The concept of counter-transference refers to the clinician’s unconscious misrepresentation of the client in the therapeutic relationship (Hong & Ham, 2001). Countertransference can develop even though an Asian American clinician who may perceive similarities with an Asian client (Hong & Ham, 2001). Transference is ubiquitous and not restricted to therapy session only. Instead, I think it is manifested in interactions in everyday life.
Even if clients appear to have high levels of acculturation, they still face the possibility of transference, which influences all aspects of their lives. The technique of interpretation is the most crucial part in psychoanalytic therapy where the clinician interprets and educates clients concerning other ways to understand their behaviors, thoughts and feelings. The clinician’s interpretation can be effective only if it is relevant to the clients’ experiences in their social and cultural contexts.
In addition, the clinician’s interpretation is contingent on the meaning attributed to the Asian client’s behaviors and experiences. For example if the client is uneasy and silent in the free association method, a culturally adept clinician will interpret this as an infringement of client’s sense of privacy from an Asian cultural viewpoint rather than resistance. The clinician should also be aware of cultural normative behaviors and whether they are relevant to interpretation.
Due to the emphasis placed on past experience affecting the present behaviors in psychoanalytic therapy, the clinician should be informed of the differences in child rearing practices between Western and Asian cultures. When working with Asian immigrants, a clinician may perceive premigration childhood experiences (which are a part normal Asian parenting) as abusive and neglectful. Another point of note is Asian cultures typically consider sexual expression as a taboo and should be done in privacy.
While making an interpretation of a client’s internal emotional state the clinician should be sensitive to client’s feelings of shame and embarrassment. If clinicians point out the client’s manifestation of underlying feeling with an interpretation, they may only make the client’s reticence toward sexual issues (which is a major part of the unconscious) worse and lead to premature withdrawal from therapy. Regardless of the content of interpretation, the deliverance of information should be congruent with the client’s communication style and education.
For psychoanalytic therapy to be effective, the clinician should engage the client by relating to the social and cultural intricacies and follow a way that meets the client’s expectations (Hong & Ham, 2001). A second therapeutic orientation involves person-centered therapy, which is syntonic with Asian philosophical concepts such as human benevolence, compassion, virtue, enlightenment, self-understanding and perfection.
The most remarkable similarity between person-centered therapy and Asian culture is its premise of the innate goodness of human beings, self-knowledge and self-actualization. Although the key concepts of person-centered therapy may be applied to Asian American clients, the challenge for the clinician will be to implement strategies and techniques in a culturally sensitive manner. The mechanism of therapeutic change is centered on the therapeutic process and the clinician- client relationship without any direct interventions.
This client-clinician relationship is characterized by congruence (the genuineness and authenticity of the therapist), unconditional positive regard (the genuine caring, respect and acceptance of client by therapist) and empathy (the therapist’s sensitivity and understanding of client’s feelings) (Hong & Ham, 2001). Clinicians using person-centered therapy developed by Rogers (1965) focus on expression of emotions to assist clients in achieving a unified whole and help clients realize their inner self-concept (Kim, Li & Liang, 2002).
The therapeutic process in the person-centered therapy begins with the establishment of a comfortable rapport with the client. Throughout the process, the clinician takes a non-judgmental stance and allows the client to take initiative in introducing topics for discussion, disclosing issues and even determining the frequency of therapy sessions (Hong & Ham, 2001). Asian students consider counseling as a directive, authoritative and paternalistic process and anticipate the counselor to give remedial course of action.
They do not easily disclose emotional problems to the counselor due to shame brought to the family, so they present somatic problems. It may be necessary to emphasize confidentiality in order to gain their trust, and provide relief to the client (Baruth and Manning, 2003). Another consideration would be to normalize the problem by indicating that it is not an unusual family issue or externalize the problem by attributing it to an acculturation issue. The therapist could point out differences in expectations stemming from a generational gap without minimizing the problem, but yet offering hope at the same time (Sue & Sue, 2003).