Cross-Cultural Attachment,Internationalization,and Systems Theory

Thank you. How have you focused your clinical practice when working with families or couples in terms of a theoretical framework?

Most of my work tends to involve families and couples. So naturally, I would use systems concepts and my training in marriage and family counseling to guide my work with families. Oftentimes, I don’t approach my clients with a specific perspective. I’d see how my client’s issues or the family issues present themselves. For example, if the issues presented are more obviously related to the structural issues of the family, then I would use structural family therapy with them. Or, if the issues are related to attachment, then I would work with an attachment lens. And, if the issues were more about differentiation, enmeshment, and triangulation, then I would work from a Bowenian perspective. I believe that clients present themselves very uniquely for whatever seems to be most salient at the time. And, the issues that bother them most are the ones presented to you in sessions. So, you can actually use the clinical presentation to guide your choice of theory. Of course, we can use various theories to look at the same thing. But I think that oftentimes, certain things are presented to you, or that they emerge in a very clear way that it’d make sense to look at them from a particular perspective.

To be able to be flexible with that.

Yeah, and this works very well with me because of the issues, the presentation of the issues, and the uniqueness of the family.

So through your doctoral program you specialized in marriage and family issues, did you also do your clinical training with families?

Yes, I did my practicum and internships in a community agency. In such settings, you’d oftentimes see families. So, most of my client load was families. I see them with kids, younger or older kids, and adolescents in the family. I had adult individuals who came to see me bringing along their family issues as well. So, you still do family counseling in individual therapy. It is just the theory, the lens you use.

And then when you moved to Charlotte, did you continue to work with families?

I’ve seen a few families here when I was seeing clients part time in an agency earlier. I’ve recently started doing some private practice. Though I do see individuals, I tend to have more couples. I enjoy doing couples work.

Did you also see couples or families in Malaysia when you went back after your master’s program?

Yes, I did. When I went back to Malaysia, I was teaching in a psychology program in a private college. I taught psychology classes, like counseling psychology theory and techniques at the undergraduate level. But part of my job involved providing counseling to students and staff. They allowed me to also see clients from outside the school. So, I saw individuals, families, as well as couples. Sometimes, I would see the students and their families together because the issues were family related. I’d invite the family to come. I saw different races, too, for Malaysia is ethnically diverse.

Would you say that among the three different places, Texas, North Carolina, and Malaysia, there has been a common clinical theme or have there been any stark differences?

Themes. I think they are very different settings. For example, in Texas, I did my doctoral internships in a campus-based community counseling center as well as a community-based counseling center. I also worked as a licensed counselor in two other community-based counseling centers.

Ok, like an on-site clinic.

On-site clinic. That is different from the student counseling center in the Malaysian college. The on-site clinic had an outreach program where student counselors went into area schools. The schools would refer students with problematic issues to us. We would do an assessment in the school with the families and recommend them to come to our clinic for follow-up sessions. We also saw self-referred individuals and families. We only charged them five dollars or nothing if they couldn’t afford it because it’s a training center that served the community.

In the other part of my internship, I had to go to another city, a small little town south of Dallas, called Lancaster. Lancaster Outreach Counseling Center was developed after a tornado devastated the town of Lancaster. It was a community effort in helping the community to recover. I think seven churches came together, pulled together their resources, bought a place, and started an outreach center. A lot of social work happened there, like helping people from low socioeconomic status to find jobs and funding for various outreach projects. The summer is very hot in Texas, so paying the energy bills becomes very difficult for some families. The center would help folks find the resources to pay their energy bills.

After developing the outreach center, they bought a house next door, a little three-room bungalow house, and turned it into a counseling center. The house might have been donated. I can’t remember the exact details. We had a playroom and two individual rooms that we could use to hold family sessions. We turned the kitchen into an office, and the living room was our waiting area. It was very neat. And there was a warehouse next door, like a Goodwill store; so they had a lot of old stuff, and things like that could help people who relocated there, and when folks needed clothing or furniture they couldn’t afford, we would write our clients a voucher, so they could get clothing and household items for themselves and their families. There was also a food bank where folks could get groceries as well. It was a very nice setting. They didn’t have a lot, but they were able to serve a great purpose in the community. I also did some paid work at another counseling center in Garland, Texas. So we saw a lot of families. We saw children, too. That is where I did play therapy and worked with families and couples. I guess you could say there was a common theme of serving families in all the places I’ve worked as a counselor.

