Developing a Diagnostic Filter for Cross-CulturalCounseling: Five Cases Involving Asian AmericansExamined from a Worldview Perspective

Aart M. van Beek

# Springer Science+Business Media New York 2013

Abstract The author advocates a holistic approach to multicultural counseling with AsianAmericans that features the exploration of the dynamic interrelationship between worldview,identity, sense of belonging, and identification as a methodology that aims to support counseleegrowth and integrity as well as to prevent unintended and unproductive suffering. The argumentsmade may be considered equally valid for other multicultural counseling contexts.

Keywords Psychology . Counseling . Culture . Cross-cultural . Diagnosis . Culturalanthropology . Sociology . Religion . Asian American

Problem and objective

In June of 2011 Jose Antonio Vargas, a well-known gay Filipino American and accomplishedjournalist, admitted that he was an undocumented immigrant. He writes about his experience inNew York Times Magazine (Vargas 2011). The article is accompanied by a photograph of a fakeidentity card. While a judge in her or his strict adherence to the law might be able to isolate thecase by looking at legal status only and see Jose Antonio Vargas as merely a violator of the law,a counselor has the responsibility to consider the whole human being. This riveting caseillustrates vividly the challenge faced in multicultural counseling, specifically when it comesto worldview. Vargas’s story is about worldview and identity, but it is also about the sense ofbelonging of a young boy put on a planewithout his consent to join his grandfather in Californiaand about his identification as an American. Without looking at all four of these aspects, and hedescribes them all, one cannot understand his story. Below I will argue that the same is true ofclients in multicultural counseling.

When I wrote my book on cross-cultural counseling (van Beek 1996) I envisioned theconcepts of identity, sense of belonging, worldview, and identification as forming the elementsof a method for simple cross-cultural counseling. My audience was mostly pastors whose dutiesinclude a lot more than counseling. I formulated the following principle: “The cross-cultural

Pastoral PsycholDOI 10.1007/s11089-013-0553-5

A. M. van Beek (*)Multicultural Proficiency Project, 11987 Prospect Hill Drive, Gold River, CA 95670, USAe-mail: aartvanbeek@yahoo.comURL: multipaspro.blogspot.com

caregiver should help care seekers integrate or reintegrate worldview, identity, and sense ofbelonging by focusing on identification processes in the care seeker’s life” (van Beek, p. 78). Inthe years since the book’s publication, the usefulness of these interdisciplinary concepts incross-cultural interactions have become increasingly obvious, and as a result I have beencommitted to probing and promoting their usefulness. In this article I want to make a case fortheir use in counseling therapy beyond the pastoral setting. Of course, these four concepts arenot new to psychologists. Abraham Maslow (1943) firmly placed belonging needs in hispyramid of human needs more than 60 years ago. Erik Erikson (Erikson 1994) produced aground-breaking exploration of identity and also underlined the importance of identification inhis work around the same time. Derald Sue provided therapists with pioneering insight intoworldview for cross-cultural counseling (Sue 1981, pp. 73–97) in a way that opened my eyes.The interplay of identity, sense of belonging, worldview, and identification, however, has notreceived enough attention in therapeutic literature. This article aims to illustrate how theseconcepts could be useful.

Since any multicultural or cross-cultural study necessitates exploring the work of culturalanthropology at some point, my study of symbolic anthropologists (e.g., Shweder and Le Vine1984), structuralism (Lévi-Strauss 1963), and the Culture and Personality School (Benedict 1934)has been enlightening. They respectively underlined the struggles of the self in a culturallycomplex context where symbol and culture are closely intertwined, the power of kinship, and therelationship between culture and personality. Lévi-Strauss underlined the power of kinship andcommunity, while Margaret Mead in her foreword to Benedict’s Patterns of Culture describedhow culture is personality on a larger canvas, thereby opening the door wider to the idea ofpersonal culture. The symbolic anthropologists transformed culture into a more flexible construct.These thinkers helped lay the groundwork for my argument. I have begun to see identity, sense ofbelonging, identification, and worldview when connected as forming a kind of worldview safetyfilter. After all, in amulticultural helping context therapist and counselor engage in risky behavior.They are opening themselves up to a way of seeing and thinking and feeling that could beradically different from their own way. I have become convinced that systematic examination ofthe dynamic interconnectedness of worldview, identity, identification, and sense of belonginghelps prevent harm through the therapist’s interaction with the counselee in a holistic sense. Thepsycho-therapeutic literature refers generously to holistic approaches. What really makes theapproach I am advocating holistic in multicultural settings is that each of the concepts relatesintimately to culture. One cannot determine one’s identity aside from one’s cultural experience.For example, one could refer to “Vu’s Story: I Am an American” (Schwarzbaum and JonesThomas 2008, pp. 163–182). where a Vietnamese boy is ripped from his family as a young childand is raised by a foster family in the United States. His case also illustrates how identification andculture are related. He loses his identification with his family back in Vietnam. Worldview andculture are also clearly related. One could present the experience of Li Ling, a Chinese-bornpastor’s wife struggling with her Chinese American pastor-husband’s negative theological viewsabout women and her role within her Asian American Christian congregation (LimKwong 2010,pp 263–264). Both cases illustrate how one’s sense of belonging and one’s (assumed) culturemutually affect each other.

