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Differentiation of Self in Asian American Culture: Empirical Evidence and Clinical Applications from Cultural and Christian Perspectives.

Bowen family systems theory (BFST; Bowen, 1978) has become a prominent framework guiding research and practice in the field of family therapy. BFST emphasizes the centrality of the family as an emotional unit consisting of interlocking relationships, where the "thoughts, feelings, and behaviors of each member both contribute to and reflect what is occurring in the family as a whole" (Kerr & Bowen, 1988, p.9). The operation of the emotional system reflects an interplay between two counterbalancing life forces--individuality and togetherness. Individuality is the force toward being distinct and is reflected in the striving to feel, think, and act for oneself. In contrast, togetherness is the force to be connected and is reflected in the motivation to act, feel, and think like others, as well as in the desire to have others reciprocate (Kerr & Bowen, 1988). Bowen posited that a key principle factor that contributes to the balancing between these two forces within family functioning is differentiation of self (DoS), which manifests itself on both the intra- and interpersonal levels. At the intrapersonal level, DoS refers to the ability to distinguish between thought and emotional processes and to maintain a clearly defined sense of self, even when pressured to do otherwise (Bowen, 1978). At the interpersonal level, DoS describes one's ability to maintain a healthy level of autonomy while establishing connection and intimacy with others (Bowen, 1978; Kerr & Bowen, 1988). Once individuals are able to manage and tolerate the dilemma of conflicting and recurring forces to favor togetherness and separateness in the family system, they have developed healthy levels of DoS. Achieving this balance is considered a lifelong and dynamic process that is fundamental and universal to all human beings (Erdem & Safi, 2018; Kerr & Bowen, 1988).

Current research has provided a plethora of empirical evidence for the relationship between DoS and various emotional, relational, and psychological outcomes (Jankowski & Sandage, 2012, 2014; Krycak, Murdoch, & Marszalek, 2012; Sandage & Jankowski, 2010; Skowron & Dendy, 2004). It is important to note, however, that the majority of the studies were conducted in the United States, drawing upon samples that were predominantly White, middle to upper class, and highly educated (Erdem & Safi, 2018). This has challenged some to question whether BFST constructs, such as DoS are "simply reflections of White cultural values" (Gushue & Constantine, 2003, p.2) and not as relevant or positively related to psychological functioning in other cultures and societies (Lee, 1998). Others have suggested that DoS is a meaningful construct, yet may look different in non-Western cultures, particularly within Asian societies (Tuason & Friedlander, 2000). Therefore, within the last few decades, there has been an accumulating body of research focused on expanding BFST to be more culturally expansive in its premise, concepts, and clinical application (Erdem & Safi, 2018).

Asian and Asian American Culture and Values

Culture has been described by Gardiner and Kosmitzki (2005) as a learned and shared way of life of a group of people (shared beliefs, practices, behaviors, symbols). Cross-cultural researchers have asserted that a key dimension to contextualizing cultures is the influence of cultural values, which has been defined as "universalistic statements about what we think are desirable or attractive" (Smith & Bond, 1994, p.52). While Western and Eastern cultures have many differences, one of the most significant difference is the value dimension of individualism-collectivism, which has been shown to shape differing views of the self and the family (Chang, 2015; Triandis, 1995). Individualism is "a social pattern that consists of loosely linked individuals who view themselves as independent of collectives; are primarily motivated by their own preferences, needs, rights, and the contracts they have established with others; give priority to their personal goals rather than the goals of others" (Triandis, 1995, p.2). This worldview of the self explains why the Western family's goal is toward individuation, independence, and self-sufficiency, whereby each member develops a distinct and unique self-concept that is separate from other family members (Chung & Gale, 2009). Without individuation occurring, the expected result is over-connectedness to one's family, resulting in lower levels of DoS (Hung, 2006). Collectivism, on the other hand, is "a social pattern that consists of closely linked individuals who see themselves as parts of one or more collectives (family, co-workers, tribe, nation); are primarily motivated by the norms of, and duties imposed by, those collectives; are willing to give priority to the goals of these collectives over their own personal goals; and emphasize their connectedness to members of these collectives" (Triandis, 1995, p.2). This explains the traditional Asian family's tendency toward connectedness, interdependence, conformity, and harmonious interpersonal relationships (Hung, 2006). At times, through a Western cultural lens, Asian families could be described as lacking emotional autonomy, or exhibiting lower levels of differentiation.

