Cultural issues in disease management for chinese americans with type 2 diabetes

The purpose of this study is to highlight culturally unique experiences and responses to type 2 diabetes among Chinese immigrant families. Patient and spouse narratives from 16 different families were elicited in a series of group interviews on this topic. Using interpretive phenomenology, 5 primary cultural considerations in diabetes management emerged from the narratives: (1) conceptualization of diabetes, illness and health, (2) significance and meaning of food, (3) perceptions of Chinese and Western medicines, (4) exercise and physical activity, and (5) effects of the disease on family dynamics. The relation of these cultural considerations to an interdependent view of the self, collectivistic social orientation, Chinese cultural beliefs and norms, and acculturation processes are discussed. Clinical recommendations for culturally appropriate disease management strategies are outlined.     

教育价值观和逆境信念在家庭经济压力与初中生学业成就之间的作用

大量研究表明,家庭经济压力对青少年学业成就具有显著的不利影响。但是,目前学界对家庭经济压力“怎样”（中介机制）以及“何时”（调节机制）影响青少年学业成就仍知之甚少。本研究在整合贫困文化模型及心理韧性理论的基础上构建一个有调节的中介模型,考察青少年教育价值观（读书是否有用）在家庭经济压力与学业成就之间的中介作用,同时检验中国文化逆境信念对该中介路径的调节作用。采用随机整群抽样,选取四川省9所普通中学1613名初中生（平均年龄13.42岁,SD = 1.22）作为研究对象。被试匿名填写家庭经济压力问卷、教育价值观问卷、中国文化逆境信念量表以及学业成就问卷。结果表明：（1）在控制了性别、年龄等人口学变量后,家庭经济压力显著负向预测学业成就。（2）教育价值观在家庭经济压力与学业成就之间具有部分中介作用。（3）积极逆境信念能缓冲家庭经济压力对教育价值观的消极作用,进而减少对学业成就的不利影响。本研究证实了“读书无用论”是经济困难与学业成就的重要联系机制,并肯定了中国文化逆境信念对经济困难青少年的保护作用。这一内在保护机制的揭示对教育实践有一定的启示。     

Maternal Beliefs,Adolescent Perceived Maternal Control and Psychological Competence in Poor Chinese Female-Headed Divorced Families

Based on the data of 337 female-headed divorced families living in poverty in Hong Kong, the relationships among maternal beliefs (Chinese cultural beliefs of familism, maternal expectations of children’s future, maternal attribute of children’s achievement to effort), adolescents’ perceived maternal control and adolescent psychological competence (indexed by beliefs in the future, clear and positive identity, and resilience) were examined. Results indicated that adolescents’ perceived maternal control mediated the influence between maternal beliefs and adolescent psychological competence in poor female-headed divorced families in Hong Kong. With the paucity of research on family beliefs and indigenous parenting practice, the present study underscores the importance of maternal beliefs and maternal control on nurturing adolescent psychological competence in Chinese divorced families facing adversity, which contributes to the development of Chinese familial model of resilience. Theoretical and practical implications of the findings are discussed.     

Therapy with Families in China: Cultural Factors Influencing the Therapeutic Alliance and Therapy Goals

Rapid economic and social development in China is producing opportunities for a better standard of living for many families but also is associated with significant stress. Family therapy is one of the forms of mental health services that have become increasingly available. Western-derived models of family therapy are being used and adapted to meet the cultural traditions and needs of Chinese families. This article describes a variety of Chinese cultural factors that can influence the establishment of therapeutic alliances with family members (communication styles, collectivist values, family roles, and structure) and those that can shape family therapy interventions by addressing contextual factors affecting Chinese families (economic development, migration patterns, academic pressure, and changing gender roles for women). Suggestions are offered for using cultural sensitivity to address these factors tactfully to build strong therapeutic alliances and help families cope with significant life stresses.     

Practising family therapy in India: how many people are there in a marital subsystem?

