Working with Chinese Immigrant Individuals & Families in Psychotherapy What Do You Need to Know? Wei-Chun “Vivi” Hua, Psy.D. Queens Psychological Association 10/18/2015 Before we get started, I want to thank you all for coming to the presentations today, not so much as one of the speakers, but as a member from an ethnic minority group. As an immigrant myself, I appreciate having the opportunity to know that there are people from this society wanting to know about individuals from a different culture. And I think this kind of professional openness and curiosity is the very first step and a very critical step to working with people with a diverse background, in any sense. It says a lot about your interest and curiosity to know more about ethnic groups that you may come in contact with in a professional setting and possible ways to engage them in therapy. Especially those from a culture in many ways so different from yours... Is a brave thing.. To recognize that there are things we don't feel we know a whole lot about... But I wanna learn more about them... And I want to be able to understand them... I want to give the audience a big applause-- for your high professionalism and deep level intellectual curiosity to be interest in today's topic and come here-- for me-- a genuine sense of interest to know our clients/patients..   Because no matter where we are from, our ethnicity, culture, country of origin, skin color, SES, sexual orientation, it comes down to the bottom line that we are all human beings, and we are yearning for ppl's understanding and acceptance of us. And to know that someone is wanting to understand us.. Especially for ppl with a minority background.. That is just a tremendous beginning of self validation for us... Of our existence and value... This is at least from my perspective but at least I believe it can speak the truth to many minority members in the society.   And just having this part checked, you guys are already in a good position to start thinking about how to show your openness and to approach them in a way that that them know you are open to them and want to understand them and be able to relate to them-- This is then about the technical issues that we will be talking about today in my presentation-- It took me a bit of time to think about what I can share with you today, the audience, in a way that may be helpful to you... As I'm a more or less a member of this cultural/ethnic group... More or less because chinese community is large.. And ppl speak various dialects... And even if you speak one, you don't necessarily understand another.. I think think about the first time I came to this country.. That was 10--- next August 11th it will be 10 years.. And I wanna approach this from what I felt was sooooo new and soooo different and sometimes perhaps soooo uncomfortable to me that I felt I wish I could get out of this room for a while so that I can take a break from all these changes that's happening at every second around me Wherever I go..

Outline My background: cultural and professional Background of Chinese immigrants in NYC Major presenting issues of (undocumented) Chinese immigrants Cultural differences in therapy

My Cultural Background Country of origin Immigration Language

My Professional Background Gouverneur Healthcare Services (NYCHHC) Early childhood center SCO Family of Services (foster care)

Chinese Immigrants in NYC Older generations of Chinese immigrants Cantonese-speaking After 1980-1990s: Fuzhou, Fujian Province of China Fuzhounese, Mandarin-speaking A large number w/o documentation Primary population in local, social service agencies in Chinese community

Major Presenting Issues A sense of loss Family & social network: source of support Use of language Identity: majority group → minority group Power Resources Sense of belonging The self is split Identity: I look different from other people… I don’t know about a lot of what’s happening around me and they don’t seem matter to me Also consider their cultural, social-economic background where practicality is important…

Major Presenting Issues (cont’d) Acculturation/adjustment issues Language Food Holidays Transportation Navigating new systems School: parental rights, parent teacher conferences Legal: “appropriate” parenting Medical Their presenting issues: -acculturation/adjustment issues: language, transportation (use of travel to therapy to help motivate them), insurance--healthcare, unfamiliarity with school, legal systems-- need advocates.. They are confronted with a new set of values in parenting approaches,

Common Clinical Symptoms Depression: sleep problems, loss of appetite Anxiety: heart palpitations, shortness of breath Anger, explosive behavior Psychosomatic symptoms Loss, grieving, Not knowing…

