How do psychologists treat eating disorders (EDs) and subclinical issues in Asian American women in a culturally competent manner? Disordered eating and body dissatisfaction are so common in women that most therapists work with the issues to some degree, and it is increasingly likely they will see women of color. Asian American women are at significant risk and yet little treatment literature exists. Twelve therapists with experience in ED treatment were interviewed about their work with Asian American women. Grounded theory and consensual qualitative analysis methods were used to analyze the data, resulting in two central domains of conceptualization within the cultural context and treatment approach. Therapists reported that their clients were mostly first-and second-generation Americans who experienced acculturation stress and cultural conflict, particularly with elders. Other results suggested therapists perceived a strong connection between clients' desires to be thin and successful, and clients' efforts to conform to traditional Asian cultural values and fit in with U.S. mainstream culture. Therapists emphasized the cultural contextualization of family dynamics, developmental processes (e.g., individuation), and intergenerational conflicts. They viewed EDs as providing clients with culturally congruent coping strategies to affectively disconnect and to express distress. Treatment themes centered on psychoeducation and the importance of including parents in the treatment of their adult daughters. Helping clients navigate autonomy within the family and cultural context, and challenging clients and parents on the cultural (both Asian and mainstream U.S.) pressures regarding achievement and beauty were particularly important. Implications for therapy are discussed.
Asian American women experience disordered eating and body dissatisfaction, which puts them at risk for eating disorders and medical complications, as well as depression, anxiety, and related mental health issues. Help-seeking is low, and clinician bias hampers referral for adequate treatment, suggesting need for greater understanding of cultural context. Asian Americans experience many of the same risk factors as do other groups; however, research has not examined their phenomenological experiences of these issues in the cultural context, or their perceptions of what has helped them heal. To address this gap in the literature, modified consensual qualitative analysis (CQR-M) was used to analyze written narratives from 109 Asian American women who identified as having had concerns with weight, body, or eating, out of 354 Asian American women who responded to an online survey on eating behaviors and attitudes, and family relationships. They were asked to describe (a) any problems with weight, body, and eating; (b) their perceptions of the causes; and (c) their perceptions of what had helped them heal (if that was the case). Results indicated that weight gain, mild body dissatisfaction, and desire to be thinner were the most common experiences, and nearly one quarter had engaged in disordered eating. Participants' perceptions of the causes included Asian culture's emphasis on thinness, family criticism of weight, developmental events, and comparison to other Asian women. They reported that positive changes came primarily from social support, increased physical activity, and a shift toward internal validation. Implications for clinical practice are provided.
Recent research confirms that Asian Americans (AAs) experience disordered eating (including full-syndrome and subclinical symptoms of eating disorders). However, the role of culture in disordered eating has largely focused on acculturation, with inconclusive results, and although some traditional cultural values have been hypothesized to contribute to risk for eating disorders, there has been little empirical research to support these claims. This exploratory study examines the role of culture in AA women’s disordered eating from 2 perspectives: adherence to 5 dominant traditional cultural values using the Asian American Value Scale–Multidimensional (Kim, Li, & Ng, 2005) and generational status. A diverse community sample of 241 AA women participated in an online survey. Although there were no generational differences in cultural beliefs, second-generation women reported significantly more disordered eating than did their first- and third-generation (and above) counterparts, suggesting a potentially significant role of cultural conflict, or biculturative stress, in disordered eating. Among the cultural beliefs, endorsement of Family Recognition Through Achievement and Emotional Self-Control were the 2 significant risk factors for overall disordered eating assessed by the SCOFF (Morgan, Reid, & Lacey, 1999). Results of this study offer support for more exploration of cultural context in the risk for disordered eating in AA women in several ways, including the role of biculturative stress, the perils of the perceived pressure to achieve, and the possible use of disordered eating as a method of expressing distress in a covert manner. Implications for clinical interventions are discussed.
Disordered eating and body dissatisfaction are occurring among Asian American women, but the vast majority of treatment literature is based on White Western women. Empirically supported treatments are increasingly encouraged for eating disorders, but therapists find little guidance for implementing them in a culturally sensitive manner. This paper reviews eating problems in Asian American women and explores concepts important to cultural competency in therapy. Examples of how cultural adaptations could be made to an empirically supported treatment are illustrated in a case scenario using aspects of C. G. Fairburn's Enhanced Cognitive Behavioral Therapy for Eating Disorders (2008).
Among the Maori of New Zealand, Aboriginals of Australia, and other Indigenous peoples, family dynamics strongly influence the ways that issues emerge in counseling. This study explores aspects of gender and power within the context of birth practices in rural Nepal. In‐depth interviews were conducted with 15 postpartum women, as well as family members, to collect narratives of birthing experiences that highlight issues of oppression, marginalisation, and power struggles. Implications for multicultural and social justice awareness in family therapy are discussed, especially with regard to the subtle, disguised ways that power operates behind the scenes, often sabotaging efforts by health and mental health professionals to bemost helpful.
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