14-chinese culture and way of thinking

8/6/2019 14-Chinese Culture and Way of Thinking

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PRACTICE FORUMThe Use of Traditional Chinese Culture andValues in Social W ork Health Care RelatedInterventions in H ong Kong

Cecilia Lai-Wan Chan and Howard A . Palley

This column presents information about tra-ditional Ch inese values and "ways of think-ing " and how such values and understand-ings may affect or hinder a Western approach tosocial work p ractice. We suggest approaches thatpractitioners can use to adjust their practice to ac -knowledge and build on cultural values in waysthat are therapeutic in health and mental healthsettings.We examine p rimarily the relevance of tra-ditional Chinese culture and practices to effectivetherapeutic techniques among the Chinese popu-lation in Ho ng K ong that is imbued with this cul-

ture. (We acknowledge that not all Hong KongChinese, wh o constitute 95 percent of Ho ng K ong'spopulation follow this traditional way of life.)USING TRADITIONAL CHINESE CULTURETO IMPROVE THE EFFECTIVENESS OFSOCIAL WORK INTERVENTIONSThe following examples describe some ofthe cul-tural and behavioral characteristics of traditionalpatients and their families and indicate how thesecharacteristics can be used to facilitate successfulsocial work practice in health and mental healthsettings (Chan, 2001).Value Placed on LearningBecause many Chinese peop le put considerable em -phasis on academic achievement, social workers candesign courses o r programs that are educational innature. Traditional C hinese come to classes morereadily than to less formal groups because they aremore willing to learn in a formally structured en-vironment (Ho, 1986). Instructions using a cogn i-tive-behavioral training approach have been found

were packaged in the form of training classes (Chanet al , 1996;Law et al., 1998).The participants wereactive in doin g their "ho m e-w ork assignment" andparticipated actively in learning breathing exercisesand acupressure points during the classes (Chan &Chow, 1998). Such psychosocial-educational in-tervention may be more facilitative for a traditionalChinese population than an emotion-focused in-tervention (Chan & Ch ow).Use of Culture and Trad itionTo prevent clients from feeling a "loss of face," so-cial workers may use a consultation approach, wh ichinvolves older family mem bers and parents as con-sultants instead of clients (Bond & Hwang, 1986).Chinese people, who are pragmatic, willingly par-ticipate in collective problem solving if they arenot seen as "the client" but as helpers. A bereave-ment center in Hong Kong invited bereaved hus-bands to share their experiences as men with thefocused goal of helping a female social worker un-derstand men in grief. These widowers were thenmore willing to share their feelings because theyfelt that they were contributing to the social worker'sability to help other bereaved men. If the socialworker can show a sincere appreciation of theindividual's pride in Chinese ethnicity and respectfor Chinese cultural norms, the clients often showa beneficial therapeutic effect.Respect for RitualsTraditional Chinese families continue to partici-pate in family rituals and celebrate major Chinesefestivals. Such practices enhance family interac tionsthat legitimize the showing of concern for one an-


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wishes in public for good health for all family mem-bers. Death rituals can be used also to reduce thepain of bereavement and hasten recovery (Chan,1998a, 1998b; Chow , 1995;Yang, 1995a, 1995b).Dur ing major festivals such as the full moon din-

ner, the dragon boat festival, end of the year gath-erings , and the C hinese New Year, there are familymeals and social exchanges of gifts and good wishes.Such gatherings may be an important source ofinformation for social work diagnosis involvinghealth and mental health problems.Moreover, if social workers can be more activein home visits, especially during meal time, the so-cial worker is able to generate importan t informa-tion about family health-related problems and be-reavement that can never be generated in officeinterviews.Promoting the Acceptance of Iiiness,Adversity, and LossTraditional Chinese values place strong emphasison concepts such as Buddhist and Confucian vir-tues of "en du ring" suffering (Yang, 1995a). Elderlypeople can easily talk about their chronic illness-related pains and suffering and therefore should notbe told by social work counselors that "they willget over it" (Shanghai Cancer Club, 1993).

