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Australian Journal of Music Therapy Vol 27, 2016

Mianzi and other social influences on music therapy for older

Chinese people in Australian aged care

Lauw, E.

To cite this article: Lauw, E. (2016). Mianzi and other social influences on music therapy for older Chinese people

in Australian aged care. Australian Journal of Music Therapy, 27, 57-68. Retrieved from

http://www.austmta.org.au/journal/article/mianzi-and-other-social-influences-music-therapy-older-chinese-people-

australian

In plain language:

As the world becomes increasingly global, music therapists must develop cultural competencies so they can work

sensitively and effectively with clients of different cultural backgrounds. While the development of music therapy

practices is rooted in Western philosophy, it is necessary to integrate Western and Eastern thinking when working

with Asian immigrants in Western countries, who are likely to still be influenced by their home culture. This may be

challenging as there are often “hidden rules” in each culture. These are hard to identify and articulate because people

of that particular culture have grown up intrinsically knowing them. This article shares the clinical reflection of a

Singaporean-Chinese music therapist, who in her final training experience developed a music therapy program in a

Chinese residential aged care facility in Victoria, Australia. She discusses how she was able to consider these hidden

rules in the Chinese culture and modify her Western therapeutic process to respect and work with her clients.

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Australian Journal of Music Therapy Vol 27, 2016 Lauw Music therapy for older Chinese people

Clinical Reflection

Mianzi and other social influences on music therapy for older

Chinese people in Australian aged care

Eta Lauw BCommStudies MMusThrpy, RMT1 2

1. University of Melbourne, Australia

2. Khoo Teck Puat Hospital, Singapore

Abstract

As the world becomes increasingly global, music therapists have to develop cultural competencies to work with

clients of different cultural backgrounds with appropriate sensitivity to encourage therapeutic growth. Just as there are

differences in Western and Eastern cultures, it is necessary to integrate Western and Eastern methods when working

with Asian populations, especially with those who are older adults. This may be difficult, if one is not familiar with

the “hidden rules” in the client’s culture. This article shares one therapist’s clinical reflections on experiences in

developing a music therapy program in a Chinese residential aged care facility in the state of Victoria, Australia.

Consideration is given to the socio-cultural concepts such as guanxi, mianzi and linguistic diversity, and how these

interact with Western therapeutic processes when working with Chinese clients.

Keywords: Chinese, culturally and linguistically-diverse, music therapy, culturally-sensitive, cultural-empathy

Introduction

As a Singaporean Chinese person pursuing music

therapy studies in Australia, I often wondered if the

music therapy approaches, frameworks and methods

taught in Australia were as applicable to non-Western

cultures. Given that music has a strong cultural context,

the importan ce of developing ‘culture-sensitive

resources’ for use in music therapy has been advocated

in the literature discussing the need for integration of

Eastern and Western cultures for music therapists in

East Asia (Kim, 2015). I had personally witnessed

differences in the responses of Eurocentric clients in

Australia compared to Singaporean clients when

approached for music therapy; with the Singaporean

clients typically less forthcoming and appearing more

self-conscious when asked to participate in music

therapy. During my final student placement1 in an aged

care facility in Victoria for older Chinese adults I

reflected on two questions which informed my

development of the music therapy program. Firstly,

what are the inherent differences in clients’ attitudes

towards therapy? Secondly, how do these differences

affect music therapy approaches and methods?

Personal Stance

As a third-generation Chinese person living in

Singapore, I speak Mandarin. However, English,

being the official working language in Singapore, is

the language with which I am most comfortable. I

have knowledge of certain Chinese customs and

traditions: my family celebrates the Lunar New Year,

but we dispense with the celebrations and customs on

other Chinese festivals. Traditional Confucianist

values such as family ties, respect for elders and filial

piety (duty to obey and care for parents and elderly

family member) have also been inculcated into me

since I was young. Yet, I have also been localised to

a unique Singapore culture; one that is strongly rooted

Address correspondence to:

Eta Lauw: [email protected]

1. In Australian training, the final placement is equivalent to the internship

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AJMT Vol 27, 2016 Lauw Music therapy for older Chinese people

in pragmatism (Low, 2007) with influences from

both the Eastern culture (Han, 2007) and the Western

media (Ho, Krishna & Yee, 2010). Being born and

bred in multiracial and multicultural Singapore

meant that I am also conscious and respectful of the

differences in culture, customs and traditions

between the Chinese race and the other dominant

races in Singapore (such as Malay, and Indian).

