Counseling Asian Americans and Pacific Islanders

Compare and contrast the challenges associated with counseling Asians Americans and Pacific Islanders. Identify cultural influences and state how counselors need to be aware and knowledgeable in identifying those differences and how they impact the counseling relationship




Counseling Asian Americans and Pacific Islanders


Recent studies show the numerous challenges facing counseling amongst Asian and Pacific Islanders. There is a widespread belief that people in these ethnic communities terminate and drop out of counseling programs that affect the recovery process. However, they are many underlying cultural factors that contribute to inadequate or no counseling. These include age, communication barrier, level of acculturation, gender, and income issue. Asian Americans and Pacific Islanders are diverse populations with deep-rooted traditional belief systems and myriad family expectations geared toward suppressing the psychological being to enhance the physical being. These beliefs and family expectations converge on counselors to provide accurate diagnosis and treatment.  Treatment providers need to be aware and knowledgeable on the beliefs and family expectations within the Asian cultures to better understand the underlying problem for mental illnesses. Developing and becoming culturally competent aids the counseling relationship that promotes therapeutic alliance, healing and recovery.


Counseling Asian Americans and Pacific Islanders

Over the last three-decade research has shown that the number of Asian Americans and Pacific Islanders seeking counseling services has significantly dropped. Many of these ethnic minorities terminate counseling prematurely, which deteriorates their mental condition. According to the 2014 U.S Census, approximately 13.9% of people in Asian Americans and Pacific Islanders community are mentally unstable (Each Mind Matter, 2020). Studies show that that communication barrier, age, religious beliefs hinders the process of diagnosis and treatment of mental illnesses. Asian Americans and Pacific Islanders make up 4% of the American population today. These ethnic minorities are diverse in terms of culture and historical events. In the Asian culture, children are taught at a very young age, the importance and value of interdependence, interpersonal relationships, and harmony in the community (Each Mind Matter, 2020). The philosophies and teachings of Confucianism discourage them from expressing their emotions and much more to strangers. In some Asian communities expressing one’s feelings is a sign of weakness — people who seek to face enormous shame and stigma from the community members. Mental illness reflects poor upbringing of the person or lack of moral support, which taints the family image and can be used by elders to determine if someone is suitable for marriage or not. It is, therefore, of paramount importance for American Asians not to openly display emotions either consciously or unconsciously. Therefore most of them channel their emotions to the body rather than the mind.


Communication barrier

In a recent study conducted by the President Advisory Commission in the U.S, 40% of Pacific Islanders and Asian Americas do not speak English well. The communication barrier is one of the critical challenges associated with counseling (Kenny, Evelyn, & Henry, 2002). Most of the Asian dialects and language are only spoken within an ethnic group due to the level of acculturation; therefore, it is quite a challenge for them to communicate appropriately.  The level acculturation also affects the groups’ ability to communicate. Based on the newness of western culture communication, most Asian Americans may take a relatively long time to adapt to western culture. Some Asian Americans also use non-verbal cues to express themselves within their ethnic groups. This means of communication causes misinterpretation as they are only dominant in Asian culture. Unlike Asian Americans, Pacific Islanders are descendants of the American Indians and native Alaska’s whose lives were greatly affected by the arrival of the European Explorers. Within the years, Pacific Islanders have greatly acculturated and borrowed the local dialect to match the universal language. Therefore these communities better connect with the native language of the westerners.

To break down the language barrier, counselors should identify the number of generations of the individual in order to determine the level of acculturation in a particular ethnic group. Typically, it takes three-generational cycles for an ethnic group to fully adapt to the lifestyle of the prevailing culture. Having this background knowledge allows the counselor to formulate a clear and concise plan for the diagnosis and treatment. In the beginning, this includes scheduling an appropriate time to cross-check the ethnic traditions and introduces an interpreter into the counseling sessions. It also includes laying out the plan of action and consciously involving the individual of the importance of the treatment. Through this, the counselor can build trust with the Individual, which leads to a robust therapeutic alliance that aids in the treatment process.