Definition of terms

The terms I use here are all processive in nature. I define worldview as views or opinions inprocess of how life was, is, will be, or should be organized. I define identity as self-concept-in-process, whether it is self-generated or imposed from outside. I define sense of belonging

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as the human need to have a place within groups. It too is in process. I define identificationas the dynamic act of seeing oneself in another person or group of persons in a way thatimpacts worldview, identity, or sense of belonging. I define culture as meaning-providingprocesses. I define holistic as taking into account all aspects of a person’s functioning. Idefine Asian Americans as all persons residing in the Americas who have ancestry on theAsian continent or its adjacent islands. I define counseling as a systematic act of helping thatuses interpersonal communication and is guided by professional principles governed by anin-depth understanding of human functioning.

Explaining the worldview angle

Nowhere can we experience the proliferation of religious expression more than in Asia. It alsohas high ‘worldview fertility,’ having given birth to all of the world’s major religions. AsianAmericans have either taken in these beliefs or inherited them, while adjusting them to their lifesituation. The variety of views is overwhelming. When I teach a course or a workshop inmulticultural counseling, I emphasize two precepts that are in tension with each other: “learn asmuch as you can about your counselees’ culture” and then “assume you know nothing about it.”The method I am proposing here seeks to bridge “knowing” and “knowing nothing.” It alsoseeks to begin bridging the divide between emics and etics in multicultural counseling(see Gerstein et al. 2009, pp. 92–93, 98) by addressing cultural relativism and particularity. Itdeals with the question of how we know enough about every group to counsel effectively andhow we can keep from harming people whose culture we do not know.

This issue is not only highly relevant within Asian American experience, but is a majorquestion in the discussion of philosophical foundations in contemporary counseling psy-chology. More and more graduates of professional counseling schools have been trained atreligiously oriented institutions. Their background and personal worldview color theirapproach to counseling. There are those counselors who seek to distance themselves fromtheir fundamentalist upbringing (Mercer 2009), and there are those who seek to advocate thelegitimacy of an evangelical Christian worldview undergirding counseling philosophy. In APeacable Psychology, Alvin Dueck and Kevin Reimer speak of the “thickness” of a religiousapproach to counseling (Dueck and Reimer 2009, pp.134–138) as opposed to the “thinness”of secular counseling. They challenge the idea that religious approaches to counseling areinferior and actually seem to argue the opposite. It is not entirely clear how open the authorsare to a counseling method informed by a Hindu or Sikh or Muslim worldview, but theircontributions should not be ignored. This raises the hidden tension within the world of thosecommitted to be multicultural helpers: our commitment to be multicultural tends to beselective to the degree of our openness to the worldviews of others. A potluck mentality ispervasive. We are more accepting of some worldviews than of others, depending on our ownworldview and experience. The most difficult worldviews to deal with are the ones thatexclude us (for example, there are a number of worldviews in this country that would refuseto validate the experience of Jose Antonio Vargas).

Seldom is the ugliness that lurks in the background of all cultural experience acknowl-edged. But how can we be truly multicultural if we are not willing to address that uglinesshead-on? This question underlines the need for the kind of methodology I am proposing. In adiverse society, helping professionals must find a way to deal systematically with clashingworldviews. Not only are these worldviews highly numerous and varied in the AsianAmerican experience, but the interaction of those forces with the worldviews of the potentialtherapists of Asian Americans quickly increases the complexity of the counseling encounter.

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Therefore, it follows that the conclusions of this article do not apply to the Asian Americanexperience only, but must be relevant to the full complexity of multicultural counselingencounters. So let me sum up the reasons for the worldview angle: (1) the diversity of AsianAmerican worldviews, (2) the author’s personal expertise, and (3) the current discussionsabout the role of worldview among professional psychotherapists. Below, five brief caseswill be presented as support for the premise that attention to the interrelationship amongidentity, sense of belonging, worldview, and identification should play a prominent role inany method used in multicultural counseling with Asian Americans. In these cases, I amtrying to present cross-cultural therapeutic relationships to highlight that no matter what thecounselees’ backgrounds are, they are always impacted by cultures other than their own. Mybook already pointed in the direction of this exploration: “The incongruence that becomesapparent between worldview, identity and sense of belonging can point to a new way ofviewing a problem. Also, through that search, the tensions between dissonant worldviewscan be mitigated” (van Beek, p. 75).

