Cover Story

Society usually portrays Asian Americans as high achieving in careers and school and well-adjusted, with few mental health problems. But that positive stereotype masks the psychological and cultural disparities that Asian Americans face, researchers say.

"Asian Americans still do experience prejudice and discrimination, but because the model stereotype is positive, less people evaluate it or question it," says Margaret Shih, PhD, an assistant psychology professor at the University of Michigan who studies multiracial identities. "Some Asian Americans are successful, but some are still struggling."

Some of those struggles are rooted in Asian Americans' position between two cultural identities-that of Asian-and European-American traditions.

But psychologists have yet to thoroughly study Asian Americans' struggles in balancing their multiple identities, their level of ethnic pride in their identity and how they experiencediscrimination. Another area ripe for research: the differences among the approximately 50 Asian-American groups and how they acculturate in America, says Stanley Sue, PhD, a professor of psychology and Asian-American studies at the University of California, Davis.

Indeed, the majority of psychological research on Asian Americans has centered on Chinese-American or Japanese-American experiences, which are then often generalized to other Asian-American populations, says Richard Lee, PhD, an associate psychology professor at the University of Minnesota, Twin Cities.

"We need to look more specifically at ethnic groups because the history and context of each of these groups and how they've adapted and settled into America are different and can influence their psychological development," says Lee, who has studied ethnic identity in Korean Americans and Hmong Americans.

To fill such research gaps, psychologists are studying how various cultural characteristics influence Asian Americans, including how the cultural values they hold may influence treatment outcomes in therapy or the psychological effects of balancing their multiracial identities.

Multiple racial identities

After all, many Asian Americans often feel they don't fit perfectly with either Asian or American values.

"Asian Americans are living in the intersection of two cultural worlds," Shih says. "They don't just experience rejection and discrimination from the majority, but also from minority communities too."

Shih and Diana T. Sanchez, PhD, an assistant psychology professor at Rutgers, conducted a meta-analysis of 43 quantitative and qualitative studies on the psychological adjustment of multiracial individuals. They found that multiple racial identities can make multiracial individuals susceptible to rejection and discrimination because they are a minority in a minority group-but it can also pose many benefits, such as being able to tap multiple worldviews in tackling problems in their lives. Their findings are documented in the July 2005 Psychological Bulletin (Vol. 131, No. 4, pages 569-591).

Previous research had shown that multiracial people often identify with only one of their racial backgrounds rather than with their multiple racial categories. As a result, they struggle to find similar role models and understand their racial identity, especially since their parents have differing racial backgrounds too. However, Shih and Sanchez found that these struggles were mostly found in clinical populations studied, not the general population.

Indeed, Shih and Sanchez found that many multiracial individuals are thriving-often receiving support from a larger number of cultural communities than monoracial individuals. These benefits were especially strong in studies conducted in the last decade, suggesting that Americans are becoming more accepting of multiracial people.

However, when compared with the majority population-Caucasians-multiracial individuals had higher incidences of depression and behavioral problems. On the other hand, multiracial individuals tended to do better than their monoracial Asian-American peers in their school performance.

"They live in a multicultural environment so they learn multicultural competencies," Shih says. "They have exposure of looking at the world from different perspectives, which gives them some flexibility when they experience hardship."

Ethnic identity and discrimination

Some research has found that multiracial individuals who have a strong ethnic identity-or connection to their culture-better weather some hardships, such as discrimination. Lee, however, is finding that strong ethnic identities in Asian Americans are not always a protective factor against discrimination.

In fact, a strong ethnic identity, such as a sense of emotional pride and belonging to an ethnic group, actually was associated with greater depressive symptoms when people perceived high levels of racial discrimination-that is, discrimination that occurs repeatedly, Lee found in a study of 84 Korean-American undergraduate students. Ethnic pride was associated with lower social connectedness to their community when discrimination was perceived to be high. People who have a strong sense of pride in the ethnic group may perceive the discrimination as a direct threat to their own identity, which may then heighten their anxiety and stress, Lee notes. The study appears in the January 2005 Journal of Counseling Psychology (Vol. 52, No. 1, pages 36-44).

In related findings, Lee and principal author Hyung Chol Yoo, a sixth-year psychology doctoral student of Lee's, evaluated whether coping strategies can lessen the effects of racial discrimination among 155 Asian-American college students. They found that Asian Americans with high ethnic identity used more social support seeking and problem-solving coping strategies to manage discrimination. The study, which appears in the October 2005 issue of the Journal of Counseling Psychology (Vol. 52, No. 4, pages 497-506), also found that Asian Americans with a high ethnic identity who used cognitive restructuring and problem-solving as coping strategies reported less distress only when they experienced infrequent discrimination. To their surprise, these coping strategies did not buffer against more frequent discrimination.

