PRACTICE FORUM

The Use of Traditional Chinese Culture and Values in Social Work Health Care Related Interventions in Hong Kong
Cecilia Lai-Wan Chan and Howard A. Palley

his column presents information about traditional Chinese values and "ways of thinking" and how such values and understandings may affect or hinder a Western approach to social work practice. We suggest approaches that practitioners can use to adjust their practice to acknowledge and build on cultural values in ways that are therapeutic in health and mental health settings.We examine primarily the relevance of traditional Chinese culture and practices to effective therapeutic techniques among the Chinese population in Hong Kong that is imbued with this culture. (We acknowledge that not all Hong Kong Chinese, who constitute 95 percent of Hong Kong's population follow this traditional way of life.)

were packaged in the form of training classes (Chan et al, 1996;Law et al., 1998).The participants were active in doing their "home-work assignment" and participated actively in learning breathing exercises and acupressure points during the classes (Chan & Chow, 1998). Such psychosocial-educational intervention may be more facilitative for a traditional Chinese population than an emotion-focused intervention (Chan & Chow).

Use of Culture and Tradition

To prevent clients from feeling a "loss of face," social workers may use a consultation approach, which involves older family members and parents as consultants instead of clients (Bond & Hwang, 1986). Chinese people, who are pragmatic, willingly participate in collective problem solving if they are not seen as "the client" but as helpers. A bereavement center in Hong Kong invited bereaved husbands to share their experiences as men with the focused goal of helping a female social worker understand men in grief. These widowers were then more willing to share their feelings because they felt that they were contributing to the social worker's ability to help other bereaved men. If the social worker can show a sincere appreciation of the individual's pride in Chinese ethnicity and respect for Chinese cultural norms, the clients often show a beneficial therapeutic effect.

USING TRADITIONAL CHINESE CULTURE TO IMPROVE THE EFFECTIVENESS OF SOCIAL WORK INTERVENTIONS

The following examples describe some ofthe cultural and behavioral characteristics of traditional patients and their families and indicate how these characteristics can be used to facilitate successful social work practice in health and mental health settings (Chan, 2001).

Value Placed on Learning

Because many Chinese people put considerable emphasis on academic achievement, social workers can design courses or programs that are educational in nature. Traditional Chinese come to classes more readily than to less formal groups because they are more willing to learn in a formally structured environment (Ho, 1986). Instructions using a cognitive-behavioral training approach have been found to generate good responses (Leung, 1997). In counseling groups for cancer patients, as well as anxious or depressed single parents and divorcees, programs

Respect for Rituals

Traditional Chinese families continue to participate in family rituals and celebrate major Chinese festivals. Such practices enhance family interactions that legitimize the showing of concern for one another during such events as the illness or death ofa family member. Families may go as a group to sweep the graveyard of ancestors twice a year and make

CCC Code: 0360-7283/05 $3.00 O2005 National Association of Sociai Workers

wishes in public for good health for all family members. Death rituals can be used also to reduce the pain of bereavement and hasten recovery (Chan, 1998a, 1998b; Chow, 1995;Yang, 1995a, 1995b). During major festivals such as the full moon dinner, the dragon boat festival, end of the year gatherings, and the Chinese New Year, there are family meals and social exchanges of gifts and good wishes. Such gatherings may be an important source of information for social work diagnosis involving health and mental health problems. Moreover, if social workers can be more active in home visits, especially during meal time, the social worker is able to generate important information about family health-related problems and bereavement that can never be generated in office interviews. Promoting the Acceptance of Iiiness, Adversity, and Loss Traditional Chinese values place strong emphasis on concepts such as Buddhist and Confucian virtues of "enduring" suffering (Yang, 1995a). Elderly people can easily talk about their chronic illnessrelated pains and suffering and therefore should not be told by social work counselors that "they will get over it" (Shanghai Cancer Club, 1993). Especially in circumstances where health and mental health problems combine with social and economic adversities that are beyond the individual's control or ability to change, acceptance and willingness to endure suffering are traditional characteristics. Unable to address emotionally laden issues, talking about suffering and bitterness in life allows traditional Chinese to vent emotional frustrations in language that makes cultural sense to them. It is important for social workers to appreciate the strength of traditional Chinese clients in Hong Kong and elsewhere in persevering and performing their obligations as parents, spouses, or children and giving their best to their family members despite their adverse life situations Qeffers, 1993).
A CULTURE-SENSITIVE EMPOWERMENT APPROACH IN HEALTH CARE SETTINGS