Empirical Evidence for Differentiation of Self in the Asian Culture

In light of the emerging cross-cultural variations in the construct of DoS, a number of researchers have examined DoS as related to emotional, relational, and psychological functioning in Asian and Asian American individuals and families (Chung & Gale, 2006; Chung & Gale, 2009; Lee & Johnson, 2017; Noh & Ross, unpublished). Recent studies have utilized the Differentiation of Self Inventory-Revised (DSI-R; Skowron & Schmitt, 2003), which identifies four aspects of DoS: emotional reactivity, defined as one's level of emotional response to environmental stimuli; I-position, referred to as the ability to adhere to one's convictions despite external pressure; emotional cut-off, described as the capacity to connect with others even in the face of perceived relational threat; and fusion with others, which is the degree to which one is able to maintain a sense of self that is separate from others. Those who are high on DoS as measured by the DSI-R are described as having greater awareness and regulation of their emotions, are more likely to stay connected with others in the midst of conflict, and are able to hold a coherent sense of self while engaging in intimate relationships with others. A sampling of the current studies have yielded a number of interesting and unexpected results.

1. In a study by Kim et al. (2014), relationship between DoS and family functioning within the South Korean culture was examined. It was found that those who had higher levels of differentiation reported healthier family functioning, greater family satisfaction, and more positive family communication than those with lower levels of differentiation. However, contrary to the original BFST, it was found that those who reported more "fusion with others" reported higher levels of family functioning.

2. Similarly, in a study by Chung and Gale (2006), which examined for cross-cultural differences in the relationship of DoS with psychological well-being, it was found that levels of DoS were greater for European Americans than for Koreans and more strongly associated with psychological well-being. However, higher levels of fusion with others was a significant predictor of lower depressed moods in the Korean sample. It has been suggested that for individuals in the South Korean culture, fusion statements might be interpreted as indicating Asian values, such as family unity and social support, which positively contribute to family functioning and psychological well-being. Thus, it would be important for mental health professionals, when working with South Korean families, to "distinguish strong family unity and togetherness among Korean family members from fusion that impedes healthy family [and individual] functioning" (Kim et al., 2014, p.263).

3. In another other cross-cultural study, researchers examined whether DoS had the same association with healthy family functioning, family communication, and family satisfaction among three different samples: South Koreans living in South Korea, South Korean-born citizens living in the United States, and White Americans living in the United States (Kim et al., 2015). Consistent with previous studies, higher levels of differentiation were significantly associated with healthier family functioning in all three groups. However, an interesting finding that emerged was that, compared with the other two groups, South Koreans living in the US reported lower levels of differentiation, yet higher levels of family satisfaction. In addition, there was no significant difference between the White Americans and Korean Americans living in the US in terms of healthy family functioning. Taken together, the results suggest that for individuals influenced by the South Korean culture, where values of family unity and harmony are important, high levels of family satisfaction and family functioning can be experienced with lower levels of differentiation of self, as compared to White Americans. One major limitation noted in this study was that cultural values (collectivism vs. individualism) of the participants were not measured.

4. Finally, in a study which examined the degree to which DoS as related to family functioning was valued differently by Korean and European American individuals (Chung & Gale, 2009), it was also found that both levels of differentiation of self and perceptions of healthy family functioning by the US participants were higher than for their Korean counterparts. However, contrary to what was expected, there was no difference in the magnitude of the association of family health with "I-position" between the groups. This implies that regardless of the specific culture, functional families encourage members to develop the ability to maintain a clearly defined sense of self and express one's personal thoughts and perspectives. Yet, the country where individuals grow up is a more important factor for distinguishing levels of differentiation. Once again, a major limitation to this study was that cultural values of the samples were not measured.