While I am aware of the differences in language,

culture and customs between the different races in

Singapore, prior to the student placement, I was not

conscious of the inherent complexities in working

with the Chinese community, despite being of the

same race. These complexities can be attributed to

the linguistic diversity and political sensitivity of the

Chinese community living in the different regions as

well as some “hidden rules” (Thomas & Sham, 2014)

in Chinese culture. Hidden rules are aspects of

culture beyond traditions and systems of culture such

as health and education, which are hard to identify

and articulate (Thomas & Sham, 2014). I had been

brought up intrinsically knowing and adhering to the

“hidden rules” in Chinese culture. However, I did not

consciously pay attention to them, as people around

me, even those of the different races, appeared to

understand them. It was only upon working and

trying music therapy methods and approaches

learned in Australia, that these “hidden rules”

became apparent to me.

During the placement, I experienced some

unexpected client reactions which I thought were due

to these socio-cultural factors and “hidden rules”. I

turned to the literature for guidance but found little

music therapy literature related to working with the

Chinese community. Subsequently, when adapting

approaches for the clients, I found myself drawing on

my personal knowledge of Chinese “hidden values”

and integrating them with the music therapy

knowledge acquired in my training. In this article, I

offer a clinical reflection on the blend of the socio-

cultural factors and the “hidden values” that may

affect the therapeutic process.

Background

Immigrants from Chinese-speaking countries

represent the third largest group of overseas-born

Australians (Australian Bureau of Statistics, 2012) and

the largest non-English speaking group in Australia

(ABS, 2012). Despite being of similar ancestry, these

immigrants in Australia originate from different

geographical regions; coming from China, Vietnam,

Malaysia, Singapore, Indonesia, Hong Kong, Taiwan,

and others.. They maintain different cultural beliefs,

customs, and dialects or languages, influenced by their

places of origin. Research conducted in Australia on

social isolation of older adults (Pate, 2014; Cultural

and Indigenous Research Centre, Australia, 2009),

reported that the Culturally and Linguistically Diverse

(CALD) older adults including Chinese immigrants,

tend to be more socially isolated. This could be due to

adjustment issues brought about by immigration in

later life, or language barriers.

Social Support– Chinese cultural context

The social isolation faced by members of the

Chinese community could also be due to some unique

cultural factors. Cheng’s study (2009) of social

support networks for Chinese residents in aged care

facilities in Hong Kong revealed that participants were

socially isolated, despite appearing to desire support

and depth in relationships. Collectivist Asian cultures

prioritise collective good over autonomous interests

(Ip, Lui & Chui, 2007) and emphasise being “not too

involved” for the purpose of achieving harmonious

social relationships (Gabrenya & Hwang, 1996). This

often results in older adult Chinese residents

distancing themselves in interactions with others,

making it hard to develop social networks in

residential care (Lee, 2001; Lee, 1999; Lee, 1997).

This is related to the Chinese concept of mianzi

(pronounced “me-yen-zeh”) which is a sense of

favourable social self-worth that could be affected by

uncertain social situations (Ting-Toomey & Kurogi,

1998). It is because of mianzi that Chinese people tend

to appear self-conscious or guarded in their

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interactions with others (Lee, 1999). Influences from

Buddhism and Taoism also mean that practising

emotional restraint and not disclosing private feelings

are a source of pride in Chinese culture (Williams, Foo

& Haarhoff, 2006). While this appears to be a

generalisation, Williams et. al, (2006) noted that

Chinese older adult immigrants in Western countries

continue to espouse these beliefs for many years after

migration.

The further concept of guanxi (pronounced “goo-

one-see”) means interpersonal particularistic

relationships (Luo 2007). Guanxi often governs

Chinese attitudes towards social interactions (Luo,

2007) and explains why Chinese people may be less

forthcoming with people they do not know, or with

whom they have have no connection. Guanxi is often

explained as a network of continued informal,

reciprocal and individualised, personal relationships

and connections based on commonalities such as

places of origin or a common contact person (Tsai, Chi

& Hu, 2009; Park & Luo, 2001). Ganqing [the depth

of a relationship] (pronounced “gan-ching”) and

renqing [the moral obligation from the relationship]

(pronounced “ren-ching”) are components of guanxi

(Crombie, 2011). When you have guanxi with a

person, you are expected to show renqing and do

favours for the person which you may not do

otherwise in normal circumstances. How much one

goes out of the way to do favours for others, depends

on the depth of your relationship (ganqing).