terventions in health care settings. By using the culture and rituals creatively, a worker can increase the success of an intervention (Chan & Chow, 1998; Sheikh & Sheikh, 1989). Social workers who work with Chinese clients influenced by traditional culture can be more effective if they use the following intervention strategies and skilled approaches. Forgiveness To help clients and significant others let go of their past bitterness and resentment, it is of utmost importance to help them forgive others with respect to family and other small group tensions. Forgiveness is the key to emotional tranquility. Without forgiveness, individuals hold on to grudges and hatred and remain in a state of agitation. Forgiveness can resolve destructive impulses and free individuals from anger. Forgiveness is easier said than done. Knowing the importance of forgiveness, good role models who successfully forgive can be invited to share their experiences with fellow sufferers in similar circumstances. Forgiveness stems in part from the Taoist and Confucian traditional emphasis on moderation and avoidance of extremes and may also have aJudeo-Christian overlay. Forgiveness is a way to escape the bondage of hatred and anger (DiBlassio, 1998; Sells & Hargrave, 1998). Breathing Exercises Instead of asking cHents to talk about their emotions, one Hong Kong social work practitioner has helped individuals "blow away" their emotional frustrations through simple breathing exercises. Because there is a strong resistance to talking about their anger, behavioral instructions for breathing exercises were found to be far more effective.The breathing exercises were developed from a combination of qi-gong, imagery, and NLP techniques (Lee, Cheng, Leung, Sham, & Wong, 1999; Seifel, 1986; Sham et al., 1999;Tsuei, 1992;Yang, 1995a; 1995b). Clients were asked to image breathing in "energy,""oxygen," and "love," and breathing out "frustrations," "dark clouds on their chest," and all "negativities."These techniques are termed "onesecond techniques," that is, individuals are able to regain control of their emotions through breathing and body movements that take only a few seconds. Such assurance is very empowering. Group members were willing to practice these techniques throughout the day.

From the brief discussion of how tradition and culture in Chinese societies may affect social interaction and emotional exchanges, w^e begin to understand the barriers and hurdles faced by many Chinese who pursue conventional social work in-

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Mutual Support Groups In addition to strengthening clients' individual capacities to cope with adversities in their lives, it is crucial that solid support links and networks be established.When clients graduate from groups, tbey may organize themselves into alumni associations, wbich continue to meet every month. Establishment of sucb effective support is important for promoting a mutual belp atmosphere (Ho, 1998; Seaward, 1997;Wong & Chan, 1994;Yeung, 1990). Advocacy for Justice To move clients from self-absorption in tbeir pain and self-pity, they may be organized into advocacy action groups so tbat tbey can express tbeir opinions on related public matters (Cban & Chan, 1998). Cancer patients bave organized tbemselves to lobby tbe Hospital Autbority to provide adequate psycbosocial care for patients. These patients then felt tbat tbeir suffering could be turned into constructive action in seeking an overall improvement in society.Tbey felt tbat such action gave an enhanced meaning to their suffering. They were helping fellow sufferers as well as tbemselves (Cban & Cban). CONCLUSION Appreciation ofthe cultural barriers of traditional Cbinese clients to a Western model of social work services can enhance and foster tberapeutic rapport between social workers and clients. Such appreciation can also foster important insigbts for social workers regarding culturally related resistance of clients to social work interventions and belp social workers provide effective tberapy in health and mental health settings. i!W''i
REFERENCES
Bond, M. H., & Hwang, K. K. (1986).The social psychology ofthe Chinese people. In M. H. Bond (Ed.), The psychology ofthe Chinese people (pp. 213 266). Hong Kong: Oxford University Press. Chan, C. (1998a, November8-11). Transformation through pain: The growth challenge in cancer and bereavement. Paper presented to the 5th Hong Kong Cancer Congress, Hong Kong. Chan, C. (1998b, July 5-9). Cultural sensitive practice in palliative social workApplying an Eastern belief system into care for the dying. Paper presented at the Joint World Congress of the International Federation of Social Workers and the International Association of Schools of Social Work, Jerusalem. Chan, C. (2001). An Eastern bodymindspirit approach (Resource Paper Series No. 43). Hong Kong: University of Hong Kong, Department of Social Work and Social Administration. Chan, C , & Chow,A. (1998). An indigenous psychoeducational counseling group for Chinese