Relationship challenges in an age of diversity

Cathy andMario are a newly married couple. Cathy is Chinese American and a state employeein Sacramento, California. She and her parents are members of a small Chinese-Americaninterfaith congregation that is becoming more and more multicultural. Her older brother hasmoved out of the area. Mario is a Mexican American who, like Cathy, was born in the citywhere they live. He is a middle school teacher and has been married before. He has twodaughters from his previous marriage with aMexican American woman. The children are 7 and10 years old. Cathy and Mario ask for help from Cathy’s European American friend, LindaMetcalf, a therapist in a relationship with a Japanese American woman who is also a member ofCathy’s church. Although they have only been married 6 months, Cathy andMario increasinglydisagree on religious issues. This problem has become worse now that Cathy has just found outshe is pregnant. Linda conducted their pre-marital counseling sessions, so they are both quitecomfortable talking to her. As soon as they sit down, Mario begins to speak:

M1: I agreed to be married in your church, Linda, but I’m Catholic and my tradition isimportant to me. My daughters will have their quinceañera at my home church, and Iwant our child to grow up in the Catholic tradition also.C1: Well, I’m comfortable here. This is my church. It is the neighborhood I grew up in.I played in this park here as a child [pointing out the window of the pastor’s office].M2: Yeah, and your parents own half this neighborhood.C2: Hold, hold on, what’s that supposed to mean? And where is that coming from? Iseverything suddenly game?L1: Can we talk about what’s going on here? It’s obviously more than meets the eye.M3: Linda, are you taking her side already? Is this the woman thing? Look, her parentsown a lot of property and they just put pressure on the city to defeat proposals for rentcontrol. There are a lot of poor Latino kids in my classes who will lose their place tolive, and I wouldn’t be surprised if some of their parents pay rent to your parents[pointing to Cathy].

After some probing, it becomes clear to Linda that a lot of the differences that come witha cross-cultural marriage had been pushed below the surface because of the excitement of therecent wedding. The two had not known each other long, and the marriage plans had been

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spontaneous. As they spent time with Cathy’s parents, Mario became bothered by theirviews on society and politics. Cathy pushed back by defending her parents and becomingincreasingly resistant to change.

Clearly identity, identification, sense of belonging, and worldview are all a problem in Cathyand Mario’s relationship. Cathy sees herself as a daughter and does not react favorably at all toMario describing her parents as ruthless landlords. She identifies with her parents and with thepeople in her religious community. Her sense of belonging is in that community, but as a ChineseAmerican she has a powerful sense of belonging in the family. Her worldview tells her that herchurch is the place to be, and she is comfortable with her values. On the other hand, she now hasa sense of belongingwithin her new nuclear family that includesMario and his children. She alsohas a new partial identity as a wife, expectant mother, and stepmother. She does not have a strongsense of belonging with Mario’s culture or religious background. Her worldview is not neces-sarily closed to Mario’s religious traditions, but she is resistant. Mario’s identity as the father ofhis children by another woman and his new identity as a spouse really stand out. He wants tobalance the two. However, he still identifies with the symbols and symbolic rituals of his ownculture, and his sense of belonging within it is very strong. He is trying to protect himself fromlosing that in his new marriage. He is resistant also. Understanding these issues is an importantstarting point, but it is necessary to delve deeper. First, what is happening within identity, senseof belonging, and worldview, and are there conflicting identifications? Second, what is going onbetween sense of belonging, worldview, identity, and identification? It starts with the identifi-cation that Cathy and Mario have with each other through seeing the mate in each other, whichdevelops into a love relationship. Mario now becomes lover to a Chinese American woman andCathy lover to a Mexican American man. This makes the way the world sees them and the waythey see themselves different. There is also a belonging tension emerging. Cathy has to balanceher belonging within her parents’ unit with belonging in her new nuclear family. Mario has tobalance his belonging to his children with his belonging to Cathy. He also has to balancebelonging in Cathy’s religious community with belonging in his Mexican American Catholicworldview community. Cathy and Mario’s worldviews are also put under pressure. Mario wantsto know how far he has to go to comply with the religious worldview Cathy espouses. He drawsthe line at the issue of social justice related to “rent control.” Cathy draws the line at having herparents’ place in her worldview challenged by Mario. So there are clear internal tensions withinidentity, worldview, sense of belonging, and identification for both Cathy and Mario. If, as acounselor in a multicultural setting, Linda has developed an understanding of where Cathy andMario have moved with these four issues, she has laid a foundation for cross-cultural under-standing. The next step is to find out how the dynamic between the four issues plays itself outand then what the clues are for action or intervention.

