I have chosen to focus this assignment on the Aboriginal and Vietnamese cultures. I hope to be working in an area which will have these two cultures as the dominant groups. The reason I have focussed on Vietnamese refugees instead of the culture of Vietnam as a whole is that the facility I hope to work in has refugees as its main client group. I will give an overview of my research into how best to work in a counselling relationship with people from Aboriginal and Vietnamese cultures, ensuring that I am as culturally sensitive and aware as possible.
Aboriginal culture and counselling:
Most research indicates that cultural barriers are the major reason why Aboriginal people are discouraged or dissuaded from using the mental health service. As practitioners, counsellors have often failed to identify, acknowledge and recognise the central role of Indigenous culture. Historically, there has been a long period of mistrust among the Aboriginal people and white Australians. Federal governments for much of the twentieth century developed paternalistic policies and practices that regarded the removal of children from Aboriginal families as essential for their welfare.
Continuing statutory responsibilities for the protection of children have made many Aboriginal women fear approaching the Department of Family and Community Services for assistance, especially in domestic violence and child abuse issues. It is a fact that Aboriginal people have and continue to experience being discriminated against by white Australians. A large socio-economic gap exists between white Australians and Aboriginal people.
Despite there having been recorded experiences of both Aboriginal counsellors and non-Aboriginal counsellors attempting to keep Aboriginal clients engaged in the mental health service, it is evident that some Aboriginal clients may only turn up for one or two sessions but drop out of the system. The possible factors behind their lack of motivation to keep engaging in counselling service may lie in the means of assistance they are looking for.
The problems of engaging Aboriginal clients in mental health services exist mainly because mainstream services have not provided relevant responses to their crisis situation. Aboriginal clients would first seek practical assistance such as refugee accommodation and food, and they would also seek assistance from their families, extended families or their own communities. Aboriginal people have retained strong kinship ties and extended family commitments. As in traditional times, Aboriginal people feel a great obligation to their kinship ties. The extended family will always be first in helping if there is a crisis or even a slight problem. Only when they cannot get enough or suitable help from their extended family or their own community, will they turn to outside help or support.
There are particular issues to be aware of when working in a counselling role with Aboriginal clients. For example, it is not suitable to refer to a dead person by name and Aboriginal people view hallucination or delusion as spiritual experience not necessarily as symptoms of mental illness. Eye contact is considered offensive to Aboriginal people. Making eye contact (particularly with some one of the opposite sex) is shaming. Gender rules within Aboriginal cultures are important and must be respected whenever possible regarding intervention. Ideally, women staff should work with women and male staff should work with men.
Women may feel embarrassed talking to male staff and men may feel shame if helped by female staff. In building a trust with Aboriginal people, most Aboriginal people would prefer to work with an Aboriginal worker regarding their problems. However situations may arise where clients may know or be related to an Aboriginal worker. They may feel shame or be restricted through kinship rules in discussing personal problems with them. Fear that the worker will breach confidentiality with the local community may be another concern. Where possible, clients should be given the choice of both Aboriginal and non- Aboriginal workers.
Aboriginal clients will usually take the initiative in seeking assistance when a crisis emerges, such as domestic violence or services being disconnected, or having no money to buy food and other essentials for their children. Aboriginal people would first consider practical forms of assistance, such crisis care, financial assistance, medical services, accommodation, food when a domestic problem arises. This sort of assistance is what they really need and want, not just “talk therapy”. Before they can sort out their basic living problems, they may not have the capacity or attention to deal with other psychological issues.
Once Aboriginal clients have settled down and can take a calmer approach to their predicament, it still does not guarantee they will stay with the mental health service. It is not uncommon that once they have solved a problem, they will feel it not necessary to remain a part of the service but may come back a few months later for help when another issue arises. If mental health service workers, for example, have patiently developed a good relationship or rapport with them, counsellors can take advantage of this by reminding their clients of the good they can do when relationships or domestic situations are at risk. The ability of counsellors to invite clients to talk about their problems may make it possible to explore other problems. Aboriginal clients’ particular issues or crises may be linked to other problems, such as child abuse, alcoholism, mental health, unemployment and parenting problems.
It is crucial for counsellors to build a trusting relationship with the Aboriginal community. A relationship that is simply based on “talk therapy” will not work for Aboriginal clients. Counsellors need to know where to get practical assistance for Aboriginal clients. Otherwise, Aboriginal clients may only turn to those services that they feel can really assist them. A counselling service that provides support and practical assistance can become a meaningful referral point within the Aboriginal community.
Vietnamese refugees and counselling:
My research found that there are three recommended points of entry for developing trust and rapport with Vietnamese refugees. These are: Self- presentation of the Counsellor; Approaching the problem and Working through an Issue. Self Presentation of the Counsellor: The style and presentation of the counsellor could be described as ‘being a friend’ to the traumatised client. ‘Being a friend’ does not at all mean shedding the professional counselling role with boundaries and ethics, but rather means that counsellors dealing with these clients should be caring, sharing and acting as a true friend would normally be. Communicating caring to Vietnamese clients is being friendly, warm, interested in family, attentive to concerns raised, being an empathic listener, trying to understand and respond to non-verbal communications, and being ready to assist with practical matters.
