Multicultural Therapy: A Japanese Perspective

Abstract

In today’s multicultural world, marriage and family therapists are confronted with many cultural subtleties, which helping professionals need to understand in order to assist the client. Many of the therapeutic approaches used today were developed in the Western hemisphere and are less effective in helping clients of Eastern descent. This literature review discusses differences between Japanese cultural and familial influences and those found in the Western cultures asking, which therapeutic approaches and tools are most effective for Western therapists seeking to assist Japanese clients? Japanese cultural values, family dynamics, and social influences are discussed in the context of Western therapeutic approaches, including the application of Asai and Olson’s (2004) PREmarital Personal and Relationship Evaluation (PREPARE) Inventory, McGoldrick and Carter’s (2001) technique of family therapy for the individual and Adlerian therapeutic approaches. Implications of this research may include higher efficacy for therapists assisting Japanese clients, families, and couples seeking marriage counseling.

Keywords: Japanese, family, therapy, multicultural

Multicultural Therapy: A Japanese Perspective

In today's multicultural world, therapists must understand their personal biases and know the effects of cultural influences on marriage and family dynamics to meet their client's needs effectively. These differences are often within the cultural context of the therapist; therefore, the work that must be done is arduous but not alien. This sentiment is not valid in the case of Japanese clients. As most therapeutic approaches were developed in the West, with clients from the West in mind, these therapeutic approaches intrinsically violate Japanese clients' cultural and social norms, thus hindering the therapeutic process.

Japan does not have a culture that is conducive to therapy, as it is in Western societies. Particularly in the Japanese social culture, therapy is a foreign concept that has never gained much traction among nationals. However, the need for therapy is becoming more prevalent in these societies due to many common issues. Japanese families are demanding in regard to personal accomplishment and do not display affection similar to Western cultural norms; this can leave some people feeling disconnected and lonely (Kajino, 2012). Japanese workdays extend past 10 p.m. and begin before the sun rises, creating a high-stress environment and little time to cope (Kajino, 2012). More people from the Millennial and Gen Z generations choose to become hikikomori or social recluses, and the pressure of the massive aging population is crushing those responsible for their care (Kajino, 2012). Add to these social issues the emotional and psychological difficulties common to all human beings, and you have a recipe for trouble.

Still, individual and family therapy remains an elusive part of Japanese culture. For helping professionals working with members of this population, one question remains, what therapeutic approaches and tools provide the most significant efficacy for Japanese clients and their families? Therapeutic approaches and tools which can be easily tailored to the individual, like Adlerian Therapy, McGoldrick and Carter’s (2001) Family Therapy for Individuals, and the PREmarital Personal and Relationship Evaluation (PREPARE) Inventory are most effective for Japanese clients.

Adlerian Therapeutic Approaches

Carlson and Carlson (2000) focus on applying the principles of Adlerian therapy to Asian-Americans, specifically to one case study of a 15-year-old Japanese student named Jin, a 15-year-old Japanese American student that had started declining at school. For Jin, there was tension in acculturation which led him to believe he had to reject his family's long-held cultural norms to absorb certain American cultural beliefs. Using Adlerian methods, the therapist assisted Jin in finding his independence within his family structure while maintaining the health of these relationships. Carlson and Carlson (2000) offer insight into factors that show Adlerian therapeutic approaches' efficacy in the context of Asian-American families.

Carlson and Carlson (2000) describe everyday struggles found in Asian-American families and the mental health issues that are most prevalent in those that seek therapy. It is noted that a smaller number of clients from this population does not necessarily coincide with fewer mental issues. Instead, it may be explained by a lower social acceptance of therapy in general due to a perception of weakness and shame, particularly for one's family should the help become common knowledge. The article goes on to describe methods of adapting Adlerian therapeutic approaches to Asian-American individuals. Carlson and Carlson (2000) point out that, to efficiently help a large population, therapists tend to focus on general cultural differences and stereotypical notions of culture while applying this to their clients. This practice is, of course, a mistake. Just as each American is different from one to the next, each Asian-American had a distinct set of differences which make them an individual – enter Adlerian therapy.

