Working with Asian Indians in America

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Working with Asian Indians in America

• Anita McLean, Psy.D.
• Training Coordinator
• Counseling and Psychological Services, Princeton
  University
• Instructor
• Graduate School of Applied and Professional
  Psychology, Rutgers University
• Private Practice
• Contact amclean_at_princeton.edu 732-319-9104
• Visit nj-spychologist.org

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Incidence of disability is difficult for any
family.

• What is different about the South Asian Family?
• The idea of interdependence
• The implication for roles, duties and privileges
• The influence of immigration on values
• The impact of immigration on access to care

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1. The idea of interdependence

• Western Values individualism, autonomy, and
  independence
• A healthy individual is self efficacious,
  independent, and regulates own self esteem and
  believes that destiny is self determined.
• South Asian Values interdependence, mutuality,
  and interconnectedness
• A healthy individual is dependent on and
  responsible for others, regulates the self esteem
  of the other while allowing the other to affect
  own self esteem and believes that destiny is
  determined outside of self but good will is
  rewarded

What is the implication if someone is disabled?
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Stigma and interdependence

• In Asian families, each family member is
  connected to and dependant on every other family
  member so that their decisions, actions and
  behavior deeply affect others. For example,
  children are considered extensions of the family
  and not independent entities.
• Therefore, a defect in terms of a disability in
  any one family member reflects poorly on the
  entire family. Thus, not only is the individual
  shamed but it causes shame for all.
• For example,
• Parents may blame themselves for the childs
  limitations.
• Children may want to shield their family from
  feelings of guilt
• Families may fear a reduction in the perceived
  status in the community
• Parents may fear that well children may be
  perceived as potentially defective and result
  in difficulty in making marriage alliances for
  these family members.

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2. Roles

• South Asian relationships are hierarchical and
  roles are implicitly or explicitly established
• Roles are predefined and come with both
  privileges and duties/obligations which are
  unequal
• role of the (eldest son)
• Duties toward daughter
• Role of the provider
• What happens if someone is disabled and cannot
  fulfill their role?

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3.Impact of immigration on values

• Values contributed by the immigration experience
• Emphasis on success
• Retention of old culture
• Trust of own group and suspicion of others
• What happens if someone is disabled in the family?

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4. Immigration Barriers to Access to Care

• All Americans face the following barriers
• Cost of care
• Fragmentation of services
• Lack of availability of services
• Societal stigma toward disability.
• However, immigrant families face additional
  barriers
• Mistrust and fear of treatment
• Racism and discrimination
• Language difficulties
• Differences in Communication Patterns The
  cultural meaning of disability
• The traditionally acceptable methods of coping
• The traditional methods of treatment
• The lack of information, knowledge, and awareness
  of availability of services and availability of
  systemic supports

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How can we help?

• Systems can meet
• Linguistic needs
• Bilingual staff
• Interpretation services as appropriate
• Brochures/literature/educational material in
  several languages
• Cultural Competence
• Agencies need to hire diverse staff
• Support continuing education and training for
  those working with minority cultures
• Provide appropriate supervision for ensuring
  cultural competence for clinicians
• Provide referrals to community support groups.
• Information about services available and how to
  access them
• Integrated treatment
• To the extent possible, primary care,
  psychotherapy, medication, support services etc.
  should be closely connected with cross referral
  possibilities

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Clinicians can provide..

• Understanding of and Respect for family hierarchy
• Accommodations to family involvement
• Immediate support assurance
• Interventions based on Acculturation level. For
  example, assuming lack of knowledge and awareness
  can be insulting to a highly acculturated client
  but essential for a less acculturated family.
• Convey respect by understanding the cultural
  embedded-ness of the client but also of yourself
  .
• Normalize what is healthy in their culture
  while explaining why it may not work here
• Use appropriate methods of communication
• Be aware of role relationships, your role and
  place in the heirarchy
• Seek creative and non-orthodox solutions
• Respect the need to save face.
• Respect the power of the familial connection and
  implications for the entire family
• Refer for psychotherapy support

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Thank you

• Questions?