Systemic therapy would appear to be a viable form of treatment for people who exist in cultures that contain complex, extended family systems, such as those found in India. The practice of family therapy in India has evolved from Western concepts. These concepts appear to offer Indian therapists relevant and practical ways of working with families. However, some of these concepts need modifying before they can be used in an Indian context. Indian families may have very different worldviews and ideas of 'self' compared to families in the West, leading to different family organization. The situation can be further complicated by the cultural norms of therapists themselves. Therapists in India are often highly educated, come from upper-middle-class families and have been exposed to different cultures. They increasingly share many of the values of their counterparts in the West. At the same time, they retain aspects of their own cultural heritage, which is also the dominant culture for a large number of the families with whom they work. Thus, not only must Indian family therapists seek to work in culturally appropriate ways; they must also tolerate their own internalized conflicts regarding differing cultural norms. With the use of clinical data, this paper describes some of the personal and professional problems experienced by an Indian family therapist working with Western constructs of family organization.     

Understanding Thai Families: A Cultural Context for Therapists Using a Structural Approach

This article describes six cultural influences that affect Thai families: religious beliefs, rural and urban considerations, family relationships, societal values, masculine and feminine roles, and sexuality. A case study of a Thai family struggling with these issues and interventions from a structural therapy perspective is presented.     

Integrating Homework Assignments Based on Culture: Working with Chinese Patients

Cognitive therapy as espoused by A. T. Beck (A. T. Beck, Rush, Shaw, & Emery, 1979) is increasingly used as a therapeutic modality and applied to a variety of cultural groups throughout the world. However, the majority of the literature on empirical and clinical practice has been focused on the use of cognitive therapy for Western cultures. In this article, we discuss Chinese patients’ adherence to therapy homework assignments in terms of Chinese cultural values and practices, their customary problem-solving process, and other traditional beliefs. Through the use of a case study, we illustrate how some of these culturally specific beliefs can influence the process of integrating homework assignments into the course of therapy. This resource on supervising practitioners’ treatment of Chinese patients with cognitive behavior therapy is offered as a contribution to the emerging literature on CBT for non-Western cultures.     

Mothers', fathers' and children's perceptions of parents' expectations about children's family obligations in nine countries

Children's family obligations involve assistance and respect that children are expected to provide to immediate and extended family members and reflect beliefs related to family life that may differ across cultural groups. Mothers, fathers and children (N = 1432 families) in 13 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand and United States) reported on their expectations regarding children's family obligations and parenting attitudes and behaviours. Within families, mothers and fathers had more concordant expectations regarding children's family obligations than did parents and children. Parenting behaviours that were warmer, less neglectful and more controlling as well as parenting attitudes that were more authoritarian were related to higher expectations regarding children's family obligations between families within cultures as well as between cultures. These international findings advance understanding of children's family obligations by contextualising them both within families and across a number of diverse cultural groups in 9 countries.     

Family Cultures in The Context of Migration and Ageing

Intergenerational family relations are embedded in family cultures which influence how families regulate their relations over the whole life span with regard to key issues, such as autonomy and relatedness, or support exchange and reciprocity, and which may vary inter- and intraculturally. Migrant families undoubtedly face a special situation as values and expectations from the culture of origin and from the host cultural context might differ. Not much is known yet about how migrant families adapt their family cultures to the host cultural context. The present article will focus on aspects of intergenerational family regulation by taking into account family cultures of migrant compared to non-migrant families in a life span perspective. We will illustrate our theoretical outline by presenting first results from the IRMA-study comparing Luxembourgish and Portuguese immigrant families living in Luxembourg. We focus on issues of family cohesion, enmeshment and normative expectations regarding adult children’s support for their ageing parents, by drawing both on quantitative questionnaire as well as qualitative interview data. Implications for the experience of ambivalence and conflicts as well as well-being of family members from both generations will be discussed.     

Treatment Expectations and Treatment Experience of Chinese Families Towards Family Therapy: appraisal of a common belief

This paper reports results of a qualitative study on family therapy conducted in Hong Kong, which aims to identify Chinese families' treatment expectations, delineate their subjective experience and the outcome in treatment. By comparing the expectations, the experience and the outcome, this study examines and challenges the belief that the practice of family therapy should necessarily be fundamentally adapted to be 'culture-specific', an assumption that has hitherto been untested and possibly based on overgeneralized cultural stereotyping. This study provides empirical evidence for family therapists who have interests in working with local and overseas Chinese families to improve their practice.     