Adlerian therapy is referred to as Individual Psychology due to the practice of tailoring the therapeutic approach to the individual's personal experience of the world. The therapist forms a unique and personal bond with the client before any work is done. The therapist invests in the client relationship by endeavoring to understand the client's unique perspective of the world, including memories, perceptions, beliefs, and cultural values. Only then, after the groundwork is set, does the actual work begin. This approach is successful for Japanese American clients because Japanese values are, in many ways, upside down from American ideals. Understanding the person as an individual guarantee that the person will get a tailored therapeutic approach rather than a generalized one. Adlerian therapeutic approaches are therefore ideal for Japanese clients.

Family Therapy for Japanese Individuals

People need help with problems going on in their lives, which is not unique to Western society. Often, these issues involve family members, but the individual does not wish to involve those members, the members are not interested in being a part of the therapeutic process, or the client feels shame in confessing that they are seeking therapy for internal struggles. The latter is most significant in the Japanese cultural context. In these cases, it becomes necessary to use techniques from family therapy for the benefit of one individual.

One reason that family therapy for the individual is so effective in the Japanese context is that Asian cultures are collectivistic rather than individualistic, meaning that the societal goal is to come together rather than stand apart (Kajino, 2012). From birth, children are seen as independent units that should be taught to be part of the whole (Kajino, 2012). Japanese mothers focus on bonding techniques and rarely leave their babies during the early years; they are utterly devoted to bringing the child into the family's fold and greater society (Kajino, 2012). This sentiment continues throughout development and is the core of Japanese society. Therefore, it stands to reason that addressing the family unit to strengthen it would appeal to Japanese family members.

McGoldrick and Carter (2001) posit a technique in individual coaching while focusing on helping clients adapt their perspective of their role in the nuclear and parental family unit. In the individual approach to family therapy, the therapist identifies the most motivated and psychologically functional family unit members and invites them into the therapeutic process. This approach is different from traditional therapy in that, formerly, the most dysfunctional family member was singled out for therapy and treated as somewhat of a pariah. In the individual approach, a person struggling within the family unit is seen not as an isolated problem but as a symptom of a more significant systemic problem. This sentiment aligns with Japanese cultural values and is something that would be naturally understood.

If individual therapy is provided for the weakest and less influential member of the family, the chances are that the behavioral pressures of the rest of the family unit will cause the client to regress into past behaviors and previous roles within the family (McGoldrick and Carter, 2001). If the most vital and most powerful member of the family is used to assert the change within the unit, this process will most likely be longer-lasting (McGoldrick and Carter, 2001). In family therapy for the individual, the therapist focuses on the patterns described by the most functional family member to assess the situation of all members. The functional family member is then empowered to make the changes necessary to assist in the family unit's healing process and ultimately assist in the positive progression of the unhealthiest members. In individual family therapy, the focus is on the "who, what, where when, and how" rather than the "why" of individual psychotherapy (McGoldrick and Carter, 2001).

The most influential and psychologically healthy member of the family should be the one to assert the change within the family unit by using words, attitudes, and actions to redefine the weakest members in terms of their new roles. Clients are trained to become learners and researchers of their behaviors in the family system and the other family members so that this change can be supported outside of the therapy relationship (McGoldrick and Carter, 2001). By rewriting the family "rules," the selected member of the family unit may assist in breaking the chains of family members struggling with unfair or harmful labels.

This approach is highly effective in Japanese cultures since it is unlikely that the entire family would be involved in therapy. However, by focusing on just one healthy family member, perhaps a successful brother or sister, aunt or uncle, the entire dynamic of the family may change for the benefit of the weakest member. The psychologically healthy family member can influence other family members within the context of Japanese family culture and the greater society.

Japanese PREPARE scale for Premarital Counseling

In today’s global world, there are many instances in which Japanese individuals may need therapy, but none is more common or likely as Japanese individuals preparing to marry American service members. Asai and Olson (2004) focus on cultural adaptations for Japanese couples of the PREmarital Personal and Relationship Evaluation (PREPARE) Inventory. A significant group (n=849) of engaged individuals were involved in the study. Collaboration between the U.S. and Japanese researchers ensured the efficacy of the adaptations, and the internal consistency was good among Japanese PREPARE scales. The research resulted in several unique features of the PREPARE scale for Japanese couples.

