such as empathy, warmth, respect, in t e r e s t ) and linked these to successful outcome (Strupp, Fox & Lessler, 1969; Truax & Carkhuff, 1967). Gurman, following a comprehensive research review (Gurman, A., "The patient's perception of the therapeutic r e l a t i o n s h i p " i n Gurman & Razin, 42 eds. (1977) reported that consistent support f o r the therapeutic effectiveness of such counsellor t r a i t s as accurate empathy, nonpossessive warmth, and genuineness were conditional on the use of the c l i e n t ' s own perceptions, rather than the therapist's perceptions, as data. Qperationalization of the d e f i n i t i o n of therapeutic a l l i a n c e . Research on the therapeutic a l l i a n c e has moved from estab l i s h i n g that i t i s important to defining how i t i s important, and to narrowing down the common factors or processes of the a l l i a n c e or r e l a t i o n s h i p to a more operational d e f i n i t i o n (Henry & Strupp i n Horvath & Greenberg, 1994; Truax & M i t c h e l l , 1971). Certain interpersonal s k i l l s of the therapist have been i d e n t i f i e d as s i g n i f i c a n t i n forming a p o s i t i v e therapeutic r e l a t i o n s h i p across a wide var i e t y of psychotherapy models. These s k i l l s , as mentioned previously, are the q u a l i t i e s of empathetic understanding, unconditional p o s i t i v e regard (non-possessive warmth), and genuineness (Trux & M i t c h e l l , 1971) " A l l schools of therapy accept the notion that these...variables are important f o r s i g n i f i c a n t progress to occur and are i n essence fundamental i n the formation of a working a l l i a n c e " (Duncan, Solovey, & Rusk, 1992, p. 32). ...therapists or counsellors who are accurately empathetic, nonpossessively warm i n attitude, and genuine, are indeed e f f e c t i v e . Also, these findings seem to hold with a wide 43 v a r i e t y of therapists and counsellors, regardless of t h e i r t r a i n i n g or theoretic orientation, and with a wide var i e t y of c l i e n t s or patients...Further, the evidence suggests that these findings hold i n a v a r i e t y of therapeutic contexts and i n both i n d i v i d u a l and group psychotherapy or counselling (Truax & M i t c h e l l i n Handbook of Psychotherapy and behaviour change, Bergin & G a r f i e l d , 1971, p. 310). A more detailed description of the three es s e n t i a l therapist c h a r a c t e r i s t i c s / q u a l i t i e s follows: a. ACCURATE EMPATHY. As early as 1912, Freud spoke of the "curative e f f e c t s of warmth or p o s i t i v e a f f e c t . " In a discussion of transference and the therapeutic r e l a t i o n s h i p , he s p e c i f i c a l l y advocated the therapist's use of "warmth and i t s r o l e " (Truax & Carkhuff, 1967, p. 35). According to Carl Rogers, who emphasized i n his psychotherapeutic model the empathetic q u a l i t i e s of the therapist, empathy entailed f i r s t of a l l the a b i l i t y "to sense the c l i e n t ' s bewilderment, anger, love or fear as i f i t were the therapist's own f e e l i n g " (Truax & Carkhuff, 1967. p. 286) - i n other words, to perceive and to appreciate the c l i e n t ' s feelings and experiences and the meaning of those feelings and experiences from the c l i e n t ' s perspective. Another c r u c i a l aspect of empathy i s the a b i l i t y to communicate, accurately and with s e n s i t i v i t y , the perception of both the c l i e n t ' s feelings and experiences and the s i g n i f i c a n c e and meaning behind those feelings and 44 experiences (Truax & Mitchel, 1971). The a b i l i t y to convey empathy i n a c u l t u r a l l y consistent and meaningful manner may be the c r u c i a l variable to engage the c l i e n t . Understanding of c l i e n t worldviews and c u l t u r a l i d e n t i f i c a t i o n and having a cleare r comprehension of c l i e n t concerns can greatly f a c i l i t a t e empathetic understanding and responding. (Ibrahim, 1991, p. 18). b. UNCONDITIONAL POSITIVE REGARD (or NONPOSSESSIVE WARMTH). Unconditional p o s i t i v e regard r e f l e c t s an attitude of the therapist towards the c l i e n t which i s p o s i t i v e , nonjudgemental, and accepting. The therapist does not attempt to control, i n t e r p r e t or force conclusions upon the c l i e n t , but, rather, without c r i t i c i s m l e t s the c l i e n t "be himself even i f t h i s means that he i s temporarily regressing, being defensive, or even d i s l i k i n g or r e j e c t i n g the therapist himself" (Truax & M i t c h e l l , 1971, p. 46). c. GENUINENESS (OR CONGRUENCE). Genuineness implies that the therapist i s w i l l i n g to be open and non-defensive with the c l i e n t about who he/she i s as a person i n the moment and to avoid "the temptation to hide behind a mask of professionalism" (Rogers & Sandford, 1985, p. 1379). A c r u c i a l aspect of genuineness i s the therapist's recognition of the c l i e n t ' s being the expert on t h e i r own experiences and fee l i n g s , so that the therapist approaches the c l i e n t and the c l i e n t ' s concerns with an attitude of 45 "cautiousness and tentativeness" (Duncan, Solovey, & Rusk, p. 36). The c u l t u r a l context of the therapeutic r e l a t i o n s h i p . Viewing the a l l i a n c e as an i n t e r a c t i v e interpersonal process assumes that the family and c u l t u r a l h i s t o r i e s of both the patient and the therapist are highly relevant to the p o s i t i v e formation of the therapeutic a l l i a n c e . Both c l i e n t and therapist/counsellor have a unique interpersonal h i s t o r y that a f f e c t s t h e i r perceptions and the meanings they make of t h e i r experiences, including that of the interpersonal dynamics within the therapeutic r e l a t i o n s h i p . Many counsellor educators claim that universal at t r i b u t e s of genuineness, love, unconditional acceptance, and p o s i t i v e regard are the only things needed. Yet the question remains, how does a counsellor communicate these things to c u l t u r a l l y d i f f e r e n t c l i e n t s ? While a counsellor might have the best of intentions, i t i s possible that h i s or her intentions might be misunderstood. (Sue and Sue, 1990/81, p. 89). If our goal as therapists/counsellors i s to achieve and demonstrate accurate and non-judgemental understanding of the c l i e n t ' s experiences and meaning system, i t i s imperative that we f i r s t understand the value system of the c l i e n t ' s culture. Not doing so may lead to ethnocentrism: assumptions and conclusions about behaviour based on a c u l t u r a l background which does not f i t 46 with the c l i e n t ' s h i s t o r y . The core conditions of an a f f e c t i v e a l l i a n c e (empathy, genuineness, and unconditional p o s i t i v e regard), as we have discussed e a r l i e r , are only e f f e c t i v e i f they are perceived to be present by the c l i e n t . Each c l i e n t w i l l experience the core conditions, demonstrated i n behaviourial terms by the counsellor, d i f f e r e n t l y . The complex interpersonal i n t e r a c t i o n between therapist and therapist's culture, and c l i e n t and c l i e n t ' s culture, can lead to misunderstanding or al i e n a t i o n and i n a b i l i t y to develop a p o s i t i v e therapeutic a l l i a n c e . During the re l a t i o n s h i p , the interactants are assessing each other. They take note of what i s said and how i t i s s a i d (Clement Vontress, 1971, p. 12). Kagawa-Singer and Chung (1994) suggest that when attempting to es t a b l i s h rapport with a c l i e n t from a d i f f e r e n t c u l t u r a l background, the therapist/counsellor needs f i r s t to know the rules of s o c i a l i n t e r a c t i o n of the c l i e n t ' s culture with regard to respect, s o c i a l etiquette, verbal and nonverbal communication s t y l e s , degree of s e l f - d i s c l o s u r e by therapist or by c l i e n t , age appropriate behaviours, and gender rules of in t e r a c t i o n . The therapist/counsellor then has the opportunity to in t e r a c t i n ways that are consistent with the c l i e n t ' s experiences of empathy, genuineness, and unconditional p o s i t i v e regard. Accurate empathetic reflections...demonstrate that the counsellor understands the complexity and nuances of 47 the c l i e n t ' s f e e l i n g s . Accurate empathetic r e f l e c t i o n s and interpretations require practice and, also, f u l l understanding of a c l i e n t ' s culture. True, the counsellor never knows p r e c i s e l y how any i n d i v i d u a l c l i e n t f e e l s , since each person's l i f e and subjective experiencing are unique? but the more the counsellor knows about a c l i e n t ' s c u l t u r a l , s o c i a l , and f a m i l i a l environment, the more accurately the counsellor can picture the c l i e n t ' s r o l e and attitudes and the more sharply focused w i l l be counsellor feedback. (Marsella & Pedersen, 1981, p. 205). Sue (1977) suggests that d i f f e r e n t c u l t u r a l groups require d i f f e r e n t communication processes. Because the psychotherapeutic process can be viewed as an interpersonal i n t e r a c t i o n , the counsellor/therapist and the c l i e n t must both be able to communicate appropriately and accurately by sending and receiving both verbal and nonverbal messages: The counsellor needs to accommodate a wide range of therapist and c l i e n t r o l e s , integrating them with the c l i e n t ' s worldview without at the same time l o s i n g h i s or her own c u l t u r a l i n t e g r i t y . (Sue, 1977) Furthermore, the counsellor/therapist's f a c i l i t a t i o n of the therapeutic a l l i a n c e i s a balance between awareness of c u l t u r a l differences and the a b i l i t y to transcend c u l t u r a l categorization i n order to focus on the uniqueness of the i n d i v i d u a l c l i e n t . In 48 other words, although i t i s important to i d e n t i f y c u l t u r a l differences i n communication processes i t i s equally important to recognize that a c l i e n t , to f e e l genuinely understood, cannot be confined to a stereotype of his or her culture. As George Ke l l y (1955) expressed, so well: ...the c u l t u r a l approach should never be more than a preliminary step i n the understanding of (the) c l i e n t , the f i r s t i n a serie s of approximations which bring the c l i e n t into sharp focus i n a complex matrix of psychological dimensions. Conclusion Both the counsellor and the c l i e n t bring a set of c u l t u r a l values and expectations to the counselling r e l a t i o n s h i p . Formation of a common understanding and acceptance of the s t y l e , goals and l i m i t s of the r e l a t i o n s h i p i s necessary f o r e f f e c t i v e psychotherapy to proceed. Counsellors/psychotherapists f i r s t need to have an awareness, therefore, of how t h e i r own c u l t u r a l assumptions and biases impact on the formation of the rel a t i o n s h i p , and an acceptance that there may be more than one way to es t a b l i s h the necessary conditions for a therapeutic a l l i a n c e to develop. Secondly, a knowledge of the c l i e n t ' s c u l t u r a l values, b e l i e f s and expectations, along with an a b i l i t y to convey such knowledge i n a c u l t u r a l l y appropriate way, i s ess e n t i a l i n enabling the c l i e n t to f e e l understood and accepted. 49 A counsellor/psychotherapist may be able to avoid the dangers of applying general c u l t u r a l knowledge of a c l i e n t i n a stereotypic fashion by a. maintaining an awareness that differences between subgroups within the c l i e n t ' s culture may be large, b. remaining open to questioning t h e i r own biases and assumptions when confronted with a d i f f e r e n t perspective, and c. remaining open to the c l i e n t ' s own unique combination of c u l t u r a l i d e n t i t i e s . The focus of t h i s research study i s on the experiences of counsellors/psychotherapists attempting to put the above requirements into p r a c t i c e . 50 CHAPTER THREE RESEARCH DESIGN Theoretical and methodological perspectives The research design of the study was a q u a l i t a t i v e approach using a semi-structured interview format as described by Schumacher and McMillan (1993). I chose t h i s design f o r several reasons. F i r s t , there are many advantages to an interview format when dealing with such a complex issue as the in t e r a c t i o n of c u l t u r a l worldviews. Guba and Lincoln (1981) have expressed one of the major strengths of the interviewing research approach as being that "the interviewer i s l i k e l y to receive more accurate responses on se n s i t i v e issues, and the interview i t s e l f i s l i k e l y to provide a more complete and in-depth picture than other forms of inquiry" (p.315). Areas of in t e r e s t or confusion can be explored and "probed" to gain the maximum possible information. Another strength of the interview format pointed out by Guba and Lincoln, and of p a r t i c u l a r relevance to my study, i s the "allowance for the respondent's own words and terms, his natural language" (p. 315). As my study focuses on culture, subtle differences i n language can be an important indicator of underlying meaning and orient a t i o n . Secondly, f a r from attempting to be a neutral, objective evaluator of the phenomenon under study, I am engaging i n an in t e r a c t i v e dialogue, collaborating with the interviewee i n a search for understanding and meaning. 51 Significance i n q u a l i t a t i v e , or "ethnographic," research i s derived " s o c i a l l y , not s t a t i s t i c a l l y , from how ordinary people i n p a r t i c u l a r set-ups make sense of the experience of t h e i r everyday l i f e " (Jaegar, p. 191). The interview format i s , therefore, p a r t i c u l a r l y appropriate i n understanding how Western trained Chinese counsellors apply knowledge of t h e i r t r a i n i n g and t h e i r culture to s p e c i f i c counselling si t u a t i o n s ( i n the case of t h i s research study, that of working with a c l i e n t of a s i m i l a r c u l t u r a l background). Thir d l y , Ponterotto (1988) i n a meta-analysis of f i f t y - t h r e e research a r t i c l e s r e l a t i n g to mul t i c u l t u r a l factors i n counselling found that there was an over-reliance i n the research on paper-and-pencil outcome measures (for example, Counsellor Rating Scales and S e l f -Disclosure Questionnaires). This over-reliance can be a danger, Ponterotto has suggested, when used with c u l t u r a l groups who highly value respect for and deference to authority, because the responses to scales and questionnaires may be so biased as to "render the re s u l t s v i r t u a l l y uninterpretable" (p. 415). As I wanted my interpretation and analysis to be grounded i n the subjects' construction of r e a l i t y , I chose a q u a l i t a t i v e research approach i n which, t r a d i t i o n a l l y , the researcher attempts to "construct the s o c i a l world through the interpretation of, and inte r a c t i o n with, other human actors" and "understand the world through the subjective perceptions and meanings of i t s human actors" (Chiu, 1994, p. 61). 52 F i n a l l y , my study takes into consideration Ponterotto's recommendation that research i n the area of m u l t i c u l t u r a l counselling concentrate on the strengths and s i m i l a r i t i e s of s p e c i f i c cultures, rather than stre s s i n g the differences. I have incorporated an interview format with professionally Western-trained and experienced counsellors/therapists which looks f o r what works i n counselling with a s p e c i f i c c u l t u r a l i n t e r a c t i o n rather than what does not work, and looks at why people stay with counselling, rather than why they do not come. David Wing Sue (1994), i n a more recent a r t i c l e , also recommends the development of a more culture-centred approach to research, and acknowledges that helping roles evolve within a c u l t u r a l context and are, therefore, culture-bound. Sue suggests that research might be best directed at i d e n t i f y i n g the t r a d i t i o n a l or i n t r i n s i c healing systems within a culture which could then provide a balance to Western models of mental health counselling. My study i s an attempt to discover c u l t u r a l l y - p r e f e r r e d methods of Western-trained Chinese counsellors i n creating an i n i t i a l counsellor-c l i e n t therapeutic a l l i a n c e . The intent i s to provide counsellors with the concept of using a more colla b o r a t i v e and f l e x i b l e approach when working with c l i e n t s of a culture d i f f e r e n t from t h e i r own. Research Instrument Data f o r t h i s study was obtained by the use of the semi-structured interview as described by Schumacher & McMillan (1993) 53 and Sproull (1988). I chose the interview as the instrument for data gathering because i t i s most consistent with the intent or purpose of the study, which i s to understand the interview p a r t i c i p a n t s ' conceptual meaning: how counsellors from a p a r t i c u l a r culture would t h e o r e t i c a l l y conceive of and, given a preference, go about creating a professional working a l l i a n c e with t h e i r c l i e n t . An interview schedule (see Appendix A) consisting of open-ended questions was used f o r data c o l l e c t i o n . Following the interview quide suggested by McMillan and Schumacher (1989), topics were selected i n advance, but the sequence and wording of the questions was decided on during the interview. The interview, for conceptual as well as a n a l y t i c purposes, was divided into eight major topic areas. These areas were based on p r i o r research on the t o p i c of therapeutic a l l i a n c e formation (Horvath & Greenberg, 1994; Hougaard, 1994; and Truax & Carkhuff, 1967). Interview questions were meant to be a guideline for covering the topics of i n t e r e s t to the researcher; however, subjects were encouraged, through probing and prompting, to expand t h e i r answers as much as possible so that information attained would be as f u l l and r i c h as possible and capture the unique responses of each subject. The interview topic areas to be covered were: - physical s e t t i n g - involvement of others i n the counselling s e t t i n g and process (for example, friends, family, other professionals) 54 - making i n i t i a l contact - establishing c r e d i b i l i t y and t r u s t - s e l f - d i s c l o s u r e of the counsellor - introduction to s p e c i f i c c l i e n t problem or concern - communication s t y l e (verbal) - communication s t y l e (nonverbal) P i l o t Interview The interview schedule underwent a pre-test, with a par t i c i p a n t matching the study p a r t i c i p a n t s ' c r i t e r i a , to ensure that the instrument was appropriate i n s t y l e and that i t e l i c i t e d the kind of content information looked f o r i n the research study. The length of the interview was also assessed through the p i l o t interview process. Minor a l t e r a t i o n s to reduce ambiguity of questions and to allow f o r the i n c l u s i o n of ommitted areas of concern to the participants were made before the interview schedule was used i n the sample interviews. Selection of Interview Participants Eight Western-trained counsellors/therapists were interviewed for the study. A l l of the respondents were f i r s t or second-generation immigrants from Hong Kong with experience counselling c l i e n t s from Hong Kong and/or Mainland China, because I speak only English, and cl e a r communication was necessary f o r accuracy of understanding, I decided to chose to x 55 s e l e c t participants who spoke English f l u e n t l y . I did not choose to use interpreters, because t r a n s l a t i o n can involve a change i n the meaning of a communication, and an intermediary could detract from the establishment of rapport between the interviewer and the pa r t i c i p a n t interviewees (see Appendix F for further information about interview p a r t i c i p a n t s ) . As i t turned out, the participants were divided equally i n terms of gender (four women and four men), although t h i s was not a planned c r i t e r i a f o r s e l e c t i o n . The i n i t i a l contact was through a previous connection made at a Workshop on Multicultualism and Mental Health sponsored by the Greater Vancouver Mental Health Association (March 23, 1995). From there, a network or snowball sampling approach was used (French, 1993; McMillan & Schumacher, 1993). Following t h i s procedure, the i n i t i a l contact was asked for suggestions of other appropriate and p o t e n t i a l l y w i l l i n g people to interview for the study. Subsequent interview participants were also asked for recommendations of people to contact regarding the study, and so f o r t h . There are drawbacks to the snowball sampling method (which I w i l l discuss further under v a l i d i t y constraints) due to the non-randomization of the sample. However, one of the advantages i s that participants are selected from knowledgeable and informed recommendation. The f i n a l interview participants came from a wide range of agencies including S.U.C.C.E.S.S. (The United Chinese Community Enrichment Services Society), Family Services, MOSAIC, 56 and Greater Vancouver Mental Health Services. A l l of the partic i p a n t s were very open and w i l l i n g to discuss the subject of the study and to share t h e i r personal counselling-related experiences and learning with me. Three interviews were also conducted with "key informants" (Goetz & LeCompte, 1984). These interviews were not used as part of the data for analysis as they did not f i t the c r i t e r i a of the eight sample interview p a r t i c i p a n t s . However, the information from these interviews was used to provide background information and additional reference information for the data analysis. The three interviews were conducted with a. a Chinese p s y c h i a t r i s t working i n mental health, and an avid educator on Chinese culture and mental health, b. a doctor from Mainland China using the t r a d i t i o n a l Chinese medicine approach to healing, and c. a Ph.D student from Mainland China studying Counselling Psychology. Interview Procedure Each of the eight interview participants was contacted i n i t i a l l y by l e t t e r (Appendix D) and then by follow-up phone-call to set up an interview time and place. A l l interviews were scheduled at the convenience of the pa r t i c i p a n t s . Each pa r t i c i p a n t chose to be interviewed at t h e i r place of work. Before beginning the interview, the participants were asked to read and sign a consent form regarding t h e i r willingness to be interviewed for the research study and to have the interview 57 audio-taped, and confirming that t h e i r c o n f i d e n t i a l i t y and anonymity would be maintained (Appendix B). Each of the eight interviews lasted about one hour and was audio-taped f o r l a t e r t r a n s c r i p t i o n . Two of the interviews had to be re-taped, with the consent of the interviewee, due to technical d i f f i c u l t i e s . I began the interview by reviewing b r i e f l y the subject of the research study, the purpose of the interviews. A standardized d e f i n i t i o n of "therapeutic a l l i a n c e formation" to be used throughout t h i s study was then c l a r i f i e d : that i s , the aspect of the therapeutic a l l i a n c e focusing on the f i r s t one to three meetings with the c l i e n t , including the i n i t i a l contact, i n which the counsellor/therapist attempts to b u i l d a sense of rapport with the c l i e n t . There was also an opportunity at t h i s stage for the participants to ask me any questions they had regarding my study, my credentials, or the interview process i t s e l f . The main part of the interview followed using the Interview Schedule (Appendix A) as a general guide. As much as possible, however, participants were encouraged to share and p r i o r i t i z e t h e i r experiences and concerns i n t h e i r own way. A l l interviews were conducted i n English as t h i s i s the only language i n which I am fluent. There were shortcomings, as well as advantages, to using English f o r communicating c u l t u r a l concepts; I w i l l discuss these advantages and disadvantages further under v a l i d i t y constraints. A l l eight interviews were transcribed verbatim from the audio-taped sessions as soon as possible a f t e r the interviews. 58 Data C o l l e c t i o n Since the research was exploratory i n nature, I used the method of "tri a n g u l a t i o n " (McMillan & Schumacher, 1989) i n which several data c o l l e c t i o n methods v e r i f y the primary interview data. The data c o l l e c t i o n methods used for t r i a n g u l a t i o n were: a. to f a m i l i a r i z e myself with the history and experience of Chinese immigrants i n Canada (see Chapter Four); b. to educate myself on past and current themes and approaches i n mul t i c u l t u r a l counselling (see Chapter One), i n p a r t i c u l a r the experience of Western counselling used with Asian c l i e n t s (Sue & Sue, 1990; Ivey, Ivey, & Simek-Morgan, 1993; and McGoldrick, Pearce & Giordano, 1982). c. to interview "key informants" who had valuable information r e l a t i n g to the experience of Chinese c l i e n t s within the mental health or medical profession. These "informal" interviews were used to gather information which would add to the general understanding of the phenomenon under study. An interview schedule was not used, and although the interviews were audio-taped, they were not transcribed. Notes on the key points and concepts were taken down so as to be used l a t e r i n supplementing and corroborating the "formal" interview r e s u l t s . F i n a l l y , the eight semi-structured interviews were arranged, audio-taped, and transcribed verbatim. The information from these interviews was the primary data source f o r the study. 59 Data Analysis Following the procedure f o r data analysis described by Guba and Lincoln (1981) and French (1993), each interview t r a n s c r i p t was read through c a r e f u l l y and each separate theme or s p e c i f i c subject content area copied onto a three-by-five card. The cards were referenced to a p a r t i c u l a r interview and page number so that the context of the item could l a t e r be retrieved i f useful or necessary. A l l content data from the eight transcribed interviews were coded i n t h i s way. Each coded item of data was "mutually exclusive" (no item was recorded more than once) and "exhaustive" (no item was omitted). To ensure i n t e r n a l r e l i a b i l i t y of these "themes" or "codes," an independent rate r was asked to go through a copy of the eight t r a n s c r i p t s and repeat the process of i d e n t i f y i n g and l a b e l l i n g the content of the interviews. Agreement between the co-rater and my own o r i g i n a l content categories was very high and areas that d i f f e r e d were reviewed and modified u n t i l a mutual agreement was obtained (Guba & Lincoln, 1981; French, 1993). Further to t h i s independent r a t i n g , a copy of the appropriate interview t r a n s c r i p t , with the coded categories l a b e l l e d , was sent to each of the interview p a r t i c i p a n t s . The participants were asked to make any comments, additions, suggestions, or c l a r i f i c a t i o n s that they wished to make i n regard to both the i n i t i a l t r a n s c r i p t information and the coding categories. When t h i s process of content analysis was completed, the 60 coded cards of content information were sorted into s i m i l a r categories, and each category was t i t l e d according to the main i d e n t i f i a b l e theme. For example, comments, concerns, or c o n f l i c t s around c l i e n t differences i n country of o r i g i n , immigration status, age, and generation were compiled and l a b e l l e d under the t i t l e Mwithin-group differences." Each piece of carded information was sorted into t h i s p i l e or set aside as a potential new category; and the process repeated u n t i l a l l the cards were exhausted. The f i n a l p i l e s or broad categories were then reviewed f o r i n t e r n a l consistency. At t h i s stage of the data analysis a second rater , or "auditor," reviewed the f i n a l category p i l e s to ensure that they were both i n t e r n a l l y homogeneous (si m i l a r i n content theme) and externally heterogeneous (as d i f f e r e n t as possible from category to category). F i n a l l y , each of the category p i l e s was analyzed and written up according to the general themes and concepts and underlying meaning emerging from the data (Appendix C). The data was simultaneously cross-referenced with and corroborated by information ("evidence") gained from the "key informant" interviews and from the previous l i t e r a r y research on the relevant subject areas. 