It sounds as though you had more access to families in Texas and in Malaysia and you were really providing a great deal of resources to these clients. Very different from the wraparound services we have here in North Carolina, being geared toward more individual plans. It seems to discourage family work; at least that is my experience.

So, I might be wrong, but based on your experience you’ve shared with me, it seems like that’s how it is here in North Carolina. I don’t know, maybe they don’t believe in family counseling or family issues are not reimbursed readily. Or even couples work, many third-party payers don’t reimburse for such work.

True, and also I think there is a cultural piece in North Carolina at least with the clients I see from lower socioeconomic status is that family issues are not to be discussed, you are just supposed to focus on the identified person.

Yes. I don’t know who decided how service is defined, and how service is to be provided. Obviously, it is not systemic. It doesn’t have the systemic perspective I know. Even though they say we are providing systems of care, wraparound service, we really wrap around everyone individually.

Right. And I think that leads into the third question, summarizing your theoretical orientation. Because I’m hearing a lot of systemic theory as your base, and attachment is systemic and intergenerational.

I would say most of the time I operate from a systems perspective that looks at values and gives importance to the interrelationships among different members of the families and the interactions between the families and the larger systems; not just within the family but in relation to the culture and the larger society. For example, the policies and practices of the so-called systems of care instituted by the state and local government affect our clients and what and how they are being served.

Right. And there are so many different levels of the systems, even for us professionally we have systems interacting with other systems. It’s hard. You scratched your head earlier. It’s hard to understand how people don’t use a systems framework because it just seems so intuitive.

But on the other hand, a lot of clinicians are not trained in systems thinking. Part of the problem, I think, is that traditionally counseling has been quite individually based. The focus has been on the individual. Most counseling theories, such as Rogerian, are individual oriented. Even though it talks about the environment being conducive or not conducive for growth, in the end, it’s still very individual based. The family is often not involved in the treatment process. It doesn’t address specifically how you’d change the environment other than the therapist having to provide the core conditions to promote growth. In the end, it’s an intrapersonal model. And of course, you have rational emotive behavior therapy (REBT), cognitive behavior therapy, which are internally and individually focused as well.

And even the history of counseling started with career counseling, helping the individual find a career.

Probably, it’s a reflection of individualism, the dominant philosophy in Western societies. I wondered if the counselors had said to ourselves, “We are not supposed to be systems-oriented because we are not social workers and we are not marriage and family therapists. So, let’s stay away from systems thinking.”

It’s almost like the counseling profession has tried so hard to create its identity as different from social work and marriage and family therapists that we refuse to accept or incorporate the incredibly good things associated with them into our professional practices. We miss out a lot when we try to differentiate ourselves from other helping professions so much.

You know, it’s interesting because I’m thinking about this as we talk. Like in my family class which is normally not a big class. It is an elective; you would think that a lot more students would take the class because they have to work with families when they are out there. We all know that, if you are not trained in systems thinking, or if you do not know how to look for systems dynamics, you will not even know when they hit you. For example, when you get triangulated into a family system, you didn’t even know it because you were not trained to identify and understand the dynamics. And you think you’re helping. So, what I was trying to get at is that after a while, a lot of students in the family class really like the systems framework; they really embrace it and say things like, “Oh, now I see it so differently!” But I have had some students in the Couples and Family classes, in the past would say, “Ok, I’m not going to do it.” They are so frightened by the immensity or the complexity of having to keep in view all that goes in a system. They find the multilayered presentation of the family to be overwhelming. So, it’s very easy to go right back to a linear model such as REBT: “Ok. So, this is your irrational belief.” I’m not sure. Maybe, it’s the way we train and also the way we develop in Western societies as individuals. We are so much more comfortable with problem-solving approaches, as well as individualized approaches. Perhaps, the comfort that comes from accumulated training and exposure prevents a lot of students from actually venturing out and acquiring systems training. What do you think?

I think students do get overwhelmed like you mentioned. Overwhelmed by the complexity of family work, the very nature of viewing families through a systemic lens.

And I think that family work is scary, because it’s one therapist and you’re sitting in front of five people. How do you manage the whole system?