Family meaning of self-starvation: themes discerned in family treatment in Hong Kong

This study aims to identify themes from the treatment of Chinese families with an adolescent or an adult member suffering from anorexia nervosa (AN), through a multiple case study. This study reveals that self-starvation may be regarded as a cultural metaphor. Four major themes emerged at the family level: self-starvation as an expression of love and control, coalition of the AN daughter with the mother, family loyalty, and the powerlessness and helplessness of the mother. The themes identified are narrative accounts of the Hong Kong Chinese families, rather than causal explanations proposed by Western literature. The emerging themes are believed to be constructed and legitimized by traditional Chinese cultural values, with females being subordinated to and dependent on males and the self being subjugated to or sacrificed for the collective. Treatment implications are discussed.     

Chinese College Students’ Experiences in the Encounter Group

In theory, the encounter group is well suited to addressing the problems of Chinese college students, but in practice, significant conflicts exist between the nature of the encounter group and the internalized beliefs of this group of students. This brief report identifies six areas of notable conflict in the therapeutic process: freedom of expression, belongingness, learning from diversity, impacts of an exam-oriented education, social inequalities, and indirect communication. The advantages for the encounter group members were the opportunities to enjoy self-expression, gain acceptance regardless of social status, learn about differences between themselves and other members, provide nonstandardized answers, increase the level of self-advocacy, and feel safe directly expressing themselves. On the negative side, group members may have felt distressed due to the conflicts between the basic character of the encounter group and their own cultural beliefs. The limitations of this study are found in the sample types, my multiple roles and biases as the author and group leader, and the features of the encounter groups conducted. Nevertheless, this brief report may increase both therapeutic applicability of the encounter group to Chinese college students and the level of cultural competence in group psychotherapists who may use the encounter group or work with this population.     

Reducing work/home conflicts in employed couples: A proposed program to balance job and family demands

Work/home conflict is a dominant stress for workers in industrialized countries, particularly in dual-employment families. Interindividual (husband/wife) and interrole (work/home) conflicts in such families are a unique source of stress and adversely affect family and marital relationships as well as performance at work. Neither family therapy nor the stress literature have reported any interventions directed specifically at reducing work/home conflicts in employed couples or parents, although many workplaces today offer stress prevention programs aimed at individual workers. This paper discusses the underlying theoretical rationale for a marital enhancement intervention currently being developed for prevention of distress associated with work/home conflicts. The program combines marital enrichment and training principles with stress management techniques and aims at reinforcing shared coping resources. It focuses on four main variables associated with interpersonal processes: unrealistic expectations based on irrational beliefs, social undermining, shared decision control, and social support.     

Assessing Representations of Close Relationships Among Chinese and Japanese Adolescents and Young Adults: Commonalities and Differences in the Two Confucian Cultures

This article proposed an affective relationships model with its assessment instrument and examined how Chinese and Japanese adolescents and young adults construct mental representations of their close relationships, and the influence of Confucian cultural beliefs on these representations. The participants were 1,565 students aged 14 to 24 years living in China or Japan. The students were asked about their relationships with four figures: mother, father, closest friend, and romantic partner. We found that: (a) adolescents and young adults in both cultures constructed constellations of relationships containing multiple figures, and they articulated reasons for each figure's significance; and (b) there were between-group differences in the relationships with the father and the romantic partner for Chinese versus Japanese adolescents and young adults. These differences were partly explained by the influence of Confucianism on the Chinese participants’ cultural beliefs that retained the patriarchal values.     