5. In light of these unexpected findings and the noted need for studies to measure and assess cultural values of participants, Noh and Ross (unpublished) conducted a study that explored the moderating effects of Asian American cultural values in the relationship between DoS and psychological well-being in a sample of bicultural adults living in North America. Consistent with previous findings, higher levels of DoS on all subscales of the DSI-R were positively related to psychological well-being. However, this study also found that Asian American cultural values (e.g., collectivism, conformity to norms, emotional self-control, family recognition, and humility as measured by AAVS-M; Kim, Li, & Ng, 2005) moderated the relationship between DoS and psychological well-being in a number of interesting and important ways. First, those who had higher levels of DoS and yet adhered more strongly to the Asian American values that one should conform to the norms of society (conformity to norms) and that one should not express strong emotions because it may disrupt interpersonal harmony (emotional self-control) reported lower psychological well-being. Second, those who held stronger to the value of conformity to norms and merged less with others reported lower levels of psychological well-being. Finally, those who adhered more strongly to the value of collectivism, their tendency to hold a stronger I-position weakened the positive relationship with psychological well-being. Integrating the findings together, these results suggest that although DoS is a meaningful construct in Asian societies, stronger adherence to specific cultural values that are in conflict with the intra- and interpersonal dimensions of differentiation negatively impacts personal and relational well-being for bicultural Asians.

Clinical Applications When Working with Asian and Asian North American Individuals and Families

As noted by Hung (2006) the differences between Western and Asian (Eastern) cultural values can affect the proper counselling of Asian American individuals and families in at least two ways. First, differences between members of the same family due to varying acculturation levels to Western culture can result in increased conflict and disharmony. Second, counseling constructs and techniques that are based upon Western presuppositions, such as differentiation of self, establishing boundaries, and maintaining a clear sense of self can create internal conflicts for individuals and relational conflicts in families influenced by the Asian culture. Thus, therapists working with Asian and Asian North Americans can enhance their clinical work through the application of a few strategies gleaned from research that can be used in practice.

1. Recognizing the importance of DoS as related to emotional, relational, and psychological functioning and well-being, therapists can administer the DSI-R (Skowron & Schmitt, 2003) to assess the level of differentiation in Asian American individuals and family members (Kim et al., 2015). If evidence of lower levels of DoS emerge, therapists can help clients to recognize how they handle tension and anxiety created in their family relationships and guide them in learning how to lower levels of emotional reactivity, unhealthy fusion with others, and/or tendencies toward emotional cutoff in their family relationships (Kim et al., 2015). As supported through the research findings, in order to maximize therapeutic effects with individuals who experience psychological distress or families who exhibit decreased family functioning, therapists need to include efforts to increase levels of differentiation within each member of the family (Chung & Gale, 2006).

2. It would also be beneficial to construct a three generational genogram (McGoldrick & Gerson, 1985) and engage in further discussions with the client(s) to assess for interactional patterns, including triangulations (Kim et al., 2015). Emphasis on intergenerational dynamics by Bowen fits the Asian family tree as it is culturally acceptable to have three generations living together (Chang & Yeh, 1999). If evidence of triangulation is occurring along with other issues, the therapist can coach family members in detriangulating, after which the emotional system of the family can be modified. However, instead of promoting individualism, therapists will need to work with individuals to define and value the "self" within the context of the family system which is congruent with levels of acculturation.

3. At the same time, therapists working with Asian individuals and families in North America should continue to be mindful about their cultural values and strive to work with, and not against them (Tuason & Friedlander, 2000). Clients who report higher levels of psychological or relational distress may benefit from taking an assessment that measures levels of adherence to cultural values (e.g., AAVS-M; Kim et al., 2005) to identify any potential difficulties or conflicts between the different value systems. Caution should be taken in utilizing therapeutic interventions that focus on increasing levels of differentiation, establishing clear relational boundaries, and maintaining a defined sense of self with clients who express strong adherence to values of collectivism and/or conformity to norms. Rather, therapists can help Asian American individuals and families discover the right balance of separateness and connectedness for their particular family unit and needs (Hung, 2006).