Preserving mianzi is important in guanxi (Crombie,

2011), which is perhaps a reason why favours are

done. Preserving mianzi can also build trust, the key to

a “guanxi” relationship (Crombie, 2011).

Linguistic Diversity

Beyond mianzi, emotional restraint and guanxi,

linguistic diversity could also be a cause for social

isolation. While the Chinese language is used in

mainland China, Taiwan, Southeast Asia and other

parts of the world (Kurpaska, 2010), this does not

mean all people who speak Chinese understand each

other. Scholars have catergorised at least 7 to 15

dialects (with more sub-dialects) in the Chinese

language (Kurpaska, 2010; Tang & van Heuven,

2015), most of which are not mutually intelligible

(Kurpaska, 2010). Since 1955 China’s language

policy has supported Putonghua (based in Mandarin)

as the official standard (Kurpasa,2010). Most young

people in China are more fluent with the use of

Putonghua than other dialects, while the older

generations are more comfortable with their own

regional dialect (You, 2004). A majority of older adult

Chinese immigrants in Australia also have difficulties

with the English language (Ip, Lui & Chui, 2007).

Considering the diversity of the Chinese immigrants

in Australia, communication can be expected to be

poor between older adult Chinese immigrants from

different regions living in a community. Hence,

communication also becomes an important

consideration in group therapy activities with older

adults of the Chinese race. Given that the concept of

music and health is deeply rooted in Chinese culture

(Ip-Winfield, Wen & Yuen, 2014), music therapy is a

worthwhile option as a non-verbal way to provide

support for these older Chinese immigrants.

Culturally-sensitive Music Therapy

As the world becomes more multicultural and

with music therapists called upon to work with diverse

cultural populations, it has become increasingly

important for music therapists to develop cultural

competency in their work (Brown, 2002). Cultural

empathy goes beyond cultural sensitivity to clients’

culture, ethnicity and musical preferences. It includes

understanding nuances in behaviour, such as

appropriate eye contact (Brown, 2002), which is

expressed differently in different cultures

(Arrendondo, 1987). Given that genuine empathy

based on the client’s frame of reference promotes

therapeutic growth (Rogers, 1957), it is important to

have cultural awareness to convey empathy to the

client. This might be difficult when working with

clients of a different culture, given the “hidden rules”.

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Apart from cultural awareness and competency,

there is a need for music therapists to be aware of their

use of music when working with CALD clients. Music

is supposed to be a universal concept, transcending

cultures and allowing cross-cultural communication

(Higgins, 2012). However, it also has strong

association qualities (DeNora, 2000), which could

have a strong cultural context (Blacking, 1987).

Brown (2002) also argued that even though the

building blocks of music such as form, rhythm, and

melody can be used similarly across different cultures,

music therapists need to be aware of the extra-musical

associations associated with music. This is especially

so given that music and culture share close ties.

Beyond extra-musical association, musical

authenticity is another aspect to consider in the

culturally-sensitive music therapy practices (Ip-

Winfield, Wen & Yuen, 2014). Sourcing and learning

to sing culturally-specific repertoire could be

challenging and clients may prefer recordings over

live recreations of foreign language songs In

particular, Ip-Winfield, Wen and Yuen (2014)

discussed the difficulties in recreating certain types of

Chinese music even by experienced music therapists

who speak Chinese dialects because of the

complexities in musical styles and linguistic diversity.

Despite the significance of this issue, little research

has been conducted on musical authenticity in

culturally-sensitive music therapy practices.

Music Therapy and Australian Chinese

community

There appears to be limited music and music

therapy literature on working with the ethnic Chinese

population in Australia. Some of these limited studies

(Li & Southcourt, 2012) tend to view Chinese

immigrants as homogenous, without considering their

different cultural and linguistic backgrounds, which is

not reflective of the socio-cultural landscape. Yeung,

Baker and Shoemark (2014) surveyed older Chinese

adults in a day program in Australia to develop a list

of popular preferred songs. Most of the songs were in

Cantonese or Mandarin. Shanghai-style Mandarin

pop songs were considered mainstream pop music for

the Chinese community from the 1920s to 1970s, even

for those whose first language was not Mandarin

(Moskowitz, 2010; Yeung, et. al., 2014).