Especially in circumstances where health andmental health problems combine with social andeconom ic adversities that are beyond the individual'scontrol or ability to change, acceptance and will-ingness to endure suffering are traditional charac-teristics. Unable to address emotionally laden is-sues, talking about suffering and bitterness in lifeallows traditional Chinese to vent emotional frus-trations in language that makes cultural sense tothem.It is important for social workers to appreciatethe strength of traditional Chinese clients in HongKong and elsewhere in persevering and perform-ing their obligations as parents, spouses, or childrenand giving their best to their family members de-spite their adverse life situations Qeffers, 1993).A CULTURE-SENSITIVE EMPO WER MENTAPPROACH IN HEALTH CARE SETTINGSFrom the brief discussion of how tradition andculture in Chinese societies may affect social inter-

terventions in health care settings. By using the cul-ture and rituals creatively, a worker can increase thesuccess of an intervention (Chan & Chow, 1998;Sheikh & Sheikh, 1989). Social workers who workwith Chinese clients influenced by traditional cul-ture can be more effective if they use the followingintervention strategies and skilled approaches.ForgivenessTo help clients and significant others let go of theirpast bitterness and resentment, it is of utmost im-portance to help them forgive others with respectto family and othe r small group tensions. Forgive-ness is the key to emo tional tranquility. W ith ou tforgiveness, individuals hold on to grudges andhatred and remain in a state of agitation. Forgive-ness can resolve destructive impulses and free indi-viduals from anger.

Forgiveness is easier said than done. Knowingthe importance of forgiveness, good role modelswho successfully forgive can be invited to sharetheir experiences with fellow sufferers in similarcircumstances. Forgiveness stems in part from theTaoist and Confucian traditional emphasis on m od -eration and avoidance of extremes and may alsohave aJudeo-Christian overlay. Forgiveness is a wayto escape the bondage of hatred and anger (DiBlassio,1998; Sells & Hargrave, 1998).Breathing ExercisesInstead of asking cHents to talk about their emo-tions, one Hong Kong social work practitioner hashelped individuals "blow away" their emotional frus-trations through simple breathing exercises. Becausethere is a strong resistance to talking about theiranger, behavioral instructions for breathing exer-cises were found to be far more effective.The breath-ing exercises were developed from a combinationof qi-gong, imagery, and NLP techniques (Lee,Che ng, Leung, Sham, & W ong, 1999; Seifel, 1986;Sham et al., 1999;Tsuei, 1992;Yang, 1995a; 1995b).Clients were asked to image breathing in "en-ergy,""oxygen," and "love," and breathing out "frus-trations," "dark clouds o n their chest," and all"negativities."These techniques are termed "one-second techniques," that is, individuals are able toregain control of their emotions through breathingand body movements that take only a few seconds.


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Mutual Support GroupsIn addition to strengthening clients' individual ca-pacities to cope with adversities in the ir lives, it iscrucial that solid support links and networks beestablished.When clients graduate from groups, tbeymay organize themselves into alumni associations,wbich continue to meet every month. Establish-me nt of sucb effective support is important for pro -mo ting a m utual belp atmosphere (Ho, 1998; Sea-ward, 1997;Wong & Chan, 1994;Yeung, 1990).Advocacy for JusticeTo move clients from self-absorption in tbeir painand self-pity, they may be organized into advocacyaction groups so tbat tbey can express tbeir opin-ions on related publicmatters (Cban & Chan, 1998).Cancer patients bave organized tbemselves to lobbytbe Hospital Autbority to provide adequate psy-cbosocial care for patients. These patients then felttbat tbeir suffering could be turned into construc-tive action in seeking an overall improvement insociety.Tbey felt tbat such action gave an enh ancedmeaning to their suffering. They were helping fel-low sufferers as well as tbemselves (Cban & Cban ).CONCLUSIONAppreciation ofthe cultural barriers of traditionalCbinese clients to a Western model of social workservices can enhance and foster tberapeutic rap-port between social workers and clients. Such ap-preciation can also foster important insigbts for socialworkers regarding culturally related resistance ofclients to social work interventions and belp socialworkers provide effective tberapy in health andmental health settings. i!W''iREFERENCESBond , M. H., & Hw ang, K. K. (1986).The socialpsychology ofthe Chinese people. In M. H. Bond(Ed.), The psychology ofthe Chinese people (pp. 213266). Hong Kong: Oxford University Press.Chan, C . (1998a, Novembe r8-11) . Transformation throughpain: The growth challenge in cancer an d bereavement.Paper presented to the 5th Hong Kong CancerCongress, Hong Kong.Cha n, C. (1998b, July 5 -9). Cultural sensitive practice inpalliative social work A pplying an Eastern belief sys teminto care for the dying. Paper presented at the JointWorld Congress of the International Federation ofSocial Workers and the Internation al Association of