61 CHAPTER FOUR CHINESE CULTURAL CONTEXT In order to understand the expectations, reactions and experiences of t r a d i t i o n a l Chinese c l i e n t s towards the Western counselling process, i t i s necessary to have some knowledge of t r a d i t i o n a l Chinese philosophy and hi s t o r y . By providing a base of background information i n these areas, my intent i s to "set the stage" for the subsequent analysis of interview information (Chapter f i v e and Chapter s i x ) . History of Chinese Immigrants i n Canada F i r s t A r r i v a l s (1858 - 1884) to Western Canada There are accounts of Chinese people a r r i v i n g i n B r i t i s h Columbia (Meares Island) as early as 1788 to help b u i l d ships (Hardwick & Moir, 1975): They were B.C.'s f i r s t Chinese immigrants and they came on the ship of B r i t i s h fur trader John Meares. The year was 1788, and the Chinese were taken to Nootka Sound on Vancouver Island, where Meares intended to es t a b l i s h a colony. The Spanish took oyer the B r i t i s h ship and the Spanish took the Chinese workers hostage....It's s t i l l a mystery what happened 6 2 to them Unconfirmed documents have them intermarrying with the native Indian population, taken to the Spanish colonies by t h e i r captors, or returning to China (Dolan, 1991). However, i t was i n the 1850's and 1860's that thousands of Chinese immigrants arrived i n B r i t i s h Columbia from C a l i f o r n i a or d i r e c t l y from China i n response to the Cariboo gold rush. Another wave of Chinese immigrants arrived i n the early 1880's with the construction of the Canadian P a c i f i c Railway. The Canadian government, needing a large volume of cheap labour, recruited Chinese people. According to Barman (1991), "between 1881 and 1884, over 15,000 Chinese labourers were imported to work on the CPR (p. 82)." China by the l a t e 1800's had suffered years of famine, war and economic hardship. The bulk of Chinese labourers recruited for emigration were men from a poor r u r a l farming d i s t r i c t of Kwangtung province i n Southeastern China. Agents from Hong Kong would go from v i l l a g e to v i l l a g e to r e c r u i t labourers f o r shipment from Hong Kong to Canada (Hardwick & Moir, 1975). Like other immigrants, the Chinese came to Canada to escape from conditions at home and to seek a better l i f e . Most believed that they would stay temporarily as "sojourners," work hard, and make lo t s of money to take back with them to China. However as they were paid l i t t l e (1/3 to 1/2 less than Europeans, according to Barman, 1991, p. 133), i t was d i f f i c u l t to repay the money fo r 63 t r a v e l which had been advanced, and t h e i r d i f f i c u l t y prolonged the time i n which they could save enough money to return to China. Most also had received l i t t l e education i n China, did not speak English, and did not understand Western culture. These factors, plus increasing r a c i a l h o s t i l i t y , contributed to the Chinese immigrants making l i t t l e e f f o r t to integrate into Canadian society. Between 1881 and 1884 as many as 17,000 Chinese came to B r i t i s h Columbia. Over half came d i r e c t l y from China; a substantial portion of the res t from the United States. About 1,500 died of disease or accidents, an unknown number crossed i l l e g a l l y into the United States, and many (about 1,000 i n 1885) returned to China (Roy & Tan, 1985, p. 7). With the completion of the railway i n 1886, many remaining Chinese labourers were poor, undernourished and without family support. Some set up small businesses, others took on jobs i n canneries, lumber-mills, or mining. Restricted Entry C1886 - 1923) Between 1886 and 1903, the government of Canada, under heavy p o l i t i c a l pressure from white union workers i n p a r t i c u l a r who feared the Chinese as "unfair competition" f o r jobs because they were w i l l i n g to work long hours f o r l i t t l e pay, imposed a series of head taxes on a l l incoming Chinese: f i r s t $50.00, increased i n 64 1900 to $100.00 and then three years l a t e r to $500.00. However, i n spite of the heavy tax and strong discrimination, Chinese immigrants continued to enter Canada. The anti-Chinese movement became wide-spread and Chinese immigrants suffered from r a c i s t attacks and discrimination. As Sue and Sue (1990) explain: The Chinese were e s p e c i a l l y vulnerable as scape-goats because of t h e i r "strange" customs and appearance; that i s , they wore t h e i r h a i r i n queues ( p i g t a i l s ) , spoke i n a "strange tongue," and ate "unhealthy" food (p. 193). My father was one of the f i r s t Chinese i n Canada to cut o f f h i s p i g t a i l , or "queque". That meant he could never return to h i s native land. Three hundred years before, when the Manchus conquered China, they forced a l l Chinese to wear p i g t a i l s to show that they were a vanquished people. Later the Chinese made the "queque" a badge of honour but reminders of i t s shameful o r i g i n remained - In China, anyone caught without a p i g t a i l was beheaded (Lim, S., 1979, p. 5). In 1873 an Anti-Chinese Society was formed i n V i c t o r i a to "Keep Canada white," and i n 1878 the Working Men's Protective Association i n i t i a t e d a p o l i c y of not h i r i n g Chinese or patronizing Chinese businesses and agreed to "neither aide nor 65 abet Chinamen." Chinese were frequently k i l l e d , beaten, or "hosed down" (Hardwick & Moir, 1975). Such open racism came to a head with an eruption of violence, known as the " A n t i - A s i a t i c Riots," which broke out i n Vancouver's Chinatown i n 1907. I was born i n 1915. We l i v e d on the f i f t h f l o o r of a huge building on Pender Street, one wing stretched down Shanghai A l l e y and the other down the r a i l r o a d tracks. In the centre was a court-yard c a l l e d Canton A l l e y . Eight years e a r l i e r , r i o t e r s had smashed a l l the windows i n the Chinese d i s t r i c t and then gone on to attack the Japanese. The new building was meant to protect us i n case of future r i o t s . I t had only one entrance with an iron gate that could be closed i n an emergency, l i k e a prison or a f o r t (Lim, S., 1979, p. 14). During the F i r s t World War China was an a l l y of Canada. Chinese labourers were recruited to dig trenches, and Chinese battalions fought along side Canadians against Germany. 66 About twenty single men l i v e d i n the apartment below us... They talked of the thousands of Coolies from Northern China who were kept locked up i n boxcars on the r a i l - r o a d tracks alongside our building. They were being taken across Canada and sent on to France to dig trenches during World War 1. (In 1916-1917, more than 200,000 passed through Canada t h i s way). People from our building would go down, t a l k to the frightened men, and pass food into the cars (Lim, S. 1979, p. 15). Exclusion C1923 - 1947^ After the F i r s t World War Canada experienced an economic slump. Returning s o l d i e r s were often unemployed and factory workers were l a i d o f f . Racism soared as white workers again blamed the Chinese f o r taking away t h e i r jobs and i n 1923 pressured the Canadian federal government, under Prime Minister MacKenzie King, into passing The Chinese Immigration Act, or Exclusion Act, which successfully prevented Chinese immigrants from entering the country from 1924 to 1947 (Lai, 1988; Barman, 1994) . Under the Exclusion Act people of Chinese o r i g i n were prohibited from coming int o Canada unless they were "exempted classes such as consular o f f i c i a l s , children born i n Canada, 67 merchants and students ( L a i , 1988. p. 56)." There was a sharp decline i n the Chinese population during t h i s time due to the severe immigration r e s t r i c t i o n s ("During the period of exclusion, only twelve Chinese were admitted to Canada as Immigrants." L a i , 1988. p. 56); to the f a c t that many l e f t the country which they found h o s t i l e and unsupportive ("Between 1921 and 1930, a high of nearly 59,000 Chinese registered to leave." L a i , 1988. p. 56); and to the low b i r t h rate because of the low number of Chinese women i n Canada. Women were not as mobile as men i n China...Women were nei-ren or "inside people"... This stereoptype emanates from centuries of Confucian philosophy which defines women's i d e a l place i n the domestic sphere. While many men borrowed money from r e l a t i v e s f o r the passage to the New World, women were expected to stay at home to take care of aged parents and children, waiting for t h e i r husbands to send money home (Chiu, 1994, p. 15). Post-War Selective Entry f1947-Present) During the Second World War, China was, again, an a l l y of Canada, and Chinese-Canadians volunteered for active duty and raised money to finance the war. Chinese-Canadians began lobbying against the Chinese Exclusion Act, and they were successful i n 1947 when the Canadian parliament f i n a l l y repealed 68 the act. Men holding Canadian c i t i z e n s h i p were allowed to bring i n t h e i r wives and unmarried children under the age of 18 (Barman, 1991, p. 311). There continued, however, to be r e s t r i c t i o n s on Chinese immigration u n t i l the Canadian government changed i t s immigration Pol i c y i n 1967. After the new p o l i c y was introduced immigrants of Chinese descent "quadrupled to almost 100,000" (Barman, 1991). A r r i v a l s tended to concentrate i n the Greater Vancouver area to such an extent that by 1981 Vancouver contained "almost 90 per cent of B.C. residents whose mother tongue was a Chinese language" (Barman, 1991, p. 311). Post-war Chinese immigrants came from many d i f f e r e n t areas aside from Mainland China: Hong Kong, Taiwan, S.E. Asia, B r i t a i n and the U.S. Unlike the poor, unemployed, and often uneducated Chinese "pioneers," many of the new immigrants are educated professionals with English s k i l l s and exposure to Western culture. Growing numbers of immigrant a r r i v a l s from Hong Kong r e f l e c t e d , and continue to r e f l e c t , the uncertainty and concern over t h e i r economic and p o l i t i c a l s i t u a t i o n when China takes over the now-B r i t i s h colony of Hong Kong i n 1997. In 1971 Prime Minister Trudeau f i r s t introduced a Canadian p o l i c y of Multiculturalism (see Appendix E), and i n 1978 a new Immigration Act was passed i n which Chinese immigrants, e s p e c i a l l y those who could generate employment i n Canada, were encouraged to s e t t l e i n Canada. Meanwhile, the Chinese government relaxed i t s emigration r e s t r i c t i o n s so that Chinese wives and 69 families (mostly farmers or farm labourers with no English) could be reunited with t h e i r family member i n Canada. Canada also opened i t s doors to a large number of Southeast Asian refugees from mainland China and Vietnam ( S t a t i s t i c s Canada 1981b). As a re s u l t , between 1978 and 1981, Asians accounted for 43.8 per cent of a l l immigrants to Canada ( S t a t i s t i c s Canada 1981b). There i s obviously tremendous d i v e r s i t y among recent Chinese immigrants to Canada: Socio-economic status among immigrants varies from well-to-do families who bring t h e i r l i f e l o n g savings to invest i n Canada, to low income refugees who have to work long hours to support t h e i r f a m i l i e s . Educational background also ranges from professionals^who are universi t y educated to people with no education who are i l l i t e r a t e i n both English and t h e i r home language. (Waxier-Morrison, Anderson & Richardson, 1990. p.72) Tr a d i t i o n a l Chinese Values and B e l i e f s Many t r a d i t i o n a l Chinese values stand i n d i s t i n c t contrast to t r a d i t i o n a l Western-European values. However, i t i s important to keep i n mind that the values inherent i n any culture are constantly changing. Many long-held Western values and b e l i e f s , as described previously i n Chapter One, such as the emphasis on 70 autonomy and s e l f - r e l i a n c e and the respect given to l i n e a r , " l o g i c a l " thinking over that given to i n t u i t i o n , have been challenged by p o l i t i c a l / s o c i a l groups within the culture (McGoldrick, Anderson, and Walsh, 1989). S i m i l a r l y , many of the t r a d i t i o n a l Chinese values are being challenged by d i f f e r i n g generational perspectives and inter-group experiences: ...the struggles of immigrants i n the la t e 1800's and early 1900's are l i k e l y to be d i f f e r e n t for new immigrants the presences of f i f t h and s i x t h generation Asian Americans and of new immigrants w i l l r a i s e even greater issues of group i d e n t i t y and s o l i d a r i t y ; the presence of the children of i n t e r r a c i a l marriages w i l l also r a i s e major issues of group i d e n t i t y , acceptance, and s o l i d a r i t y (Sue & Morishiroa, 1982, p.187). However, understanding the underlying h i s t o r i c a l roots of a culture provides a necessary basis for understanding the o v e r a l l context of an indiv i d u a l ' s values. This section, therefore, looks at some of the Chinese values, assumptions, and b e l i e f s that underlie Chinese culture. The predominant philosophical perspectives within Chinese history which have shaped Chinese culture are Confucianism, Taoism, and Buddhism. Confucianism Confucius (whose Chinese name was Kung Fu-tse) was a teacher and philosopher who l i v e d i n the Northern Chinese province of Lu 71 from 552 - 479 B.C. This was a time of war and upheaval i n China, and Confucius philosophy r e f l e c t s a desire to return to and maintain harmony and s t a b i l i t y . (Das, 1987). How one achieved such harmony, according to Confucius, was through s t r i c t and proper adherence to c e r t a i n rules of interpersonal conduct. In contrast to the Western-European conception of man as an i n d i v i d u a l autonomous being, Confucius saw man as a r e l a t i o n a l being: "In the Confucian human-centred philosophy, man cannot e x i s t alone; a l l actions must be i n a form of i n t e r a c t i o n between man and man" (King & Bond, 1985, p. 31). The i n d i v i d u a l was, therefore defined and shaped by a r e l a t i o n s h i p context, and each re l a t i o n s h i p had a "proper" set of behaviours (a "role system"), c a l l e d L i , set out by Confucius: Li, which can be conceptualized as the grammar of re l a t i o n s h i p s , lays out the guidelines for harmonious interpersonal r e l a t i o n s h i p s (King & Bond, 1985; Shon & Ja; 1982). In the Confucian s o c i a l system, the family occupied a place of central importance. I t was considered the primary s o c i a l group as well as the prototype for a l l s o c i a l organizations. A hierarchy of relationships status and structure was defined according to sex (the father-son bond being of highest importance); age (both generational and chronological); and kinship proximity. Obedience to the rules of proper behaviour, according to these l i n e s of hierarchy, entailed subordination of the s e l f to the family group: 72 The family, as the primary s o c i a l r e a l i t y for Chinese, was c h i e f l y responsible f o r s o c i a l i z i n g i t s members to function within these r e s t r a i n t s to achieve harmony. Often t h i s harmony was purchased at the price of in d i v i d u a l i n t e r e s t s , despite the considerable emphasis on i n d i v i d u a l development and c u l t i v a t i o n . (Tseng & Wu, 1985, p. 37). Restraint of emotions were expected throughout one's l i f e to achieve the goal of moderation, balance and harmony as prescribed by Confucius (King & Bond, 1985). From childhood, Chinese are trained to control emotions that are considered adverse and disruptive to harmonious s o c i a l interactions (Tseng & Wu, 1985, p. 10). As a r e s u l t , Chinese people are sometimes considered emotionally reserved by Western-European standards: Chinese people have some character t r a i t s that are u t t e r l y d i f f e r e n t from those of Westerners. For example, Chinese are emotionally more reserved, introverted, fond of t r a n q u i l i t y , overly considerate, s o c i a l l y overcautious, habituated to s e l f - r e s t r a i n t , and so f o r t h (Tseng & Wu, 1985, p. 53). In Southern China the family grouping was extended to that of a "lineage, " which included "a group of male r e l a t i v e s and t h e i r households l i v i n g together i n one v i l l a g e of about one 73 thousand people. A lineage would include both r i c h and poor members, a l l with the same l a s t name" (Riddach, S., 1979, p. 285). The lineage council arranged marriages, made decisions regarding the groups property management, decided who would be educated and who would emigrate, and provided protection and assistance to members who could not work or were i l l . The emphasis on kinship r e l a t i o n a l patterns was extended to friends outside of the family: What i s probably a d i s t i n c t i v e c h a r a c t e r i s t i c of Chinese friendship i s that i t s nature i s always couched i n kinship terms. That i s , r e l a t i o n s among friends are constructed along the pattern of elder brothers and younger brothers (Tseng and Wu, 1985, p. 38). However, nowhere, according to Tseng and Wu does Confucius discuss r e l a t i o n s among strangers, and discomfort with new contacts can be the r e s u l t : In the case of the Chinese, the indiv i d u a l ' s discomfort with strangers l i e s p a r t l y i n the f a c t that he i s unable to r e l a t e to strangers through any lun prescribed by Confucian ethics (Tseng & Wu, 1985, p. 39). 74 Tongs were family or clan organizations. We belonged to the Lim tong (sometimes spelled Lam or Lum), one of the largest i n Canada. The tong helped members with money problems and protected them from outsiders. At the meetings complaints were heard against any member who had not acted r i g h t l y . There were many tongs or family associations i n Vancouver's Chinese community. One of the most c o l o u r f u l was the Gee Gung Tong, or the Chinese Free Masons. I t started as a secret society and haven f o r n a t i o n a l i s t s who hoped to free China from the rule of the Manchu dynasty. They c a l l e d themselves Free Masons because i t made them sound l i k e a legitimate secret society to Westerners, although they were not recognized by the true Free Masons. Af t e r the Manchu dynasty f e l l i n 1911, i t stopped being secretive and members wore the Chinese Free Mason i n s i g n i a buttons on t h e i r l a p e l s . Even today, the society i s very active i n l o c a l Chinese a f f a i r s (Lim, S., 1979, p. 50). Taoism T r a d i t i o n a l Chinese medicine i s based i n Taoist philosophy which aims to achieve balance and harmony between l i f e forces within the body and between the body and the universe. This i s achieved through behaving i n ways which conform to the laws of nature: "...(man) w i l l be reunited with the whole (Tao), i f he 75 w i l l y i e l d his egoism so that the whole may be preserved ( L i , K. C , 1987)." T r a d i t i o n a l Chinese medicine i s based on Taoist philosophy which, does not separate mental and physical processes: According to the Nei Ching (an ancient text of Chinese medicine), man i s inseparable from h i s universe, which i s viewed as a vast, i n d i v i s i b l e e n t i t y . A l l of man and nature are related to each other i n a harmonious balance. Individuals must adjust themselves wholly to the environment and maintain t h i s balance, since imbalance brings i l l n e s s . Five elements - wood, f i r e , earth, metal, and water - form the universe (Waxier-Morrison, Anderson, & Richardson, 1990, p. 78). Taoism conceptualizes two major l i f e forces: Yin (which i s negative, female, darkness, night, moon, cold) and Yang (which i s po s i t i v e , male, l i g h t , day, sun, warmth), both c i r c u l a t i n g throughout the body's "meridians." The unimpeded flow of Yin and Yang produces good health, a blockage of flow produces disease ( L i , K.C, 1987). The human body i s viewed as a g i f t from parents and forebears, and should be well cared f o r and preserved. Chinese,..medicine bases many of i t s ideas on c l a s s i c a l sources, but the concepts may hold d i f f e r e n t meanings. "Hot" and "cold" are often substituted f o r Yang and Yin, although harmonious balance must be maintained between 76 the two opposing forces (Waxier-Morrison, Anderson, & Richardson, 1990, p. 78). Both Confucianism and Taoism stress the importance of proper interpersonal relationships and the s o c i a l consequences of behaviours. Social factors, rather than intra-psychic factors such as insight, are considered the most important element i n the causation or resolution of emotional disturbance. According to the Taoist (as well as Buddhist) perspective, a presenting problem may r e f l e c t a punishment from "God" f o r a v i o l a t i o n of a moral norm committed by any member of the family, including ancestors. Buddhism Buddhism originated i n India around 500 B.C. and l a t e r spread to other Asian countries, including China. Buddha (the founder of Buddhism) created a philoshophy to transcend human pain and suffe r i n g , which he saw as an inevi t a b l e part of human l i f e : " f r u s t r a t i o n s and su f f e r i n g are the r e s u l t of craving or desire f o r things human want and fear of things they want to avoid" (Tseng & Wu, 1985, p. 38). Buddha stressed, therefore, avoidance of overindulging oneself, on the one hand, and a relaxation of s e l f - d e n i a l , on the other. Buddhism i s s p l i t into two major d i v i s i o n s : the Thervada form which stresses personal salvation through s e l f - d i s c i p l i n e (This stream i s primarily concentrated i n S r i Lanka, Burma, and 77 Thailand); and the Mahayana form i n China, which emphasizes universal salvation and compassion for a l l . The Thervada id e a l i s the "arhat," one who has severed a l l t i e s to family, friends and possessions to become t o t a l l y free of t h i s world. The Mahayana id e a l i s the "bodisattva," which means the "enlightenment-being". The bodhisattva i s a highly compassionate being who has vowed to remain i n t h i s world u n t i l a l l others have been freed from s u f f e r i n g . An i n d i v i d u a l human being can ask for help from one of the "bodhisattvas." Zen buddhism i s a major offshoot of the Mahayana. According to Mahayana Buddhism, knowledge and wisdom are passed down through the Buddhist teacher from one generation to the next. Deeds of t h i s l i f e , good or bad, can a f f e c t the l o t of future generations, just as deeds of past ancestors can a f f e c t one's current l i f e s i t u a t i o n . One's actions have consequences f a r beyond the immediate and personal. (K.C. L i 1987). Proper worship of ancestors, therefore, i s an important part of showing respect for one's family. Buddhism encompassed a h o l i s t i c perspective i n which the i n d i v i d u a l i s considered part of the larger family and indeed i s part of an even larger cycle of past and future; fate and destiny play a large part i n the events of one's l i f e . A Chinese family included dead as well as l i v i n g members. One of the most important duties was that of ancestor worship. I t was very necessary to carry out 78 these ceremonies i n the proper way. Departed ancestors could help bring about the family's prosperity here on earth. If the family r i t u a l s were not conducted i n the prescribed fashion, bad luck might follow...The preparation for death might begin years...before a parent a c t u a l l y died (Riddach, 1979, p. 286). This example of " c i r c u l a r " thinking about actions, behaviour and events i s i n d i r e c t contrast to Western European l i n e a r thinking which stresses a s t r a i g h t cause-effect chain of events i n which one i s led to believe that one can be i n charge of the events of one's l i f e and d i r e c t one's own fate. 79 CHAPTER FIVE RESULTS Chapter f i v e discussed the data obtained from the content analysis of the eight interviews. The interview data revealed an immense amount of consistent responses from the interview p a r t i c i p a n t s . Although the general topic areas were suggested by the Interview Guide (Appendix A), c e r t a i n experiences and topics took on more importance than others f o r the participants based on t h e i r own experiences. Chinese family structure and dynamics, for example, created i t s ' own theme due to the frequency and l e v e l of importance given i t by the p a r t i c i p a n t s . Overlapping responses between the eight interviews on s i m i l i a r topics provided the basis f o r the t h i r t y categories which arose from analysis of the interview t r a n s c r i p t s . The categories were then combined into nine broader themes or patterns (see Appendix C f o r a detailed description of the topics, categories and themes). The data information w i l l be discussed under the headings of these nine broad themes, which are: 1. A need for counsellors to be aware of the complex and evolving nature of culture. 2 . A need for counsellors to have or to obtain knowlege of t r a d i t i o n a l Chinese family structure and dynamics, and the implications of these structures and dynamics f o r counselling. 3 . A need for counsellors to understand the expectations of the counsellor r o l e held by t r a d i t i o n a l Chinese c l i e n t s , and how these expectations might c o n f l i c t with the counsellor r o l e i n i n Western counselling. 4. A need fo r counsellors to understand c u l t u r a l differences i n t r a d i t i o n a l Chinese concepts of counselling and psychological processes, and how these contrast with Western concepts of counselling and psychological processes. 5. A need for counsellors to be aware of the potential negative e f f e c t of the t r a d i t i o n a l Western counselling s e t t i n g , and to consider possible c u l t u r a l l y appropriate a l t e r n a t i v e s . 6. The need for counsellors to be aware of c u l t u r a l differences a f f e c t i n g the c l i e n t s expectations of s e l f - d i s c l o s u r e by themselves and by the counsellor, and to be f l e x i b l e i n the l e v e l of s e l f - d i s c l o s u r e they provide f o r the c l i e n t and the l e v e l of s e l f - d i s c l o s u r e they expect from the c l i e n t . 7. The need fo r counsellors who do not speak Chinese to be aware of the variations i n meaning and interpretation of verbal communication between languages. 8 . The need fo r counsellors to be s e n s i t i v e to how t h e i r non-verbal communication may create a distance between themselves and a t r a d i t i o n a l Chinese c l i e n t , and to be cautious i n interpreting the non-verbal messages of Chinese c l i e n t s . 9. Suggestions for counsellors working with Chinese c l i e n t s , based on the interview p a r t i c i p a n t s ' experiences of blending Western counselling t r a i n i n g with t r a d i t i o n a l Chinese values 81 I w i l l now proceed to describe each of these themes i n more d e t a i l . Awareness of The Complex and Evolving Nature of Culture This theme contains comments about the d i v e r s i t y within any c u l t u r a l group. References were made to t h i s d i v e r s i t y by a l l of the interview p a r t i c i p a n t s . The importance of not making general assumptions about an i n d i v i d u a l c l i e n t based s o l e l y on generalized c u l t u r a l information was stressed. For example, although a l l the counsellors interviewed were from a Chinese culture (Hong Kong), they made a point of not speaking f o r the experience of a l l Chinese c l i e n t s . As one counsellor (A.C.) put i t : I'm from Hong Kong myself. I f I'm dealing with someone from China sometimes I don't understand the educational background they came from...or some of the things they went through during the p o l i t i c a l upheaval of t h e i r country. And the reason why they suddenly quit school, for example, was perhaps because of p o l i t i c a l reasons not because of t h e i r own lack of academic a b i l i t i e s . There i s , as another interviewee put i t , "no homogeneous culture" (J.H.). The difference between people from Mainland China, Hong Kong, or Taiwan was a frequent d i s t i n c t i o n : The Mainland Chinese are more t r a d i t i o n a l , so they s t i l l keep most of the Chinese values l i k e respect of authority, that type of thing. The Hong Kong Chinese are much more 82 Westernized, l i k e equality, respect, freedom, these kind of things. I would say that Taiwan Chinese are r i g h t i n the middle, okay? They have some exposure to the Western culture, however they are not as Westernized as the Hong Kong Chinese. The "westernization" of Hong Kong Chinese was mentioned often, and was taken to mean that there had been an incorporation of the Western-European values of individualism, competition, and achievement while "the t r a d i t i o n a l value of Zhi Zn (contentment with one's l o t ) has been abandoned by many of the Hong Kong Chinese" (Tseng & Wu, 1985. p. 199). However, although country of o r i g i n i s important, within-c u l t u r a l d i s t i n c t i o n s go f a r beyond that and are, as one interviewee expressed i t : "much more subtle" (J.H.). Other important factors include: Are they f i r s t generation, second generation, t h i r d generation? Which part of China did they come from? What i s t h e i r d i a l e c t ? , what i s t h e i r language?, and how schooled are they i n t h e i r f i r s t language?...I want even more to d i s t i n g u i s h , e s p e c i a l l y the second generation, whether they are born here, at what age they come. If i t ' s before ten, or a f t e r ten, or a f t e r seventeen, that's very d i f f e r e n t . Because i f you come at nine, you may have two or three years adjustment there before you graduate from High School...you're able 83 to say "I grew up i n Vancouver"....If you come at seventeen, you know that you're not grew up i n Vancouver, you know that you are an immigrant. You do have a second language, (but) you have enough Chinese to be able to continue to read i n Chinese and be able to t a l k i n Chinese for the r e s t of your l i f e . . . . b u t , i n between that, twelve to f i f t e e n , you don't have enough Chinese to read and write. Your English i s not good enough to read and write at that point. And you have a hard time catching up (L.C.). The c u l t u r a l influences of an urban background or r u r a l background were frequently mentioned by the interviewees as important aspects of the c l i e n t ' s culture to consider as well: That's why you have to ask when a person comes from China, WHERE i n China? The person i s very d i f f e r e n t i n the countryside, i n the c i t y , or i n a large metropolitan town l i k e Shanghai. Very d i f f e r e n t ( L . C ) . An understanding of c l i e n t ' s s p e c i f i c c u l t u r a l background a f f e c t s the counsellor's a b i l i t y to understand and to empathize with the c l i e n t ' s experience and with the a b i l i t y to gain the c l i e n t ' s t r u s t . As C A explains: . . . i n working with c l i e n t s coming from Mainland China, because of the p o l i t i c a l system there and also because of some of the s o c i a l upheavals over there...the t r u s t among people i s very small. I f i n d i t a b i t more d i f f i c u l t to gain t h e i r t r u s t , . . And as a group I think they have more experience i n betrayals, hurts, bad experiences i n growing up during the Chinese Cultural Revolution (1965 to 1975)...For people from Mainland China I have to take that into consideration. Another interviewee (E.H.) expressed i t i n t h i s way: If you're comparing a person coming from Hong Kong to someone who's coming from V i e t Nam...Hong Kong being a very a f f l u e n t , quite Westernized, information free-flowing, enterprising kind of place where people might be able to give you more information f r e e l y without thinking...than a person who came from a previously war-torn, communist kind of oppression, i f you could use that word, kind of country where people need to be more protective of things that they need to dis c l o s e , you know, information d i s c l o s i n g . The major recommendation for counsellors/therapists made by the interviewed counsellors was to not make assumptions about an i n d i v i d u a l c l i e n t based on one's own c u l t u r a l perspective or on generalized information about the c l i e n t ' s culture. Interviewees were very aware of NOT making assumptions. S.W. explained: I won't say "Okay, you are Chinese, then you are t h i s and they won't have those"...I won't make any assumptions unless the c l i e n t say something f i r s t , or unless i t ' s quite obvious. 