Given their expectations of professionals as

authoritative experts, Chinese clients appear to prefer

directive and structured approaches to therapy (Chen

& Davenport, 2005) compared to a person-centred

approach (Chu, 1999). However, the cultural

expectation of respecting the elderly (Williams et. al.,

2006) suggests that therapists need to balance being

directive while not appearing high-handed, when

working with older Chinese clients.

Method

Background to the clients

My final student placement took place in a

residential aged care facility catering for the older

adult Chinese population in Victoria. The majority of

residents were Cantonese-speaking immigrants from

Hong Kong, Guangzhou (China), Malaysia, or

Vietnam, with an increasing number of residents from

Mainland China who understand or speak Mandarin.

Interaction and communication between residents was

observed to be limited, especially between residents

who did not speak the same dialect.

Background to the music therapy program offered

Clinical music therapy sessions were offered

weekly for three months. The aim of the program was

to increase quality of life for residents by maintaining

physical and cognitive functioning, promoting

emotional well-being and enhancing social

relationships. Apart from individual sessions, a range

of group music therapy sessions were established.

They included two music and movement groups; one

for residents with dementia, and another open to all

residents. After observing that most participants were

socially isolated, an open therapeutic singing group

was formed for cognitively-able residents to promote

social engagement on a weekly basis.

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All sessions were conducted in Mandarin,

maximizing the capability of the student therapist

(author). Simple Cantonese phrases were also used in

sessions. The remainder of this article will focus on

the my reflections on the therapeutic singing group.

Because of the reflective nature of this article, I will

report the experience in the first person.

Experiences in Facilitating the Therapeutic

Singing Goals

I initially envisioned the music therapy group as a

platform to provide opportunities to foster social and

emotional connections through reminiscence and song

sharing. This weekly session goal was later changed to

focusing more on social engagement, due to the

participants’ behaviours that limited in-depth

processing.

I complied songbooks comprising some 50

Cantonese and Mandarin songs based on the preferred

songs for older Chinese adults reported by Yeung, et.

al., 2014). I encouraged residents to reminiscence to

build social identity (Haslam et. al., 2013). However

as the sessions progressed, I became aware of the need

to adapt this. The impact of Chinese culture on the

behaviours of participants meant that singing without

reminiscence became the main method, along with

instrumental playing.

With increased awareness of the Chinese value of

“respect for elders” and the preference for directive

approaches in therapy, I changed my orientation from

humanism to assimilative integration (Stricker &

Gold, 1996). In assimilative integration, there is a

primary orientation which forms the basis for the

therapeutic work while incorporating ideas and

strategies from other orientations. The basis of my

orientation was founded on humanistic values, but I

integrated behavioral methods by being more directive

and enforcing song choices with encouragement.

Being directive made the uncertain social situation

less confronting for the residents. Since autonomy was

not highly valued (Chiang, Lin & Lee, 2015)

enforcing song choices was not intended to encourage

participants to speak and share within a predictable

space since self-disclosure helps to develop a sense of

closeness in a group (Yalom, 1995).

While being directive in my practice, I still

believe that I was practicing in a client-led way, as

being directive was a part of the Chinese residents’

expectation towards a therapist. This is based on both

Brown (2002)’s and Rogers (1957)’s belief on the

importance of empathising with the clients from their

point of view which will lead to therapeutic growth

and change.

I evaluated participant outcomes by reflecting on

group dynamics, participants’ affect, and participants’

readiness to engage in singing, instrument playing and

choosing songs. These outcomes were interpreted as

reflections of the participants’ personal involvement

and acceptance of their own identity, and considered

indicators of social and emotional connections

(Hemingway & Jack, 2013).

Observed outcomes for the Therapeutic Singing

Group

Initial sessions

The group struggled with irregular and low

attendance in initial sessions. When I approached

residents to invite them for the sessions, leaving the

option open for them, most of the time the answer was

a hurried “no”. This was despite my previous

observation that these same residents appeared to

enjoy singing. Viewed through the lens of mianzi. the

new singing activity presented an unknown social

situation. However, if these residents were informed

respectfully to attend by the facility’s activities

coordinator, then they would arrive for the sessions

they had previously rejected. This could possibly be

due to guanxi, which they have developed with the

activities coordinator over time. This allowed them to

trust the activities coordinator and offer to attend the

session out of renqing, even though they were unsure

of what the session entailed.