Schools of Social W ork, Jerusalem.Chan, C. (2001). A n Eastern bodymindspirit approach(Resource Paper Series N o. 43). H on g K ong:

bereaved family members. Hong Kong Journal ofSocial Work, 32(1), 1-20.Chan, C . ,M a,J . , Chow ,A. ,Au,T. , Leung, P., Chau, P ,Fiona, C , Che ng, B.Y.,&Tam,V. (1996). Therapeuticgroups in medical settings (Resource Paper Series no.25). Hong Kong: Universi ty of Hong Kong,Department of SocialWork and Social Administra-t ion.Chan,Y., & Chan, C. (1998). From case to policy:Organization of single parents and position paper. InW. F. Law,Y. Ch an, C . Chan , S. L. Hu ng , F L.W ong,and K. H.Tsang (Eds.), Empowerment training handbook for divorced women (Resource Paper Series No.33, pp. 157 167). H on g Ko ng: University of H on gKong.Chow,A. (1995). Th e development of a practice model forworking with the bereaved relatives of cancer patients.Unp ublished master of social sciences thesis.Universi ty of Hong Kong.DiBlassio, FA. (1998).The use of decision-basedforgiveness intervention within intergenerationfamily therapy. Famity Therapy, 20,77 94.Ho , C.W.T. (1998). Social support as a predictor ofthepsychological adjustment of patients w ith rheumatoidarthritis in Hong Kong. Unpublished master of socialsciences thesis. University of Hong Kong.Ho , D.Y.F (1986). Chinese patterns of socialization: Acritical review. In M . H . Bo nd (Ed.), Th e psychologyofthe Chinese people (pp. 1-37). Hong Kong: OxfordUniversity Press.Jeffers, S. (1993). The journey from lost tofound. Toronto:R an d o m Ho u s e .Law,W. F, Chan,Y., Chan, C , Hu ng, S. L. ,Wong, F L. , &Tsang, K. H. (1998). Empowerment training handbookfor divorced women (Resource Paper Series No. 33).Hong Kong: Universi ty of Hong Kong.Lee, P W H . , C h e n g , J.Y.Y., Leung, R .Y Y , Sham,J.S .T. , &Wong,V.C.W. (1999,june 2-4). Th e potential role ofGuotin Qigong for maintaining psychological well-beingin patients with cancer. Paper presented at the AsiaPacific Hospice Conference, Hong Kong.Leung, P. (1997). Stress management for cancer patients.In C. Chan & N. Rh ind (Eds.) , Social workintervention in health care (pp. 85 103). H on g Ko ng:Ho ng K ong U niversi ty Press.Seaward, B. L. (1997). Stress management: Principles an dstrategies for health well-being (2nd ed.). Lond on: Jones& Barlett.Sells,J. N., & Harg rave,T. D. (1998). Forgiveness:Areview of the theoretical and empirical literature.Family Therapy, 20, 2 1 - 3 6 .Sham,J.S.T. , Kwok,J . , Leung, PY.Y,Y uen,J .K.T. , &Wong,V.C.W (1999, June 2-4) . Retrospective an dliterature review on the clinical benefits of Guolin QigongPaper presented at the Asia Pacific HospiceConference, Ho ng Kong.Shanghai Cancer Club. (Ed.). (1993). Challenging life:Theexperience ofthe members ofthe Shanghai Cancer Club.Shanghai: Au thor, (in Ch inese)Sheikh, A. A., & Sheikh, K. S. (Eds.). (1989). Eastern an dwestern approaches to heating: A ncient wisdom an dmodern knowledge. Ne w York: John W iley & Sons.Tsuei ,W (1992). Roots of Chinese culture and medicine. }ay3,Malaysia: Pelanduk Publications.W ong, D., & Ch an, C. (1994). Advocacy on self-help for

patients with c hronic illness: Th e H on g K ongexperience. In F Lavoie, R . Borkm an, & B. Gidron(Eds.), Setf-hetp and mutuat aid groups: Internationat


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Yang, K.A. (1995b). Taoism and health. Heilungjiang,China: Heilungjiang Xinhua Books (in Chinese)Yeung, S. (1990). Ttie dynamics of famity care for the etderty inHong Kong. Unpublished doctoral dissertation.University of Hong Kong.

Cecilia Lai-Wan Chan, PhD, RSWf 15 professor,'Department of Sociat Work and Sociat Administration, anddirector, Centre on Behavioral Health, University of HongKong, 10 Sassoon Road, Hong Kong, SAR; e-mait:[email protected]. Howard A . Palley, PhD, is professor.School of Social Work, and distinguishedfellow. Institute forHuman Services Policy, University ofMarytand, Baltimore,M D 21201-11ll;e-mail:[email protected] att correspondence to Dr Howard A. Palley.Origina l man uscript received Juiy 17, 2001Finai revision received January 24 , 2002Accepted November 22 , 2002

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14-chinese culture and way of thinking

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