85 E.H. expressed t h i s same sentiment by st a t i n g : You r e a l l y need to see the person as an in d i v i d u a l f i r s t . . . n o t that t h i s i s a Chinese person or a Caucasian person or an Indian person, you know, so that's important. That's the foremost. The dangers of assuming are, of course, that one's own c u l t u r a l perspective may d i s t o r t or mislabel a c l i e n t ' s feelings or behaviour, thus creating distance and mistrust of the counsellor by the c l i e n t . C u ltural interpretations of feelings or behaviours are not universal: . . . i n the Caucasian culture i t might look l i k e , you know, "oh, t h i s person i s r e a l l y psychotic," such as, maybe, you know, seeing s p i r i t s , seeing Gods, or whatever. But i n an Asian culture, i f they come from a v i l l a g e background, that might be an appropriate response. I t might be r e a l or i t might not be r e a l (E.H.). The interviewees had several suggestions f o r avoiding making c u l t u r a l assumptions. F i r s t , check i t out with the c l i e n t . Many interviewees, such as S.W., pointed out that: You can ASK c l i e n t s , say "Is i t t h i s way?", "Have you been thinking about t h i s ? " , "Is i t because of t h i s ? " You can ask that. E.H. repeated the same sentiment: If you f e e l that there are things during the interview that you don't quite understand and you wonder i f i t ' s a c u l t u r a l thing or not...ask them. You know, "I don't quite understand t h i s , " or "Can you explain a l i t t l e b i t more about t h i s ? " "Why d i d t h i s happen?" And once again, from A.C.: I f i n d i t h e l p f u l , i f I'm not sure, to a c t u a l l y ask s p e c i f i c a l l y . You know, "What has happened? Is that normal i n your culture?" Show them that I have some c u l t u r a l s e n s i t i v i t y that there ARE c u l t u r a l differences. J.H. perhaps explained most c l e a r l y the need for a counsellor to ask the c l i e n t f o r c l a r i f i c a t i o n i f a c e r t a i n message the c l i e n t i s sending i s not understood: Every b i t of behaviour has t h e i r family culture and ethnic culture heritage, and i t varies so much. So, I would rather l i k e to understand what that means to that person than reading my understanding of that culture into the person...But we always work with assumptions, so I t r y to f e e l out a s i t u a t i o n . If I don't understand, then I ' l l ask. The second suggestion, made by several interviewees, was to ask for input or c l a r i f i c a t i o n from someone with expertise i n the c l i e n t ' s culture: If you s t i l l f e e l perplexed...try to see i f you have a colleague or some other people, m u l t i c u l t u r a l workers or other professional people, from that p a r t i c u l a r (cultural) background that you can a c t u a l l y CONSULT with and t r y to c l a r i f y some points (E.H.). 87 And, t h i r d l y , the interviewees encouraged counsellors to educate and open themselves up to learning more about the c l i e n t ' s culture, through reading books, taking courses, and consulting with colleagues who may have more knowledge about t h i s c u l t u r a l group. This increased knowledge was seen to benefit both the c l i e n t and the counsellor: The more knowledge you have about the c u l t u r a l background of that certain...group I think the more you also f e e l comfortable working with t h i s c l i e n t e l e (E.H.). S p e c i f i c a l l y , the interviewees mentioned recognizing and respecting important c u l t u r a l events, such as Chinese New Year. A counsellor needs to respect, and make adjustments f o r the fa c t that, f o r example, some Chinese c l i e n t s may refuse to see a doctor during Chinese New Year or on t h e i r birthday as they believe i t brings bad luck. Quite a l o t of Chinese people they don't want to come to see a doctor on Chinese New Year. They will...need to see a doctor for the rest of the year.... So change that, juggle around. You can ask "That day i s Chinese New Year. Do you mind coming back then, or do you want i t to be changed?"...Sometimes, Chinese New Year, they may be busy with t h e i r own fa m i l i e s , which i s a very good sign, too. I say "Do you mind coming? Do you have time to come?" (S.W.). The interviewees also mentioned checking the immigrant status, 88 the l e g a l status, of the c l i e n t as a way to understand and show consideration f o r the c l i e n t ' s experience, thereby building a bridge to rapport: My local-born colleagues have no idea of the difference even between an immigrant and a citizen...and i f a person i s a refugee. I always t r y to check what they went through, f i n d out i f the person i s a refugee versus a landed immigrant. So I think those kind of things help (A.C.). And, f i n a l l y , many interviewees suggested counsellors learn about important c u l t u r a l b e l i e f s s p e c i f i c to the c l i e n t ' s culture. An example of an important b e l i e f of t r a d i t i o n a l Chinese culture was that of Hot and Cold foods (based on the Taoist philosophy). Quite a l o t of Chinese, they are revealing...some of the foods they eating i s c a l l e d HOT food, some of the food they eating c a l l e d COLD food, and some of the food they eat they would c a l l WIND food. For example, one of the food c a l l e d HOT food i s some deep-fried things, and spicy and c h i l i things, and these so-called HOT food give them a dry mouth or sore throat, and then quite a l o t of these psychotropic medication would give them s i d e - e f f e c t s of dry mouth. So, a l o t of them they would say, "That i s HOT food," and then, they're not taking the re s t of the HOT food. So we may have to explain to them, "Okay, t h i s i s a s i d e - e f f e c t of the medication, and maybe one solution i s to suck HOT candies, drink more waters or some more j u i c e . " 89 Juice i s what they c a l l COLD food, anyway (S.W.). The importance of such c u l t u r a l awareness l i e s i n being able to assess i f the c l i e n t ' s actions, words, and feelings f i t into the norm or are an extreme v a r i a t i o n . S.W. gives an example of an extreme v a r i a t i o n of the desire to balance HOT and COLD foods within the body. Quite a l o t of people are not eating the watermelon. They think watermelon i s COLD...and COLD food w i l l make them weak. They won't eat these. So i t ' s quite a l o t of people believe i n these, okay?...But i f the c l i e n t becomes too extreme, you s t a r t wondering where do you draw the li n e ? Sometimes some c l i e n t say "I'm not eating anything my husband i s making, because he's only making COLD food. So I'm not eating anything at home11. So then I decide what i s too extreme or delusions, and what i s the normal c u l t u r a l b e l i e f s (S.W.). The emphasis i n the interviews on culture as complex and evolving i s repeated throughout the l i t e r a t u r e on m u l t i c u l t u r a l counselling (Ivey, Ivey, & Simek-Morgan, 1993; Pedersen, 1987, 1990, 1991, 1994; Pedersen & Ivey, 1993; Ponterotto & Pedersen, 1993; Sue, 1991, 1994; Sue & Sue, 1990). Although many t r a d i t i o n a l Chinese values stand i n d i s t i n c t contrast to the t r a d i t i o n a l Western values discussed previously (Chapter Four), i t must be kept i n mind that culture, including Western-European culture, i s a continually dynamic and changing 90 phenomenon. Just as many of the long-held values and b e l i e f s of Western European culture, such as autonomy, s e l f - r e l i a n c e , and authoritarianism are being challenged by p o l i t i c a l / s o c i a l groups within the culture, such as Feminism, so many of the t r a d i t i o n a l Chinese values are being challenged by d i f f e r i n g generational perspectives and intra-group experiences due to emigration and exposure to Western European culture. Furthermore, the i n d i v i d u a l and a culture are inseparably intertwined. Both the in d i v i d u a l and the culture are constantly evolving i n response to t h e i r dynamic re l a t i o n s h i p . ...the e s s e n t i a l thing i s the l i f e of the i n d i v i d u a l . This alone makes history, here alone do the great transformations take place, and the whole future, the whole history of the world, ultimately spring as a gigantic summation from these hidden sources i n ind i v i d u a l s . In our most private and most subjective l i v e s we are not only the passive witnesses of our age, and i t s s u f f e r e r s , but also i t s makers. We make our own epoch (Zohar, 1990. p. 198). A Need for Knowledge of Chinese Family Structure and Dynamics r and the Implications for Counselling The need to understand t r a d i t i o n a l Chinese family structures, i n p a r t i c u l a r the implications of the Chinese family's interdependency as contrasted with Western counselling's 91 focus on in d i v i d u a l autonomy (or " d i f f e r e n t i a t i o n " ) , was stressed by a l l the counsellors interviewed. Without such an understanding, i t was pointed out, counsellors could inadvertently place the t r a d i t i o n a l Chinese c l i e n t i n d i r e c t confrontation with t r a d i t i o n a l Chinese culture and create c o n f l i c t within the family system. Within the t r a d i t i o n a l Chinese philosophy of Confucianism, the in d i v i d u a l i s seen i n a r e l a t i o n a l context (Chapter Fi v e ) , which i s quite d i f f e r e n t from the i d e a l autonomous s e l f of Western-European culture (Chapter One). In t r a d i t i o n a l China the family, not the i n d i v i d u a l , i s the primary important s o c i a l u n i t : The family as the primary s o c i a l r e a l i t y f o r Chinese, was c h i e f l y responsible for s o c i a l i z i n g i t s members to function within these r e s t r a i n t s to achieve harmony. Often t h i s harmony was purchased at the price of in d i v i d u a l i n t e r e s t s , despite the considerable emphasis given by Confucian teachings to the need for in d i v i d u a l development and c u l t i v a t i o n (Tseng & Wu, 1985, p. 37). Therefore, i t i s understandable that, given a t r a d i t i o n a l Chinese background, as one interviewee put i t , "anything that your parents or extended family say i s usually weighted more heavily than other things" ( L . C ) . A demonstrated understanding of the importance of input and d i r e c t i o n from the family i n a Chinese-c l i e n t ' s decision-making process can help to b u i l d rapport: understanding the r o l e the family play...I can 92 actu a l l y ask: "What does your father think of i t ? " So showing that I understand the dynamics and pra c t i c e of making a decision i s not just what YOU want to do, but what does your father think of i t , what does your family think of i t , to make sure that I bring i n a l l the support to follow through on a decision. And I think that's h e l p f u l . . . f o r the c l i e n t to know that someone understands what's involved i n his making a decision, that there are other factors that could change his mind (A.C.). There i s a danger i n a Western-trained counsellor misjudging the close family connections within a t r a d i t i o n a l Chinese family as unhealthy or abnormal: Western cultures may see Chinese families as enmeshed b u t . . . i t ( i s ) quite normal within Chinese culture (S.W.). Many interviewees described the dichotomy between the Western counselling goal of i n d i v i d u a l i t y or d i f f e r e n t i a t i o n , and the t r a d i t i o n a l Chinese family structure. For example: . . . i n a Chinese culture i t ' s very very normal for children, e s p e c i a l l y i f they're not married, to l i v e with t h e i r parents even when they're t h i r t y or f o r t y years o l d . So i t ' s not necessarily pathological behaviour which a l o t of Western-trained colleagues think (A.C.). This observation i s quite consistent with research done i n 93 Mainland China (1994) i n which i t was found that ninety percent of mental health c l i e n t s l i v e d at home. Western-trained counsellors may, i t was believed by the interviewees, lack awareness of the t r a d i t i o n a l Chinese culture's emphasis on the family as a c o l l e c t i v e concept, and of the indiv i d u a l ' s behaviour as representing the c o l l e c t i v e q u a l i t i e s of the family, including ancestors (Tseng & Wu, 1985). Without such an awareness, counsellors may react inappropriately to the needs of the t r a d i t i o n a l Chinese c l i e n t and family. I've seen Western-trained colleagues [without an awareness of Chinese culture] encouraging the c l i e n t to move out of the parents' home or some individuation, separating from the parents...sometimes they would diagnose i t as being a problem, i n d i c a t i v e of problems, and encourage the person to move out as a sign of making progress (A.C.). I t was recommended that counsellors working with t r a d i t i o n a l Chinese c l i e n t s be aware of the family p o t e n t i a l as a major c l i e n t resource, while also being aware of the possibly l i m i t i n g e f f e c t s of tolerant and interdependent family involvement on the c l i e n t ' s sense of s e l f - r e l i a n c e : Family members r e a l l y have been quite tolerant towards the c l i e n t . They may be keeping the c l i e n t at home, tr e a t i n g the c l i e n t , t o l e r a t i n g the problem ...they may give some kind of support to the c l i e n t 94 emotionally or p h y s i c a l l y as well as supporting the (by providing) a l o t of resources f o r the c l i e n t . So, some of the c l i e n t s are not sure whether they are able to function, to leave home and l i v e on t h e i r own (S.W.). An evaluation of the parents l e v e l of involvement, therefore, needs to include an understanding of the c l i e n t ' s culture so as to be able to judge what behaviour or circumstances are within the "normal" range for that culture, and what i s extreme. Such a decision i s further complicated by the within-group differences of Chinese fam i l i e s , such as whether the family came from Mainland Chinese (and i s probably, therefore, much more t r a d i t i o n a l ) or whether the family came from Hong Kong (and i s , therefore, much more exposed to Western European values of independence, achievement, autonomy). The differences created between generations and within families can be immense. One interviewee poignantly expressed the c u l t u r a l remoteness created between himself and h i s mother: ...a Hong Kong born Chinese person l i k e me could have education i n Canada, and then...I'm pretty c r o s s - c u l t u r a l . ...My parents - my mother keeps saying that I'm weird, she says, "Oh, you're so Canadian." I don't exactly understand what she means (L.C.). A major point stressed by the interviewees was the need f o r awareness of the impact of immigration on Chinese family structure. Canadian-born Chinese may have l i t t l e knowledge about 95 the experiences or values of the older Chinese born i n Mainland China. In t r a d i t i o n a l Chinese f a m i l i e s , parents are expected to make decisions for t h e i r children; children demonstrate respect for t h e i r parents by not questioning or contradicting them; a husband supports and makes decisions for the wife and family; and male family members are given p r i o r i t y over females. Such values can come into c o n f l i c t with exposure to modern Western European values i n which children are encouraged to make decisions for themselves, women are, i n theory, valued equally to men, and a wife expects to contribute equally to decisions which a f f e c t the family. Inter-generational c o n f l i c t s between parents, who are strongly attached to a t r a d i t i o n a l value system and children strongly influenced by Western-European values are common, and harmony and s t a b i l i t y within the family becomes threatened by misunderstanding: In t r a d i t i o n a l Chinese culture the emphasis on study and d i s c i p l i n e i s very heavy. And for the t r a d i t i o n a l parents, i t ' s sometimes very d i f f i c u l t f o r them to grasp that that can occupy a lesser percentage and less importance. So, very frequently, you w i l l see Chinese parents hoping to steer the kids 90 percent of the time to study, and not very understanding...So many Chinese parents f e e l : "Oh, the kids waste time here, seems to be happy-go-lucky, not taking serious nature, not taking 96 serious outlook on l i f e , not d i s c i p l i n e d enough, or wanting to enjoy l i f e too much"...So, I think t h i s i s a very major difference i n the philosophy of l i f e ( P . C ) . Another major source of misunderstanding and potential c o n f l i c t a r ises between the values of c o l l e c t i v e interdependency that t r a d i t i o n a l Chinese parents t r y to i n s t i l l at home and the values of i n d i v i d u a l development and achievement that Western schools, and Western culture i n general, encourage. As Ivey, Ivey and Simek-Morgan (1993) put i t : Children i n Western society are encouraged to excel on an i n d i v i d u a l basis, be i t i n sports, school, charm, or physical looks. Children i n China are encouraged to excel i n co-operative a c t i v i t i e s that benefit f i r s t the community, then the family, and then the s e l f (p. 335). Many of the counsellors interviewed recommended approaching such cross-generational c o n f l i c t s slowly and s e n s i t i v e l y , being aware of the enormous gulf i n c u l t u r a l values that has threatened the t r a d i t i o n a l Chinese family structure i n which harmony and s t a b i l i t y are so sought. Several of the interviewees went further i n describing how they begin to bridge the gulf that exists by, f i r s t , accepting each person's feelings as v a l i d : (With) the parents...you have to accept the feelings f i r s t , " A l l these are true, v a l i d , no doubt about i t " . ...we don't just t e l l them "Since you're here you 97 should follow the Canadian culture." We accept a l l these feelings...And, on the other hand, when we t a l k to the youngsters we also accept t h e i r f e e l i n g s , the kind of pressure they are facing (K.N.). Secondly, the counsellors attempt to allow each person to look d i f f e r e n t l y at the s i t u a t i o n by putting themselves "into the others' shoes" (K.N.): Then gradually we explain to the parents "Now, i f you are the son, i n a s i t u a t i o n i n which a l l your school-mates are doing the same, what would you do?" And l e t the person think: "Oh, yes, there may be some d i f f i c u l t y . 1 1 ...When we t a l k to the youngsters... then we would say "Imagine, using that Miracle Question, imagine that you are your father," or " T e l l me about your father's past." And the person would "Blah, blah, blah." "Imagine i f you are your father what would you say when you face such a situ a t i o n ? " And that way you increase the understanding. The marital r e l a t i o n s h i p can also come under stress due to immigration to Canada and subsequent exposure to Western European values. The t r a d i t i o n a l Chinese family structure i s a male-centered heirarchy, with the husband being responsible for the family decisions, and the wife being subservient to him. Women had l i t t l e autonomy and few ri g h t s i n t r a d i t i o n a l Chinese culture (McGoldrick, Anderson, & Walsh, 1989). (It i s important to note here, i n case the Western-trained counsellor begins to f e e l 98 somewhat smug about Western culture, that women i n Canda only received suffrage i n 1917, and were only l e g a l l y declared persons i n 1929!). Referring back to within-group differences, i t must also be remembered that a family emigrating from Mainland China, for example, w i l l be very d i f f e r e n t than a family emigrating from Hong Kong. However, the process of immigration w i l l disrupt many of the t r a d i t i o n a l roles within Chinese fa m i l i e s . Women w i l l l i k e l y be exposed to more independent, assertive roles f o r women which may make them d i s s a t i s f i e d with t h e i r t r a d i t i o n a l r o l e s : Many wives, having experienced the rewards of economic independence and a greater degree of freedom, are reluctant to accept t h e i r t r a d i t i o n a l submissive roles (McGoldrick, et a l , 1989, p. 184). This may add to the husband's sense of loss of control over the family dynamics, thereby creating further stress and c o n f l i c t within the family: Sometimes i t ' s quite d i f f i c u l t f or the man to understand "What the h e l l are the women doing? How come a l l these years you are okay and then, now you are bucking me and a r t i c u l a t i n g a l l these kinds of discontent?...So the changing r o l e of the women and the awareness of the woman as an ind i v i d u a l , as a person who may have been denied equal r i g h t s , i s sometimes quite a s i g n i f i c a n t factor i n some of these couple relationships (P.C.). 99 Because t r a d i t i o n a l Chinese culture believes i n dealing with problems i n d i r e c t l y , avoiding confrontation and c o n f l i c t and solving problems within the family, i t can be d i f f i c u l t for the family, p a r t i c u l a r l y the male head, to reach out for help during t h i s disruptive period of adjustment. It's our t r a i n i n g that we should t r y and engage the most powerful person, most i n f l u e n t i a l person, at an early stage. But i n f a c t i n the Chinese family, as you know, i t ' s usually the male, the bread-winner, the head of the family. And so when we t r y to do t h i s we meet with a l o t of d i f f i c u l t i e s because the Chinese male, they're not trained i n terms of...we were trained to show a l o t of r e s p o n s i b i l i t y , not to t a l k about our problems i n front of strangers. Especially, "I'm the head of the family. I have to be a role-model. So, I should be the person who i s being asked about problems, not you outsiders." And s o . . . i t ' s r e a l l y very d i f f i c u l t to engage the male (K.N.). Although the counsellors a l l recognized the need to collaborate with the c l i e n t ' s family and to involve them i n the counselling process as much as possible the decision about l e v e l of family involvement was given to the c l i e n t . Some c l i e n t s and fami l i e s , i t was reported, "assumed" that the family would be involved i n the counselling, e s p e c i a l l y i f the c l i e n t was a younger person s t i l l l i v i n g with the parents, and not meeting these expectations 100 could be a b a r r i e r to successful r e l a t i o n s h i p - b u i l d i n g : I can turn o f f the family by refusing to t a l k to them... I've seen some colleagues of mine they a c t u a l l y t e l l the family member to wait i n the waiting room and they just bring the c l i e n t i n and t a l k to the c l i e n t f i r s t . ..I can see how that may turn o f f a family being that they would f e e l that they're not wanted or, e s p e c i a l l y i f they disagree with the doctor or therapist, they would f e e l that the therapist i s taking the side of the c l i e n t (A.C.). The counsellors interviewed often preferred some in d i v i d u a l time with the c l i e n t , probably because of t h e i r Western-training, but also expressed openness to increased family involvement i f the c l i e n t and the family so desired: There are times I w i l l see the c l i e n t alone and I w i l l see the family members alone and then I w i l l see them together...It a l l depends. So, o v e r a l l , I prefer some rapport with the family members and the c l i e n t s (S.W.). In summary, the expectations of t r a d i t i o n a l Chinese families to have access to the counselling process were met whenever possible: Western-trained colleagues do f e e l that the c l i e n t i s the primary person that they're dealing with and they should always take t h e i r side. And I again stress s e n s i t i v i t y , towards the (Chinese) c l i e n t ' s closer r e l a t i o n s h i p with the family (A.C.), 101 At the same time, i t was found that family members were often reluctant to t a l k to "outsiders" about family problems and did not always want to be involved, even though family involvement and access to the counsellor i s welcomed by the counsellor: A l o t of times family don't want to be involved. They see the c l i e n t as the person having the problem, so the c l i e n t should be here seeing the doctor (A.C.). This attitude was e s p e c i a l l y common i f the counselling issue was related to the children: Sometimes, quite a l o t of struggling. They'll be kind of surprised or wondering "What the h e l l are you doing, because i t ' s the kid's problem." They f e e l i t ' s the kid's problem. "You should see only the k i d , I'm not involved. You don't need to see me. I have already t o l d you a l l my problems." And so when I ask them, can I see BOTH of you, then I need a l o t of explanation (P.C.). Another b a r r i e r to family involvement referred to by several of the counsellors was " l o y a l t y issues" to the family. Because of the sense of shame i n having to go to someone outside the family for help with t h e i r personal problems, i t may take great courage to involve other family members: Because sometimes they may be a f r a i d i f they bring other people, those people may blame him or her, the c l i e n t . "Why do you have to involve me?...You're bring shame to the family," that kind of thing (C.A.). 