Presenting ‘as a friend’ also means that counsellors may initially have to share, or disclose, a little more about themselves than usual. This is often necessary to put Vietnamese clients at ease and win their trust. Another dimension of being a ‘friendly’ counsellor is being a ‘friend in need’. Many counsellors of Indochinese refugee clients have found it vital to assume multiple helping roles and to be actively involved in providing them with practical assistance or concrete services that provide immediate results, before engaging them in dealing with past trauma or in making important self-disclosures. Approaching a problem: The success of establishing trust and rapport with Vietnamese clients is not only dependent upon the way that counsellors present themselves as described above, but also upon the way they approach a problem. Within Vietnamese culture there are distinct ways of dealing with problems.
Prominent features of the Vietnamese style include indirect expression of feelings, reluctance to confront conflictual situations, preference for allowing time to work out seemingly insoluble problems, and reliance on personal inner strength in facing difficulties. Given the quite different ways of dealing with problems in Vietnamese culture, we would like to suggest that non-Vietnamese counsellors have to move slowly and gently and approach with the right timing. Following a respectful, slow pace suitable to the client is important, especially during the rapport building stage, to avoid jarring or offending the client. The timing of approaching the problem is important for maintaining the relationship and for resolving the problem. If the counsellor takes the initiative to bring up an issue, it is important to do this gently, keeping in mind the cultural norm of ‘saving face’ and the risk of confrontation.
Working through an Issue: As issues begin to be worked through, there are three suggested ways of continuing to build rapport and trust with Vietnamese clients: working with somatisation, working from here and now and working through the family. A great number of Vietnamese refugees express their experience of emotional distress under the guise of physical symptoms such as headache, fatigue, insomnia. As somatisation is a culturally acceptable way of presenting mental problems, counsellors can work with these problems first, before moving onto deeper levels. Most Vietnamese refugees are concerned with day-to-day survival. Offering them practical assistance is seen as offering much needed help and assisting to set up a trusting relationship and also an external environment in which emotional issues can be more safely worked through. For Vietnamese, the family plays an important role, in a resettlement country as well as in their country of origin.
It appears to be present and influential in many issues, which the Vietnamese client discusses in the session. The family can support or sabotage the relationship between the therapist and the patient. Therefore, in post-trauma counselling with Vietnamese clients, dealing with the family dimension is crucial for the building of trust and understanding and for the success of the intervention. As in all counselling interventions, it is essential to build trust between Vietnamese-born clients and their counsellors. Points of entry rather than barriers have been referred to in the three aspects of counselling refugees. Credibility and giving are seen as being crucial in this process.
Counselling can be of great benefit to helping Vietnamese refugees on the road to recovery from trauma. Vietnamese refugees have a great need for company, because they have suffered multiple losses, including faith in the goodness of humanity. Through a counsellor establishing a trusting relationship with them, they could regain this faith, so as to enable them to live the life that they have made huge sacrifices for. Prior to undertaking this assignment I had felt that my cultural awareness of both the Aboriginal and Vietnamese communities was very high. I have travelled extensively in Vietnam and had the opportunity to teach English there. My research into trauma and Vietnamese refugee status in Australia has certainly changed a lot of my views. I could almost say that with my basic Vietnamese language and extensive travels I had been feeling almost complacency about dealing with Vietnamese clients. I have learned that there are many parallels between the Aboriginal and Vietnamese refugee cultures. Both are in trauma; both need to have their immediate needs met before effective counselling can take place.
My research into Maslow’s hierarchy of Needs has certainly given the actual practice of counselling clients in trauma an effective framework to work within. As does Erikson’s Stages of Development. Traumatised clients will have interrupted stages of development. These will need to be addressed after the initial and immediate needs are met. I had also felt that I had a particularly good understanding of the Aboriginal culture, having worked in Indigenous education.
My research for this assignment highlighted that there are many gaps to my understanding. I had not taken into account that many Aboriginal people are actually in severe crisis when they do seek help. Similar to the Vietnamese people in trauma, they would first try to find support within their kin, tribe or immediate family. When a breakdown of this occurs, outside help is sought but this is fraught with fear, shame and often misunderstanding. This has been a vital assignment for me to undertake and I will continue to seek current research and counselling developments in the areas of Aboriginal mental health and refugee trauma counselling.
Armstrong, T. (2002). Counselling Interventions and Indigenous mental health. Medicine Australia,http://www.medicineau.net.au/clinical/abhealth/abhealt1345.html. Blagg, H. (2000). Crisis Intervention in Aboriginal Family Violence, Summary report. Crime Research Centre, University of Western Australia.
Chambers, A. (1990). Responding to Domestic Violence: Spouse Abuse. Guidelines to Practice. Department for Community Services, Western Australia, September 1990. Nguyen & Robin Bowles authors, published in the Journal of Australian Social Work, June 1998.