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I also observed that residents, especially those

who were cognitively-able, sometimes found it

confronting to approach me to ask to participate in

sessions. These residents might be observing the

sessions from afar and singing along quietly.

However, if eye contact was exchanged, they would

then proceed to walk away hurriedly. Again, mianzi

could offer an explanation for this behaviour.

When residents attended sessions, they would

sing along quietly. Most were reluctant to play

instruments, even after demonstrations, perhaps an

indication of wariness of the new social situation.

Limited social and emotional connections were

observed given the difficulty in getting participants

to talk or make songs choices. The participants often

looked conflicted or chose songs on the next page

when asked to state preferences. Participants were

also reluctant or unable to engage in reminiscence

with songs, which could be credited to the cultural

factor of mianzi, a lack of knowledge of songs and

also the language barrier.

Mianzi. While female participants not from

Mainland China were familiar with the songs

suggested by Yeung, et. al., (2014), they were initially

careful not to engage in reminiscence in the group.

This was perhaps due to the wariness towards

oversharing in the community space, due to mianzi

issues.

Knowledge of songs. It was observed that male

residents from these Chinese territories were often not

familiar with these songs. A common reason was that

they spent their youth working and did not have time

to engage in leisure activities. This limited knowledge

of songs seemed to reflect the Chinese attitude towards

leisure, which is vastly different from the Western

concept (Qiu & Wang, 2012). Amongst older

Chinese, hobbies and leisure connote a sense of being

lazy (Liu, 2011) and are considered as activities for the

rich (Li, Xing & Wang, 2014). In addition, the

Chinese beliefs of having strong work and education

ethics (Deng, Walker & Swinnerton, 2005) make it

more difficult for Chinese males – often viewed as the

sole breadwinner – to discuss leisurely pursuits.

Participants from mainland China were also not

familiar with Shanghai-style mandarin pop songs,

given the ban on Chinese pop music by the

Communist government (Moskowitz, 2010). They

were reluctant to engage in reminiscing about their

youth and singing Chinese revolutionary songs that

they were familiar with, often stating that these songs

were not known to the other participants in the group,

perhaps fearing further alienation.

Language barrier. Most of the participants in the

singing group understood and spoke either Cantonese

or Mandarin, but did not understand the other dialects.

Although I was able to converse in Mandarin fluently,

I had a very basic knowledge of Cantonese, and

struggled to understand the Cantonese-speaking

residents especially on a deeper level. This also

resulted in limited interpretation that I could provide

between the Cantonese and Mandarin speakers, which

might have further limited group understanding and

cohesion.

Sessions after adjustments were made

After this initial phase, I made adjustments to

encourage participation, and the group saw regular

attendance of an average of 10 members. In the final

session, there were 17 participants who voluntarily

attended the session. Group members seemed more

relaxed. They were more willing to express choices

and play instruments; a sign of trust and group support.

Brief conversations were observed in sessions and

after sessions although conversations in sessions

appeared superficial and polite. Conversation after

sessions, usually in a smaller group, involved

discussing familiar songs and had more depth. This

initiation to interact with other residents socially was

a contrast to behaviour outside the sessions. Notably,

one of the more socially isolated participants who was

not observed to interact with other participants during

group sessions, expressed that she felt that she got to

know other people in the group by the end of music

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therapy sessions. This could be due to the fast bonding

effect of group singing (Pearce, Launay & Dunbar,

2015) which allowed her to feel a bond with others

without personal interactions.

Despite the language barrier, eventually moments

of connection were also observed between the

Cantonese and Mandarin speakers, after weeks of

interaction. Participants were seen sharing songbooks

and encouraging each other to sing. Some even teased

each other gently about the songs chosen. Despite not

understanding each other’s language well, they

understood the intent behind the language. This

suggests that some ganqing were formed due to the

guanxi established by the commonality of belonging

to the same group.

Discussion

Establishing a Therapeutic Relationship with the

Chinese Community

In conversations with some music therapists

who were referred to work with Chinese clients, a

common remark appeared to be, “the clients don’t

seem to want music therapy and often say no”. This

reflected my own experiences when I initially tried to

encourage residents to participate in the singing

group. However, my experiences also showed that

Chinese clients can enjoy participating in music

therapy sessions as well. One might have to approach

establishing therapeutic relationships with the

Chinese community in a way that guanxi is

established.