102 T r a d i t i o n a l Chinese philosophy i s the basis for the b e l i e f i n keeping problems within the family. As Sue and Sue (1990) put i t : Central to Asian b e l i e f i s the fact that the best healing source l i e s within the family (Ho, 1987) and seeking help outside ( l i k e counseling and therapy) i s nonproductive and against the dictates of Asian philosophy (p. 132). Interviewees had several recommendations to consider when working with, or t r y i n g to engage, t r a d i t i o n a l Chinese family members i n counselling. The f i r s t factor to keep i n mind was the need to very f l e x i b l e i n terms of the family sub-system involved So we do have to be very f l e x i b l e . We don't i n s i s t that you w i l l have to bring i n everybody i n the f i r s t session. If we i n s i s t that, as what family therapy usually would suggest, then we d e f i n i t e l y won't be able to s t a r t even the f i r s t session. So we are very f l e x i b l e i n terms of the family sub-system. You and the daughter come, f i n e . You and the son come, f i n e . Gradually, i f they can demonstrate some change i n the family, i t ' s l i k e l y that they can bring i n the husband (K . N . ) . The second factor to keep i n mind was the need to explain Western counselling and Western counselling goals, which may be new and unclear to the family, and may, therefore, create fear or doubt about becoming involved i n the process. An example would be: Very often I w i l l r e a l l y explain to them that I understand that they are r e a l l y very concerned about 103 the c h i l d ; they have been t r y i n g t h e i r best i n the way that they can do, and so i t ' s e s s e n t i a l that the kids f e e l l i k e they have t h e i r continued support, and so t h e i r involvement ensures that things w i l l come out better, rather than work with the k i d himself (P.C.). And, f i n a l l y , most counsellors suggested that i t i s important to show understanding of and s e n s i t i v i t y to the courage needed for t r a d i t i o n a l Chinese family members to attend counselling. One way to demonstrate t h i s would be to leave the contacting of family members to the c l i e n t . As one counsellor explains: Like, I say "I would l i k e to t a l k to your husband. Would you l i k e to ask him f i r s t to see i f he's w i l l i n g to come in?" So instead of me c a l l i n g to ask him d i r e c t l y , I would ask the c l i e n t to t r y to do that. And, i n fac t , most of them would prefer that, they doing i t f i r s t , approaching...Usually they have t h e i r own ways of going about i t (C.A.). Another way of showing s e n s i t i v i t y would be by being patient and supportive of family members' fears and stresses: Family members also need support, recognition of t h e i r burdens and stresses. Let them know you do not force family members to reveal i f they're not ready. Be patient. Spend time building rapport with them f i r s t , otherwise they ( w i l l not) come back, without t e l l i n g you why (S.W.). 104 Understanding how the expectations of the Counsellor Role Held by T r a d i t i o n a l Chinese C l i e n t s may C o n f l i c t with the Counsellor Role i n Western Counselling This theme refers to c u l t u r a l differences that the interviewees had noticed between t r a d i t i o n a l Chinese c l i e n t s and t r a d i t i o n Western counselling regarding the r o l e of the counsellor. Generally i t was found that the Chinese-Canadian c l i e n t s needed to place the counsellor into a f a m i l i a r s o c i a l context. The reason for t h i s was explained well by A.C.: Because counselling i s such a new concept i n the Chinese culture...so they have to put the counsellor, sort of, i n comparison with some other roles that they are f a m i l i a r with...And I guess they need to place the counsellor i n some kind of context whether they're r e l a t i n g to a daughter or they're r e l a t i n g to a s i s t e r or they're r e l a t i n g to a Mother (A.C.). Of course counsellors were cautioned again not to generalize t h i s expectation to a l l Chinese c l i e n t s : I t depends on...the educational l e v e l of the c l i e n t and the exposure to counselling i n the past. Now for people coming from, say Hong Kong, those who received University education overseas, when they come to you they have a more r e a l i s t i c expectation (K.N.). Nevertheless, i t was very commonly mentioned by the interviewees that i n t h e i r experience there was an expectation from 105 t r a d i t i o n a l Chinese c l i e n t s to have a more personal r e l a t i o n s h i p with the counsellor, and to be able to see the counsellor as a " r e a l " person, not just a professional. According to A.C.: It's not the t r a d i t i o n a l type of therapy where the therapist i s a t o t a l l y anonymous person...There's a r e l a t i o n s h i p where they can r e l a t e to me as more of a r e a l person. And I think that's usually the kind of r e l a t i o n s h i p the Chinese c l i e n t s are used to...they're much less l i k e l y to sort of s p i l l t h e i r guts to a stranger, someone who remains t o t a l l y , hides behind a screen...is t o t a l l y unknown, who i s just there as a professional person (A.C.). One of the interviewees explained the role confusion which sometimes r e s u l t s i n t h i s way: Sometimes ( i t ' s ) hard for them to consider that i t ' s a more formal re l a t i o n s h i p , because they are t a l k i n g about a l l these personal things with you ( P . C ) . One interviewee (CA.) considered that the i n a b i l i t y of a Chinese c l i e n t to see the counsellor as part of the "expanded family" concept, and therefore an " i n s i d e r , " would e n t a i l the biggest hindrance to the counselling r e l a t i o n s h i p . Other interviewees agreed that i t i s obviously important to bridge the gap from "outsider" to " i n s i d e r , " with the successful c l i e n t - c o u n s e l l o r r e l a t i o n s h i p being s i m i l a r to a " f r i e n d . " And yet, because the c o u n s e l l o r - c l i e n t r e l a t i o n s h i p i s not r e a l l y a friendship, but 106 primarily a professional r e l a t i o n s h i p , i t can be extremely confusing to c l i e n t s who are t r y i n g to place the re l a t i o n s h i p within t h e i r own c u l t u r a l framework: They have some d i f f i c u l t y with perceiving that we are r e a l l y kind of a very cut-and-dried person... The d i s t i n c t i o n of you as a " f r i e n d " versus a "professional" i s not very d i s t i n c t to some of them ( P . C ) . I t was generally acknowledged that being open to a broader, more personal, r e l a t i o n s h i p with t r a d i t i o n a l Chinese c l i e n t s was useful: I think i t ' s important to est a b l i s h rapport to allow them to perceive me some part as a f r i e n d , or whatever -you know, a s i s t e r , depending on that transfer rel a t i o n s h i p . I think i t helps a l o t (A.C.). However, the potential professional dilemmas a r i s i n g from such a rel a t i o n s h i p were also recognized. C l i e n t s may want the counsellor to become more involved i n t h e i r l i v e s than the one hour a week, for example, the counselling session allows: Sometimes they w i l l f e e l that you should come to the house and observe, and also you should v i s i t them, they f e e l freer i n t h e i r own environment... Sometimes they w i l l hope that they can show appreciation through giving g i f t s , personal g i f t s , so sometimes d i f f i c u l t to handle (P.C ). 107 Many of the interviewees recommended that counsellors be f l e x i b l e and adapt to the t r a d i t i o n a l Chinese c l i e n t ' s \ expectations somewhat by spending more time on the s o c i a l aspect of the r e l a t i o n s h i p and showing i n t e r e s t i n the c l i e n t as a person, not just as a c l i e n t . They also recommended s e l f -d i s c l o s i n g (see Theme #6) personal information when i t i s comfortable to do so, and e s p e c i a l l y when the counsellor shares h i s t o r i c a l , c u l t u r a l , or s o c i a l commonalities with the c l i e n t . Such openness would, i t was f e l t , show the c l i e n t that the counsellor i s not merely putting on a facade of caring and i s not just a professional who i s there to help i n a half-hearted way. At the same time, almost a l l the counsellors interviewed said that they found they spend more time c l a r i f y i n g the counsellor r o l e with t r a d i t i o n a l Chinese c l i e n t s than with Western-European c l i e n t s : If I see a c l i e n t , I w i l l t r y to t e l l them who I am, what my role i s , where I am from, and then probably ...normally, I could show the c l i e n t I do care...(I am) someone who i s able to help and they can t a l k to (S.W.). An explanation of the professional as a "helping r o l e " may not always be cl e a r enough, however, and, as several interviewees pointed out, i t can even lead to further confusion regarding the cou n s e l l o r - c l i e n t r e l a t i o n s h i p . C l i e n t s , for example, may not understand where the l i m i t s of counsellor assistance and support are, and, knowing the counsellor i s i n a helping r o l e , may begin 108 bringing more and more problems to the counsellor, expecting the counsellor to " f i x " the problems. K.N. gives an example: "My husband he's not s e n s i t i v e enough to a l l my needs and he's...gambling or taking drug and alcohol...you are male, I am female, when I t a l k to him just ignore me. You t e l l him he w i l l have to change hi s behaviour." F i n a l l y , t r a d i t i o n a l Chinese c l i e n t s , i t was noticed, were less l i k e l y to question the authority of the counsellor even when they were not i n agreement: Questioning authority i s not that easy, or i t ' s not a usual practice f o r the older generation. They might mumble behind you, okay? They might mumble instead of making i t open to question, "Why (are) you doing t h i s ? " (J.H.). Another interviewee described the experience of Chinese c l i e n t s ' indirectness i n the following way: They don't give feedback d i r e c t l y . I'm seeing the wife and the wife t e l l s me: "My husband f e l t that the terms you used were not that appropriate." That kind of thing. ...The Chinese are very i n d i r e c t i n the way they give t h e i r feedback, so you hear from other resources. They w i l l t e l l the r e c e p t i o n i s t , not you (C.A.). An avoidance of d i r e c t confrontation i s a r e f l e c t i o n of t r a d i t i o n a l Chinese philosophy (see Chapter Four) which places high value on harmonious interpersonal r e l a t i o n s h i p s . 109 Counsellors who are aware of the t r a d i t i o n a l Chinese emphasis on harmony may avoid l a b e l i n g a Chinese c l i e n t ' s lack of d i r e c t feedback or assertion as laziness, avoidance, or resistance. As McGoldrick, Pearce, and Giordano (1982) put i t : Because harmonious interpersonal relationships are so highly valued, d i r e c t confrontation i s avoided whenever possible. Therefore, much of the communication s t y l e of Asian groups aims at being i n d i r e c t and t a l k i n g around the point... There i s a reliance on the s e n s i t i v i t y of the other person to pick up the point of conversation (p. 216). Understanding Cultural Differences i n Concepts of Counselling and Psychological Processes (Western-Trained Counsellor and Chinese Client) One of the broader themes that arose out of the interview data was that of c u l t u r a l clashes a r i s i n g from differences i n concepts of psychological processes and expectations of counselling. The t r a d i t i o n a l Western-European value system views human development as a progression towards autonomy and s e l f -a c t u a l i z a t i o n (see Chapter One). However, i n d i v i d u a l freedom of choice and " d i f f e r e n t i a t i o n " are very much i n contrast with many Asian cultures, including t r a d i t i o n a l Chinese culture, i n which a persistent push towards autonomy i s considered s e l f i s h and ins e n s i t i v e to the needs of the family and community as a whole. Personal decisions, i t i s believed, need to be made with the input of the family and with consideration of the possible 110 consequences of an i n d i v i d u a l choice on the family or community, (see Chapter i v ) . I guess again with my Western bias, I would always lean toward the i n d i v i d u a l choice...I always t e l l my c l i e n t s : "You can only be responsible for what you do, you can't change the other person." And i t ' s very d i f f i c u l t f o r someone not of a t o t a l l y Chinese c u l t u r a l viewpoint to understand that Chinese culture i s much more sort of close-knit, i n t e r a c t i v e . We have a much more c o l l e c t i v e i d e n t i t y . I t ' s hard f o r them to understand: "I can't change my son" (A.C.). However, having said that, the counsellors interviewed were also avid i n expressing the need to be aware of the within-group differences (such as l e v e l of education and exposure to Western culture) which could a f f e c t the Chinese c l i e n t ' s understanding and acceptance of t r a d i t i o n a l Western-European counselling goals and processes. Usually, I think i t ' s s t i l l r e l a t i v e l y taboo f o r them to say: "Oh, I have to expose myself and i f I have to meet that other problem, i t ' s a shame." And out of the three groups (Mainland China, Taiwan, and Hong Kong) Mainland China would be the most shy of all...They are the ones who are most reluctant to come. But the Hong Kong Chinese would be more approachable, I would say. They accept the concept of counselling more, r e l a t i v e l y (C.A.). I l l I t i s important, as many of the interviewees pointed out, for counsellors to keep i n mind that while going to see a counsellor or therapist i s a common and understandable practice f o r many Western-Canadian indivi d u a l s today, for t r a d i t i o n a l Chinese c l i e n t s coming to t a l k about t h e i r problems to someone outside the family i s often a " l a s t resort" when a l l other resources have been exhausted: The problem i s that very often the Chinese c l i e n t (doesn't) come to you unless i t ' s very late...unless i t ' s a r e a l l y big c r i s i s , and they have nowhere to turn to...They w i l l turn f i r s t to t h e i r friends, r e l a t i v e s , even to neighbours. So the l a s t resort would be to us (P.C.). The major c u l t u r a l difference i n attitudes toward and expectations of counselling, a difference which was mentioned over and over again by the interviewees, i s the Western counselling focus on "i n s i g h t " and "i n t e r n a l processing" versus the t r a d i t i o n a l Chinese c l i e n t ' s focus on p r a c t i c a l , immediate solutions to concrete problems. When a Chinese person come i n they usually expect very concrete type of help, assistance. Most of them don't come i n expecting to have an appointment with me, a meeting, just to t a l k about t h e i r problems (A.C.). The lack of value placed on "talk therapy" r e f l e c t s the Chinese 112 culture's values of Taoist philosophy i n which serious i l l n e s s , emotional or physical, i s seen as a r e s u l t of disharmony or imbalance of the body's v i t a l energy ( g i ) . A strong r e l a t i o n s h i p i s believed to e x i s t between past behaviours, (including the i n d i v i d u a l c l i e n t , r e l a t i v e s and deceased ancestors) and the current imbalance of g i (yin and yang, p o s i t i v e and negative). Harmony can be created through consumption of a balance of "hot" (yin) and "cold" (yang) foods, and a reduction i n interpersonal c o n f l i c t , p a r t i c u l a r l y within the family system. Counselling, or "just t a l k i n g , " may not be seen as a useful or p r a c t i c a l solution to the rebalancing of g i energy. In f a c t , counselling can be seen by t r a d i t i o n a l Chinese c l i e n t s as destructive to harmony and good health i f i t focuses on c o n f l i c t rather than reducing the symptoms of that c o n f l i c t . (Waxier-Morrison, Anderson, & Richardson, 1990). The attitude towards the effectiveness of counselling w i l l vary within the Chinese population: Depends on the educational l e v e l , depends on where they come from, but I would say that most of them don't have the s o r t of t r a d i t i o n i n seeking counselling. So t h i s i s something very foreign. And to them i t ' s a kind of "talk therapy," so just t a l k i n g and t r y i n g to help you r e l i e v e some tension. That's i t . So they b a s i c a l l y do not have a very high regard of what counselling i s a l l 113 about, e s p e c i a l l y i f you - those goals, objectives or approaches quite abstract, then i t i s r e a l l y a problem for the Chinese population (K.N.). The lack of perceived value i n the counselling process i s sometimes r e f l e c t e d i n the Chinese c l i e n t ' s reluctance to pay for services. As one counsellor explains: ...they have an idea they can always get some ears f u l l from friends, from family, from things l i k e that. So they understand that: " A l l I do i s unload something to you, and you need me to pay f o r i t ? " (K.N.). The need to pay f o r services which do not seem of value to the c l i e n t i s another b a r r i e r which keeps people from using counselling services. On the other hand, c l i e n t s may not mind paying f o r services i f they can see immediate, concrete r e s u l t s : They don't mind paying extra amount of d o l l a r s , as long as we give them the answers. Say hundred d o l l a r s , that's f i n e ; two hundred d o l l a r s , that's f i n e . ONCE... "( I f ) I'm able to have a solution, a s a t i s f a c t i o n , I'm w i l l i n g to pay you two hundred d o l l a r s , that's okay. But just once" ( L . C ) . T r a d i t i o n a l Chinese c l i e n t s , i t was found, when they did come for counselling wanted p r a c t i c a l help r i g h t away. I f t h i s was not forthcoming they would most l i k e l y not come back: If they f e e l that you are not helping them, i f you 114 cannot give them p r a c t i c a l suggestions... sometimes they f e e l : "You are not helping me," or "You're useless, not help to me." Sometimes I f i n d people not coming back because of that reason. They say: "Oh, I don't get that much p r a c t i c a l advice from the counselling session" (C.A.). For Western-trained counsellors the r e s u l t s of therapy may not be immediate. The process of in t e r n a l change i s as important as the outcome. For t r a d i t i o n a l Chinese c l i e n t s , on the other hand, the outcome i s very important. This difference i n conceptualization of psychological processes and the subsequent expectations of counselling was seen, by the interviewees, to impact on the co u n s e l l o r - c l i e n t r e l a t i o n s h i p formation i n several ways. F i r s t , i t can be a challenge for the Western-trained counsellor to l i n k the c l i e n t ' s need for immediate r e s u l t s with the Western counselling goal of long-range change. An example given by one of the interviewees follows: ...with quite a number of Chinese c l i e n t s t h e i r goal to come for counselling about the r e l a t i o n s h i p i s to see whether they can mend the re l a t i o n s h i p . Once i f they f e e l that: "We cannot mend i t , " then that's the end of the counselling sessions. They don't see any further than that. And we're not (being) able to reconcile f o r them, the re l a t i o n s h i p i s often seen as 115 a f a i l u r e . . . I t ' s very hard to persuade them to r e a l i z e that there's s t i l l something more that you can work on even though you are separated (P.C.). With knowledge of the t r a d i t i o n a l Chinese values of s t a b i l i t y and harmony as desirable a counsellor can better understand how change can be a potential source of disruption. ...there i s an a c t i v i s t orientation i m p l i c i t i n Western values that change i s preferred to no-change when given a choice between the two a l t e r n a t i v e s . When confronted with a problem where the solution i s ambiguous, the Westerner w i l l be l i k e l y to DO something. Under the same conditions, persons from any non-Western cultures would have been s o c i a l i z e d to r e s t r a i n themselves and avoid a d i r e c t response as the favoured mode of dealing with the problem. A foreign student returned home to h i s non-Western family and, seeking to j u s t i f y the expense of t h e i r sending him abroad, spoke at length about how much the experience had changed him. His more t r a d i t i o n a l family was h o r r i f i e d (Marsella & Pedersen, 1981, p. 328). This c u l t u r a l emphasis on s t a b i l i t y can also go a long way i n explaining the t r a d i t i o n a l Chinese c l i e n t ' s preference f o r f a s t solutions to c o n f l i c t . This can create a difference, between counsellor and c l i e n t i n the perception of what i s happening i n the counselling session. As one interviewee explains: For the Chinese c l i e n t , the outcome i s very important. 116 So even though they may f e e l that there's some change i n feel i n g s , but they don't see the immediate r e s u l t s being well-defined then they might not see that as improvement...And so, sometimes, even though the counsellor f e e l s or sees that there's improvement, but the c l i e n t w i l l not see i t , because they don't see any d r a s t i c or s i g n i f i c a n t improvement i n the areas that they'd hoped. Of course, down the road there might be, but i n the short term, there may not be ( P . C ) . , The second impact on the co u n s e l l o r - c l i e n t r e l a t i o n s h i p that was mentioned by the interviewees i s that there i s often an expectation from t r a d i t i o n a l Chinese c l i e n t s for the counsellor to be more d i r e c t i v e than i s t y p i c a l i n Western counsellors. This can be uncomfortable for Western-trained counsellors: ...so that there's a constant p u l l on me to f e e l that somehow I need to, i d e a l l y , have some ready-made improvement, sometimes, which i s beyond my control ( P . C ) . Another interviewee pointed out that the c l i e n t s might not be comfortable i f the counsellor, as per Western t r a i n i n g , r e f l e c t s back to them the r e s p o n s i b i l i t y f o r personal choices and f o r decisions around counselling d i r e c t i o n : I think many Chinese expect some kind of a d i r e c t i v e from the...treatment professional...and they may not be comfortable i f I give them the choice. I think they 117 would f e e l uncomfortable. I think when they come i n here they expect that the professional person knows what to do and they want advice from a professional (A.C.). Experiences counsellors have had i n attempting to blend the needs of t r a d i t i o n a l Chinese c l i e n t s with the Western counselling process are further discussed i n the following theme section. Another culturally-determined concept r e l a t i n g to the counselling process i s that of TIME. While Western-trained counsellors expect scheduled, time-limited appointments with c l i e n t s , f o r example, t r a d i t i o n a l Chinese c l i e n t s may expect a less-structured or time-limited meeting with the counsellor: ...so they would l i k e us to do a telephone interview and give them answers over the phone. We usually say, "No, I can't do that. Would you l i k e to come i n and t a l k ? " . . . so they say: "Yes, come i n . " But they don't want you to structure an hour; they want you to structure whatever time i s necessary. "Mine i s the problem, I'm i n c r i s i s . " So when they say "two o'clock"...they don't have an idea that at three o'clock time to get them out. They have to come again i n a week or so, and another hour. They want us to t a l k as long as necessary to get everything done. ...they want to continue (L.C.). Edward H a l l (1976) labels the Western and non-Western perspectives of time as, respectively, "monochronic" and "polychronic," and describes each of them as follows: 118 Monochronic-time (M-time) emphasizes schedules, segmentation, and promptness. Polychronic time (P-time) systems are characterized by several things happening at once. They stress involvement of people and completion of transactions rather than adherence to preset schedules (p. 17). However, once again, awareness of within-group v a r i a t i o n needs to be applied, i n t h i s case to the Chinese c l i e n t ' s view of time - i n p a r t i c u l a r , to the scheduling of appointments. Chinese c l i e n t s with exposure to Western-European culture (for example, many younger Hong Kong immigrants, or second-generation Chinese-Canadians) understood the need f o r counsellors, because of demand for services and busy schedules, to book appointments ahead of time and to s t i c k to the a l l o t t e d time. Chinese c l i e n t s with a more t r a d i t i o n a l Chinese orientation would seldom see the need to make appointments, and would just show up and wait to see the counsellor. C l a r i f i c a t i o n and negotiation around scheduling was, therefore, needed to ensure that these c l i e n t s did not interpret an i n a b i l i t y to see them when they dropped by as neglect or dismissal: ...people from Hong Kong, es p e c i a l l y , they are used to the appointment system. They u s u a l l y . . . w i l l phone you to make appointment before they come i n . But f o r the Mandarin-speaking group, e s p e c i a l l y those from Taiwan, e s p e c i a l l y i n the i n i t i a l stage, they would expect that 119 ...when they're a need they would just come i n . . . j u s t drop by, come i n to your s i t e and w i l l see whether you're there (K.N.). Because of these major conceptual differences between Western counselling and t r a d i t i o n a l Chinese culture, most of the interviewees discussed the need fo r outreach education to the Chinese community regarding counselling services to overcome resistance towards coming to counselling. Some would rather go to a f o r t u n e - t e l l e r than to a counsellor, because they want advice, they want to have t h e i r fortune changed. So...sometimes we have to r i v a l with these people. So helping them to understand the process of counselling i s a great challenge (P.C.). Educational outreach programs mentioned included workshops on Family L i f e Education i n the community, Parenting S k i l l s Programs i n the community and i n the schools, a r t i c l e s i n Chinese newspapers, and t a l k s on Chinese radio and Chinese t e l e v i s i o n . Much of the education centred around d i s p e l l i n g misconceptions and fears around counselling services: Their understanding about counselling and t h e i r fears of t a l k i n g about these personal things to a stranger, t h e i r fear of d i s c l o s i n g to people. Actually t h i s i s a very unfounded fear because we are more c o n f i d e n t i a l than many of t h e i r friends and r e l a t i v e s . So I think i t ' s a lack of understanding about who we are and what we do (P.C.). 