Psychotherapy with Southeast Asian Refugees: Implications for Treatment of Western Patients

Abstract

Working with Southeast Asian refugees in psychotherapy can teach Western psychotherapists how our culture-impacted notions of health, psychopathology, and psychotherapy influence the way we hear, understand, and respond to our patients. Western conceptions of individual boundaries, family ties, the relationship of mind and body, and ways of knowing are among the issues that arise for the Western psychotherapist who works with Southeast Asian refugees. While we in the West have seen rapid technological advances, we also have suffered dislocations, change, and the loss of traditional bases of meaning. Yet despite the differences, there are also elements within Western culture that resonate with what are usually considered "Asian" ways. These include the self-in-relation concepts described by feminist writers and the attitude of therapist as learner described by some contemporary psychoanalysts as well as by a contemporary Western philosopher. Refugees and Western patients alike want their unique faces "seen" and hope to birth new and expanded meanings in their psychotherapeutic dialogues.

The Psychology of Worldviews

“…The relational orientation also occupies an important place in Dake's (1991) analysis of cultural biases and the perception of risk. Differences between ethnic minority populations and majority populations in the United States in terms of relational orientation, with consequences for counseling and psychotherapy, have been noted regarding African Americans (Carter & Helms, 1987), Cuban immigrants (Szapocznik, Scopetta, Aranalde, & Kurtines, 1978), Korean immigrants (Donnelly, 1992), Puerto Ricans (Inclan, 1985), and Southeast Asian refugees (Gerber, 1994).…”

Implications of socio-cultural contexts for the ethics of clinical trials.

“…In the psychiatric case, where what the patient says is frequently taken to be part of the symptomatology, there is a considerable literature not only about ways of getting informed consent and of constructing proxy consent, but also in "transcultural" psychology. [203][204][205][206][207] Psychiatry is about identification, diagnosis, treatment and management of pathologies of behaviour, which include linguistic behaviour. However, the concept of pathology has a social content, as well as a naturalistic content.…”

“…Certainly there is evidence that the quality of informed consent obtained from American patients of Mediterranean cultural origin is diminished where such patients are unable to consult their families. [192][193][194]199,201,204,285,286 In cases where the patient is able to go away and think about the choice for some time this problem probably does not arise, since the patient can then consult with his family. Where this is not possible -because the decision is required quickly, or because the patient is hospitalised -the individual who is culturally inclined to place his interests in the context of the interests of his family will need to have his family with him to help think through the decision.…”

Responsibility and survivor testimony.

“…We collaborated on this project believing that as different as the groups of participants might be, there are also commonalities, as well as insights to be gained. Lane, influenced by Robert J. Lifton (1976), has speculated that the nature of Western societal changes—including increasing groundlessness, loss of a sense of continuity and heritage, the accentuation of the monadic self, and multiplying violence in the world and Western culture—is creating a situation in which the experience of Southeast Asian survivors may be instructive to the rest of us who increasingly feel like survivors in this contemporary age (Gerber, 1994). David Harrington (1997) has become concerned that changing technology has led to both a decrease in literacy, with a resultant loss of connection to three millenia of our cultural legacy, and an increasing isolation of persons in front of televisions and computer screens.…”