Guanxi or Therapeutic Alliance?

It may be argued that participation within sessions

grew towards the end of the program because of a

therapeutic alliance (Ackerman & Hilsenroth, 2003)

that developed allowing residents to trust the

therapeutic process and space. It appears that there are

certain elements in establishing the therapeutic

alliance that are similar to establishing guanxi in

Chinese culture. Both require trust, time, and an

individualised relationship.

A therapeutic alliance with Chinese clients may

take some time, as the basis of guanxi stems from

commonality. A therapist who is not privy to the

existing web of relations that the Chinese older adults

have, might take a longer time to build trust and

reciprocity in the relationships before renqing can be

developed. Eventually, the participants’ attendance in

sessions could be seen as giving me renqing and

mianzi. Typically, one might not think of therapeutic

relationship where the client is doing favours or feel

socially obligated to the therapist as a healthy one.

However, this willingness to give the therapist mianzi

and renqing is a sign that the client is willing to

embark on a relationship with the therapist, which then

allows for further therapeutic growth to develop.

Before reaching this stage, there could be many

refusals. All the interactions involving refusals

establish the basis for ganqing, allowing guanxi to be

developed. Establishing guanxi also requires some

understanding of Chinese culture and the “hidden

rules” to create a quicker sense of commonality.

Forms of Address and the “hidden rule” of

respecting elders. Establishing commonality starts

at the point of approaching and addressing the client.

In my other placements with older adults in

Australia, I learned to address my Australian clients

by their first name. However in the setting for this

program, I realised that the staff addressed the

residents by pak and shuk [both meaning uncle], jie

[sister], yee [aunt], por [grandmother], all of which

meets the cultural expectation for respecting the

elders within the Chinese population (Sung, 2001).

As a Chinese person, I had always been

reminded to address my older relatives, family

friends, or even acquaintances of my parents in this

way to accord them respect when I was growing up.

“Respect the elderly and the wise” is an old Chinese

adage.There were also a few residents who were

addressed by X Toi [Mrs X] or X Sang [Mr X], for

those who did not feel comfortable with the familiar

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“family-style” greeting, but still expected respect.

Using salutary greetings, being courteous and using

respectful language, are some ways that one shows

respect to the elderly in Chinese culture (Sung,

2001).

“Hidden rule” of mianzi. The concept of

mianzi means uncertain social situations (in this case

group singing) will be rejected as older Chinese

people fear that their choice may be judged.

However, if not given a choice, the uncertain social

situation of whether to accept or reject an invitation

is removed, and mianzi is preserved. I learned that

while being directive in encouraging them to attend

the session, there was also a need to encourage

participation in a friendly, non-confrontational,

authoritative manner.

Mianzi could also explain why certain methods

were more acceptable. Across the range of activites,

offered, music to movement worked the best,

especially when the participants were given

instructions for the actions. Music and drawing

seemed to confront participants, with participants

expressing that they had no artistic flair and did not

know what to draw. Similar to music and drawing,

most participants were reluctant to play instruments,

even after demonstrations, which was perhaps an

indication of their wariness of the new social situation.

However, as sessions continued, participants were

perhaps more aware of what the situation entailed, and

with encouragement appeared to be less self-

conscious and engaged in playing instruments,

Socio-cultural differences in repertoire. The

Chinese concept towards leisure and the different

socio-cultural backgrounds of Chinese immigrants in

Australia meant that it is difficult to use singing with

reminiscence as a method. Looking at the song

preferences of the participants from different

geographical regions suggests that there is probably no

single comprehensive list of popular song choices that

accurately reflects the diversity of the Chinese

immigrants. Music therapists have to continually be

mindful of generalisation and continue to be client-

centred when working with this population. Also,

older Chinese adults who enjoy music sometimes

prefer to listen to dialect–focused operas, such as

Beijing Opera, Teochew Opera, Cantonese Opera,

which may be difficult to replicate live due to the

complexity of the music. From experience, while

some immigrants from more rural areas in China enjoy

singing, their knowledge of repertoire consist of folk

songs and nursery rhymes sung in their dialects which

are difficult to locate on YouTube, either because they

have not been notated, or written down in a time when

illiteracy was common2. Therefore, it is imperative

that music therapists are attuned to clients’ individual

music preferences and develop ways to work

creatively around such potential challenges. Just as

Western music comprises different genres, there are

also different genres in Chinese music, beyond

Shanghai-style mandarin pop songs.