120 A noticeable increase i n the number of Chinese c l i e n t s v o l u n t a r i l y attending counselling services over the past few years was attributed to the p o s i t i v e e f f e c t s of community outreach and education, and to the increase i n number of new immigrants: ...for three years...the number of families or persons seeking d i r e c t help from us, phoning i n or dropping i n , increase tremendously...especially f o r immigrants. They are quite isolated...when they face some problems i n the family they can r e a l l y have no where to turn to (K.N.). Another aspect of community education and outreach that was discussed by a number of the interviewees was the need for collaboration with other professionals and s o c i a l service providers i n the community to overcome b a r r i e r s f o r t r a d i t i o n a l Chinese c l i e n t s needing services. One of the b a r r i e r s mentioned was lack of c u l t u r a l s e n s i t i v i t y to differences i n c u l t u r a l values: In some of the c h i l d abuse cases the s o c i a l worker would just ignore the parents' f e e l i n g s , and when they intervene i n the i n i t i a l stage, when the parents come to explain to them: "That's too bad. Since you're here you w i l l have to follow the Canadian values"...Some s o c i a l workers are very c u l t u r a l l y s e n s i t i v e , they did a good job. But f o r some s o c i a l workers they tend to, sort of "That's the law," and they tend to ignore the parents' f e e l i n g s . I f e e l 121 frustrated too. I t r y to explain to the s o c i a l worker about what's happening...you'll have to address the feelings f i r s t (K.N.). Language b a r r i e r s are another major factor mentioned by the interviewees which l i m i t e d a c c e s s i b i l i t y to services and resources f o r t r a d i t i o n a l Chinese c l i e n t s . The interviewees often found themselves being frustrated by the lack of community services available i n the c l i e n t ' s language: One thing that we f i n d most d i f f i c u l t i s the lack of resources f o r people who have a language and c u l t u r a l a c c e s s i b i l i t y problem...All the groups outside they speak English...Parents In C r i s i s groups, they a l l i n English. They have got many good programs...all these brochures, but they're useless (K.N.). Interviewees often found themselves i n the position of acting as interpreter and/or intermediary for c l i e n t s with community services: I play a l o t of ro l e of being the interpreter, again, because of the language b a r r i e r that many of my c l i e n t s face....the only service provider i n c l i e n t ' s l i f e who i s b i l i n g u a l . So (I) end up being somewhat of an advocate, case-manager, because the c l i e n t s bring a l l the problems they have i n communicating with other agencies to me (A.C.). However, several of the interviewees also mentioned they support 122 and encourage c l i e n t s , whenever possible, to contact community resources themselves: Many of the Chinese c l i e n t s l i k e me to act on t h e i r behalf, or to t a l k with the schools, to t a l k to the doctor...Many of the Chinese c l i e n t s were kind of scared of reaching out to those agencies. So, i f I f e e l that they r e a l l y have great d i f f i c u l t y i n doing that, I would help them to do it. . . B u t i f I assess that they can have the (language) a b i l i t y to do that, I would rather coach them and help them to do i t themselves. I think i t ' s part of the empowering process...I w i l l spend many hours with them to help them see how to get t h e i r points across, get them to r e a l l y learn the process ( P . C ) . The issue of language i n counselling, and i n the formation of the counselling r e l a t i o n s h i p , i s discussed i n more d e t a i l i n Theme #seven (Verbal communication between Chinese c l i e n t s and Western-trained counsellors). Consideration of the c u l t u r a l appropriateness of the counselling s e t t i n g This theme covers the issues related to home and/or o f f i c e v i s i t s raised by the interviewees. Home v i s i t s provided the counsellors with the a b i l i t y to see the c l i e n t i n "context" and to meet and b u i l d rapport with and assess the c l i e n t ' s main support system, the family 123 I would do home v i s i t s mostly to access the home si t u a t i o n , to see i f the person has adequate housing, to see i f the person l i v e s alone, to make sure that he's up-keeping the place properly...And i f the family i s not w i l l i n g to come i n f o r a v i s i t i t gives me a chance to observe the i n t e r a c t i o n between the c l i e n t and the family members, as much of i t as possible (A.C.). Many interviewees believed that t r a d i t i o n a l Chinese c l i e n t s often preferred the counsellor to v i s i t at home: Quite a number of c l i e n t s w i l l f e e l quite surprised that I'm not going home to v i s i t them. Quite a number of them expect that you come home - come to t h e i r home, v i s i t them, and chat, maybe have dinner with them ( P . C ) . Much of the l i t e r a t u r e on m u l t i c u l t u r a l counselling also suggests that home v i s i t s may sometimes be more appropriate for c l i e n t s : Home v i s i t s are another outreach t a c t i c that has been used t r a d i t i o n a l l y by s o c i a l workers. Counsellors who use t h i s ploy would be meeting the needs of minority c l i e n t s ( f i n a n c i a l d i f f i c u l t i e s with transportation), allowing the counsellor to see the family i n t h e i r natural environment, making a p o s i t i v e statement about t h e i r own personal commitment and involvement with the family, avoiding the intimidating atmosphere of large, informal and unfamiliar i n s t i t u t i o n s and perhaps allowing the counsellor to d i r e c t l y 124 observe the environmental factors that are contributing to the family's problems (Sue & Sue, 1990, p. 135). Sometimes, i t was noticed that younger c l i e n t s also f e l t uncomfortable coming into the o f f i c e s e t t i n g : Teenagers and youths, I found that they, quite often they don't f e e l comfortable with coming i n . They may f e e l more comfortable i f you...go along with them i n t h e i r natural environment and they f e e l kind of awkward to s i t here and face me and t a l k ( P . C ) . Some, but not a l l , interviewees were w i l l i n g to accommodate t h i s whenever possible: If they f e e l that they would...needed a neutral place or at t h e i r home, then I would t r y to accommodate them as much as I can...A neutral place might be a suggestion i f , while you're t a l k i n g with them, you sense some sort of reluctance when you're proposing either the o f f i c e or the home (E.H.). However, time considerations, as well as complexities of co-ordinating v i s i t s with other professionals involved (such as nurses, doctors, f i n a n c i a l workers) often l i m i t e d the counsellor's a b i l i t y to be able to v i s i t the c l i e n t s at home. An o f f i c e s e t t i n g also was seen as an advantage by the interviewees i n being a p o t e n t i a l l y less d i s t r a c t i n g , and more private, environment to work i n : It's not r e a l l y our practice to go out and v i s i t . . . 125 We can't spare the time. And the second reason i s about being d i s t r a c t e d . I have less d i s t r a c t i o n here and i t ' s within my control much better, because i f I go out and v i s i t them i t ' s very hard f o r me to c o n t r o l . They may be watching the t e l e v i s i o n , or have somebody, or have some phone c a l l s , so i t ' s very hard to do the work ( P . C ) . The privacy of an o f f i c e v i s i t would, i t was believed, appeal to some c l i e n t s who would NOT welcome a home v i s i t , because of the issue of c o n f i d e n t i a l i t y . Some c l i e n t s would f e e l intimidated i f you v i s i t them r i g h t away, because they f e e l that you're i n f r i n g i n g on t h e i r privacy, you know, t h e i r home (E.H.). Several interviewees mentioned paying s p e c i a l attention to the o f f i c e set-up so as to create a comfortable environment fo r the t r a d i t i o n a l Chinese c l i e n t . Examples included, a poster which showed a fun, l i g h t side to the counsellor, and a small, round table placed between the c l i e n t and counsellor to create a more informal, s o c i a l atmosphere which allows the c l i e n t to see the counsellor i n a more personal, informal way: ...I always keep the, you know, fun-looking pictures (posters) to show that I am a pretty relaxed and -person to r e l a t e to, and then a p l a i n background so I can focus on l i s t e n i n g to the c l i e n t . . . W e l l , I think i t ' s good to have a cabinet and the bookshelves, so they know I'm serious, more than just a poster person 1 2 6 And see those c e r t i f i c a t e (s) and some information here to show that I'm serious too. So, I think Chinese c l i e n t s need to see that you are a nice person to r e l a t e to (J.H.). Awareness of Possible Cultural Differences A f f e c t i n g C l i e n t and Counsellor Self-Disclosure There were two aspects to the issue of s e l f - d i s c l o s u r e which arose i n the interviews: the f i r s t was s e l f - d i s c l o s u r e by the counsellor, the second was s e l f - d i s c l o s u r e by the c l i e n t . In the f i r s t case, almost a l l the counsellors interviewed expressed some l e v e l of c o n f l i c t i n determining how much to s e l f -d i s c l o s e . Based on t h e i r Western-training, and sometimes on t h e i r c u l t u r a l or personal preference, the counsellors wanted to maintain professional boundaries: I am aware of my boundary as a professional person, from the t r a i n i n g I have. And also a c t u a l l y from myself being a person that r e a l l y i s quite reserved about r e v e a l i n g . . . t e l l i n g about my own personal things to other people...It's a struggle sometimes (E.H.). Yet, perhaps because of t h e i r own Chinese background, they were sympathetic with the t r a d i t i o n a l Chinese c l i e n t ' s need fo r knowing more about the counsellor as a person, and, as mentioned i n Theme #seven (Expectations of the counsellor r o l e ) , the need to b u i l d a more personal r e l a t i o n s h i p with the counsellor. As one interviewee explained: 127 It makes i t not a sort of a two-way stre e t for them, so that they f e e l that "Oh, I'm t e l l i n g them a l o t about myself. I'm opening my door, my family door, the house or the home or myself, to t h i s therapist, but at the same time I'm also getting to know my therapist more as a person not just as a professional counsellor (E.H.). One interviewee c l e a r l y described the desire f o r s e l f - d i s c l o s u r e by the therapist from the c u l t u r a l perspective of the c l i e n t : Chinese people don't have a...the concept of the professional boundary. So they...a l o t of time they don't see anything wrong with asking me personal questions. In f a c t , to them i t ' s an ice-breaker, i t ' s what they do...on a s o c i a l basis when they meet someone new. They s t a r t to chat about these things, and so they don't see anything wrong...I guess i t ' s sort of a good sign that they're interested i n knowing about me rather than couldn't care less (A.C.). Most of the interviewees were w i l l i n g , based on the needs of the c l i e n t and the recognition that revealing something personal of themselves would help to "gain rapport much quicker with Chinese c l i e n t s (E.H.)," to s e l f - d i s c l o s e personal information, but tended to keep i t as general as possible, so as to protect t h e i r own privacy. For example: 128 I guess I'm not as comfortable d i s c l o s i n g . I do dis c l o s e recognizing that I'm dealing with someone from a d i f f e r e n t c u l t u r a l background and i t ' s hard for them to understand why I'm so secretive about my own background... So, I would do that. (But) I generally don't go into a l o t of depth about my personal background (A.C.). One area, however, i n which s e l f - d i s c l o s u r e appeared to not be l i m i t e d by the counsellors, was the sharing of personal information and hi s t o r y that demonstrated a commonality with the c l i e n t s (such as the immigration experience), the sharing of which helped the counsellors to b u i l d a rapport with t r a d i t i o n a l Chinese c l i e n t s . This concept r e l a t e s , again to Theme #three (Expectations of Counsellor Role) i n which the t r a d i t i o n a l c l i e n t ' s w i l l i n g to s e l f - d i s c l o s e was based on seeing the counsellor as an " i n s i d e r " : So sometimes I say, you're from China, okay, I've been to China a few times, ray family came from China. I was born i n Hong Kong, but my father was born i n China. To people from Taiwan I say: "Oh, yeah, I've been to Taiwan a few times, and my brother-in-law i s now working i n a ho s p i t a l i n Taiwan"...Because I think the concept of families ( i s ) very important among the Chinese. And i f they can see me as part of family, they can expand the concept of family: "you know people 129 from my v i l l a g e , you know people from my province, people from the Southern part of China, or people from China 1 1... A l l those are important features (C.A.). Knowing where to place the counsellor i n terms of " i n s i d e r " and "outsider" can inform the c l i e n t as to how much the counsellor understands about t h e i r background, and how much they may need to explain: Chinese c l i e n t s are very l i k e l y to ask me personal questions about my background...it's maybe because they want to know i f I would understand where they're coming from...So knowing where I'm from they sort of know how much they need to explain and how much they can just assume that I know (A.C.). The immigration experience was mentioned by several of the interviewees as an example of the counsellor's being able to disclose shared personal experiences to the c l i e n t i n order to bridge a gap and b u i l d rapport: Being an immigrant can be very i s o l a t i n g and s o l i t a r y ; they don't mix with others, so many of the c l i e n t s , these immigrant c l i e n t s , they're looking for sharing, looking for support, and usually I think they want also to get some affirmation, some sharing about processes and so that's why I think a number of them may be interested to see how I myself go through these processes. So at times, i f I f e e l i t ' s a need and i t ' s relevant, I w i l l do i t ( C A . ) . 130 The second aspect of s e l f - d i s c l o s u r e was that of c l i e n t s e l f - d i s c l o s u r e . T r a d i t i o n a l Chinese c l i e n t s were noted to be very reluctant i n s e l f - d i s c l o s i n g personal or family h i s t o r y (such as f i n a n c i a l or medical information). This was attributed by the counsellors to two factors, the f i r s t being g u i l t and shame associated i n the Chinese culture with t a l k i n g about problems to an "outsider," a "stranger." .. .When you l i s t e n to the message you have to be very s e n s i t i v e , supportive, and assume that c o n f i d e n t i a l i t y i s there...There's a family saying that: "Talking about family problems to the outsider i s ac t u a l l y a family shame, that's shame to the family." So they would be very cautious. And i t r e a l l y takes courage f o r a person to share his or her concern, depending on the type of problem, to somebody else (K.N.). The second factor l i m i t i n g the t r a d i t i o n a l Chinese c l i e n t ' s s e l f -disclosure was the d i f f i c u l t y i n t a l k i n g about feelings . . . i t i s a t r a d i t i o n f o r Chinese c l i e n t s not to express t h e i r emotions. And we tend to receive some t r a i n i n g , I mean some subconscious t r a i n i n g , from the past generations not to disclose our feelings (K.N.). As a r e s u l t of these factors (sense of shame i n t a l k i n g about problems and d i f f i c u l t y i n t a l k i n g about feelings) interviewees cautioned against t r y i n g to get too much personal information 131 from c l i e n t s too quickly. We don't know how to control once i t come out, I would say. So...when the c l i e n t comes to you, and in the f i r s t beginning stage i f you allow . . . a l l the emotions (to) come out, flooded with emotion, and i f you encourage that without good f i n i s h i n g , good closing , then you're bound to have problems. That person w i l l f e e l very g u i l t y because: "I express a l l my emotion. Oh, my God! And why? That's only a stranger, I don't know him well." So we tend to..go with the c l i e n t at a very natural pace without t r y i n g to encourage the c l i e n t to go too deep at the f i r s t , i n the f i r s t i n i t i a l session....Because i f we do, then sometimes the c l i e n t w i l l be very r e g r e t f u l , because the rapport i s not there, the t r u s t i s not there (K . N . ) . Another interviewee mentioned that a f e e l i n g of safety i n expressing personal feelings also implied not being c r i t i c i z e d , as t h i s was a possible fear that could prevent c l i e n t s e l f -disclosure: The second meaning about the use of "safe" i s they are very a f r a i d of being c r i t i c i z e d , or being judged. ...They are a f r a i d that i f they reveal themselves, they w i l l be c r i t i c i z e d and judged...I think t h i s has something to do with the Chinese background. Parents used to c r i t i c i z e , the Chinese people teach by 132 c r i t i c i z i n g , so I think many people are a f r a i d of that. So they...have to f e e l safe by knowing that whatever he says won't be c r i t i c i z e d or judged. Okay then, they f e e l comfortable to t a l k (C.A.). Interviewees also cautioned against rushing into discussion of t o p i c areas which could be p o t e n t i a l l y s e n s i t i v e f o r the c l i e n t . Knowing about c u l t u r a l "taboos" would help avoid emotional clashes f o r the c l i e n t . Sex would be one of these p o t e n t i a l l y s e n s i t i v e topic areas, as would medical history, alcohol and drug problems, hi s t o r y of mental i l l n e s s i n the family, and f i n a n c i a l d i f f i c u l t i e s . As one interviewee explained i t , i n the t r a d i t i o n a l Chinese culture each member of the family r e f l e c t s on the family as a whole: Some of my c l i e n t s might...even deny i n i t i a l l y that there ( i s ) a family history of mental i l l n e s s . . . A l o t of times i t ' s because there are a l o t of family connections and when members of the family are getting married i t means a l o t that the other family wants to know, and sometimes do consider, the health and the mental health of the family as a whole (E.H.). And, f i n a l l y , interviewees cautioned against l a b e l l i n g t r a d i t i o n a l Chinese c l i e n t ' s possible reluctance to s e l f - d i s c l o s e as d e l i b e r a t e l y being " r e s i s t e n t " : I f you do f e e l that sometimes maybe you r e a l l y need to know something and then you're h i t t i n g , and you 133 ask the question and you h i t a brick wall, then maybe you need to t r y again l a t e r on, rather than just r i g h t o f f hand thinking that t h i s person i s evasive or very secretive (E.H.)-A c l i e n t ' s willingness to s e l f - d i s c l o s e i s viewed from a Western counselling perspective as a sign of openness and maturity. However, i n many c u l t u r a l groups, including t r a d i t i o n a l Chinese culture, the expectation of d i s c l o s i n g intimate personal information to a "stranger" may not be considered appropriate behavior: Among many (cultures) intimate aspects of l i f e are shared only with close friends. Relative to white middle-class standards, deep friendships are developed only a f t e r prolonged contacts. Once friendships are formed, they tend to be l i f e l o n g i n nature. In contrast, white Americans form relationships quickly, but the relationships do not necessarily p e r s i s t over lonq periods of time. Counselling seems to also r e f l e c t these values. C l i e n t s t a l k about the most intimate aspects of t h e i r l i v e s with a r e l a t i v e stranger once a week f o r a fifty-minute session. To many c u l t u r a l l y d i f f e r e n t people who stress friendship as a precondition to s e l f - d i s c l o s u r e , the counselling process seems u t t e r l y inappropriate and absurd. After a l l , how i s i t possible to develop a friendship with b r i e f contacts once a week? (Sue & Sue, 1990, p. 40). 134 Awareness of Cultural Variations i n the Meaning and Interpretation of Verbal Communication Between C l i e n t and Counsellor The theme of verbal communication i n the interviews covered both the choice of language used i n counselling and the s t y l e of communication as affected by the language used. Choice of language was based on a number of factors, with the c l i e n t ' s preference being given p r i o r i t y . Several counsellors mentioned that using the c l i e n t ' s language of choice helped to b u i l d an immediate rapport and t r u s t between c l i e n t and counsellor. They f e e l that there i s an a f f i l i a t i o n r i g h t away because they know that you speak the same language, you may have come from the same area of the world and, therefore...they f e e l that they don't have to explain a l o t more than they have to (E.H.). Of course, t h i s f l e x i b i l i t y i n choice of language was only possible i f the counsellor was able to speak the p a r t i c u l a r Chinese d i a l e c t (such as Cantonese, Mandarin or Toisan) of the c l i e n t , therwise, the session would be conducted i n English. In cases where the c l i e n t did not speak fluent English, or spoke a d i f f e r e n t d i a l e c t than the counsellor, writing was sometimes used to supplement the verbal communication because the written Chinese language i s the same across d i a l e c t s : There may be some other Chinese c l i e n t who may speak i n a d i f f e r e n t d i a l e c t , so there are times I do write, 135 w r i t i n g . . . i n Chinese ( a l l d i a l e c t s ) are the same. So i t ' s one way to communicate, or else to supplement the verbal language. For example, the c l i e n t may speak i n a d i f f e r e n t d i a l e c t and there's a p a r t i c u l a r word... you're not quite sure, you write i t (S.W.). However, as the interviewees pointed out, i t cannot be generalized that a l l Chinese c l i e n t s want to speak i n t h e i r native language. In fa c t , as one interviewee explained, sometimes the assumption that they would not want to speak i n English could be taken as an i n s u l t : In many cases, my f i r s t question would be: "What language do you f e e l most comfortable with?" Whether people speak Chinese, well, Cantonese or Mandarin, or English. So t h i s i s almost the f i r s t question I ask, because I know some people f e e l more comfortable using Chinese. However, there are people who f e e l some kind of i n s u l t - you know, they want to speak i n English and I speak Chinese to them, they would have the f e e l i n g that I don't respect them or have the misconception that they don't know how to speak English...They have the fear that i f they don't speak English, (they) might not have the respect from me (C.A.). Some interviewees found that English was most commonly used i f the c l i e n t was b i l i n g u a l : Some of them speak Cantonese only, some Mandarin only, some a mixture of English and Chinese. That's quite common for people from Hong Kong, e s p e c i a l l y the educated ones. Also, the second generation Chinese a l l English...If Cantonese i s the only language they know, then no choice. But f o r people who speak English, they tend to use English (K .N). A decision on choice of language was, according to the interviewed counsellors, influenced greatly by the c l i e n t ' s a b i l i t y to discuss some problems and concepts more c l e a r l y and in-depth i n t h e i r own language. For instance, i n some situations such as c r o s s - c u l t u r a l marriages, the counsellor might consider i t most appropriate to speak English. However, i n c l a r i f y i n g c u l t u r a l meanings or concepts, the counsellor and c l i e n t s might often r e f e r back to the Chinese language. A d i r e c t t r a n s l a t i o n of a concept i n English i s not always accurate or meaningful i n Chinese language: Sometimes...I f i r s t get concept i n Western Culture i n English and i f I just translate i t d i r e c t l y to the Chinese, they f i n d i t to be so odd and sometimes they f e e l that I'm too distant. So...I have to f i n d a s i m i l a r term which i s indigenous Chinese, which may not be an exact meaning...For example, with "energy." I f I just use the word "energy," the l i t e r a l t r a n s l a t i o n , they kind of "What does that mean?" If I use a s i m i l a r term, which a c t u a l l y means " s p i r i t " i n Chinese, they can accept the term more and they can f e e l more related (C.A.). 137 Another i n t e r e s t i n g example of the influence of language on meaning which was mentioned by another interviewee was the use of metaphors. Although some of the d i f f i c u l t y experienced by Chinese c l i e n t s i n getting into imaginary roles or s t o r i e s was attributed to the more pragmatic nature of many Chinese c l i e n t s (They w i l l f e e l that: "Why are you asking me to do t h i s ? . . . I have to deal with d a i l y problem" A.C.), t h i s interviewee also suggested that the actual choice of metaphors could create a c u l t u r a l b a r r i e r : ...I think maybe i f we can use some of the metaphors., (which are) more i n tune with our own culture, metaphors or fables from our own story or history, and f o l k l o r e , that may work fo r our clients...So i n a way I think i t ' s a d i f f e r e n t use of metaphors or f o l k l o r e . Whereas with Caucasian c l i e n t s , the imaginative r o l e w i l l be quite handy and the c l i e n t w i l l f i n d i t quite i n t e r e s t i n g to get into that mode. And also the connection between the ideas and the body may be quite e a s i l y f e l t . . . I think for Chinese c l i e n t s (to) just have these wild ideas may not work very well. But, I need to go into c u l t u r a l s t o r i e s . The metaphors that have been passed along a l l these generations, and that may bring better value to the c l i e n t . ...In a way our culture always looks back - so from generation to generation we pass along f o l k l o r e , many st o r i e s that are supposed to be educational...So we r e a l l y 138 need to..get a f e e l (for) those f o l k l o r e and then I think the c l i e n t w i l l f e e l more f a m i l i a r , more adapted ( P . C ) . Wong (1995) describes a successful incorporation of Chinese metaphor into a Chinese c l i e n t ' s discussion of emotional experience: Chinese clients'...expression of intense inner experiences through metaphors, which are embedded i n Chinese idioms or poems, r e f l e c t another communication s t y l e and possibly a more h o l i s t i c approach to one's experience (Nguyen, 1992). An example of such a metaphor, expressed i n a group of Chinese c l i e n t s , i s included i n the following idiom: "A mute boy eats yellow lotus seeds (a b i t t e r t a s t e ) , nowhere could he express his grievance.". The pain and f r u s t r a t i o n s of the c l i e n t who c i t e d t h i s metaphor were conveyed to the counselling group i n a powerful way (p. 110). I t was noticed by the interviewees that i t was often easier f o r t r a d i t i o n a l Chinese c l i e n t s to t a l k about sens i t i v e or very emotional, or "taboo" subjects i n English, because the use of a language other than t h e i r mother tongue could provide emotional distance from what they're discussing: Sometimes when I have c l i e n t s t a l k i n g about t h e i r sexual problems, then when you t a l k about the genitals or sexual organs, then they use English... And when they, sometimes when they f e e l angry, they 139 w i l l use the f o u l language i n English language. I t seems to be more distant, less offensive, that way (P.C.). On the other hand, one of the major disadvantages that interviewees mentioned i n regard to counselling and the Chinese language was the l i m i t e d range of emotional vocabulary. A number of the counsellors referred to the "narrow pool" of verbal vocabulary f o r describing f e e l i n g s : ...we don't have too much vocabulary i n Chinese i n terms of our emotion. They are quite foreign to us. Say something l i k e : "I r e a l l y f e e l very, very, very depressed;" "I f e e l bad," things l i k e that. In Chinese i t ' s d i f f i c u l t to...narrow i t down (K.N.). The li m i t e d range of emotional expression i n the Chinese language could sometimes create confusion as well i n the dialogue between counsellor and c l i e n t : Sometimes i f I ask a f e e l i n g question they don't understand. Again, i t may have something to do with the Chinese language i t s e l f . . . I can give you an example. If I ask you "How do you f e e l ? " i n English, you know what I'm asking, but i n Chinese i f I ask you "How do you f e e l ? " that can be a question about opinion rather than f e e l i n g . In Chinese, you can just ask Li got gak ging yao?...The term got gak can be a f e e l i n g word, "How do you f e e l ? " or i t can be "What's you're opinion?" (C.A.). Counsellors recommended avoiding confusion by t r y i n g to ask for a s p e c i f i c f e e l i n g , rather than asking i n a general way: 140 I t r y to avoid t h i s question: Li got gak ging yao?. I would ask i t i n a d i f f e r e n t way. Instead of asking "How do you f e e l ? " . . . I would make i t into a WHAT question and they have to pinpoint the f e e l i n g (C.A.). A lack of emotional expression i s quite consistent with t r a d i t i o n a l Chinese philosophy which encourages modesty and harmony i n a l l things: In the Chinese family open expression or discussion of emotion i s generally not encouraged, except i n certa i n r i t u a l i s t i c s i t u a t i o n s , such as funeral when the women are supposed to cry loudly to demonstrate t h e i r g r i e f The Chinese believe that excess emotion endangers health. For example, lo s i n g one's temper i s described i n Chinese as the discharging of spleen element (fa pi g i ) . The common b e l i e f i s that i t i s a r e s u l t of too much f i r e element i n the l i v e r (gan huo shen). An overt expression of emotion, such as anger, may cause inner organ damage and, therefore, ought to be discouraged (Tseng & Wu, 1985, p. 100). One of the reasons given by several interviewees f o r the lack of emotional vocabulary i n the Chinese language i s that the emotions are described i n a more physical way, the "physical sensation," rather than i n a "psychological" way. For example: Like i n HAPPY, the word "happy" i n Chinese l i t e r a l l y means "my heart i s open" — Like SAD, right? In 141 Chinese i t l i t e r a l l y means "hurting heart." The word heart has to be there, something physical...The Chinese language attaches physical symptoms to feelings (C.A.). Using the vocabulary of p h y s i c a l i t y to describe feelings i s quite consistent with the t r a d i t i o n a l Chinese philosophy (see Chapter Four) of Taoism, which stresses the unity of "the whole": T r a d i t i o n a l Chinese medicine i s based on Taoist philosophy, which includes c l e a r and calm awareness of a l l cosmic phenomena, including the diverse functions of the human personality. Taoists do not separate mental and physical processes (Das, 1987, p. 35). Another recommendation fo r discussing emotional feelings with t r a d i t i o n a l Chinese c l i e n t s was, therefore, to use the language of p h y s i c a l i t y to further describe and narrow down the f e e l i n g : I would t r y to focus on t h e i r emotion, but I would t r y to l i n k i t up with t h e i r physical f e e l i n g s , t h e i r physical symptoms. Sometimes what they say, they describe t h e i r f e e l i n g which I'm not sure, I would ask them to describe t h e i r physical sensation at that time. For example, i f the c l i e n t says: "I'm f e e l i n g sad" then I say "What do you mean by that?", "How does your body f e e l when you say you are sad?" (C.A.). Many of the interviewees discussed the influence of the Chinese language on the s t y l e of communication between counsellor and c l i e n t . In p a r t i c u l a r , several interviewees mentioned the 142 inherent directness of the Chinese language: Sometimes the Chinese language i t s e l f i s structured such that you say things d i f f e r e n t l y than i f you are speaking i n English. So things just come out more d i r e c t . Either i t ' s t o t a l l y d i screte, or i t has to be very d i r e c t (A.C.). How t h i s directness of language might impact the rel a t i o n s h i p , p a r t i c u l a r l y i n terms of c l i e n t feedback and i n expectations from t r a d i t i o n a l Chinese c l i e n t s f o r a d i r e c t i v e approach from the counsellor, are discussed respectively under Theme #3 (Expectations of the counsellor role) and Theme #9 (Blending Western-counselling with t r a d i t i o n a l Chinese culture) And, f i n a l l y , interviewees mentioned the expectation of t r a d i t i o n a l Chinese c l i e n t s f or a ce r t a i n "formalness" of language i n l i n e with the expected professional r o l e of the counsellor. A more informal approach, such as the use of humour during the session, could r e s u l t , i f used incautiously, i n losing the respect and rapport of the c l i e n t : I would t r y to c u l t i v a t e a casual atmosphere...but... the words I use have to be car e f u l i n the sense that I cannot be too casual with some of the terms, or slang, or jargon I use because, again, I would say i n the Chinese people's mind they cannot accept professional people being so careless with t h e i r language. Like using the language of the lower c l a s s , f 143 so to speak. So I have to be ca r e f u l about that. Sometimes some c l i e n t s cannot even use the use of humour. The Caucasian c l i e n t s are more accepting of... you say a few jokes with them or use a sense of humour. I would be very c a r e f u l about that with Chinese c l i e n t s (C.A.). S e n s i t i v i t y to Possible Cultural Differences i n Non-Verbal Communication Between C l i e n t and Counsellor Non-verbal communication of Western-trained counsellors working with t r a d i t i o n a l Chinese c l i e n t s was a d i f f i c u l t topic f o r most of the interviewed counsellors to t a l k about because, as one interviewee put i t , so much of non-verbal behaviour i s unconsciously ingrained or "automatic." However, counsellors were able to t a l k about some of t h e i r nonverbal responses to what they saw as the c l i e n t ' s preference for physical reserve and distance i n the re l a t i o n s h i p . With couples, Caucasian couples may be more intimate, p h y s i c a l l y intimate, i n front of me. Whereas Chinese couples w i l l be...more reserved i n that way ( P . C ) . I t was assumed that t r a d i t i o n a l Chinese c l i e n t s would not f e e l comfortable touching someone unless i t was someone they knew: I don't think they expect that kind of thing...unless i t ' s someone they've known f o r years and i t ' s a spec i a l occasion (A.C.). 