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Cross Cultural Equity, Cultural Diversity, the Marginalized, & Ethical Boundaries: Coping with the Challenges
Ethics and Cultural Diversity  continuing education psychologist CEUs

Section 2
Cultural Values in Counseling Marginalized Asian American Clients

Ethics CEU Question 2 | Ethics CE Test | Table of Contents
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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In the last section, we discussed cultural and historical perspectives of Asian Americans as those perspectives relate to counseling Asian American clients. We also discussed some of the implications of these perspectives on counseling.

In this section, we will consider a case study of ethically counseling a culturally different client who is Asian American. We will consider this case in light of the topics of Asian American value systems and the coping methods of traditionalism, marginalism, and rebelliousness discussed in the previous section. As we discuss the case, consider the ethical issues being raised.

♦ Case Study: Chiyo
Chiyo (chee’-yo) is a 21 year old Chinese student majoring in electrical engineering who sought counseling because he was having academic difficulties. Chiyo had trouble focusing on studying, and had received his first failing grades as he began his senior year at college. These academic troubles were accompanied by physical problems as well. Chiyo started having headaches, indigestion, and insomnia. Chiyo at first blamed the academic problems on his physical health, but after seeing a doctor Chiyo discovered he had no physical disorders.

During Chiyo’s first session, he seemed depressed and anxious. All his responses to questions were short yet polite statements, and he rarely volunteered information about himself. Chiyo presented his problems as strictly educational ones and avoided statements about his emotions and feelings. Chiyo seemed to doubt the value of counseling and needed reassurance and feedback throughout the session.

The Breakthrough
After several sessions, Chiyo’s therapist made a breakthrough and discerned that Chiyo did not like his electrical engineering major. Chiyo was only going into the field to please his parents. The therapist realized that Chiyo would not take responsibility for his actions, was excessively dependent on his parents, and was unable to express his anger towards them for pushing him into a career he didn’t like.

♦ Gestalt's "Empty Chair"
Chiyo’s therapist decided to use the Gestalt "Empty Chair" technique with Chiyo. As you know, in the Gestalt "Empty Chair" technique, the client pretends that someone specific is seated in an empty chair opposite him or her and expresses his or her true feelings towards that person. In Chiyo’s session, his therapist asked him to pretend his parents were seated in two chairs opposite him. The therapist experienced difficulty getting Chiyo to express his feelings at first.

However, after much encouragement from the therapist, Chiyo did finally begin to vent some of his true feelings. Following this session, Chiyo seemed more withdrawn and guilt-ridden than ever. Subsequent sessions with Chiyo proved nonproductive. What ethical issues regarding culturally different clients who are Asian Americans can you see in this case? How did Chiyo’s Chinese family background influence his decisions and choices? Did the therapist understand Chiyo’s Chinese values? Did the therapist’s therapy techniques agree with Chiyo’s value system?

3 Ethical Issues

♦ Ethical Issue #1: Family Background
As you can see, the first ethical issue in this case is Chiyo’s family background. I have found that often Asian American clients will make decisions based on their parents’ desires. As a Chinese American, Chiyo selected his electrical engineering major based on his parents’ wishes. Through appeals to familial obligation, Chiyo’s parents made their wishes clear. Through the instillation of guilt and shame, Chiyo felt that he could not defy his parents’ wishes. As you are well aware, familial obligation as well as guilt and shame play a key role in the Asian American value system. I have found that in the Asian American value system, it is the family unit, not the individual, which is most highly valued.

♦ Ethical Issue #2: The Goals
A second ethical issue to consider is the therapist’s relationship with Chiyo and the goals that he established for Chiyo’s sessions. Regarding the therapist’s relationship with Chiyo, the therapist did not seem to understand the Asian American value system. I have found that the Asian American value system places emphasis on the restraint of feelings. Yet Chiyo’s therapist encouraged him to explore and express his emotions. Do you see how the therapist established inappropriate goals for Chiyo’s counseling? As a culturally different client from a Chinese background, Chiyo approached the counseling situation expecting advice regarding his academic problems. The therapist responded by establishing goals for Chiyo that he might have established for any typical white client. The therapist established Chiyo’s goals as learning to take responsibility for his own decisions and exploring his feelings. While these goals would be compatible with most traditional white clients’ value systems, they clashed with Chiyo’s Asian American value system.

♦ Ethical Issue #3: The Process
Finally, the third ethical issue to consider is that of process and goals. The establishment of inappropriate goals and the therapist’s lack of understanding for the Asian American culture and value system led to the use of an inappropriate process. Do you see how the Gestalt "Empty Chair" technique may have made Chiyo’s situation worse?

In my experience, one aspect of the Asian American value system is indirect and subtle approaches to conflict. Obviously conflicts are not dealt with directly in an Asian American value system. Yet Chiyo’s therapist used a technique that forced his Asian American client to directly approach his emotions. I have found that in addition, the Asian American value system emphasizes familial obligations and respect for elders. As such, a technique like the Gestalt "Empty Chair" technique, which required Chiyo to talk back to his parents, even through imaginary dialogue, caused more guilt in him than he was already experiencing. Make sense?

Do you have a culturally different client who is Asian American? What are the ethical implications of the counseling techniques you are using? How might your counseling techniques be influenced by knowledge of the Asian American culture system?

In this section, we have discussed Chiyo’s case and the effect the Asian American value system had on his counseling experience.

In the next section, we will discuss cultural perspectives in counseling culturally different clients who are African American. We will also discuss the implications of these cultural perspectives.

Peer-Reviewed Journal Article References:
Chopra, S. B. (2021). Healing from internalized racism for Asian Americans. Professional Psychology: Research and Practice, 52(5), 503–512.

Kim, B. S. K., Li, L. C., & Liang, T. H. (2002). Effects of Asian American client adherence to Asian cultural values, session goal, and counselor emphasis of client expression on career counseling process. Journal of Counseling Psychology, 49(3), 342–354.

Kim, B. S. K., Ng, G. F., & Ahn, A. J. (2005). Effects of Client Expectation for Counseling Success, Client-Counselor Worldview Match, and Client Adherence to Asian and European American Cultural Values on Counseling Process With Asian Americans. Journal of Counseling Psychology, 52(1), 67–76.

Kim, E., & Hogge, I. (2021). Microaggressions against Asian international students in therapy. Professional Psychology: Research and Practice, 52(3), 279–289.

Ma, P.-W. W., & Lan, M.-Y. (2021). Marginalized identities, family conflict, and psychological distress: The process of psychotherapy with a Chinese American adolescent. Asian American Journal of Psychology.

Sandeen, E., Moore, K. M., & Swanda, R. M. (2018). Reflective local practice: A pragmatic framework for improving culturally competent practice in psychology. Professional Psychology: Research and Practice, 49(2), 142–150.

Wang, S., & Kim, B. S. K. (2010). Therapist multicultural competence, Asian American participants' cultural values, and counseling process. Journal of Counseling Psychology, 57(4), 394–401.

Yip, T., Cheah, C. S. L., Kiang, L., & Hall, G. C. N. (2021). Rendered invisible: Are Asian Americans a model or a marginalized minority? American Psychologist, 76(4), 575–581.

Why might the Gestalt "Empty Chair" technique be inappropriate for Asian American clients like Chiyo? To select and enter your answer go to Ethics CE Test.

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