Recommendations

Building Guanxi. It is important to establish

guanxi with the clients from the beginning. Finding

commonality is important, and it can be done by

asking a third person (perhaps a staff member) who

the client is familiar with to introduce the music

therapist to the client. Music therapists should also be

mindful of and observe certain Chinese values, such

as respect for elderly, to try and establish trust with

the clients.

Overcoming barriers due to mianzi. Music

therapists may want to consider removing potentially

uncertain social situations for clients, demonstrating

and modelling behaviour whenever possible, and

removing choice-making for clients. Therapists may

need to be more directive in sessions, yet encourage

participation in a friendly, non-confrontational, and

authoritative manner. Eventually, as the therapeutic

alliance is built, clients may start to express their

2 Prior to 1949, only 20 per cent of China’s then population of 500 million were literate and compulsory education laws were

passed only in 1986 (Yeoh & Chu, 2015).

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choices more, even without encouragement from the

therapist.

Overcoming the language barrier. From

experience, it is likely to be difficult to find a suitable

interpreter especially in a group setting where there

are different dialects spoken. Learning simple

phrases in Cantonese gave me a start and I would

highly encourage therapists who work with the

Chinese population to learn some simple phrases in

the correct Chinese dialect to help them in their work.

It might also be better to conduct an activity-driven

program in a group instead of a group requiring more

verbal processing. This is in line with past

suggestions on using activity-oriented methods

instead of verbal therapies for work with the CALD

populations (Dileo,2000; Ip-Winfield & Grocke,

2011; Ip-Winfield, Wen & Yuen, 2014).

Learning Songs Together: A Possible Activity

to Overcome Socio-Cultural Differences

A possible method that could have been used was

learning new songs together. This would fit into the

Chinese preference of collective identity, and building

the group’s social identity and camaraderie without

needing to express themselves through conversations

starters or song choices. Learning music was shown to

have positive psycho-social effects on the Chinese

community (Li & Southcott, 2015), which is not

surprising, given the Chinese adage of “learning as

one grows old”, which promotes lifelong learning.

Considering the large percentage of Chinese older

adults living in Australia, more research on music

therapy can be undertaken with the Chinese

population, particularly on music therapy methods

Limitations

My experiences at the Chinese aged care facility

were very specific and are not intended to for

generalisation about Chinese people, nor to create a

sense of a simplified East-West dichotomy in terms of

attitudes. It should also be noted that as I was working

with older adult Chinese immigrants who have moved

to Victoria only within the last twenty years. It is likely

that they were still heavily influenced by Chinese

cultures, customs and attitudes from their growing up

years, rather than have fully assimilated into

Australian culture.

As a person of the same race, I also recognise that

I share similar physical attributes to my clients,

although my socio-cultural background is different.

With that, I recognise that I have an advantage when

trying to address the clients as an older relative – as it

is expected within the Chinese culture and perhaps

guanxi could be established more easily with me than

with someone from a different race.

Conclusion

In my clinical experience todate, I have found

that there have been inherent differences between

establishing a therapeutic relationship with Chinese

clients and Eurocentric clients. I believe this

stemmed from “hidden rules” in culture, such as

respect for the elderly, expectations of therapists,

mianzi, guanxi and other socio-cultural factors. Even

though I grew up in a country different from the

residents from the aged care facility, the fact that I

was brought up ethnically as a Chinese person might

have made it easier to reflect on and understand the

cultural perspectives and beliefs of the residents.

Having an implicit awareness of these hidden rules

perhaps made it easier for me to adapt my methods.

While music and medical healing had a place in

Ancient Chinese history, it appeared that the use of

music in the participant’s time of youth was not as

prevalent as in other cultures perhaps due to the

influence of the other Chinese customs and values

such as the focus on hard work or the indifference

towards the concept of leisure. However, the outcome

of the program showed that these older adults still

enjoyed music in sessions despite having no or little

prior association with music.

What is important is how music therapists adapt

their methods and incorporate appropriate cultural

cues from the onset of therapy to build a therapeutic

alliance to promote therapeutic growth. While being

66


culturally sensitive, one ought to be aware of potential

generalisation of the differences between the Eastern

and Western beliefs and be attuned to client needs.

Acknowledgements

Special thanks to Jason Kenner from the University of

Melbourne for guidance throughout the placement.

Funding No funding was received for this study.

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