We have already determined that the problem starts with Mario and Cathy’s identificationwith each other, which creates a tension with the identifications that already exist from theirexperience in their family of origin. This creates identification issues between them. However,sense of belonging is the core issue here. Mario feels he has compromised his worldview bybecoming a part of the life of Cathy’s church bymarrying in her church. Of course, a wedding inthe Mexican American Catholic tradition might not have been possible, since he was divorced,but that does very little to assuage his loss of a sense of belonging. He realizes that by belongingto Cathy, he now belongs less to his own community, and this causes him anxiety. There is asense of abandonment of the Mexican American community. This makes him see himself lessas a Mexican American. Cathy, on the other hand, resents that the mutually agreed uponarrangement is being reneged on, and she is angry that Mario feels he has to attack her parents.This negatively impacts her identity as a daughter and her worldview that her parents are goodand responsible members of society. For both of them, this taps into deep pain related to the

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sense of belonging and identity of the members of their respective ethnic communities, a paincaused by the worldview of the majority European American community that has marginalizedboth Mexican Americans and Chinese Americans and prevented them from belonging. As wecan see, our discussion by reference to our four concepts is now lifting the veil further on thepitfalls and complexity of cross-cultural counseling, which will be deepened with the explora-tion of the cases below.

Facing the justice system

Herry is a 25-year-old Southeast Asian male who lives in a neighborhood of a large southernCalifornia city that is equally divided between people of Southeast Asian and African descent.His parents go to the same congregation as a prison chaplain named Goodluck Brown, who wasborn in Liberia. One afternoon Goodluck receives a call from Herry’s mother. She is callingfrom the Superior Court, where her son has just gone through a preliminary hearing. During thehearing, the public defender failed to convince the DA that Herry was innocent. A Ukrainianimmigrant family living above him had accused Herry of breaking the front and rear windowsof their car. The public defender had told Herry that he might have to pay some restitution to thefamily, but that he would have no record. Instead, Herry has been ordered into anger manage-ment classes and community service, which jeopardizes his job.

Chaplain Brown sits next to the young man on a bench outside one of the courtrooms andputs his arm on his back:

B1: How are you, son? Looks like you had a bad day.H1: I don’t know how this could happen. I never broke no car windows and now Ihave to pay money, take anger management classes, and go into community service.What am I going to do?B2: You know, sometimes these things can be blessings in disguise that the Great Onecan use to teach us something. You know this isn’t the end of the world.H2: But you know that it isn’t true, don’t you? I never did anything like that! Never,never. You have to help me! I cannot be the only Karen who is bad!B3: But there isn’t anything I can do. It’s not the end of the world, son.H3: But I’m the oldest son. What are my brothers going to think of me? What kind ofexample am I setting for them? I wasn’t raised with them, and now that we are alltogether, I want to be an example [throws his arms up].B4: What do you mean you weren’t raised with them? Where were you?H4: When I was eight, my mother sent me from Burma (Myanmar) to live with myaunt, who was alone in Thailand. I already had three younger brothers by then. Imissed them but I was tough, even though I moved from school to school. But I am areal local boy, a real person from my ethnic group. We fight the Burmese army. That’swhy my e-mail address is karen@technet.com, because I am from the Karen minorityin my country even though I was mostly raised in a strange country. But now I haveshamed my people. And I haven’t even done anything. This is so unjust. [Herry restshis head in his hands.]B5: Tell me, how did you get to this point?H5: The neighbors upstairs are very loud. They have so many children, and I like todrink a bit.B6: What do you mean by a bit?H6: Not more than a six-pack a day, in the late afternoon.

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B7: That’s quite a bit.H7: But all my friends do that. Well, one night I had been drinking and it was so noisyupstairs that I took a stick and hit the ceiling. So they made stomping sounds back andI hit the ceiling. It went on like that for half an hour. That same evening somebodyslashed their tires. Guess who they blamed.

Goodluck and Herry talk about alcohol use and about the desire to be in control, and theytalk about Herry’s childhood. Herry calms down and agrees to meet with the chaplain again.