4. Finally, effective therapeutic strategies with Asian North American clients need to incorporate other unique cultural values and family characteristics. The first of these is the value of maintaining face (Zane & Yeh, 2002). Face represents the individual's sense of positive image in a social interaction (Oetzel & Ting-Toomey, 2003). Therapists using the Bowen approach can help maintain face by focusing on the more differentiated member in the family and thus protect the dignity of the individual and honor the good name of the family (Chung & Gale, 2006). Other important values include the maintaining of interpersonal harmony and emotional self-control. For clients who adhere more strongly to these cultural values, it is important for therapists to recognize that attempts to push clients for more direct and precise articulation of the problem based on his or her need to have an accurate understanding may cause the client to feel discomfort and experience a loss of face (Sue & Sue, 2016; Wang & Kim, 2010).

In summary, research in cross-cultural studies provides an important reminder to all therapists working with clients from various cultural backgrounds about the necessity of developing competencies in multicultural counselling skills. Multicultural counseling/therapy (MCT) as it relates to the therapy process and the roles of the mental health practitioner can be defined as
both a helping role and a process that uses modalities and defines
goals consistent with the life experiences and cultural values of
clients, utilizes universal and culture-specific helping strategies and
roles, recognizes client identities to include individual, group, and
universal dimensions, and balances the importance of individualism and
collectivism in the assessment, diagnosis, and treatment of client and
client systems (Sue & Torino, 2005, p. 6).


Studies have found that multicultural competence is positively related with therapy ratings and outcomes (Wang & Kim, 2010).

Differentiation of Self and Multicultural Competent Therapy: Biblical and Theological Integration

The theoretical framework of DoS focuses on both the intra- and interpersonal aspects. Theologically, the perfect communion of the Trinity addresses the interpersonal aspects of humanity, focusing on the relationships. This is reflected in the connectedness within intimate human relationships. Anthropologically, the humanity of Jesus the Son is the reflection of God, the imago Dei (Thompson, 1994), through incarnation. Through understanding the way Jesus lives, humanity is able to discern how to live in relation to one another (Thompson, 1994), while holding onto individual diversities. The personhood of Jesus, the second person in the Trinity, addresses the application of intrapersonal individuation into interpersonal relationships. This is reflected through the separateness required in relationships to create healthy relationships. The perfect communion of the Triune God and the humanness of the Son teaches and is a model for the development of relational bonds between persons.

Volf (1996) introduces the concept of exclusion and embrace by integrating values within Christian theology with the manifestation of identity, reconciliation, and differentiation. He suggested that differentiation is a creative activity, whereas exclusion is the sinful activity of reconfiguring creation. Comparing differentiation to DoS, Volf describes differentiation as, "the self and the other take part by negotiating their identities in interaction with one another." (Volf, 1996, p.66). Similarly, to increase the level of DoS, one is to achieve a balance of separateness and connectedness in intimate relationships (Bowen, 1978). Instead of deriving specific steps to formulate a universal understanding of connectedness and separateness, Volf depicts what differentiation is not, specifically through the concept of exclusion. Through dismissing interdependence, exclusion may manifest itself in forms of elimination, assimilation, domination, or abandonment. Skowron and Schmitt's (2003) two out of four identified aspects of DoS, emotional cut-off and fusion with others, parallel Volf's (1996) understanding of exclusion being abandonment or assimilation. Volf specifies that differentiation involves "separating-and-binding" (p.65), addressing the dual aspect of DoS and not dichotomizing the interpersonal and intrapersonal facets of connection.

To be connected requires an understanding of one's own identity. Volf writes, "[p]ersons are not relations; persons stand in relations that shape their identity" (Volf, 1996, p.180). Sociologically, different schools examine the different ways that a person's identity is developed. From a Biblical perspective, the emphasis is not only on the person themselves, but the reflection of God in humanity. In John 15:5 (NASB), Jesus describes himself as the vine and his followers as branches, and without him, they "can do nothing." This highlights the idea of dependence on God in the Christian faith. Without the definitive truth of who God is, a person being imago Dei will lack an anchoring point to base their identity from. Basing one's identity in God allows a person to grow in their capacity to be in relationship with another, welcoming the other into their life without forfeiting their own. Sandage and Jankowski (2010) engaged with Volfian theology, noting that the differentiated capacity to embrace is nurtured and understood through one's understanding of God's love and embrace. Ultimately, any connectedness that humanity has with one another cannot be expressed even partly holistically without the connectedness one has with God.

