1. 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 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..

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

3. My Cultural Background
Country of origin
Immigration
Language

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

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

7. 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…

8. 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,

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

10. 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,

11. 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…

12. 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….

13. 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…

14. 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

15. 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

16. 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

17. 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…

18. 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.

19. 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,

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