In all forms of the PREPARE scale, there are three areas of focus (a) personal background and contextual features, (b) individual experiences and personality traits, and (c) couple interactions and processes (Asai and Olson, 2004). Personal background and contextual features apply to the person's age, education level, occupation, and income. These factors also consider the familial context of the individual and how they were taught to manage finances. Individual traits are measured by evaluating behavior, leisure activities, personality traits, expectations, and religious orientation. Finally, the PREPARE scale focuses on the couple's interactions regarding children and parenting, conflict resolution, sexual relationship, equalitarian roles, and communication (Asai and Olson, 2004).

Significant changes have been made to the PREPARE scale for Japanese couples and individuals. During the translation process, it was discovered that the Religious Orientation Scale lacked the cultural and familial application needed to be relevant for Japanese couples. This difference is because religion in Japanese contexts is more ritualistic than Western religions, and their practice is deeply embedded into their family history in more subconscious ways (Asai and Olson, 2004). Also, Japanese people are more likely to identify as part of many religious systems than choosing one (Asai and Olson, 2004). Due to these stark differences, the Religious Orientation Scale was dropped from the Japanese version of the PREPARE scale. Instead, researchers included a far more applicable section for Japanese individuals and couples entitled Family Cooperation Scale (Asai and Olson, 2004). This scale considers the expectations for extended family and future in-laws in the marriage, care of aging grandparents, and the reciprocal nature of extended family obligations in Japanese families. For these reasons and more, the PREPARE scale for premarital counseling is an invaluable tool for therapists working with Japanese clients.

Conclusion

Japanese and other Asian cultures are distinct from Western cultures. They apply to culture, society, personality, development, occupation, expectation, and every other facet of life, but this does not mean that current therapeutic approaches and tools are obsolete in these contexts. Therapeutic techniques that focus on each individual's unique qualities are highly effective for Japanese clients because fundamental cultural values are engrained within the client's belief systems. Adlerian therapy tailors the therapeutic relationship and goals to these belief systems; therefore, they are innately effective for many cultures.

One of the starkest differences between Japanese and Western cultures is the collectivistic thinking of Asian cultures. Many therapists may believe that his difference is insurmountable using therapeutic approaches for families developed in the West, but this is not the case. By adopting Western family therapies, McGoldrick and Carter (2001) make it possible to apply practical techniques using one family member as the catalyst for the whole. This family therapeutic approach for the individual considers the differences in Asian cultures while building on the strengths of collectivistic thinking.

Finally, the highly effective tool for premarital counseling, the PREPARE scale, gives therapists invaluable tools for preparing young Japanese and Western couples for marriage. This tool conforms to the societal norm of Japanese collectivist beliefs and considers the importance of extended family. By focusing on these critical factors, the PREPARE tool honors the culture of Japan and strengthens its newest married couples and future families.

References

Asai, S. G., & Olson, D. H. (2004). Culturally sensitive adaptation of PREPARE with Japanese premarital couples. Journal of Marital & Family Therapy, 30(4), 411–426. https://doi- org.proxy.ccis.edu/10.1111/j.1752-0606.2004.tb01252.x

Carlson, J. M., & Carlson, J. D. (2000). The application of Adlerian psychotherapy with Asian American clients. Journal of Individual Psychology, 56(2), 214. https://proxy.ccis.edu/login?u... a9h&AN=9055000&scope=site

Kajino, M. (2012). Individual psychology in Japan. Journal of Individual Psychology, 68(4), 337–350.

https://proxy.ccis.edu/login?u...a9h&AN=85822798&scope=site

McGoldrick, M., & Carter, B. (2001). Advances in coaching: family therapy with one person.

Journal of Marital & Family Therapy, 27(3), 281–300. https://doi- org.proxy.ccis.edu/10.1111/j.1752-0606.2001.tb00325.x