DoS is not determined solely by the relationship between people. Rather, the individuals' identities are significant in the building of relationships. In 1 Corinthians 12 (NASB), Paul presents the idea that followers in the church are the body of Christ. In particular, Paul emphasizes that there are varieties of gifts, ministries, and effects, but the same God (1 Cor 12:4-6). This passage of Scripture was originally addressed to the Corinthian church and presents the idea of diversity within unity in the church. In contrast, Paul encourages the church of Philippi to share in the fellowship "by being of the same mind, maintaining the same love, united in spirit" (Philippians 2:2, NASB), denoting unity in diversity. Biblically, Scripture sheds light on DoS from a transcultural standpoint with attentiveness towards contextualization. While engaging with the idea of culture, Volf (1996) writes, "[b]oth distance and belonging are essential. Belonging without distance destroys... But distance without belonging isolates" (p.50). As such, individuation and being in relationship both play an important role in understanding individualism and collectivism. To acquire the aptitude to sit in the ever-changing nature of relationships is highly dependent on contextualization, which requires discernment.

In closing, contextualizing the concept of DoS to cultures with varying degrees of separateness and connectedness, specifically in individualistic and collectivistic cultures, requires much consideration. Hung (2006) writes that in practice, the cultural relevance of DoS is influenced by a culture's identity, family values, and view of self. Thus, for therapists working with clients from diverse cultural backgrounds, it is important to hold culture in perspective while trying to understand the intricacies and nuances of DoS. To do so effectively, cultural competence is necessary, but it may not be sufficient. Other attributes, such as cultural humility, have been suggested as being central to effective multicultural counselling (Gallardo, 2014; Sue & Sue, 2016). The concept of cultural humility refers to an openness to working with culturally diverse clients that appears more like a "way of being" rather than a "way of doing" (Owen, Tao, Leach, & Rodolfa, 2011). Therapists who embody culturally humility approach clients with respectful willingness to work collaboratively with them to "understand the unique intersection of clients' various aspects of identities and how that affects the developing therapeutic alliance" (Hook, Davis, Owen, Worthingon, & Utsey, 2013, p. 354). In a therapeutic context, cultural humility of therapists was found to be strongly related to the strength of the therapeutic relationship, likelihood of continuing treatment, and perceived benefit and improvement in therapy (Hook et al, 2013; Owen et al., 2014; Sue & Sue, 2016). Within a biblical context, Jesus exemplified a life of humility (Matthew 11:29) and we as His disciples are called to live with this same attitude (Philippians 2:5-8). As therapists who are both psychologically and biblically grounded, we hold to the belief that DoS must ultimately be God-centered, allowing humanity to be the reflection of both the perfect communion and the perfect distinctiveness of the three persons of the Triune God. And that the differentiated capacity to embrace others is facilitated by a relationship with God in which the person has experienced God's loving embrace of him or her (Sandage & Jankowski, 2010; Volf, 1996). Our role then as therapists is to reflect both cultural and Christ-like humility in who we are and how we counsel.

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Helen K. Noh and Nicole Chow

Tyndale University College & Seminary

Author

Helen K. Noh, Ph.D. Assistant Professor of Counseling Psychology, Tyndale University College and Seminary, 3377 Bayview Avenue, Toronto, Ontario, M2M3S4; graduated from the University of Toronto (Honors BSc in Psychology); MSc and Ph.D in Marital and Family Therapy from Graduate School of Psychology at Fuller Theological Seminary; MA in Theology at Fuller Theological Seminary; hnoh@tyndale.ca

Nicole Hoi Ling Chow, BSc. (University of Toronto) is a third-year Masters student from Tyndale University College and Seminary, completing her Masters of Divinity (MDiv) specializing in clinical counselling.

Please address all correspondence to: Helen K Noh, Ph.D, Assistant Professor of Counselling Psychology, Tyndale University College & Seminary, 3377 Bayview Avenue, Toronto, ON, M2M3S4; hnoh@tyndale.ca
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Title Annotation:RESEARCH INTO PRACTICE
Author:Noh, Helen K.; Chow, Nicole
Publication:Journal of Psychology and Christianity
Geographic Code:9SOUT
Date:Jun 22, 2019
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