Age is a cultural factor associated with mental health in Asian culture that differs from the Pacific Islander. Research shows that the rate of psychiatric problems among Pacific Islanders is slightly lower in children and young adults than in Asian children and young adults (National Institute of Mental Health , 2001). The depressive signs and symptoms of a Pacific Islander match that of an average white youth. Age is a predominant factor associated with mental health in Asian American communities. Children are highly valued in Asian American families. From an early age, they are taught to be quiet, respectful, shy, and polite to everybody. Morality is expected and emphasized. An open display of emotion is discouraged. Young people’s lives revolve around fulfilling the expectations of their parents and building the family name. It is fundamental for children to meet their family’s expectations to prevent shame or loss to the family name in the community. According to the Asian culture showing love and affection causes laziness and irresponsible behavior. Therefore Asian parents rarely show love to their children. Education is essential in the Asian American culture, and poor academic performance reflects poorly on the family’s image. Parents seldom encourage their children or, better yet, talk about personal development.  In most Asian cultures, Adolescence is not considered a rite of passage as self-discovery is not allowed in the community. Seeking an identity and purpose outside the family is discouraged and goes against the cultural norms (Kenny, Evelyn, & Henry, 2002).

By nature, children acculturate easily into a new culture compared to parents and elders. As a result, children act as interpreters or a negotiator for the older generations. In as much as parents want their children to learn the new language and skills that will contribute to a successful future, they are reluctant for them to learn all the aspects of western culture. In most cases, they encourage their children to learn English but may limit the use of English in Asian households. These conflicting expectations confuse the child and may fall into Tran’s generational conflict. He/she may experience anxiety disorders, severe levels of stress, which leads to isolation and may eventually fall into depression. As a result, it becomes increasingly difficult for counselors to intervene as the children are undergoing an identity crisis.

For most young Asian adults meeting the family’s expectations is a top priority. However, the introduction of western culture, values, and ideas significantly contradicts their traditional norms. Young adults severely conflict with peer pressure and family expectation and end up questioning their family values. As a result, most of them find themselves in a dilemma on which ideals to follow and may end up living two different identities. Identity crisis at an early age disorients the mental well-being of the children, which leads to social anxiety and may end with psychological disorders. Other children may isolate themselves from society, which leads to severe depression. Also, Asian American parents chose careers for their children. Failure to comply with the choices can lead to family conflicts. Young adults in these conditions require a sensitive counselor who is attuned to the racial and cultural background of the patient. He/she needs to be aware of the importance of family in the Asian culture and the associated interdependence. (Derald & David, 2008).

Due to sudden culture change, conflicting traditions, children tend to express different reactions in the process of enculturation. It is, therefore, essential for a counselor to identify the racial identity of the person to address the presenting emotions and reactions effectively (Derald & David, 2008). Our cultural background forms the basis for expression and recognition of psychiatric problems. Every ethnic group has diverse reactions to social pressures, anxiety, and depression.  Children and young adults are usually the first to acculturate; therefore, they might experience rapid culture shock and emotional distress. It is, therefore, the duty of the counselor to conduct due diligence on the ethnic background of the children under the teachings, philosophies, and ideals ingrained in him/her to break the prevailing myths and misconceptions about therapy. By doing this, a counselor creates a healthy environment to start the treatment and identify ways to merge both cultures to resonate with the identity of the child. The counselor should also be knowledgeable about the value of familial interdependence, and interpersonal relationships in order to bring families together during past adaptation, coping (Albert, 2020). In the long run, the counselor establishes a healthy and robust relationship with the patient as the treatment process merges traditional values and western ideals.

Occupation issues

Pacific Islanders trace their origins to American Indians and Alaska’s. Therefore they are the descendants of the native inhabitants of the land before the first contact. The Pacific Islanders have struggled through the path of prejudice and discrimination, racism, and made a niche for themselves in the US. As a result, they are legal citizens with proper jobs and a healthy work environment and minimal work-related mental illnesses as well as counseling challenges. While on the other hand, the Asian American population in the US comprise of immigrants, refugees, and American-born Asians. With the majority of Asian Americans born overseas, very few Asians acquire legal documentation or license verification to live or work in the US.  As a result, many Asian Americans are not able to retain their previous careers or jobs. Regardless of this, Asian Americans chose to work in farms, factories, and restaurants where they acquire minimum wages.