144 Physical contact was generally l i m i t e d to a handshake: Well, handshake are quite good. Like i n i t i a l l y when I meet the c l i e n t f o r the f i r s t time, very often I w i l l shake hands with them and I think the c l i e n t s f e e l comfortable with that ( P . C ) . Even here, however, some counsellors were cautious i n i n i t i a t i n g physical contact: I would not shake the person's hand i f the person doesn't extend his hand. I would greet the person by a s l i g h t bow, or just acknowledge the person, make a point of i t . So, any person that shakes hands with me, usually the person has t h e i r hand ready, then I would extend i t . . . t o the c l i e n t (L.C.). The only other physical contact mentioned was sometimes a l i g h t pat on the shoulders given by the counsellor: Sometimes (I) give someone a pat on the back or something, a very l i g h t touch ( A . C ) . Several of the interviewees attributed some of t h e i r physical r e s t r a i n t to t h e i r own Chinese background as well: I don't touch. That may be my own Chinese up=bringing. I generally don't touch anyone, and I think that, I don't know, but I think that probably i s compatible with my Chinese c l i e n t s . Most of them were probably raised the same way ( A . C ) . In terms of proxemics, the preference of the majority of 145 counsellors interviewed was to keep a considerable s p a t i a l distance out of respect f o r the c l i e n t . In terms of Chinese c l i e n t s , s p a c i a l l y I would not p u l l up. I would give more space. You would never see two Chinese c l i e n t s speaking to each other face-to-face with just one foot i n between them...I would not p u l l up. I would be at le a s t seven feet away from the client...And, when the c l i e n t stands up and they're leaving the session, I am very much aware. I w i l l not go so near to the c l i e n t . I w i l l wait t i l l the c l i e n t moved a l i t t l e b i t before I would come up any further. I would stand up when the c l i e n t comes and when the c l i e n t leaves, but I would not move i n to a distance which i s an...upset f o r the c l i e n t ( L . C ) . To create a more comfortable physical space between counsellor and c l i e n t s , several of the interviewees mentioned the use of a small round table across which the dialogue took place. I t was the impression of these counsellors that the small table created a "safer," and more "informal" s e t t i n g for the session, more l i k e a conversation between fri e n d s : ...with the table i n between (taps table)...that has made c l i e n t s f e e l more comfortable, they f e e l less exposed. It's a safe buffer i n between ( C A . ) . Non-verbal behaviours of t r a d i t i o n a l Chinese c l i e n t s which were noted to a f f e c t counselling included less eye contact than 146 Western-European c l i e n t s and l i m i t e d f a c i a l expression. The noticeable lack of eye contact was mentioned by many of the interviewees as being a c u l t u r a l i n d i c a t i o n of p o l i t e attention: I think there's less eye contact i n Chinese culture. Actually there i s . . . I t ' s just a c u l t u r a l thing. I t ' s not p o l i t e to look at someone's eyes f o r too long... So, sometimes when I look at a c l i e n t , she would be t a l k i n g to the shelf ninety percent of the time, or even the whole time (J.H.). However, i t was also mentioned that generational differences and differences i n country of o r i g i n have affected t h i s behaviour so that i t i s no longer as prevalent: Some people say that Chinese people don't look at me i n the eye, because i n the past, a long long time ago, I think there's the saying that i f you look at people i n the eye, you are impolite. But I don't think that works any more...Maybe for some more t r a d i t i o n a l Chinese people, they w i l l s t i l l not look at you intensely f o r concern that they are being too interested; they are impolite. But I think gradually things have changed, and I look at c l i e n t s i n that way, and they also look at me i n the eye, so not so much difference (C.A.). Several of the counsellors responded to the perceived reserve i n t r a d i t i o n a l Chinese c l i e n t s by exaggerating t h e i r own f a c i a l expressions as a kind of "role-modelling" and to make sure that 147 the counsellor acceptance of the c l i e n t was received by the c l i e n t : One thing I've noticed...usually the Chinese people are less expressive, less f a c i a l expression, as i f they are more uptight and they are t r y i n g to hide t h e i r f e e l i n g . And sometimes I, as a demonstration, I would amplify my f a c i a l expression to show them, as an example, or as a demonstration. So sometimes I i n t e n t i o n a l l y exaggerate my f a c i a l expression i n order to make them f e e l more comfortable i n doing the same. Their face can be stone, or p l a i n for the whole session. They can t a l k about very t e a r f u l issues, but face won't show i t (C.A.). Nonverbal demonstrations of respect by the counsellor f o r the c l i e n t were also sometimes shown by exaggerated f a c i a l or bodily expression. For example, ...for Chinese c l i e n t s , when I agree with them, again, I w i l l exaggerate a l i t t l e b i t more, l i k e nod my head heavy enough f o r them to notice whereas for Caucasian c l i e n t s , I would just not my head "Oh, yeah, good, okay." So w i l l stress i t to show i t to them. Again when I work with my Chinese c l i e n t s I want to convey more of the p o s i t i v e feelings...with proof of my acceptance to them. By exaggerating a l i t t l e b i t , I want to make sure that they caught i t . So my expression i s more e x p l i c i t , rather than subtle (C.A.). 148 A number of counsellors emphasized the need to demonstrate an obvious warmth and f r i e n d l i n e s s towards the c l i e n t , that perhaps refers back to the discussion of t r a d i t i o n a l Chinese c l i e n t s need for a more f r i e n d l y , intimate r e l a t i o n s h i p with the counsellor. As one interviewee put i t : Just be f r i e n d l y , l i k e with a smile on your face or something to show that...you are a personal rather than you're just going i n to do a job (E.H.). Another interviewee described the same approach i n more d e t a i l : Nodding the head, smile...a gentle voice. Yes, t r e a t i n g them with very welcoming attitude, rather than a blank face...(not j u s t ) : "Come i n , s i t down, what do you need today?" That's... just not me. I've seen other...counsellors who are more cold than I am. That's just not me (J.H.). The appearance of the counsellor was frequently mentioned as an important factor a f f e c t i n g the t r a d i t i o n a l Chinese c l i e n t ' s acceptance of and respect f o r the counsellor as a professional. I think most of them w i l l expect that you are not too sloppy, not "hippy-like." And so, b a s i c a l l y , neat and t i d y I think i s the basic e s s e n t i a l s . And not too l a v i s h l y decorated...Because i f you're too l a v i s h l y i n your, decorating yourself, I think that puts people o f f and that creates a greater distance between you and them....Because they may f e e l that i f 149 you are dressed that p e r f e c t l y or sophisticatedly then you may not understand t h e i r sorrow or t h e i r pain so much (P. C.). Appearance was considered an important step i n establishing i n i t i a l rapport, getting the c l i e n t ' s t r u s t and willingness to l i s t e n to the counsellor: I think they w i l l l i s t e n to you more when you are dressed professionally...My co-worker i n Hong Kong, she went..to work wearing a pair of jeans and (the) c l i e n t c r i t i c i z e d her...the c l i e n t ' s parents: "I won't t r u s t my daughter with you" (S.W.). Several counsellors also mentioned t h i s expectation of counsellor appearance i n a broader way which included not only dress, but body language and manner: ...and i f you are too l i b e r a l , say i n terms of our dress, for example, i f I am i n a t - s h i r t and jeans and ...legs spreading out and, you know (lounging) i n the chair, then they would quickly l o s t confidence i n you. Even smoking. You know, things l i k e that. Because you're a role-model, i n a sense, they have got cer t a i n expectations (K.N.). I t was found that older counsellors gained respect more e a s i l y , as did male counsellors over female counsellors. One interviewee discussed h i s d i f f i c u l t y i n being accepted as a professional because of his youth: 150 They know that I have a couple of degrees to back me up, and how many years of experience behind me, they (usually) respect me. But sometimes when they walk i n and see: "Who i s t h i s young k i d with long hair?", i t was quite a b i t longer, and then they would doubt, and i f they don't have a need bigger than the doubt, then they would s t a r t showing some signs of questioning it...Maybe t h e i r f a c i a l expression would show the doubt. Maybe something they say, or would say: "Have you dealt with these kind of thing before?" (J.H.). Gender also influenced the co u n s e l l o r - c l i e n t r e l a t i o n s h i p , with t r a d i t i o n a l Chinese female c l i e n t s p r e f e r r i n g a female counsellor, and t r a d i t i o n a l Chinese male c l i e n t s tending to prefer a male counsellor. A female counsellor has experienced lack of t r u s t from Chinese male c l i e n t s because of her gender: I'm not sure how many men, male c l i e n t ( s ) w i l l t r u s t me...whether they w i l l t e l l me anything i n depth or what i s wrong...Quite a l o t of older Chinese men, they w i l l think the woman (does) not think, only the man knows better. They t r u s t men more than they t r u s t women (S.W.). I t may be d i f f i c u l t for men to reach outside the family for help, and e s p e c i a l l y to ask for help f o r personal issues from a woman: I think f o r men to come i n and t e l l t h e i r problem to a woman i s very challenging, and, es p e c i a l l y f o r 151 Chinese men, because they're not used to t a l k i n g about t h e i r f e e l i n g s . I t ' s d i f f i c u l t f o r them. And so, to t a l k about these inner things with a woman takes a l o t of courage and a l o t of - great l e t t i n g go of the shame, the sense of embarrassment ( P . C ) . On the other hand, t r a d i t i o n a l female c l i e n t s may f i n d i t easier to t a l k to a female counsellor: They tend to...say that: "Well, you are just another man who would probably side with my husband" (K.N.). Consideration of Suggestions by Counsellors Experienced i n Blending Western Counselling Training with T r a d i t i o n a l Chinese C l i e n t Expectations A l l of the Western-trained counsellors interviewed f o r the study were of a Chinese background and had experience working with t r a d i t i o n a l Chinese c l i e n t s . Based on t h e i r experience i n blending Western t r a i n i n g with Chinese c l i e n t expectations, they had a number of s t r a t e g i c recommendations fo r counsellors working with t r a d i t i o n a l Chinese c l i e n t s . The most challenging and frequently mentioned dilemma mentioned by the counsellors was the need to meet the expectations of t r a d i t i o n a l Chinese c l i e n t f o r d i r e c t i o n and advice while using the usual non-directive and insight-focused approach of Western counselling t r a i n i n g . Several interviewees recommended meeting the c l i e n t ' s i n i t i a l need for concrete d i r e c t i o n and behavioral focus, before leading i n to deeper, more introspective issues: 152 So i n the f i r s t session, what we usually do i s that we t r y to i d e n t i f y something concrete because they would expect you to give them advice...If you don't do anything concrete i n the f i r s t two or three sessions then you quickly would lose your c l i e n t (K.N.). Demonstrating a willingness to meet the c l i e n t ' s concerns as presented allowed a t r u s t to develop between counsellor and c l i e n t : In working with the Chinese c l i e n t s , usually for f i r s t session or second session I would focus more on issues rather than t h e i r own personal feelings or t h e i r personal issues. For example, the presenting problem might be the c h i l d behaviour. So usually f o r the f i r s t two sessions I would spend more time t a l k i n g about the c h i l d , or the c h i l d ' s behaviour and less on the parenting s t y l e they have...because, again, I'm a f r a i d that might be too personal, and they may take i t as a c r i t i c i s m . So I have to be with them i n the concerns and make them f e e l that I'm seeing things, or at l e a s t I'm t r y i n g to see things, from t h e i r perspective f i r s t instead of going to the issues which I think are the core issues (C.A.). I f the i n i t i a l concrete concerns of the t r a d i t i o n a l Chinese c l i e n t were met, interviewees found that c l i e n t s f e l t confident i n the counsellor's a b i l i t i e s , were more w i l l i n g to t r u s t that the counsellor could help them, and would l i s t e n to the 153 counsellor's suggestions: For example, i f they're not sure about the educational system here, why i t ' s ^ s o vague, what's happening i n the cl a s s , i f you can f i n d some material (to) explain to them that's what's happening i n the school or you can make a phone-call f o r them, do some interpretations or go with them to a meeting with the "head-master," they w i l l f e e l a sort of: "Oh, t h i s person can r e a l l y help, with a l l t h i s concrete support," and they would have some sort of t r u s t i n you (K.N.)-Once the t r u s t was b u i l t between c l i e n t and counsellor, the interviewees would begin to reframe the presenting issue, and move into deeper, more core concerns: So i n i t i a l l y , a f t e r hearing some of t h e i r perceptions about how things are or what t h e i r perception of the problem i s , I may give some idea of how I f e e l about the s i t u a t i o n . . . I w i l l maybe i n the middle or near the end (of the session) or at the beginning, give a "rap-up", kind of a statement on how I see t h e i r problem and where we are going with that...So i n that way they might f e e l that they have a handle on how the s i t u a t i o n i s (P.G.). An example given by one of the interviewees was; Don't ignore what they put forward...They t a l k about t h e i r son and you "It's not your son's problem, i t ' s somebody else's problem." They would...quickly (lose) t r u s t i n you 154 and they would just go away, walk away. So we sort of say, for example: "Perhaps you could t r y t h i s and that with your son and see what would happen tomorrow. When you come back probably you would expect some improvement." ...They would t r y out and they come back and: "Oh, i t works"...So sometimes you would suggest one or two techniques of communication, role-play, then they t r y i t at home. Then they come back: " I t r e a l l y work." But i t may not be the core of the problem. I t may be a problem with the family communication. So gradually we would bring i n the family picture (K.N.). Several counsellors pointed out that moving from solution-focused to insight-focused counselling, although i n i t i a l l y not an expectation of many Chinese c l i e n t s , seemed to be, i n the long-ru, more s a t i s f y i n g f o r the c l i e n t ...on the surface they want some advice from me, they want some d i r e c t i o n , they want to be t o l d what to do, l i k e asking a doctor to advise them, but very often even i f I gave advice to them they w i l l s p e l l out a l l kinds of d i f f i c u l t i e s and things that challenges, not very overtly, that your method won't work...I think very often they come here, of course they want the solution, but they want THEIR solution...And so i f they f i n d that t h i s therapist i s giving them a d i f f e r e n t solution then they w i l l think that i t doesn't work and w i l l compile a l l the d i f f i c u l t i e s , and 155 then ask i f you have any OTHER solution...In a way, sometimes i t ' s a trap...on one hand I f e e l the need f o r them to have an expert to guide them, but I know inwardly that i f I do that i t w i l l not work very well ( P . C ) . However, as was also mentioned by a number of the interviewees, moving into s e l f - r e f l e c t i o n and introspection was sometimes d i f f i c u l t and confusing for the t r a d i t i o n a l Chinese c l i e n t : I f I concentrate on a way that w i l l work with Caucasian c l i e n t s , l i k e asking them stimulating ( r e f l e c t i v e ) questions, quite a number of times they kind of f e e l l o s t and they w i l l f e e l : "Why asking me these questions? I came here f o r answers, not f o r you to ask me...So what i s i t that you are doing?" ( P . C ) . Several interviewees discussed how the "psychological framework," or c u l t u r a l worldview, of the c l i e n t could be focused d i f f e r e n t l y i n t r a d i t i o n a l Chinese c l i e n t s than i n Western-European c l i e n t s : We're (Chinese) not very used to that kind of psychological framework...we're more emphasis on behaviour practice. Like, a Chinese parent w i l l be very emphatic on the k i d i s behaving good at school, has good marks and concentrating on study, being p o l i t e , being obedient. But..."What i s the importance of having good self-esteem as related to that?" And somehow not very e a s i l y grasped...The emphasis i s more on "I hope that we can encourage him to work harder, to be more 156 p o l i t e , more on track, and be a good c i t i z e n , be l o y a l to family, r e s p e c t f u l . " The emphasis i s more on the behaviour patterns. Whereas maybe with Caucasian c l i e n t s , they w i l l be more emphatic on hoping that the c h i l d can have good self-esteem, a sense of being empowered, and then they f e e l that things w i l l be d i f f e r e n t that way. So, the emphasis may be a b i t d i f f e r e n t ( P . C ) . Most importantly, as i n Theme #1, counsellors mentioned the need to be aware of within-group differences and to check out c u l t u r a l assumptions of c l i e n t expectations: We would see that t h i s c l i e n t probably he or she would accept more of a non-directive approach, then we would go f o r a more very Western s t y l e of giving counselling. But i f a person i s . . . a t y p i c a l example i s a f o r t y year o ld woman coming i n t e l l i n g , complaining about the son and the daughter's education l e v e l . . . J u s t f i n i s h about s i x years i n education only, that's a l l she got, no language a b i l i t y , new immigrant. Then b a s i c a l l y you would know t h i s person would expect something very concrete and they would, they are very vocal i n asking you: " T e l l me what I should do," " T e l l me..," keep on urging you to do that (K.N.). With t r a d i t i o n a l Chinese c l i e n t s , therefore, i t was considered most e f f e c t i v e to do something "concrete" i n the f i r s t two or three sessions to gain the c l i e n t ' s t r u s t and confidence. 157 Counsellors also tended to move slowly to the "core" issues, because moving too quickly to intimacy, or f a i l i n g to demonstrate a willingness to be of p r a c t i c a l help to the c l i e n t , could mean losi n g the c l i e n t altogether. Many of the interviewees expressed a willingness, therefore, to give the c l i e n t time to adjust and f e e l comfortable i n the counselling s e t t i n g : Chinese c l i e n t s may need more time to get themselves... to f e e l that they f i t i n the s i t u a t i o n . And I think the whole counselling s e t t i n g i s very foreign to them.. So, to begin I mainly spend some more time sharing, maybe some r e l a t i v e l y s o c i a l or personal things with them, l i k e where do they come from...and how do they come here. So t h i s kind of s o c i a l c h i t - c h a t t i n g r e a l l y may l a s t a b i t longer... With Chinese c l i e n t s I think I need a longer time to r e a l l y make them f e e l comfortable, that they are i n the r i g h t place and that they w i l l not be interrogated...So the i n i t i a l period of s o c i a l joining w i l l be a b i t longer ( P . C ) . The i n i t i a l c l i e n t contact was considered by many of the counsellors to be a c r u c i a l factor a f f e c t i n g the t r a d i t i o n a l Chinese c l i e n t ' s attitude towards counselling services. I t was found that having someone greet the c l i e n t i n t h e i r own language whenever possible was h e l p f u l . Counsellors found i t most successful to greet the t r a d i t i o n a l Chinese c l i e n t personally whenever possible, e s p e c i a l l y i f they were the only s t a f f member able to speak the same language: 158 If I know that they do not speak English then I would say: "Just ask for me" and give my name..and have them practice my name, and then I would also inform the re c e p t i o n i s t just before the c l i e n t would come that...so and so w i l l be coming at one-thirty or something...watch out f o r that person and just c a l l me out as soon as they arr i v e (E.H.). It was also important, the interviewees stressed, to be able to understand that the shame or g u i l t , f o r a t r a d i t i o n a l Chinese c l i e n t , i n t a l k i n g about problems could create an i n d i r e c t i n i t i a l - p r o b l e m statement from the c l i e n t , and, therefore, necessitates the a b i l i t y of the counsellor or i n i t i a l contact person to "read between the l i n e s " of the c l i e n t ' s request f o r assistance. So I would say that the i n i t i a l phases of reception i s r e a l l y important. That means the one who pick up the phone, and that person would s t a r t using some excuse: "I have got a f r i e n d who i s f e e l i n g sad" or some would t r y to...project the problem to somebody else. So you w i l l have to learn (to)...read between (the) words. That means when you l i s t e n to the message you have to be very s e n s i t i v e , supportive, and assure that c o n f i d e n t i a l i t y i s there (K.N.). And, f i n a l l y , the interviewees referred to the i n i t i a l information-gathering, and recommended using a more informal, 159 less structured approach to obtaining personal information from t r a d i t i o n a l Chinese c l i e n t s : ...you should not, I think, follow some kind of a format that you have...Let's say you have twenty questions that you want to ask, you t r y to work on asking those twenty questions during the interview but maybe not i n the order that i t ' s been l i s t e d on your piece of paper. And i n the end you would s t i l l have a l l the information, or most of the information, but then i t ' s not so structured that i t would look kind of unnatural. So you want i t to be a comfortable as possible f o r the person as i f they're t a l k i n g (E.H.). This "informal" method of i n t e r a c t i n g with t r a d i t i o n a l Chinese c l i e n t s was often even extended to the s e t t i n g of appointments: Even i f I schedule f o r them, regular appointments, I would do i t i n some more informal way. I would chat with them a l i t t l e b i t about t h e i r d a i l y l i f e (A.C.). Conclusion In summary, the interview participants were i n agreement i n stressing a number of areas which they believed to be c r u c i a l i n establishing the therapeutic a l l i a n c e with Chinese c l i e n t s : a) knowing or learning about the values and b e l i e f s of the Chinese culture and how these might impact on the building of a 1 6 0 therapeutic a l l i a n c e , b) applying t h i s general c u l t u r a l knowledge i n a s p e c i f i c way according to the i n d i v i d u a l c l i e n t ' s personal and s o c i a l history, and c) remaining f l e x i b l e , when building the therapeutic a l l i a n c e , to possibly adapting or changing the usual assumptions and practices of Western counselling so as to best meet the needs of the Chinese c l i e n t . Each of the counsellors interviewed d i f f e r e d somewhat i n t h e i r approach to integrating Western counselling theory and practice with Chinese c u l t u r a l values, but a l l agreed that some r e v i s i o n of t r a d i t i o n a l Western counselling was e s s e n t i a l to b u i l d a therapeutic a l l i a n c e with t r a d i t i o n a l Chinese c l i e n t s . Being of the same c u l t u r a l background as the c l i e n t was no guarantee of immediate rapport between counsellor and c l i e n t , as there was often wide differences i n terms of educational l e v e l , i n terms of subgroups within the culture, and i n terms of understanding and acceptance of Western counselling values. However, from the interview r e s u l t s , i t appears that Western counselling can be used e f f e c t i v e l y with t r a d i t i o n a l Chinese c l i e n t s i f the counsellor i s w i l l i n g to remain f l e x i b l e i n negotiating a working r e l a t i o n s h i p that f i t s comfortably with the c u l t u r a l values and b e l i e f s of both the counsellor and the c l i e n t . CHAPTER SIX 161 DISCUSSION Theoretical Implications This research study has demonstrated that c u l t u r a l differences e x i s t i n the effectiveness or appropriateness of Western counselling approaches to establishing rapport. In t h i s regard the research study r e s u l t s are consistent with and confirm p r i o r research findings and t h e o r e t i c a l l i t e r a t u r e on m u l t i c u l t u r a l counselling. By looking at the i n t e r a c t i o n of Western counselling assumptions around the a l l i a n c e formation i n r e l a t i o n to t r a d i t i o n a l Chinese values, a number of broader issues related to the universal a p p l i c a b i l i t y of Western counselling have arisen. Most importantly, i t appears that applying Western assumptions of a l l i a n c e formation regardless of s e n s i t i v i t y to the appropriateness or inappropriateness to a p a r t i c u l a r c l i e n t ' s c u l t u r a l worldview can r e s u l t i n a c l i e n t who f e e l s misunderstood, mi s t r u s t f u l or distant to the counsellor. The danger of not gaining and applying knowledge of the c l i e n t ' s culture i s i n f a i l u r e to b u i l d a therapeutic a l l i a n c e and, therefore, losing the c l i e n t altogether. I t seems from the re s u l t s of t h i s study that i t i s necessary f o r the Western-trained counsellor/psychotherapist to be aware of t h e i r own c u l t u r a l values and how they might impact on those of the c l i e n t . The process of establishing an a l l i a n c e becomes, with t h i s 162 awareness, one of counsellor and c l i e n t dynamically creating a mutual understanding of the r o l e of the counsellor, the boundaries of the re l a t