"Discrimination is not something you can problem solve very well," he explains. "It's something that happens to you that is out of your control. Being a good problem solver helps you and promotes your well-being, but in this circumstance, it can be frustrating, and it might elevate negative affect."

Cultural values

Asian Americans' choice of seeking social or professional support, though, may be influenced by whether they hold traditional Asian values or European-American values, finds Bryan Kim, PhD, an associate professor of counseling, clinical and school psychology at the University of California, Santa Barbara. He has found, not surprisingly, that Asian Americans who strongly adhere to European-American values view psychological services more positively than those with traditional Asian values. Those with traditional Asian values tend to be less willing to seek counseling services because Asian cultures tend to attach stigma and family shame to mental illness, he notes.

How can psychologists counter this? Counselors who share a similar worldview with the client may be one key, Kim has found. Counselors who, for example, spark a discussion about the clients' cultural values can help make clients feel more understood by therapists, and the therapeutic relationship is more likely to grow, according to his study in the January 2005 Journal of Counseling Psychology (Vol. 52, No. 1, pages 67-76). He evaluated 88 Asian-American volunteer clients who underwent a single counseling session with a therapist who either matched or mismatched the clients' worldview. Clients whose therapist had a matching worldview perceived a stronger client-counselor working alliance and greater counselor empathy than those in the mismatch condition.

"Sometimes we rush into treatment without fully understanding the client," Kim says. "We have an understanding of the nature of the problem, but not the cultural values and cultural norms that relate to the presenting problem."

Kim is finding that such understanding is essential to the therapeutic alliance. In an ongoing study, Kim and his doctoral student Shihwe Wangare are showing participants video of mock therapy sessions in which a counselor either uses or fails to use one of the cultural competencies outlined in, for example, APA's Multicultural Guidelines. Next, he surveys the Asian Americans on which therapy session they thought was the most effective.

So far, Asian Americans have rated the counseling sessions' working alliance, therapists' empathy and counselor credibility much higher in the multicultural settings, in which counselors showed a greater appreciation for language differences and culturally diverse interventions, such as by suggesting acupuncture or consulting a traditional healer.

Cultural influences on therapy

Sylvia Wen-Hsin Chen, a third-year Texas A&M counseling psychology doctoral student, and her associate psychology professor Donna S. Davenport, PhD, suggested how therapists may be able to improve their working alliance with Chinese-American clients when using cognitive-behavioral therapy (CBT). The article appears in the Spring 2005 issue of Psychotherapy: Theory, Research, Practice, Training (Vol. 42, No. 1, pages 101-110).

Using CBT with Chinese Americans may be ineffective if it isn't tailored to address certain cultural differences, Chen says. For example, Chinese Americans tend to hold stronger allegiances to their families, discourage expressing emotions, emphasize interdependence rather than independence, show greater respect for authority, prefer direct and immediate solutions to problems, and have a lower tolerance for ambiguity.

Chen and Davenport warn therapists not to apply such cultural information in a stereotypic manner. Rather, their review of the research suggests that psychologists who make the following modifications may improve CBT treatment outcomes for Chinese-American clients:

  • Explain and reframe the role of the therapist and the client in the beginning of therapy. For example, they suggest that therapists emphasize their role is an "expert in therapy" and the client is the "expert in his or her life." Otherwise, clients may be reluctant to disagree with the therapist or express their concerns.

  • Don't discount physical complaints. Chinese-American clients often express their emotional stress-which they link with shame and stigma-with physical complaints. Acknowledge those complaints and recommend physical treatments, such as referrals to a doctor, and then address the emotional stress they may be facing.

  • Avoid asking too many personal questions during initial sessions. In CBT, therapists often challenge a client's beliefs with "why" and "what" questions, but Chinese-American clients may feel ashamed if they cannot respond correctly. Instead, they suggest therapists provide clients with ways to view the challenges in their lives and provide rationales for doing so. Or, therapists may use the sentence stem technique to get clients to open up, such as asking them to finish the following sentence, "If I let my parents down, I…"

Chen says that techniques such as sentence stem, guided imagery or dream analysis may help bring out the client's deep emotions.

"It is crucial," she notes, "for the therapist to spend more time communicating the concept of psychotherapy to the client and to carefully access the client's readiness for emotional explorations."

Melissa Dittmann Tracey is a writer in Chicago.