In some instances, Asian women are paid higher than the men, which contradict the conventional Asian society where the man held a higher social status than the woman. Asian culture does not allow independent thinking, self-sufficient women. As a result, women lower their status to allow the men to dominate and avoid spousal conflict to maintain peace at home. After such ordeal, women experience chronic low self-esteem, which leads to psychiatric disorders such as obsessive-compulsive trauma, anxiety disorders, stress-related to acculturation, and unresolved marital conflicts, continuous emotional torture can make a woman resist any form of counseling or drop out of counseling programs prematurely. At this point, the counselor needs to handle the patient without bias to better understand her reaction and extent of the damage. The counselor needs to be aware of foundational issues leading to mental illness and solicit ways to implement conventional traditional beliefs and family expectations. It is also ideal for the therapist to give the patient attention as most are uncomfortable sharing personal information about their culture. Additionally, the counselor can introduce traditional interventions to complement the medication such as Tai Chi Breathing exercises as natural stress relievers (Albert, 2020).

Family structure and intergenerational issues

Asian Americans and Pacific Islands both value and uphold the family hierarchy. These ethnic minorities are committed to the close-knit family unit as well as an extended family whereby two or three generations live in the same compound. Every member of the family has a role to play in achieving the need of the family. Roles and responsibilities are assigned based on age, gender, and social status within the community. All rituals, customs, family celebrations, funeral rites are conducted in harmony to appease the gods and drive away evil spirits. Therefore most Asian Americas and Pacific America believe that lack of a good connection or harmonious relationship with oneself, family, or evils spirits cause mental illness. As a result, these communities emphasize the need to maintain peace with family members and other members of the community as this is the foundation of mental wellbeing. By fulfilling all the obligations, duties, there exists a peaceful coexistence, healthy relationships, and emotional interdependence that shun away seeking help from an outsider. According to the family hierarchy, the father is the sole decision-maker, followed by the eldest son who receives preferential treatment as he will soon assume the position. Mothers are the caregivers and nurturers for their husbands and children, while the male children have a higher status than the female children in the family. While conducting family therapy, the mental health professional needs to become acquainted with the family structure and communication father. Following the hierarchical and patriarchal structure while addressing the family members can be productive (Derald & David, 2008).



In both Pacific Island and Asian communities, men have high social status than women. Male spouses are accorded preferential treatment and have the legitimate right to make the final decision about all the family issues. The stigma associated with gender roles and responsibility is collective in both racial groups. Women believe men are of higher social class, and their decision is final. Therefore women refrain from marital conflicts to maintain peace and harmony in the household. As a result, most women are prone to develop psychiatric disorders during their lifetime.  A higher number of women will suffer from anxiety disorders, mood swings, and other psychiatric diseases without seeking help due to the cultural limiting factors. Not only do men have to dominate in decision making, but the preferential treatment also manifests in sex-specific infanticide and the growing number of females in adoption centers and orphanages.

The traditional Asian and Pacific Islander ideas, values, and culture much contradict modern-day Americans. Asian women will encounter contradicting beliefs ideals of independent thinking, equality, and achievement, which severely conflict with hers. As a result, these women might show mental health symptoms of severe stress, anger, and conflict, especially in female teenagers who may end up in depression. In others, the new culture may cause marital conflict as women are accorded the same social status as men in the workplace. As a result, women can fall into a sense of fatalism, whereby they resist psychiatric treatment resulting from damaged self-esteem (Kenny, Evelyn, & Henry, 2002). In order to provide appropriate diagnosis and treatment, counselors should be made aware of these cultural dynamics in order to be more sensitive while handling Asian/Pacific Islander women. Through this, Asian women will gradually acculturate to the therapeutic process, which leads to mental wellbeing.