i o n s h i p , and the rules f o r working together. P r a c t i c a l Implications Due to the small sample s i z e and s p e c i f i c q u a l i t i e s of the sample interviews, r e s u l t s are not generalizable. However, there are a number of p r a c t i c a l suggestions for counsellors that can be drawn from the research study. These are described i n the following section. F i r s t , i t i s a r e s p o n s i b i l i t y of the counsellor/therapist to educate themselves (through t r a i n i n g , research, or consultation) on the culture of the s p e c i f i c c l i e n t they are counselling so as to understand the background experiences and c u l t u r a l b e l i e f s and values which influence the c l i e n t ' s perspective. Cultural knowledge can then be used as a framework from which to begin defining the in d i v i d u a l c h a r a c t e r i s t i c s . Sue and Sue (1990) describe t h i s framework as a "background from which the figure emerges" (p. 48). For instance, i f we know that a man i s from North India and we know that area, we can guess with a ce r t a i n p r o b a b i l i t y that he has dealt mostly with people from his caste, that he has had to contend with very crowded 163 buses, that he has seen a vari e t y of people at work as he walked through the town's narrow lanes, and that he has been expected to be obedient to h i s parents and at the proper time submit to t h e i r choices for h i s occupation and marriage partner (Marsella & Pedersen, 1981, p 30). I t i s important f o r counsellors to not apply c u l t u r a l information i n a stere o t y p i c a l way. Sue and Sue (1990) describe stereotypes as " r i g i d preconceptions we hold about ALL people who are members of a p a r t i c u l a r group...The b e l i e f i n a perceived c h a r a c t e r i s t i c of the group i s applied to a l l members without regard f o r in d i v i d u a l v a r i a t i o n s " (p. 47-48). To avoid stereotyping indiv i d u a l s within a p a r t i c u l a r culture, and to begin to perceive the in d i v i d u a l variations unique to a p a r t i c u l a r c l i e n t , i t i s necessary for counsellors to be aware of within-group differences that may be present. F i n a l l y , i f a counsellor i s confused or unclear about a c l i e n t ' s c u l t u r a l b e l i e f s , values, or expectations and whether or not these are influencing the c l i e n t ' s s i t u a t i o n or the counselling process, i t i s useful to ask the c l i e n t f o r c l a r i f i c a t i o n . One must be careful not to apply c u l t u r a l information i n a stereotypic manner. Ishisaka, Nguyen, and Okimoto (1985) point out that c u l t u r a l d i f f i c u l t i e s , such as the degree of assimilation, socioeconomic background, family experience, and educational l e v e l , impact each i n d i v i d u a l i n a unique manner. Knowledge of c u l t u r a l values can help generate 164 hypotheses about the way an Asian might view a disorder and hi s or her expectations of treatment, but i t must not be applied i n a r i g i d fashion (Sue & Sue, 1990, p. 197). The assumptions of Western counselling, and the underlying Western European values, may need to be challenged as to t h e i r appropriateness with p a r t i c u l a r c u l t u r a l groups. For example, the assumption that counselling i s a move towards greater autonomy and s e l f a c t u a l i z a t i o n may not be comfortable for a l l c u l t u r a l groups. As Ivey, Ivey and Simek-Morgan (1993) point out autonomy/self-actualization assumes an " i n d i v i d u a l " i d e n t i t y of s e l f i n which the locus of r e s p o n s i b i l i t y l i e s within the i n d i v i d u a l . Such a b e l i e f may be i n d i r e c t opposition to culture which assumes a " c o l l e c t i v e " i d e n t i t y of s e l f i n which the locus of r e s p o n s i b i l i t y resides i n the family and the community. Autonomy and s e l f - a c t u a l i z a t i o n sound l i k e wonderful ideas with which no one could t r u l y disagree. However, an exclusive focus on the s e l f would be considered s e l f i s h and even and i n d i c a t i v e of mental disorder i n much of Asia, South P a c i f i c , and African culture. As another example, American Indian culture has long focused on the re l a t i o n s h i p of the in d i v i d u a l to the group and to the environment. The Sioux Nation t a l k s of mitakuge ogasin - " a l l my r e l a t i o n s " (Ivey, Ivey, & Simek-Morgan, 1993, p. 13). Western counsellors who are unaware of the variations of c u l t u r a l 165 d e f i n i t i o n s of the s e l f , may, as Sue and Sue (1990) point out, ascribe negative attributes or motives to c l i e n t s from a " c o l l e c t i v e " culture: (There are) a number of individuals who describe Asian c l i e n t s as being dependent, unable to make decisions on t h e i r own, and lacking i n maturity. Many of these analyses are based on the f a c t that many Asian c l i e n t s , do not see a decision-making process as an in d i v i d u a l one. When an Asian c l i e n t states to a counsellor or therapist: "I can't make that decision on my own; I need to consult with my parents or family," he or she (may be) seen as being immature (p. 36). Another focus of Western counselling i s insight and s e l f r e f l e c t i o n , rather than p r a c t i c a l , immediate solutions to concrete problems: T r a d i t i o n a l psychotherapy i s t y p i c a l l y i n sight and fe e l i n g oriented. Therapists help c l i e n t s explore t h e i r feelings and understand t h e i r problems. Asians, on the other hand, frequently perceive therapists s i m i l a r l y to medical doctors. They seek concrete advice, structure, guidance, and directions to deal with t h e i r problems. Indepth personal questions by therapists may cause intense discomfort and disillusionment (Lefley & Pedersen, 1986, p. 201). However, counsellors interviewed i n my research study found i t 166 e s s e n t i a l , i f rapport was to be established with t r a d i t i o n a l Chinese c l i e n t s , to demonstrate a willingness to meet the c l i e n t ' s i n i t i a l concerns as presented. Once t r u s t was established, the counsellor could begin to reframe the issues and move to deeper l e v e l s of understanding at a pace comfortable for the- c l i e n t . Western-trained counsellors may, therefore, need to evaluate the directness and pacing of t h e i r approach to the deep i n t e r n a l issues and c o n f l i c t s of the c l i e n t . Confrontation and c o n f l i c t are assumed i n Western counselling to be part of the struggle towards desired change and growth. However, the values of harmony and s t a b i l i t y i n c e r t a i n cultures, such as t r a d i t i o n a l Chinese culture, may override the desire f o r change and growth. Without knowledge and s e n s i t i v i t y to c u l t u r a l values around c o n f l i c t and s t a b i l i t y , a counsellor may create undue stress between a c l i e n t and the c l i e n t ' s c u l t u r a l values: Asian Confucian philosophy...stresses a set of rules aimed at promoting l o y a l t y , respect, and harmony among family members (Sue & Morishima, 1981; Yamamoto & Kubota, 1983). Harmony within the family and the environment leads to harmony with the s e l f . . . A s i a n cultures tend to accommodate and/or deal with problems through i n d i r e c t i o n . . . i t i s believed better to avoid d i r e c t confrontation and to use d e f l e c t i o n (Sue & Sue, 1990, p. 126). 167 Western-trained counsellors also need to be aware that c u l t u r a l differences e x i s t i n attitudes towards time. Western counselling assumes a l i n e a r , cause-and-effect orientation to time. Misunderstanding a c l i e n t ' s c u l t u r a l conception of time could a f f e c t the establishment of rapport with the c l i e n t . Edward H a l l describes two d i s t i n c t c u l t u r a l concepts of time, which he labels "monochronic" time and "polychronic" time: American time i s what I have termed "monochronic", that is...prefer(ing) to do one thing at a time, and t h i s requires some kind of scheduling..."polychronic" systems are characterized by several things happening at once. They stress involvement of people and completion of transactions rather than adherence to preset schedules (Ha l l , 1976, p. 17). Western counsellors' concept of time as a lim i t e d commodity, necessitating the scheduling of appointments, and the l i m i t i n g of the length and frequency of meeting times may, therefore, clash with c l i e n t s from a d i f f e r e n t time system. Counsellors may need to be less r i g i d i n t h e i r scheduling, and perhaps negotiate a way of meeting that i s comfortable f o r both counsellor and c l i e n t . Counsellors may, therefore, need to move towards intimacy and c l i e n t s e l f - d i s c l o s u r e at a pace that i s comfortable f o r the c l i e n t , and may be slower than the Western-trained counsellor i s used to: An American-Indian family who values "being i n the 168 present," and who values the "immediate experiential r e a l i t y of being," may f e e l that the counsellor lacks respect f o r them and i s "rushing them" (Lewis, 1981; Red Horse et a l . , 1981) while ignoring the q u a l i t y of the personal r e l a t i o n s h i p . On the other hand, the counsellor may be dismayed by the "delays," " i n e f f i c i e n c y , " and lack of "commitment to change" among the family members ...The r e s u l t i s frequently d i s s a t i s f a c t i o n among the parties, lack of e s t a b l i s h i n g rapport, misinterpretation of the behaviours or s i t u a t i o n s , and probably discontinuance of future sessions (Sue & Sue, 1990, p.128). I t i s important f o r counsellors to understand that Western counselling's expectation of the counsellor r o l e may not be the same across cultures. In Western counselling the r o l e of the counsellor i s generally understood to be that of a professional who provides objective, f a c i l i t a t i v e encouragement and support to a s s i s t the c l i e n t to make personal changes. I t may be d i f f i c u l t , but necessary, f o r the counsellor to change counselling s t y l e s to meet the expectations of a s p e c i f i c c l i e n t f o r a d i f f e r e n t type of working r e l a t i o n s h i p . For example, the t r a d i t i o n a l Chinese c l i e n t may expect a more personal, informal r e l a t i o n s h i p i n which they would get to know the counsellor as a person, not just a professional; and may expect a more d i r e c t i v e rather than f a c i l i t a t i v e r o l e from the counsellor. I t i s necessary for the counsellor to not assume a common 169 understanding of the counsellor r o l e . C l a r i f i c a t i o n of the role of the counsellor i n Western counselling may be necessary, and, as well, the counsellor needs to remain f l e x i b l e i n negotiating a therapeutic a l l i a n c e which i s comfortable for both the counsellor and the c l i e n t . Higginbotham (1977) indicates that many people from other cultures expect an active authoritarian r o l e on the part of the therapist while the patient takes a passive, dependent r o l e . Obviously, these "images" of c e r t a i n c l i e n t e l e must be checked out against the r e a l behaviour of individuals and groups...Still...the therapist should expect that, i n a p l u r a l i s t i c society, c u l t u r a l backgrounds may contribute to r o l e expectations, and i t w i l l be h i s or her r e s p o n s i b i l i t y to be aware of these and to take them into account i n therapy (Marsella & Pedersen, 1981, p. 45-46). Another implication of the research study i s that i t i s important for counsellors to be aware that t r a d i t i o n a l family structures vary from culture to culture, and that the family experience and context i s c r u c i a l to understanding an individual's behaviour and expectations. Although the Family Therapy f i e l d has tended to ignore the larger context, i t i s increasingly obvious that family relationships cannot be separated from the wider culture that defines the types of relationships which are possible i n families and who i s available to 169 p a r t i c i p a t e i n those relationships...We must move to assume a t r u l y systemic perspective, one which takes into account a l l system l e v e l s , from the microbiologic to the s o c i o p o l i t i c a l structure of society (McGoldrick, Anderson, & Walsh, 1989, p. 12). For example, although the t r a d i t i o n a l Western model of the family developmental l i f e cycle views "separation from family" as part of Young Adulthood (Ivey, Ivy & Simek-Morgan, 1993, p. 337) i n the t r a d i t i o n a l Chinese family an in d i v i d u a l i s expected to l i v e at home u n t i l they marry, and perhaps remain l i v i n g with the parents even a f t e r marriage. C o n f l i c t s within the family system are dealt with according to c u l t u r a l expectations and, therefore, need to be viewed by the counsellor from a perspective of c u l t u r a l understanding of the family system. For example, t r a d i t i o n a l Chinese families i n which harmony i s paramount may want to avoid parent-child c o n f l i c t s i f at a l l possible; t r a d i t i o n a l Western families may want to be more d i r e c t about confronting such c o n f l i c t . Counsellors need to be aware, also, that i n immigrant families intergenerational c o n f l i c t s can a r i s e because of the d r a s t i c clash of c u l t u r a l values and the subsequent impact of these values on the family system. It i s important, f i n a l l y , f o r counsellors to recognize the constantly s h i f t i n g variations i n family structures and dynamics i n response to p o l i t i c a l , economic and s o c i e t a l changes such as 170 i n t e r r a c i a l marriages and loss of extended family support through emigration. The c l i n i c i a n working with immigrant f a m i l i e s . . . should obtain information regarding the following: How many times did the c l i e n t move i n the past? From where to where? With whom? What were the reasons? Which family members are s t i l l behind? What was the order of migration? Were these voluntary or involuntary migrations? To what p o l i t i c a l and economic systems was the family exposed?...Have family members experienced upward or downward mobility since immigration? How d i d they cope with a l l the new changes? (McGoldrick, Pearce, & Giordano, 1982, p. 531). Western counselling generally takes place i n the privacy of a formal o f f i c e s e t t i n g ; home v i s i t s are infrequent. When working with cultures which are not f a m i l i a r with or comfortable with a formal se t t i n g f o r counselling, the counsellor may have to be f l e x i b l e i n terms of the meeting place and consider other alt e r n a t i v e s : the c l i e n t ' s home, a neutral place (for example a quiet restaurant), or the outdoors. Without presuming, the counsellor can ask the c l i e n t where they prefer to meet, and attempt to accommodate t h e i r preference. The formal process i t s e l f may need to be adjusted to meet the comfort l e v e l of the c l i e n t , and a more informal process put i n place, such as the c l i e n t and counsellor p a r t i c i p a t i n g i n an a c t i v i t y together where 171 they can get to know each other on a more personal and informal l e v e l . The set-up of a counselling o f f i c e i s something that the counsellor may need to consider, as well, because the t r a d i t i o n a l o f f i c e s e t t i n g may be intimidating for c l i e n t s from some cultures. Perhaps allowing for the personality of the counsellor to come through by creating a more relaxed, personal environment may encourage c l i e n t s to f e e l a sense of t r u s t with the counsellor and the counselling process. In Western counselling i t i s presumed that the c l i e n t w i l l w i l l i n g l y s e l f - d i s c l o s e intimate d e t a i l s to the counsellor within the f i r s t two to three sessions. The counsellor, on the other hand, maintains s t r i c t "professional" boundaries regarding the sharing of personal information. Disclosure by the counsellor i s limited to very general information and recommended only as i t pertains to s p e c i f i c c l i e n t issues. Most forms of counselling and psychotherapy tend to value one's a b i l i t y to s e l f - d i s c l o s e and to t a l k about the most intimate aspects of one's l i f e . . . T h e converse of t h i s i s that people who do not disclose r e a d i l y i n counselling...are seen as possessing negative t r a i t s such as being guarded, m i s t r u s t f u l , and/or paranoid (Sue & Sue, 1990, p. 39-40). Again, an implication of the research study i s that i t may be necessary for the counsellor to recognize that culture may a f f e c t the l e v e l and pace of s e l f ^ d i s c l o s u r e by the c l i e n t , and the 172 c l i e n t ' s expectation of s e l f - d i s c l o s u r e by the counsellor. Verbal communication i s one of the e s s e n t i a l ingredients of the Western counselling process. Counselling i s considered an interpersonal r e l a t i o n s h i p i n which the counsellor influences the c l i e n t to change: The counsellor establishes a power base, or influence base, with the c l i e n t through the three r e l a t i o n s h i p enhancers of expertness, attractiveness, and trustworthiness. This influence base enhances the q u a l i t y of the r e l a t i o n s h i p and also encourages c l i e n t involvement i n counselling (Cormier & Cormier, 1991, p. 42). In order to a c t i v e l y influence the c l i e n t to change Western counsellors i n i t i a l l y use a combination of verbal and nonverbal messages to convey "attractiveness, expertness, and trustworthiness." During the i n i t i a l , or rapport-building, stage of the counselling r e l a t i o n s h i p counsellors r e l y heavily on verbal communication to demonstrate consistency, congruency, attentiveness, a b i l i t y , caring and openness (Cormier & Cormier, 1991). During t h i s i n i t i a l stage, Western-trained counsellors also t r a d i t i o n a l l y negotiate agreement on the r o l e of the counsellor, what the counselling process w i l l e n t a i l , and agreement on outcome goals (Cormier & Cormier, 1991). A reliance on verbal communication, i f the native language of the counsellor and the c l i e n t i s not the same, may create dissonance i n what i s meant and what i s understood. The intent of the counsellor's 173 verbal expression may not be what i s ac t u a l l y transmitted to the c l i e n t . Counsellors also need to be aware that what they assume i s meant by the c l i e n t ' s statements may not be what i s actually meant. Direct interpretation of words into another language does not always r e s u l t i n the same concept or meaning. Therefore, i t i s important f o r the counsellor to c l a r i f y whenever possible that messages being sent and received are the same. English may not be (the c l i e n t ' s ) primary language, (therefore) they may have d i f f i c u l t i e s using the wide complexity of language to describe t h e i r p a r t i c u l a r thoughts, feelings and unique s i t u a t i o n . C l i e n t s who are li m i t e d i n English tend to f e e l that they are speaking as a c h i l d and choosing simple words to explain complex thoughts and f e e l i n g s . If they were able to use t h e i r native tongue, they would e a s i l y explain themselves without the huge loss of emotional complexity and experience (Sue & Sue, 1990, p. 46). Western counselling furthermore assumes a comfortableness with "talk therapy," verbally communicating one's feelings and experience. This i s not always the case with a l l cultures. The primary medium of communication i s verbal (talking -e s p e c i a l l y i n standard English)...A person who i s r e l a t i v e l y nonverbal, speaks with an accent, or uses nonstandard English may be placed at a disadvantage. The lack of b i l i n g u a l counsellors makes t h i s f a c t even more glari n g (Sue & Sue, 1990, p. 29). 174 Also, directness of verbal, emotional and behavioral expression i s considered i n Western counselling to be a sign of genuineness and congruence. However, as Sue and Sue (1990) point out: In many t r a d i t i o n a l Asian groups, subtlety i s a highly prized art, and the t r a d i t i o n a l Asian c l i e n t may f e e l much more comfortable when dealing with f e e l i n g i n an i n d i r e c t manner (p. 8 8 ) . I t needs to be kept i n mind by the Western-trained counsellor that nonverbal cues may not have the same meaning across cultures. T y p i c a l l y , i n Western counselling nonverbal cues are given to transmit the counsellor's expertness. These might include displayed c e r t i f i c a t e s and licences, t i t l e s , reputation, s i z e and location of the o f f i c e . These nonverbal cues may be even more important for c l i e n t s from a culture, such as t r a d i t i o n a l Chinese culture, which i s more h i e r a r c h i c a l i n nature than Western culture and, therefore, put more t r u s t i n a counsellor who has demonstrated an "expertness" or "authority." Nonverbal cues, such as physical appearance, dress, hygiene, posture, are also used by c l i e n t s as a measure of the counsellor's attractiveness e s p e c i a l l y i n the early stages of counselling (Cormier Se Cormier, 1991) . These nonverbal factors, according to the interviewees i n my research study, may be even more c r u c i a l to c l i e n t s from cer t a i n cultures. Furthermore, what appearance and behaviour i s considered " a t t r a c t i v e " and "trustworthy" may vary from culture to culture. 175 I t i s important for counsellors to be aware that t h e i r appearance (including t h e i r age and sex) and t h e i r nonverbal behaviour may be interpreted d i f f e r e n t l y depending on the c l i e n t ' s c u l t u r a l perspective. S i m i l a r l y , the nonverbal behaviour of the c l i e n t may have d i f f e r e n t meaning than the same behaviour i n another culture. Cl i e n t s from a t r a d i t i o n a l Chinese background, for example, may be more reserved p h y s i c a l l y than c l i e n t s from Western-European culture, and may prefer more distance between themselves and the counsellor: Research on proxemics (Susman & Rosenfield, 1982; Wolfgang, 1985) leads to the inevitable conclusion that conversational distances are a function of the r a c i a l and c u l t u r a l background of the conversants (Sue & Sue, 1990, p. 53). Conclusion In summary, one of the basic assumptions i n Western counselling i s the need f o r the counsellor to demonstrate to the c l i e n t an empathetic understanding of the c l i e n t ' s perspective and experience. Without an understanding of the c l i e n t ' s c u l t u r a l values and b e l i e f s , however, the counsellor may believe they are being empathetic when i n f a c t t h e i r words or behaviour i s being interpreted as uncaring or i n s e n s i t i v e from the c l i e n t ' s c u l t u r a l perspective. 176 Clients must be confident that t h e i r speech and actions are being decoded by the counsellor accurately and that t h e i r messages are received as intended (Westwood & Ishiyama, 1990, 0. 166). To avoid misunderstanding and miscommunication, the counsellor needs to a) be aware of both t h e i r own and the c l i e n t ' s c u l t u r a l values and b e l i e f s , b) be w i l l i n g to question t h e i r own c u l t u r a l assumptions, and c) remain f l e x i b l e i n establishing a r e l a t i o n s h i p and counselling process which i s respectful of both the counsellor and the c l i e n t ' s culture. Limitations of the Research Study My own c u l t u r a l perspective, Western European, was both a disadvantage and an advantage i n interpreting and analyzing information from the research interviews. The major disadvantage stems from my being an "outsider" to the culture under study (Chinese). I t i s possible, and even probable, that information about the Chinese culture was distorted or devalued when interpreted from my c u l t u r a l perspective, and that I may not have understood the s u b t l e t i e s of culture or language issues as raised by the interviewees. Such cautions have been raised by A l c o f f (1981) as follows: How what i s said gets heard depends on who says i t , and who says i t w i l l a f f e c t the s t y l e and the language i n which i t i s stated, which w i l l i n turn a f f e c t i t s perceived s i g n i f i c a n c e (p. 13). 177 I t r i e d to minimize personal bias as much as possible by c l a r i f y i n g words and ideas often with the interviewees, and by being aware of the possible e f f e c t s of my presence as a young Western European woman on the respondents' "rapport" with me and on the answers given to interview questions. Another disadvantage to being an "outsider" i s that individuals from a t r a d i t i o n a l Chinese culture can be less open to sharing experiences and feelings with "outsiders" than are Westerners: In general, the Chinese view of human encounters follows the family network. Within the network, the encounters are seen as a f f i l i a t i o n a l . As the Chinese f e e l that r e l a t i v e s are most trustworthy and dependable, they often extend kin relationships to nonkin and form pseudokin ties...The people one knows who have been made pseudokin are c l a s s i f i e d as zi ji ren (own people), and a l l strangers wai ren (outsiders). (Hsu i n Tseng & Wu, 1985, p. 101). I found a l l the interviewees, however, to be extremely forthcoming i n t h e i r sharing of counselling and c u l t u r a l experiences with me. Perhaps the commonality of our Western counselling t r a i n i n g and the interviewees' knowledge and involvement i n Western culture helped to create a bridge. Being and "outsider," although p o t e n t i a l l y r e s t r i c t i n g and d i s t o r t i n g of research data, the distance and o b j e c t i v i t y can also be an advantage: 178 Ordinarily an outsider to the group being studied, the ethnographer t r i e s harder to know more about the c u l t u r a l system he or she i s studying than any in d i v i d u a l who i s a natural participant i n i t , at once advantaged by the outsider's broad and a n a l y t i c a l perspective, but, by reason of that same detachment, u n l i k e l y ever t o t a l l y to comprehend the insi d e r ' s point of view (Wolcott, 1987, p. 189). According to Schumacher and McMillan (1993) the preferred research r o l e i s that of "a person who i s unknown at the s i t e or to the par t i c i p a n t s " (p. 386). Furthermore, they state "a researcher who i s a par t i c i p a n t or already has status within the s o c i a l group being observed l i m i t s r e l i a b i l i t y " (p. 386). A l e v e l of o b j e c t i v i t y , i n other words, i s provided by the outsider r o l e . I t i s d i f f i c u l t f or anyone to look objectively at t h e i r own culture, and although many of the counsellors interviewed had thought and discussed the issue of Western counselling as applied with t r a d i t i o n a l Chinese c l i e n t s , they were not always able to verbalize to me t h e i r c u l t u r a l bias, values or motivation as counsellors working with Chinese c l i e n t s . As one interview p a r t i c i p a n t expressed i t : I tend to be more d i r e c t i v e with some of my Chinese c l i e n t s . And that i s a pretty automatic thing. I don't deliberately...think "Oh, t h i s i s a Chinese c l i e n t , I should speak l i k e t h i s , or take t h i s approach"...! don't 179 know i f there are things, I wonder sometimes i f there are things I do unconsciously (A.C.)* R e l i a b i l i t y of the data analysis was increased by a) having two co-raters independently code the interview data, and b) having each of the interviewees review a transcribed and coded copy of t h e i r own interview. Interviewees were encouraged to make any comments, changes, or additions at t h i s point. A major threat to i n t e r n a l v a l i d i t y came as a r e s u l t of the "snowball sampling" method of s e l e c t i n g participants. Because each interview participant was referred by someone who knew them, there i s the p o s s i b i l i t y of a biased sample of like-minded participants, and data cannot, therefore, be generalized to a wider population. Also, because the interviewees volunteered to p a r t i c i p a t e i n the research study, they might have been more motivated than a random sampling of participants, and they might have responded d i f f e r e n t l y to the questions than a non-volunteer group might have. External v a l i d i t y of the research findings i s l i m i t e d due to the small sample siz e and the narrow pool from which sample participants were drawn. However, my research study does not aim to generalize r e s u l t s of the findings, but rather to add to the understanding for counsellors/psychotherapists of possible c u l t u r a l variations i n the i n i t i a l formation of the therapeutic alliance^. 