The chaplain has a difficult challenge. Not only does he not know Herry’s culture, he alsodoes not know if he is telling the truth, so he has no choice but to view the entire situation frominside the world of this young man, even though he may eventually step out of that world tochallenge Herry’s attitudes. Identity is a big issue for Herry. Having moved away from hispeople in Southeast Asia when a child, he was uprooted and uprooted once more when he cameto North America. His choice of e-mail “handle” expresses how badly he wants to belong to thesafe childhood world he left. He wants to be indigenous. He feels he has been robbed of time athome when he was sent as the oldest son to another island to be educated, which is verycommon in Asia. He is nostalgic for the world he has left. His lack of healthy identifications isglaring. There is no one for this youngman to look up to or to want to be like. He had to help hisparents once the rest of the family joined Herry in the United States. His father could not helphim. Also, when he was young his father was not present. All he could dowas find a connectionwith the tough guys in the neighborhood from different cultural backgrounds, who gave him theslang he expresses himself with. But his identity is still that of a good responsible boy, althoughthe younger members of his family who came to the United States with his help have all beenmore successful academically and economically.

Herry also has huge difficulties with a sense of belonging. He is comfortable with the worldof the streets, the tough banter, the alcohol and the drugs. He dresses like a gangmember, but helongs to be closer to his family. He just doesn’t know how. Then there is the issue of worldview.On a superficial level, Herry buys the worldview of the street, and this worldview comes outwhen he is under the influence of alcohol. On a deeper level, he is the good local boy. Theworldview of this local “indigenous” boy is deeply offended when he is accused of an offensethat the boy of the streets “under the influence” may have committed. So the worldview of the“indigenous” boy clashes with the worldview of the boy “under the influence.” Again, each ofthe areas is connected. Herry’s painful loss of sense of belonging in the family and theoppression of his ethnic group and place of origin have led to an alienation and longing thatcannot be filled. This is only exacerbated by his weak identification, which in turn leads to anidentity that is quite fragile and malleable. Consequently, the worldview clash of “indigenous”and “street” is volatile. A caregiver could help this young man cross-culturally only if he or sheis aware of these dynamics that are so crucial to Herry’s personal culture. Otherwise, Herry isbound to feel more and more marginalized.

Health care and culture

DorisManning, a Shoshone woman, andDoris Chao, a Chinese American woman, are sitting inthe waiting room of an oncologist’s office next to a large hospital in Reno, Nevada. DorisManning is there alone, and Doris Chao is there with her husband.

DC1: Do you have cancer?DM1: [silent at first] Yes, I was diagnosed a few weeks ago.

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DC2: Don’t trust in your doctor too much. They just give you radiation or chemo andit sucks the life out of you. My husband went through that and he just felt awful.DM2: Are you here for your husband?DC3: Yes, they’re running some diagnostics on him downstairs.DM3: Why are you here if you don’t like doctors?DC4: Oh, I don’t think doctors are bad. They have good diagnostics in hospitals. Theyknow how much cancer you have. But I like our Chinese doctors in San Francisco. Wefound a good one near San Francisco State. Took care of my husband, only asked for adonation. The treatment isn’t nice either, because he tells my husband to take off hisclothes and he taps him with a bamboo stick and then he says: “Where it hurts terribly,that’s where you illness is, where it doesn’t hurt you’re fine.”When that stick hit someparts of his back, he cried out so loud that the neighbors could have called the police.He also gave my husband this herbal medicine. They’re all these ingredients you canget at the Chinese stores in California. You have to cook them and then the patientdrinks it. It tastes awful. It even smells awful. The doctor had said my husband hadonly a few months to live. That was a year ago. I swear by it.DM4: It must cost a lot of money.DC5: No, this doctor does it for very little, but you can give him a donation.DM5: There were traditional doctors on the reservation, medicine men. My parentstold me to avoid them, because they said their craft was not proven to work. They saidtheir pastor said it was witchcraft. So I’m a bit skeptical.DC6: Don’t worry, Chinese medicine is 4,000 years old. And look how many Chinesethere are. We must have done something right [laughs].DM6: [chuckles] I guess you have to try everything to be around a little longer for thelittle ones. I’m only 65.DC7 Hey, we’re almost the same age.[The nurse steps into the waiting room and calls out, “Doris Manning.”]DC8: Well, what do you know, we have the same funny name. All the best to you, sis.