Undocumented Chinese Immigrants Late teens and early 20s No or limited work experience Experience of stressors on multiple levels First time away from home Traumatic, circuitous migratory journey Dependent → provider of the family Huge debts to pay off Development of psychopathology Limited access to healthcare Psychiatric hospitalizations psychotic, inpatient treatment, pressure to pay off a high amount of debt,

Stigma about Therapy Therapy is a foreign concept Therapy is for “crazy” people! They come to therapy because they “have to” Utilization of: Family or social network Fortune-telling Religion, spirituality: pray, karma, vegetarian diet So a lot of times, they come to therapy because they have to…they are told to… But most of the time, they are compliant with recommendations from authority and professionals, Those who are non compliant based on my experience tend to present with more severe psychopathology in general…so hx of non compliance with treatment and medications…

Western Society Based Therapy Much value on info from the client Thoughts and feelings Inner conflicts Early life history/stories Therapists need to be aware that the concept of therapy we function with is very much based on values in western society and cultures: Euro-american psychology -important for clients to talk about feelings and thoughts -important for them to share their struggles and life stories So approaches often used in western society, such as insight-oriented, exploration of their inner world, etc may not be too effective when engaging Chinese patients….

Cultural Differences in Therapy Expressions Verbal Feelings and emotions are not a typical part of daily language Not as consciously and verbally in tune with their feelings Catch the moment, pause, and ask: What just came to your mind? Reflect that: You look sad, angry, confused, etc Not verbally expressing them, doesn’t mean they don’t feel…they are just not socialized to be verbally and perhaps consciously be in tune with their feelings and emotions… Synchrony of affect.. With children—for parents, education is very important and highly valued. With adults--- With second generation—issues about bicultural, conflicts with parents due to exposure to different cultures and values Also consider their cultural, social-economic background where practicality is important… Within group difference, micro-aggression that Chinese patients experience….bicultural issues…intergenerational conflicts…micro-aggressions…that they experience…

Cultural Differences in Therapy (cont’d) Nonverbal Gives out more info than verbal Eye contact Head-nodding: attention, not necessarily agreement Matching of affect Pay attention to nuances in their facial, nonverbal expressions

Cultural Differences in Therapy (cont’d) Pragmatic orientation Focus on the present and problem-solving: Education Job Benefits, resources, etc Daily living: transportation, family activities, etc

Cultural Differences in Therapy (cont’d) Respect for hierarchy/professionals Professional status and title Dr./Ms./Mr. vs. first names Teacher – student dynamics Directive vs. exploratory Learning, psychoeducation Specific goals, homework Little questioning: frame-setting

Chinese Families Children Parents Extensions of their parents and family Their success/failure matters to the family Know his/her role and obligations within the family Parents Life purpose: to help their children succeed Self-sacrifice Traditionally…

Chinese Immigrant Families Intergenerational conflicts Immigrant parents vs. Children born or came here when little Generational differences Traditional Chinese values vs. American values Conflicts often arise when: Decline in academic performance Change in behavior: stay out late, makeup, clothing, smoking,... Involvement in a romantic relationship as adolescents With second generation—issues about bicultural, conflicts with parents due to exposure to different cultures and values When two generations values are in conflict Parental control vs. children’s need for independence and autonomy Value self-sacrifice---Wendy’s mom Wendy doesn’t need me as much as before,…everyday I waited for her to come back from school and make sure she eats, does HM, etc.

Chinese Immigrant Families A case Child:16 yo Chinese -American female Mother: immigrated to the U.S. in her late 20’s Involvement w ACS In therapy: Validate their different values Help them understand each other’s perspective Facilitate communication How to move forward? What are absolutely important for each of them? Accept the different values and how to move forward? Parents and children—more check-ins, so parents know where she is and when she may come back…what’s parents…start to enjoy life,

Wei-Chun “Vivi” Hua, Psy.D. vivihua06@gmail.com Contact Information Wei-Chun “Vivi” Hua, Psy.D. vivihua06@gmail.com Consideration of education, SES, acculturation level,