Gender and Acculturation in Relation to Traditionalism: Perceptions of Self and Parents Among Chinese Students

The acculturation attitudes and traditionalismof Chinese university students in Toronto, Canada, wereinvestigated. Chinese men were significantly moretraditional than Chinese women in their beliefs and expectations regarding family hierarchy and thesocial roles of women and men, but they did not differin perceptions of their parents' construal of familyrelations and gender roles. Generational discrepancy between self and perceived parental values wasfound for Chinese women but not for men in the study,suggesting greater conflict with regard to traditionalgender role and cultural values for women. The acculturation attitude of separation predictedstudents' traditionalism, and marginalization predictedparents' perceived traditionalism. Gender differencesand the relevance of different modes of acculturation with regard to traditionalism are discussed inthis article.     

The role of culture in families' treatment decisions for children with autism spectrum disorders

There is little information available about how and why parents of children with autism spectrum disorders (ASD) make decisions regarding which of the many available treatments to implement with their children. Given the lack of available information regarding treatment efficacy, it is likely that parents' beliefs about child development, interpretation of the symptoms of ASD, its etiology and course, and their experiences with the health system influence treatment decisions. This article addresses these issues within the context of cultural influences. We review the small body of existing literature regarding cultural influences on decisions regarding ASD and draw implications for the study and treatment of ASD from the larger body of literature on culture and other health conditions of childhood. In addition to examining the potential for differences in clinical presentation by culture and different experiences with the healthcare system, we use Kleinman's framework of questions for understanding the role of culture in the interpretation and treatment of ASD. These questions address interpretation of symptoms and beliefs about their cause, course, and treatment. Finally, we present specific language for clinicians to use in discussion with families with different cultural beliefs about the use of less traditional treatment strategies.     

The challenge of professional identity for Chinese clinicians in the process of learning and practicing psychoanalytic psychotherapy: the discussion on the frame of Chinese culture

One important element in psychoanalysis, which is derived from Western culture, is individualization: the independency and autonomy of an individual are highly valued. However, one of the significant essences in Chinese culture is that the collective interests transcend the individual interests and the interests of social groups are more important than those of families. Therefore, when learning and practicing psychoanalytic psychotherapy, Chinese clinicians inevitably experience conflicts derived from this difference of cultural values. This article attempts to use a historical perspective to discuss the current challenges of professional identity for Chinese clinicians learning and practicing psychoanalytic psychotherapy and psychoanalysis.     

Taking the Bull by the Horns: A Family Therapy Case of an East Indian Adolescent Substance Abuser

The cultural clash between traditional East Indian cultural values and US values often leads to parent–child conflicts, which increases East Indian adolescents’ risk for substance abuse. This is demonstrated in theory and through a case presentation of an East Indian adolescent substance abuser who was treated through an approach that coincided with the core principles of multi-dimensional family therapy. Family therapy interventions that coincided with East Indian cultural values were generally effective and resulted in decreased parental substance abuse, decreased family conflict, and improved parenting skills. Family therapy interventions that conflicted with East Indian cultural values were not effective. Further study is needed to ascertain the extent of parental and adolescent substance abuse in East Indian immigrant families and the effectiveness of a multi-dimensional family therapeutic approach to treatment.     

Counsellors' self-perceived multicultural competencies model

This study aimed to develop a UK instrument measure of counsellors’ multicultural competencies. Also, it intended to analyse to what extent multicultural competencies have an influence in counselling practice in terms of processes and interventions.

The study was an expansion of the American multicultural competencies model, which related cultural competence to a combination of three factors: cultural beliefs, cultural knowledge and cultural skills. Results partially supported the hypothesis, which predicted that counsellors would present high correlation rates between cultural skills, cultural knowledge and cultural beliefs when self-evaluating their levels of multicultural competence.

The study's findings present alternative three-dimensional multicultural models that indicated how counsellors perceived multicultural competence based on both societal (e.g. race, class, patriotism) and functional (e.g. family, social norms and groups). It also discusses the correlations between cultural skills, cultural knowledge and cultural beliefs and how they played a part in helping counsellors to further understand their multicultural competencies and limitations. Finally, it is proposed that future research should investigate the possibility of developing multidimensional or multi-axial models as an alternative way of further developing the counsellors’ multicultural competencies models which emerged from this study.