The exchange above is brief and may not seem revealing at first glance, but centuries ofhistory lie behind it. The obvious issue here is worldview, worldview about health. Doris Chaohas a strong belief in traditional Chinesemedicine. She also has a strong identity as a member ofthe Chinese American community. Not much is made known about her identifications, but it issafe to say that her identification with members of her ethnic group who have been helped by atraditional healer is very strong. Doris Chao feels at home in the Chinese American communityshe is a part of and that is still largely intact. This makes her sense of belonging strong. Herworldview tells her that the work the Chinese healers do is better or as good as or at leastcomplementary to the work of the “Western” physicians. So we can see that her identity,identifications, worldview, and sense of belonging are in harmony with each other. Theystrengthen each other. This is the kind of experience a therapist would witness if she or hewere operating in a relatively homogeneous cultural setting with a client who functions in arelatively homogeneous cultural setting. That is why, in such a context, the breaking down ofthe dynamics of identity, sense of belonging, identification, and worldview is not necessary.One confirms the other. Of course, by virtue of her husband’s involvement with the “Western”health system and her residence in the United States, Doris Chao’s situation is multicultural.Worldviews are bound to collide. Doris Manning lives in a much more fractured world, incultural terms. She has been taught to distrust or disrespect traditional healing to the point thatshe is more interested in the healing practices of Chinese (American) culture than her own FirstNation traditions. For her, the worldviews clash. Her sense of belonging in her First Nation

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community clashes with the worldview about healing she has adopted from the predominantlyEuropean American society that surrounds her people. This threatens her identity within herown community and makes her identification with leaders in that First Nation communityfragile and less than nurturing. A therapist would have to begin by grasping the fractured natureof her experience before attempting to be an agent of healing.

Faith and trauma

Until recently, Leticia Legarda was a care provider at a small home for seniors and theemotionally disabled as well as a member of a Pentecostal group. She and her husband wereinjured in an attack by a patient who was not supposed to be in her care facility in Honolulu,Hawaii, because his problems made him a danger to others. The patient had only been placedthere temporarily with the permission of the owner of the care home. Leticia has experiencedserious and emotional trauma, but she will only talk to her pastor. Her medical doctor, herWorker’s Compensation liaison, and her lawyer all agree that she must see a psychotherapist.She arrives for two appointments, but they are very uncomfortable for the therapist, who is aEuropean American male from the U.S. mainland named Harvey. Harvey is very empatheticas he tries to get Leticia to talk:

H1: [leaning forward] I hear you have been through a terrible experience. You andyour husband were both injured by a confused patient. Would you like to tell me howyou feel?L1: My husband will never come back again the way he was. He has now been in acoma for 6 months already. He does not even look like the man I married. Our childrencannot talk to him. He was just visiting me at my work. [She closes her eyes and letsher head and shoulders slump down.]H2: You must be so upset. How are you feeling physically?L2: My chest still hurts and I have lost feeling in part of my skull and I cannot swallowwell. They feed me with a tube.

The therapist continually tries to delve deeper into the inner world of the client, but the onlything Leticia will express is her physical discomfort and the loss of her husband “as she knewhim.”While speaking with her caseworker, the therapist becomes aware that Leticia is a devoutPentecostal and that she only feels comfortable being counseled by her pastor. Her pastor visitedher weekly after the traumatic incident, but his visits lessened in frequency after a month or so.Although Leticia remains close to her pastor, she has expressed frustration at not knowing whyshe has suffered so greatly. She has been a good Christian. She has been faithful to her husband.She has provided for her children and sent money home to the Philippines for her mother andmother-in-law whenever she could. She prays and believes the Bible. She follows the strictdietary guidelines of Seventh DayAdventists. She wants to knowwhy this is happening. After afew sessions with the therapist, it became clear that Harvey could not get through to her. Hebegan to realize that Leticia saw him as a mental health specialist and that seeing him was just arequirement she had to go through. “I’m not crazy.” Attempts by Harvey to address the deepdepression over her loss and the consequent disruption of her spiritual relationship were resistedwith stiff silence and closed eyes. The more Harvey used contemporary therapeutic language toget Leticia to open up, the more she responded with silence. Harvey felt more and moreuncomfortable, especially since the case worker, who is also Filipino American, was present.He felt he was wasting everyone’s time and that he was only a tool in an official process that

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does not serve anyone. It seems that everyone, including Harvey, wants to get out of thissituation.