180 Research Implications I t would be necessary to duplicate the research study with a larger sample of participants to see i f the findings hold true. I t would be i n t e r e s t i n g , as well, to r e p l i c a t e t h i s research study across cultures to see i f the general conclusions hold true, and thus to confirm the v a l i d i t y of the research findings. I t can be implied from these research findings that the s p e c i f i c aspects of the counselling a l l i a n c e formation might vary from culture to culture, and that knowledge of these variations could be useful to the counsellor. I t appears that the wider the repertoire of responses the counsellor possesses, the better the helper he/she i s l i k e l y to be. We can no longer r e l y on a very narrow and l i m i t e d number of s k i l l s i n counselling. We need to practice and be comfortable with a multitude of response modalities (Sue & Sue, 1990, p. 170). I t would be most valuable, I believe, to r e p l i c a t e t h i s research study with a non-ethnic c u l t u r a l group, such as socio-economic status or sexual orientation, to determine whether the d e f i n i t i o n of culture can indeed be broadened as some writers have suggested. Paul Pedersen (1978), f o r example, has suggested that a l l counselling i s c r o s s - c u l t u r a l : If we consider the value perspectives of age, sex r o l e , l i f e - s t y l e , socio-economic status, and other special a f f i l i a t i o n s as c u l t u r a l , then we may well conclude 181 that a l l counselling i s to some extent c r o s s - c u l t u r a l (Pedersen, 1978). A broad d e f i n i t i o n of culture might encourage counsellors to move away from an us-them mentally, and instead view both themselves and the c l i e n t s as complex c u l t u r a l beings. Conclusions The c r u c i a l implication drawn from t h i s research study i s the need for Western-trained counsellors to accept that t h e o r e t i c a l aspects of the Western counselling process, such as the a l l i a n c e formation, are not u n i v e r s a l l y applicable. Counsellors need to have knowledge t h e i r own and t h e i r c l i e n t ' s c u l t u r a l biases i n order for an e f f e c t i v e a l l i a n c e to be created. Simply applying c u l t u r a l knowledge stereoypically, however, can be i n s u l t i n g to the c l i e n t , and p o t e n t i a l l y damaging to the formation of the therapeutic a l l i a n c e . 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In regard to PHYSICAL SET-UP, tell me what you would consider optimally conducive to building a positive relationship with your client? For example, where would the counselling take place? at home or in an office? inside or outside? What are the seating arrangements? the decor? Why are these important? 2. How would you go about making the INITIAL CONTACT? (i.e., setting up the meeting time and place, greeting the client). 3. Given a preference, how would you go about establishing CREDIBILITY with a client? How would you build on this initial contact to gain the TRUST of your client? What factors might HINDER this and why? 4. How would you preferably go about leading up to and ISOLATING T H E SPECIFIC P R O B L E M or concern of the client? 5. Would you prefer, and WHY, if given the opportunity, work A L O N E OR IN C O L L A B O R A T I O N with the client's family, and other professionals ( such as Western Doctors, Community Agencies, or Chinese Herbalists). 6. In regards to V E R B A L C O M M U N I C A T I O N with your client, what do you think are some of the important factors to keep in mind? How might these help or hinder the counselling process and why? 7. In regards to NON-VERBAL C O M M U N I C A T I O N with your client, what do you think are some of the important factors to keep in mind? How might these help or hinder the counselling process and why? 8. When working with a client from your cultural background, what do you think are some of the main cultural attitudes, values and beliefs which might impact on the initial counselling relationship? IS T H E R E ANYTHING E L S E Y O U W O U L D L I K E T O ADD? Appendix B Consent Forms C O N S E N T F O R M 197 I, , agree to be interviewed by Coral Arrand, a Graduate student at The University of British Columbia, for the purposes of her Thesis on Cultural variations in the creation of the therapeutic alliance. I understand that the interview will be taped and take approximately one hour. All information will remain confidential, and access to the names of the interviewees and to the specific interview data will be available only to the student researcher and the University of British Columbia Faculty Thesis Supervisors. All information will be coded and the original tapes erased and transcripts destroyed so as to ensure anonymity. (SIGNATURE) (DATE) IF Y O U WISH T O R E C E I V E A TRANSCRIPT O F T H E INTERVIEW AND/OR A S U M M A R Y O F T H E FINAL R E S U L T S O F T H E R E S E A R C H P R O J E C T FINDINGS, P L E A S E PRINT Y O U R N A M E AND ADDRESS B E L O W : N A M E : ADDRESS: 198 Appendix C Data Analysis: Topics. Categories, and Themes 199 DATA ANALYSIS F R O M INTERVIEWS WITH EIGHT WESTERN-TRAINED C H I N E S E C O U N S E L L O R S TOPICS CATEGORIES T H E M E S f i r s t , second, or t h i r d generation immigration parent-children c u l t u r a l c o n f l i c t s due to Western influence on expecations of family dynamics and parenting r o l e INTER-GENERATIONAL -DIFFERENCES WITHIN THE CHINESE COMMUNITY differences due to country of o r i g i n differences due to urban or r u r a l up-bringing differences due to socio-economic status age at time of immigration differences due to whether immigrant or refugee status — WITHIN-GENERATIONAL "DIFFERENCES IN THE CHINESE COMMUNITY T H E C O M P L E X "AND E V O L V I N G N A T U R E O F C U L T U R E not making assumptions regarding c u l t u r a l a t t r i b u t e s : s e n s i t i v i t y to i n d i v i d u a l uniqueness checking out assumptions with c l i e n t s and asking c l i e n t about t h e i r personal his t o r y educating oneself on the implications of c l i e n t ' s c u l t u r a l , s o c i a l , and p o l i t i c a l history RECOMMENDATIONS FOR COUNSELLORS educating oneself on c l i e n t c u l t u r a l b e l i e f s and values 200 TOPICS CATEGORIES THEMES neither Western-trained Chinese counsellor or Chinese c l i e n t comfortable with touching no hugs or handshakes unless c l i e n t i n i t i a t e s h— TOUCHING eye contact less i n Chinese c l i e n t s Chinese c l i e n t tendencey to be less expressive BETWEEN exaggerated f a c i a l expressions and head nodding smiling, leaning forward to show caring s l i g h t bow on i n t r o d u c t i o n — ' FACIAL EXPRESSIONS OF CHINESE CLIENTS NONVERBAL -FEEDBACK FROM COUNSELLOR s p a t i a l distance: Chinese c l i e n t s ' preference f o r distance creation of informal atmosphere through placement of table I PROXEMICS NON-VERBAL COMMUNICATION CHINESE CLIENT AND WESTERM-TRA1NED COUNSELLOR Chinese expectation of counsellor appearance i n terms of professionalism Age: increased respect with increase i n age of counsellor Gender: higher respect for male counsellor IMPACT ON CHINESE "CLIENTS OF COUNSELLOR APPEARANCE TOPICS 201 CATEGORIES THEMES giving the choice to the c l i e n t Western-trained counsellors's preference f o r in d i v i d u a l focus collaboration with c l i e n t ' s family on c l i e n t ' s perspective r i g h t of access to counselling process Traditional-Chinese bias of the family being the p r i o r i t y , not the in d i v i d u a l WHEN TO INCLUDE THE CHINESE FAMILY IN COUNSELLING CHINESE FAMILY EXPECTATION OF INVOLVEMENT IN COUNSELLING PROCESS CHINESE FAMILY |_ STRUCTURE AND DYNAMICS: COUNSELLING IMPLICATIONS reluctance of the male head to come i n reluctance of t r a d i t i o n a l Chinese family to t a l k about problems to "outsiders" counsellor's need to be se n s i t i v e to feelings of shame; to recognize courage i n coming to counselling need f o r counsellor to be f l e x i b l e i n terms of the family system involved ENGAGING THE CHINESE FAMILY-TOPICS CATEGORIES THEMES expectation of concrete support and p r a c t i c a l assistance expecation of counsellor as advocate or intermediary or interpreter with other community agencies/resources Western concept of d i f f e r e n t i a t i o n , fusion and enmeshment c o n f l i c t i n g with c o l l e c t i v e i d e n t i t y and interdependency of t r a d i t i o n a l Chinese families recognizing family as c l i e n t resource and support; while also being aware of impact of family tolerance and caring f o r on c l i e n t s ' independence and s e l f - r e l i a n c e TYPE OF SUPPORT EXPECTED BY TRADITIONAL CHINESE FAMILY TRADITIONAL CHINESE FAMILY STRUCTURES CHINESE FAMILY STRUCTURE AND DYNAMICS "COUNSELLING IMPLICATIONS (CONT.) s h i f t i n g dynamics between parents and children power s h i f t within immigrant families impact of immigration on the marital r e l a t i o n s h i p NEED FOR AWARENESS OF THE IMPACT OF IMMIGRATION ON TRADITIONAL CHINESE FAMILY TOPICS CATEGORIES 203 THEMES c o n f l i c t between c u l t u r a l preference and Western t r a i n i n g professional boundaries sharing commonalities with c l i e n t to b u i l d rapport gender differences need of t r a d i t i o n a l Chinese c l i e n t to see the counsellor as a person, not just a professional SELF-DISCLOSURE BY WESTERN TRAINED CHINESE COUNSELLOR h- SELF-DISCLOSURE g u i l t and shame i n t a l k i n g about problems to an "outsider," a "stranger" reluctance to dis c l o s e c u l t u r a l l y s e n s i t i v e or "taboo" subjects SELF-DISCLOSURE BY CHINESE CLIENT TOPICS CATEGORIES 204 THEMES counsellor as " r e a l " person not just "professional" counsellor as a "supplement" to medical or other professional services Chinese c l i e n t expectations of counsellor being solution-focused, advice-giving counsellor as a general advocate, generalized assistance within-group di f f f e r e n c e s i n understanding of the counsellor r o l e placing the counsellor into f a m i l i a r r o l e context „ CHINESE CLIENTS UNDERSTANDING hOF COUNSELLOR ROLE EXPECTATIONS OF COUNSELLOR ROLE HELD BY TRADITIONAL CHINESE CLIENT c l a r i f y i n g Western-trained concept of the counsellor r o l e spending time on s o c i a l r e l a t i o n s h i p ; showing i n t e r e s t i n c l i e n t as a person, not just a c l i e n t WESTERN-TRAINED COUNSELLOR \- RESPONSE TO CHINESE CLIENT ASSUMPTIONS 205 TOPICS C A T E G O R I E S T H E M E S use of same language to b u i l d rapport/trust c l i e n t preference; c l i e n t choice language r e f l e c t i n g expression of concepts/meanings c l i e n t a b i l i t y to discuss problem more c l e a r l y and in-depth i n own language may be easier to t a l k about sens i t i v e or "taboo" subjects i n English appropriate use of language by counsellor, as perceived by c l i e n t directness of the Chinese language; poten t i a l impact on communication use of writing to supplement verbal communication li m i t e d emotional vocabulary of the Chinese language use of physical descriptions to describe feelings c u l t u r a l variations i n abstract concepts and metaphor use CHOICE OP LANGUAGE •USED IN COUNSELLING STYLE OF COMMUNICATION VERBAL-C O M M U N I C A T I O N B E T W E E N C H I N E S E C L I E N T AND WESTERN-TRAINED C O U N S E L L O R TOPICS C A T E G O R I E S 206 T H E M E S asking questions of the counsellor willingness to t a l k more and to reveal more DEMONSTRATIONS OF TRUST BY CHINESE CLIENT V E R B A L C O M M U N I C A T I O N I— B E T W E E N C H I N E S E C L I E N T AND WESTERN-TRAINED C O U N S E L L O R ( C O N T . ) TOPICS 207 CATEGORIES T H E M E S advantages/disadvantages of home v i s i t s for counsellor advantages/disadvantages of home v i s i t s f o r c l i e n t HOME VISITS advantages/disadvantages of o f f i c e v i s i t s f o r counsellor advantages/disadvantages of o f f i c e v i s i t s for c l i e n t physical set-up i n o f f i c e to create a comfortable atmosphere for Chinese c l i e n t s o f f e r i n g tea OFFICE VISITS C O U N S E L L I N G S E T T I N G : C U L T U R A L CONSIDERATIONS i TOPICS C A T E G O R I E S 208 T H E M E S Western-European bias towards in d i v i d u a l choice and r e s p o n s i b i l i t y Individual i d e n t i t y (Western European) versus c o l l e c t i v e i d e n t i t y ( t r a d i t i o n a l Asian) counsellor awareness of within-group differences which a f f e c t c l i e n t understanding and acceptance of Western counselling -scheduling a r r i v i n g on time CULTURAL CONCEPTS RELEVANT TO COUNSELLING PROCESS CONCEPT OF TIME AS IT AFFECTS COUNSELLING C U L T U R A L DIFFERENCES IN C O N C E P T O F C O U N S E L L I N G AND P S Y C H O L O G I C A L PROCESSES (WESTERN-TRAINED C O U N S E L L O R AND CHINESE CLIENT) outcome orientation of t r a d i t i o n a l Chinese c l i e n t versus process orientation of Western counselling counselling seen as " l a s t resort" for tr a d t i o n a l Chinese c l i e n t s TRADITONAL CHINESE CLIENTS' EXPECTATION FOR IMMEDIATE, CONCRETE SOLUTIONS TO PROBLEMS courage needed to come to t a l k to "stranger" about problems TOPICS C A T E G O R I E S T H E M E S outreach to Chinese community changes i n attitudes within Chinese community regarding counselling services working i n collaboration with other professionals and community resources increased recognition i n Western counselling for the need f o r c u l t u r a l l y "matched" or c u l t u r a l l y " s e n s i t i v e " counsellors CHINESE COMMUNITY EDUCATION REGARDING WESTERN COUNSELLING SERVICES C U L T U R A L D I F F E R E N C E S IN C O N C E P T O F C O U N S E L L I N G AND C O U N S E L L I N G PROCESSES (CONT.) fee charging TOPICS CATEGORIES 210 T H E M E S repercussions to accepting Chinese c l i e n t s ' preference for d i r e c t i o n and advice ask leading questions or "stimulating" questions need to do something "concrete" i n the f i r s t two or three sessions or may possibly lose c l i e n t move gradually, slowly to core issues ("pacing") STRATEGIC RECOMMENDATIONS -FOR WESTERN-TRAINED COUNSELLORS awareness of within-group differences i n t r a d i t i o n a l Chinese c l i e n t s ' acceptance of non-directive counselling s t y l e ( i . e . , education, exposure to Western culture) "informal" rapport building so c l i e n t can see counsellor as " r e a l " person ask about c l i e n t as a person, not just a c l i e n t ( i . e . , immigration status personal history) sharing commonalities of social/personal history less formal information gathering s e n s i t i v i t y to c u l t u r a l l y s e n s i t i v e topics ESTABLISHING TRUST WITH TRADITIONAL CHINESE CLIENTS E X P E R I E N C E S O F BLENDING W E S T E R N C O U N S E L L O R TRAINING WITH TRADITIONAL CHINESE C L I E N T EXPECTATIONS TOPICS 211 C A T E G O R I E S T H E M E S same language hel p f u l giving c l i e n t time to adjust and f e e l comfortable i n the counselling setting; i n i t i a l joining i s longer greet c l i e n t s personally s e n s i t i v i t y to Chinese c l i e n t ' s shame and g u i l t i n ta l k i n g about problems to a "stranger" rece p t i o n i s t needs to "read between the l i n e s " of Chinese c l i e n t s ' i n i t i a l message, problem statement INITIAL CLIENT CONTACT E X P E R I E N C E S O F B L E N D I N G W E S T E R N C O U N S E L L O R TRAINING WITH TRADITIONAL C H I N E S E CLIENTS EXPECTATIONS (CONT.) 212 Appendix D Correspondence with Interview Participants 214 Dear I was i n attendance at the Greater Vancouver Mental Health Workshop on March 23, and had the opportunity there of hearing you speak on the issue of multiculturalism and Mental Health. I found your speech, and the workshop content i n general, very informative and also relevant to my focus of Graduate study. I am a Masters student i n Counselling Psychology at The University of B r i t i s h Columbia. The t i t l e of my thesis project i s CULTURAL FACTORS WHICH MAY SUGGEST ALTERNATIVES TO THE WESTERN-TRAINED COUNSELLOR'S APPROACH TO INITIAL RELATIONSHIP BUILDING WITH CLIENTS. The purpose of the study i s to explore alternatives that may allow counsellors to be more c u l t u r a l l y s e n s i t i v e when working i n a c r o s s - c u l t u r a l counselling s i t u a t i o n . In a world that i s becoming increasingly m u l t i c u l t u r a l , counsellors/therapists may have to change the idea of therapy as conceived of and i n s t i t u t i o n a l i z e d i n Western Canada, and embrace additional s t y l e s of intervention. The therapeutic r e l a t i o n s h i p , s p e c i f i c a l l y , may have to be redefined to resemble the c l i e n t ' s own culture. By learning, therefore, about alternative approaches to the t r a d i t i o n a l Western approach to r e l a t i o n s h i p building, the counsellor/therapist may be better able to adjust his/her s t y l e to meet the needs of the c l i e n t . I t i s important to stress that an attempt to delineate group c h a r a c t e r i s t i c s between cultures does NOT override the need fo r determining i n d i v i d u a l differences. However, each ind i v i d u a l ' s unique s i t u a t i o n and perspective can be understood only when viewed within the context of his/her own culture. We hope that Appendix E The Multiculturalism P o l i c y of Canada 218 The Multiculturalism P o l i c y of Canada Whereas the Constitution of Canada provides that every i n d i v i d u a l i s equal before and under the law and has the r i g h t to the equal protection and benefit of the law without discrimination and that everyone has the freedom of conscience, r e l i g i o n , thought , b e l i e f , opinion, expression, peaceful assembly and association and guarantees those rig h t s and freedoms equally to male and female persons; And whereas the Constitution of Canada recognizes the importance of preserving and enhancing the m u l t i c u l t u r a l heritage of Canadians; And whereas the Constitution of Canada recognizes r i g h t s of the aboriginal peoples of Canada; And whereas the Constitution of Canada and the Official Languages Act provide that English and French are the o f f i c i a l languages of Canada and neither abrogates or derogates from any rights or p r i v i l e g e s acquired or enjoyed with respect to any other language; And whereas the Citizenship Act provides that a l l Canadians, whether by b i r t h or by choice, enjoy equal status, are e n t i t l e d to the same r i g h t s , powers and p r i v i l e g e s and are subject to the same obligations, duties and l i a b i l i t i e s ; And whereas the Canadian Human Rights Act provides that 219 every i n d i v i d u a l should have an equal opportunity with other individuals to make the l i f e that the i n d i v i d u a l i s able and wishes to have, consistent with the duties and obligations of that i n d i v i d u a l as a member of society, and , i n order to secure that opportunity, establishes the Canadian Human Rights Commission to redress any proscribed discrimination, including discrimination on the basis of race, national or ethnic o r i g i n or colour; And whereas Canada i s a party to the International \ Convention on the Elimination of All Forms of Racial Discrimination, which. Convention recognizes that a l l human beings are equal before the law and e n t i t l e d to equal protection of the law against any discrimination and against any incitement to discrimination, and to the International Covenant on Civil and Political^ Rights, which Covenant provides that persons belonging to ethnic, r e l i g i o u s or l i n g u i s t i c minorities s h a l l not be denied the r i g h t to enjoy t h e i r own culture, to profess and practise t h e i r own r e l i g i o n or to use t h e i r own language; And whereas the Government of Canada recognizes the d i v e r s i t y of Canadians as regards race, national or ethnic o r i g i n , colour, or r e l i g i o n as a fundamental c h a r a c t e r i s t i c of Canadian society and i s committed to a p o l i c y of multiculturalism designed to preserve and enhance the m u l t i c u l t u r a l heritage of Canadians while working to achieve the equality of a l l Canadians i n the economic, s o c i a l , c u l t u r a l and p o l i t i c a l l i f e of Canada; 220 1) I t i s hereby declared to be the p o l i c y of the Government of Canada t o : a) recognize and promote the understanding that multiculturalism r e f l e c t s the c u l t u r a l and r a c i a l d i v e r s i t y of Canadian society and acknowledges the freedom of a l l members of Canadian society to preserve, enhance and share t h e i r c u l t u r a l heritage; b) recognize and promote the understanding that multiculturalism i s a fundamental c h a r a c t e r i s t i c of the Canadian heritage and id e n t i t y and that i t provides an invaluable resource i n the shaping of Canada's future; c) promote the f u l l and equitable p a r t i c i p a t i o n of individ u a l s and communities of a l l o r i g i n s i n the continuing evolution and shaping of a l l aspects of Canadian society and a s s i s t them i n the elimination of any b a r r i e r to such p a r t i c i p a t i o n ; d) recognize the existence of communities whose members share a common o r i g i n and t h e i r h i s t o r i c contribution to Canadian society, and enhance t h e i r development; e) ensure that a l l i n d i v i d u a l s receive equal treatment and equal protection under the law, while respecting and valuing t h e i r d i v e r s i t y ; f) encourage and a s s i s t the s o c i a l , c u l t u r a l , economic and p o l i t i c a l i n s t i t u t i o n s of Canada to be both respectful and inc l u s i v e of Canada's m u l t i c u l t u r a l character; g) promote the understanding and c r e a t i v i t y that a r i s e from the 221 i n t e r a c t i o n between individuals and communities of d i f f e r e n t o r i g i n s ; h) foster the recognition that appreciation of the diverse cultures of Canadian society and promote the r e f l e c t i o n and the evolving expressions of those cultures; i ) preserve and enhance the use of languages other than English and French, while strengthening the status and use of the o f f i c i a l languages of Canada; and j) advance multiculturalism throughout Canada i n harmony with the national commitment to the o f f i c i a l languages of Canada. 2 ) I t i s further declared to be the p o l i c y of the Government of Canada that a l l federal i n s t i t u t i o n s s h a l l : a) ensure that Canadians of a l l o r i g i n s have an equal opportunity to obtain employment and advancement i n those i n s t i t u t i o n s ; b) promote p o l i c i e s , programs and practices that enhance the a b i l i t y of i n d i v i d u a l s and communities of a l l o r i g i n s to contribute to the continuing evolution of Canada; c) promote p o l i c i e s , programs and practices that enhance the understanding of and respect f o r the d i v e r s i t y of the members of Canadian society; d) c o l l e c t s t a t i s t i c a l data i n order to enable the development of p o l i c i e s , programs and practices that are s e n s i t i v e and responsive to the m u l t i c u l t u r a l r e a l i t y of Canada; 222 e) make use, as appropriate, of the language s k i l l s and c u l t u r a l understanding of individuals of a l l o r i g i n s ; and f) generally, carry on t h e i r a c t i v i t i e s i n a manner that i s sensi t i v e and responsive to the m u l t i c u l t u r a l r e a l i t y of Canada. (Excerpts from the Canadian Multiculturalism Act, i n Berdichewsky, B., 1988, p. 27-30). 223 Appendix F Background Information on the Interview Participants 224 INTERVIEW PARTICIPANT #1 SEX: female AGE: between 40 and 50 years of age PLACE OF BIRTH: Hong Kong. Immigrated to Canada at age seventeen. LANGUAGES SPOKEN: Cantonese, Mandarin, and English TRAINING: M.A. i n Educational counselling (Washington State University) RELATED PROFESSIONAL EXPERIENCE: community worker with the Downtown Women's Centre; Counsellor with S.U.C.C.E.S.S.; counsellor with Family and children i n Hong Kong; adult primary therapist, senior mental health worker, and acting d i r e c t o r with one of the Greater Vancouver Mental Health Services Care Teams. CULTURAL IDENTITY: thinks of herself as a "marginal person," i n that she can "pretty much jump into one side or the other, i s very aware of Western values that she "treasures" and has "integrated into the Chinese part of me." Has always been interested i n people who are c u l t u r a l l y d i f f e r e n t ( i . e . , has had international pen-pals, was on the international committee at University. 225 INTERVIEW PARTICIPANT #1 SEX: Female AGE: between 30 and 40 years of age LANGUAGES: Cantonese, Mandarin, and English PLACE OF BIRTH: Hong Kong. Immigrated i n 1978 to Canada. TRAINING: Bachelor of Soc i a l Work from Simon Fraser University, Diploma i n Educational Psychology from the University of Calgary, and Master of Social Work from the University Hong Kong. RELATED PROFESSIONAL EXPERIENCE: M u l t i c u l t u r a l worker at the Calgary Cultural Centre, Psych i a t r i c S o c i a l Worker (in Hong Kong and i n Vancouver, M u l t i c u l t u r a l Mental Health Liaison with Greater Vancouver Mental Health Services. CULTURAL IDENTITY: She f e e l s that Chinese culture i s an important everyday part of l i f e , both professionally and personally, as i s Canadian culture. 226 INTERVIEW PARTICIPANT #3 SEX: Male AGE: Between 30 and 40 years of age PLACE OF BIRTH: Hong Kong. Immigrated to Canada i n 1991. LANGUAGES SPOKEN: Cantonese, Mandarin, and English TRAINING: Bachelor of Arts from the University of Hong Kong, Master of Social Work from the University of B r i t i s h Columbia. RELATED PROFESSIONAL EXPERIENCE: Student counsellor with the Po l i t e c University i n Hong Kong, Director of Program Services for S.U.C.C.E.S.S. Family and Youth Counselling Services (includes c l i n i c a l case-load, l i a i s o n with Chinese community, supervision of the Family and Youth counsellors, education and co-ordination and consultation with community agencies and the Ministry, and c r o s s - c u l t u r a l t r a i n i n g for agencies working with Chinese f a m i l i e s ) . CULTURAL IDENTITY: Family l i f e i s very involved with the Chinese culture (seniors l i v i n g at home, speaks Cantonese at home), most of friends are Chinese. 227 INTERVIEW PARTICIPANT #4 SEX: Female AGE: between 40 and 50 PLACE OF BIRTH: Hong Kong, Immigrated to Canada i n 1988. LANGUAGES SPOKEN: Cantonese, Mandarin and English TRAINING: Bachelor of Social Sciences i n Psychology at the University of Hong Kong, Master of Educational Guidance and Counselling at the University of Toronto ( O i s i e ) , and t r a i n i n g i n Family Therapy with the P a c i f i c Coast Family Therapy Association. RELATED PROFESSIONAL EXPERIENCE: Case Worker i n Hong Kong, Family and Youth counsellor and Supervisor f o r Family Counsellors, taught S o c i a l Work at the University of Hong Kong (City Polytechnic), Program Director of the Family and Youth counselling department of S.U.C.C.E.S.S., Family Counsellor with Vancouver Family Services. 228 INTERVIEW PARTICIPANT #5 SEX: Female AGE: between 30 and 40 PLACE OF BIRTH: Hong Kong LANGUAGES SPOKEN: Cantonese, Mandarin, and English TRAINING: Bachelor of Arts i n Psychology at the University of I l l i n o i s , Masters i n Counselling and i n Family Studies at Arizona State University. RELATED PROFESSIONAL EXPERIENCE: Counsellor i n mental health s e t t i n g i n Seattle (working exclusively with Chinese c l i e n t s ) , mental health worker with the Greater Vancouver Mental Health Services. CULTURAL IDENTITY: the Chinese culture i s a very important part her l i f e , speaks Cantonese at home, volunteer i n the Chinese Church, most of her friends are Chinese. 229 INTERVIEW PARTICIPANT #6 SEX: Male AGE: between 40 and 50 PLACE OF BIRTH: Hong Kong, immigrated to Canada i n 1988 LANGUAGES SPOKEN: Cantonese, Mandarin, and English TRAINING: Master of Arts i n Counselling Psychology, and Master of Social Work from the University of Hong Kong. RELATED PROFESSIONAL EXPERIENCE: Ch i l d Welfare O f f i c e r , Probation O f f i c e r , taught Social Work at University, Mental Health counsellor with the Health Department (Mental Health Centre) primarily with children and f a m i l i e s . CULTURAL IDENTITY: fe e l s h is professional l i f e i s " f i f t y percent Chinese and f i f t y percent Canadian", and his personal l i f e i s "seventy-five percent Chinese." 230 INTERVIEW PARTICIPANT #7 SEX: Male AGE: between 50 and 60 PLACE OF BIRTH: Hong Kong, l i v e d i n China from 1942 - 1945, immigrated to Canada 1988 LANGUAGES SPOKEN: Cantonese, Mandarin, Toisan, and English TRAINING: English Boarding School i n Hong Kong, College (Engineer) i n Taiwan, School of Theology i n the Philippines, Master of Theology from Hong Kong, Master of Soc i a l Work from Michigan RELATED PROFESSIONAL EXPERIENCE: Parish P r i e s t , Chaplaincy at the University (counselling University students), taught S o c i a l Work at the University of Hong Kong, therapist with New Westminster Family Services. CULTURAL IDENTITY: very rapid s o c i a l change within one generation of h i s family (grandparents and parents are very t r a d i t i o n a l . His education was primarily i n English, worked within the Anglican Church, he says he s t i l l counts i n Chinese. His current work i s the f i r s t time he has worked with non-Chinese c l i e n t s . 231 INTERVIEW PARTICIPANT #8 SEX: Male AGE: between 30 and 40 PLACE OF BIRTH: Hong Kong LANGUAGES SPOKEN: Cantonese, Mandarin, and English TRAINING: Bachelor of Arts i n Religious Studies, Bachelor of Social Work (both from University i n Ontario) RELATED PROFESSIONAL EXPERIENCE: currently working as an advocate and counsellor for Chinese c l i e n t s with MOSAIC, Mu l t i c u l t u r a l Services Society i n Vancouver. 

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