Do General Treatment Guidelines for Asian American Families Have Applications to Specific Ethnic Groups? the Case of Culturally-Competent Therapy with Korean Americans
Kim, Elena Young-Kyong, Bean, Roy A., Harper, James M., Journal of Marital and Family Therapy
To serve Korean American families effectively, marriage and family therapists need to develop a level of cultural competence. This content analysis of the relevant treatment literature was conducted to discover the most common expert recommendations for family therapy with Asian Americans and to examine their application to Korean Americans. Eleven specific guidelines were generated: Assess support systems, assess immigration history, establish professional credibility, provide role induction, facilitate "saving face," accept somatic complaints, be present/problem focused, be directive, respect family structure, be nonconfrontational, and provide positive reframes. Empirical support (clinical and nonclinical research) and conceptual support for each guideline are discussed, and conclusions are reached regarding culturally competent therapy with Korean American families.
Asian Americans are the third largest racial group in the United States, with current population estimated to be more than 11 million (U.S. Census Bureau, 2002) and projections of 20 million by year 2020 (Ong & Hee, 1993). Excluding the many Pacific Islander groups often added to this ethnic category, Asian Americans represent people from 25 countries of ancestry (U.S. Census Bureau, 2002). Not unexpectedly, this ethnic category is characterized by significant heterogeneity with respect to language, immigration history, cultural practices, and acculturation.
Perhaps stymied by the group's inherent diversity, treatment and intervention, data regarding Asian Americans are generally lacking in the family-focused fields (see Bean & Crane, 1996; Bean, Crane, & Lewis, 2002; Ho, 1987), as well as in the more individual-focused mental health disciplines (Sue, 1993; Uba, 1994). Moreover, when treatment information is presented, it often takes the form of guidelines for the collective Asian American group, rather than for specific ethnic subgroups (e.g., Chinese Americans, Korean Americans). Consistent with this approach, cultural similarities are emphasized and treatment recommendations are generally assumed to be relevant to all or most subgroups, regardless of ethnic backgrounds.
In an effort to facilitate the training and evaluation of culturally competent therapists, this content analysis was conducted to discover the most important treatment guidelines for conducting family therapy with Asian Americans. To avoid peipetuating the "myth of sameness" or racial group homogeneity (Falicov, 1995; Hardy & Laszloffy, 1992), the relevance of the various treatment guidelines were then examined to determine whether they applied and the nature of their application to a specific Asian American subgroup. Korean Americans were selected as the ethnic group of focus because of their ranking as one of the most numerous Asian subgroups in the United States. In addition, given the anticipated lack of empirical research, the authors determined that their personal and professional experience with Korean Americans would allow them to "make the most" of the available literature.
As a broad introduction, many Korean Americans are at risk for psychosocial difficulties associated with their immigrant and/or marginalized status. These challenges, which include societal prejudice and parent-child acculturation differences, can be treated using a variety of modalities; however, there is conceptual argument for the usefulness of family-based treatments. One justification can be found in the emphasis placed, compared with European Americans, on conformity to familial and social norms, hierarchical family structure, and prescribed gender-role relationships (B. L. C. Kim, 1996). In working to create and maintain a balance between these familial values/expectations and U.S. societal pressures for asserting independence/individuality, many have to find a balance between their "Korean-ness" and "American-ness" (Lee & Cynn, 1991; Park, 1999). Individual family members can often present varying and, sometimes, directly opposing ideas of how "Korean" or how "American" they should be, and family therapy is ideally situated when this conflict occurs in the family or home environment. …