Harvey’s and Leticia’s worldviews are very different when it comes to her wellbeing. Hebelieves she must open up about her anxiety, her anger at the attacker and the owner of thecare home, her frustration with God, and her sadness over the loss of a trusted life partnerwho is a shadow of his former self. Harvey believes Leticia cannot heal without entrustinghim and others with her deepest feelings. Leticia believes that God and her pastor should beenough to help her through this crisis, but they are disappointing her. Physically, she is notimproving: she can’t eat well, she hardly sleeps, she feels depressed, and she is impatient andsnaps often at the children and grandchildren she lives with. But if her pastor cannot makeher feel better and if she cannot experience the spiritual peace and joy she used to, how canshe trust a psychotherapist to make her feel better? Not only is there no logic in that forher—the very thought makes her feel guilty. The act of opening up to a therapist threatensher identity as a committed Christian. Her identification with characters in the Bible, withthe leaders of her religious denomination, with her husband who was even more devout thanshe and who lies motionless in a hospital bed, precludes her from identifying with apsychotherapist in any way, shape, or form. Leticia feels alien in the therapist’s office, as shehas felt alien in every social welfare office, lawyer’s office, and hospital ever since the trauma.Her anxiety drives her to feel alien and unsafe almost everywhere. The meeting of herworldview with the sudden reality of her loss has made her question every relationship,including her relationship with God. She has begun to think of herself as a weak, lonely,irritable, useless woman whom no one can reach and who can reach no one. Harvey does notquite understand why she is resistant to his kind prodding and gentle probing. Thus, heenhances her sense of marginality just as she deeply needs to be understood. An explorationof the dynamic of her sense of belonging, identity, identification, and worldview, i.e., a muchless threatening approach, would help him become more aware and reduce the chance of hisdoing harm. The encounter between Leticia and Harvey should raise some questions aboutHarvey’s own professional worldview and how comfortable he might be stepping outside of it.

The consequences of grief

Duc is a Vietnam-born male in his forties married to a Vietnam-born woman named Mai. Thetwomet in Corpus Christi, Texas, where their parents had immigrated. Duc was raised Buddhistand Mai Roman Catholic. When Duc proposed to Mai, she accepted on the condition that Ducwould become Catholic and that their children would be baptized Catholic. Mai’s family hasbeen in the United States for 20 years, while Duc’s parents have just recently moved to HoustonfromVietnam as part of the reunification program. Duc had only spent 2 weeks with his motherafter not seeing her for 15 years when she suddenly died of a heart attack. Duc is overwhelmedby grief and experiences a deep desire to participate in the mourning rituals that are customaryto his mother’s Buddhist religion. Mai does not approve. She believes that now that Duc isCatholic, he should grieve like a Catholic, not like a Buddhist. The Buddhist rituals requireweekly attendance at the temple in Houston for prayers and chanting, among other things. Ductalks a lot about speaking to his mother during this period and about how he feels his mother iscommunicating with him. Mai feels alienated by his experience and physically and emotionallypulls away from her husband. This hurts Duc. A number of weeks into the 7-week mourningprocess calledCun ThatDuc talks about theGiai Tang ritual in which, 7 weeks after a death, thewhite mourning head bands are burned and the family is released from mourning. He sees it ashis mother releasing him from his guilt and despair over having so little time with his mother.

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Mai does not understand this at all. “Only God can release us from mourning, only Christ canredeem us,” she blurts out. “Your mother is no longer here.”Duc breaks out in heavy sobs. Maihas never seen her husband cry like this and runs out of the house distressed. Duc calls her anhour later and tells his wife to stay away. “I don’t want to see you; why don’t you stay with yourmother and love her. I obviously am not allowed to love my mother anymore!” Mai seekscounseling from a Catholic priest who is also a trained psychologist. They discuss her fears oflosing her husband to the Buddhism of his youth. Meanwhile, Duc starts to spend more andmore time with his family in Houston. The family togetherness soothes him, as do the rituals atthe temple. They make him feel his mother is still there and that there are things he can do. Hesets up an altar in the house with a picture of his mother, and each night he burns incense andplays a tape of Buddhist chanting.

The tension in Mai and Duc’s relationship is caused by a crisis that brings out worldviewdifferences that they have papered over to make their relationship work. In some ways, they arelike Cathy and Mario. The males have done more of the worldview compromising. In Mario’scase, that has to do with wanting to start over in a new relationship and not wanting to haveanother marriage break apart. Duc madeMai’s family his own because he wasn’t able to be withhis own parents. Once he was reunited with his mother, he was able to re-balance his sense ofbelonging by recalling the identifications of his childhood. The sudden critical event of hismother’s death interrupts that process, and Duc finds himself suspended between belonging inhis childhood family and belonging with his wife. In his pain that results from the fact that hissense of belonging is no longer a choice and that his newly re-discovered identification with hismother reminds him of his loss, he finds himself pulled toward his mother’s worldview. TheBuddhist worldview about death soothes him and helps re-establish a semblance of thecomforting, albeit temporary, sense of belonging in his mother’s presence and in the realm ofhis safe re-imagined childhood. Because in his grief he is pulled back to the worldview he hascovered over with Mai’s Catholic worldview, his sense of belonging with Mai is disrupted, andthe two separate, at least for the time being. Duc’s despair becomes complete as his identity as ason and as a husband is damaged by the trauma of loss and the alienation it engenders. His senseof belonging is harmed greatly, his identification becomes weak, and his identity is transformedin a negative sense. He tries to flee into a worldview that can only be enough to sustain him if hegoes through a radical change, undergoing a kind of spiritual transformation. The challenge forany therapist is to help Duc find healing in his identity as a good yet grieving son and as a goodyet aggrieved husband. Duc in time will have to return to a positive identification with both hismother and his wife and find belonging in the narratives of both child and spouse. Both theworldview of his parents and the worldview of Mai’s family will need to be reconciled withpositive identifications, nurturing identity, and a healthy sense of belonging in the differentgroups.