Religious beliefs and spirituality

The most widely practiced religion amongst ethnic minorities is Christianity and Muslim. However, a significant number of Asian Americans and Pacific Islanders practice Buddhism. Buddhism is a religion based on Confucianism and Taoism philosophies and teachings. According to Buddhists, this religion fosters an understanding of disease causation in the spiritual realm. In essence, Confucianism is a fundamental belief that emphasizes respect for authority, fidelity, scholarship and self-development, benevolence, and justice.

On the other hand, Taoism is based on yin and yang theory and animism. In general, this is the belief that animals, human beings, and natural objects possess a soul and are spirit bound. Many Pacific Islanders and Asian Americans are steadfast believers of this religion and abide it to the core. They are taught that evil spirits cause mental illness in the spiritual realm, and the only way to reverse the mental wellbeing is to pray to the gods. In Asian and Pacific cultures, people believe mental illness is a result of sin. As they believe mental illness is caused by a lack of harmonious emotions or, sometimes, by evil spirits, Taoism further explains that one is mentally ill when the physical being is not connected to the psychological being. Taoist concepts emphasize the need for integration with nature in the pursuit of infinite power. Taoism promotes close association with the law of nature and the surroundings rather than personal development. For Taoists, Asian Americans believe that even diseases have a soul and spirit, and if duly summoned, a mentally ill person can be cured. In Christianity, Pacific Islanders, such as the Filipinos are encouraged to pray when facing challenging times. They are encouraged to converge with other fellow believers to pray or read the bible.

Suicide is considered a sin, and anybody who talks about can be ostracized and shamed in the community. So talking or seeking help about suicidal thoughts and mental health symptoms is forbidden. Treatment providers must seek knowledge on conventional spiritual beliefs of an Individual to enter into a new relationship with the patient and the theories forming his beliefs. It is also crucial for a counselor to assess their personal biases and stereotypes before interviewing a patient. Cynical facial expressions may offend the patient and shy away from revealing about their personal life. Besides, a therapist may incorporate traditional spiritual and psychological beliefs practiced by the culture to complement the medications — such yoga (Albert, 2020).

In a well-augmented assessment and treatment plan, the counselor asks the patients, family members to share in their cultural view of the presenting problem, history of the problem, treatment expectations, and the past coping patterns. This concept sets the basis for the counselor and the family members to formulate a clear plan for the diagnosis and treatment. To get the patient’s demography, the counselor should ask straightforward questions that the patient must respond without raising issues. Through these questions, the health physician grasps the patients’ beliefs about health and mental health. Family involvement also offers the much needed emotional, psychological support needed throughout the counseling process. In cases whereby family involvement is discouraged, it is good to explain the reasoning and procedure to both the parent and the patient. Since psychotherapy is foreign to many Asian Americans, a counselor should explain the plan of action and the treatment process and the importance of collecting personal and familial information (Derald & David, 2008).  Being aware of the cultural assessment treatment plan allows the counselor to be more sensitive, attune, and knowledgeable to the different challenges of counseling Asian Americans and Pacific Islanders. Knowledge in all the contrasting differences creates a safe and healthy environment that helps the patients to be comfortable enough to open up about their personal lives and traditional values. As a whole, this solidifies the counseling relationships and aid the treatment and recovery process.


Albert, G. (2020). Working with Asian American Patients. Washington, District of Columbia, US.

Derald, W., & David, S. (2008). Counseling the Culturally diverse. New Jersey: John Wiley & Sons Inc.

Each Mind Matter. (2020). Asian and Pacific Islander. Retrieved 01 18, 2020, from Each Mind Matters:

Kenny, K. E., Evelyn, L., & Henry, C. (2002). Cultural factors Influencing the mental health of Asian Americans. West J Med, 227-231.

National Institute of Mental Health . (2001). Chapter 5 Mental Health Care for Asian American and Pacific Islanders. In Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. NCBI.







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