bereaved family members. Hong Kong Journal of Social Work, 32(1), 1-20. Chan, C.,Ma,J., Chow,A.,Au,T., Leung, P., Chau, P, Fiona, C , Cheng, B.Y.,&Tam,V. (1996). Therapeutic groups in medical settings (Resource Paper Series no. 25). Hong Kong: University of Hong Kong, Department of SocialWork and Social Administration. Chan,Y., & Chan, C. (1998). From case to policy: Organization of single parents and position paper. In W. F. Law,Y. Chan, C. Chan, S. L. Hung, F L.Wong, and K. H.Tsang (Eds.), Empowerment training hand book for divorced women (Resource Paper Series No. 33, pp. 157167). Hong Kong: University of Hong Kong. Chow,A. (1995). The development of a practice model for working with the bereaved relatives of cancer patients. Unpublished master of social sciences thesis. University of Hong Kong. DiBlassio, FA. (1998).The use of decision-based forgiveness intervention within intergeneration family therapy. Famity Therapy, 20,7794. Ho, C.W.T. (1998). Social support as a predictor ofthe psychological adjustment ofpatients with rheumatoid arthritis in Hong Kong. Unpublished master of social sciences thesis. University of Hong Kong. Ho, D.Y.F (1986). Chinese patterns of socialization: A critical review. In M. H. Bond (Ed.), The psychology ofthe Chinese people (pp. 1-37). Hong Kong: Oxford University Press. Jeffers, S. (1993). The journey from lost tofound. Toronto: Random House. Law,W. F, Chan,Y., Chan, C , Hung, S. L.,Wong, F L., & Tsang, K. H. (1998). Empowerment training handbook for divorced women (Resource Paper Series No. 33). Hong Kong: University of Hong Kong. Lee, P W H . , Cheng, J.Y.Y., Leung, R . Y Y , Sham,J.S.T., & Wong,V.C.W. (1999,june 2-4). The potential role of Guotin Qigong for maintaining psychological well-being in patients with cancer. Paper presented at the Asia Pacific Hospice Conference, Hong Kong. Leung, P. (1997). Stress management for cancer patients. In C. Chan & N. Rhind (Eds.), Social work intervention in health care (pp. 85103). Hong Kong: Hong Kong University Press. Seaward, B. L. (1997). Stress management: Principles and strategies for health well-being (2nd ed.). London: Jones & Barlett. Sells,J. N., & Hargrave,T. D. (1998). Forgiveness:A review of the theoretical and empirical literature. Family Therapy, 20, 21-36. Sham,J.S.T., Kwok,J., Leung, PY.Y,Yuen,J.K.T., & Wong,V.C.W (1999, June 2-4). Retrospective and literature review on the clinical benefits of Guolin Qigong. Paper presented at the Asia Pacific Hospice Conference, Hong Kong. Shanghai Cancer Club. (Ed.). (1993). Challenging life:The experience ofthe members ofthe Shanghai Cancer Club. Shanghai: Author, (in Chinese) Sheikh, A. A., & Sheikh, K. S. (Eds.). (1989). Eastern and western approaches to heating: Ancient wisdom and modern knowledge. New York: John Wiley & Sons. Tsuei,W (1992). Roots of Chinese culture and medicine. }ay3, Malaysia: Pelanduk Publications. Wong, D., & Chan, C. (1994). Advocacy on self-help for patients with chronic illness: The Hong Kong experience. In F Lavoie, R. Borkman, & B. Gidron (Eds.), Setf-hetp and mutuat aid groups: Internationat and multiculturatperspectives (pp. 117-139). NewYork: Haworth Press. Yang, K.A. (1995a). Buddhism and health. Heilungjiang, China: Heilungjiang Xinhua Books, (in Chinese)

Health &Sociat Work VOLUME 30, NUMBER I

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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 in Hong Kong. Unpublished doctoral dissertation. University of Hong Kong.

Cecilia Lai-Wan Chan, PhD, RSWf 15 professor,' Department of Sociat Work and Sociat Administration, and director, Centre on Behavioral Health, University of Hong Kong, 10 Sassoon Road, Hong Kong, SAR; e-mait: cecichan@liku.liti. Howard A. Palley, PhD, is professor. School of Social Work, and distinguished fellow. Institute for Human Services Policy, University ofMarytand, Baltimore, MD 21201-11ll;e-mail:hpatley@ssw.umarytand.edu. Direct att correspondence to Dr Howard A. Palley.
Original manuscript received Juiy 17, 2001 Finai revision received January 24, 2002 Accepted November 22, 2002

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