Mai’s sense of belonging with her husband has been fractured, and this will push herfurther to her family of origin. Her strong identifications with family members will bestrengthened, to the detriment of her identification with her husband. Her identity as aspouse is taking a blow, and she will have to find a way to make room for her husband’s griefif the two are to reconcile. There is a danger that her priest-therapist will confirm herworldview and sense of belonging inside the Catholic tradition, and this may underlineMai’s negative views toward Duc’s childhood bereavement worldview. This may in turnunderline a sense of marginality in Duc in the therapeutic process, especially if the therapisthas a majority worldview and cultural background. On other hand, the Catholic worldviewabout marriage will push Mai back to reconciliation. At some point, the couple will need tobe seen together, but first they need a few sessions apart to unravel identity, sense ofbelonging, identifications, and worldview.

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Suggestions for cross-cultural practice

An integrative and interrelated exploration of identity, sense of belonging, and worldview, aswell as identification, if possible, should be worked into the cross-cultural therapist’s method-ology. This will all but guarantee a sensitive handling of worldview issues that are often sodivisive and alienating for all those involved in the therapeutic encounter. Tensions can existwithin a client’s identity, sense of belonging, and worldview, and also between each of them.The therapist needs to be creative with these diagnostic concepts. She or he can utilize them as ifthey were color crayons needed to a sketch a preliminary picture of clients. Because these fourconcepts becomemanifestations and receptacles of personal culture, because they are universal,and because they are not (or are at most minimally) informed by presuppositions, they form abuffer for therapist and client against emotional harm by increasing the chance for theemergence of unbiased knowledge. In fact, their universality is borne out when applied tohermeneutics beyond the narratives of therapy (e.g., to literature or religious texts).

The utilization of these concepts in dynamic relationship with each other forms a holisticmethodology for assessment. Their use is not intended as a complete multicultural counselingdiagnostic methodology. It could instead be used as complement to a therapist’s chosen cross-cultural therapy methodology. It is in the interplay of the perspective presented above and thecounseling methodology of the therapist’s choosing that a context for therapeutic change iscreated. Majority culture counselors should take into account the experienced double margin-ality of Asian American clients as diagnostic object and as cultural minority. Therefore, theemphasis should be on drawing out the client’s personal narrative naturally rather than onobjectifying diverging worldviews. My hope is that this will go a long way toward overcomingthe divide between approaches in counseling particular cultural groups such as AsianAmericans and attempts at universal approaches in multicultural counseling. My hope also isthat this approach could help the therapist arrive at a safe diagnostic moment or moments.

Therapists could create a personal mental checklist of each of the four categories as they probeinto the experience of clients with the therapeutic approach that suits them. Finally, the fourassessment concepts are useful for helping the therapist check his or her own worldview biases atthe door.

References

Benedict, R. (1934). Patterns of culture. New York: Houghton Mifflin.Dueck, A., & Reimer, K. (2009). A peaceable psychology. Grand Rapids: Brazos.Erikson, E. (1994). Identity and the life cycle. New York: W. W. Norton.Gerstein, L. H., et al. (2009). International handbook of cross-cultural counseling. Los Angeles: Sage.Lévi-Strauss, C. (1963). Structural anthropology. New York: Basic Books.Lim Kwong, Y.-L. (2010). Silent cry: In search of harmony on Gold Mountain— the Yin-Yang way in pastoral

care. In J. Stevenson-Moessner & T. Snorton (Eds.), Women out of order (pp. 255–269). Minneapolis:Fortress.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.Mercer, C. (2009). Slaves to faith. Westport: Praeger.Schwarzbaum, S. E., & Jones Thomas, A. (2008). Dimensions of multicultural counseling. Los Angeles: Sage

Publications.Shweder, J., & Le Vine, R. A. (Eds.). (1984). Culture theory. Cambridge: Cambridge University Press.Sue, D. W. (1981). Counseling the culturally different. New York: Wiley.van Beek, A. M. (1996). Cross-cultural counseling. Minneapolis: Fortress Press.Vargas, J. A. (2011, June 26). Outlaw. New York Times Magazine, pp. 22–27.

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