I wonder if it’s the maturity of the individual as well as exposure in training and all of that. Perhaps, it’s all of the above and more. But it sounds like a very interesting research project to consider. What are the individual and contextual variables that predict comfort in working with groups as well as families? Also, what sort of training needs to happen, so we can prepare counselors to feel comfortable and confident in working with systems or families?

And also, whether the person comes from an individualistic society or a collectivist one. Perhaps, the individual who comes from collectivist society is already two steps ahead of the individualistic person because for so long, the individualistic person was taught “you can do it on your own, you don’t need anyone” but the collectivist person understands the systemic framework more intuitively because of cultural immersion.

It makes sense, they don’t have to struggle with it as much, perhaps. Being comfortable with the idea that now you’re dealing with families and groups and all that. It is a level of comfort. That also makes sense why marriage and family programs have three semesters of theories and techniques before students begin their clinical experience, if what I know about MFT training is still true. So students learn all the knowledge before they start practicing. They are more prepared for family work for sure.

In terms of student learning, you’ve developed a lot of courses, the Family class, and the Couples class, for the counseling program at the University of North Carolina at Charlotte. Why do you believe it’s important for all counseling students to be exposed to those topics?

Why do I believe? Well, I believe they have to. This is how I see the world and experience our reality that anywhere you go you’d bump into people that come not from a vacuum but a system, a family, a culture. They come from a set of values that are characteristic of a particular group. So, they just don’t come to you with their irrational thoughts or whatever they’ve experienced. However, their thoughts always have a reason behind it. The voices behind their thoughts come from their own culture, their own family, their relationships at work, or in the school. We are members of multisystems, we cannot run away from it. Even monks live in a community. No man is an island, and no woman is an island, too. So I see this as our reality, this is how we live our lives. This is how our culture is created, maintained, sustained, and perpetuated; so, systems is a way to understand that. A lot of things, if you don’t understand them from a systems perspective, including multicultural issues and social justice, you’re not going to be as effective in working to change the system. It makes perfect sense that you should understand systems, and how systems work, and how systems don’t work, when systems break down. When you understand systems theory, you won’t pathologize a certain member of the system. You will also see how the symptomatic presentations might have been related to the oppression exerted on the family by a larger system such as the mainstream culture. And, it would make more sense for you to develop interventions that target second-order change and not merely first-order change. I believe this is how we work. And, I believe on the experiential level, this is our reality. I believe all therapists need to understand and trained in that perspective. They may not use systemic framework as their predominant modus operandi, at least it is something they need to be equipped with in the event they need to use that lens to make sense of what they are experiencing with their clients, or even with their own selves.

I’ll never forget that student in the family class last year who had been in an internship as a school counselor and was struggling with a student for months. And after about 7 weeks into the class, she decided that the mom needed to come in. During class 1 week she said, “I did it!” Having that lens for her just opened up all of these possibilities, and she said, “Once I was able to have that conversation, once I was equipped with that systemic knowledge, I was actually able to, something was actually able to shift.” And that was a really enlightening moment for me to see systems knowledge in action.

If you don’t have the systems lens, you will not be able to see the systemic issues. But it doesn’t mean systems is the only way to do things. No. But it is a very important way because our lived experiences make more sense when we view them from a systems perspective.

That goes back to the question of your theoretical orientation; it sounds like that is a basic assumption that you operate from, that we live in systems, and systems influence us. And thinking theoretically, of course, there are other options you choose to operate from when people, individuals, or families present to you in counseling.

It gives me an overarching foundation, a framework I frequently use.

We have talked some about multiculturalism and systems, but can you say more about how you think multiculturalism ties in with systems theory?

Systems tells you that culture is part of the system a person or a group of individuals is or are members of. You have microculture, and you have macroculture. Your own family system gives you microculture that you live in and then that microculture interacts with the larger macroculture. So, I think systems and multiculturalism go hand in hand; it makes sense to see multiculturalism from the systemic lens. It’s like when I say, “I come from a different culture,” is equivalent to saying, “I come from a different system.”

They really do seem to go hand in hand. Thank you for this discussion. We’d like to move on to our next question. Do you believe there is a specific topic or direction the field of family counseling needs to move in?

I don’t want to sound too cliché, but I think looking forward, we need to seriously consider internationalization and globalization. I think it’s very useful to see how the assumptions and values of systems thinking can help us better understand globalization and internationalization. Because when we talk about globalization, we are talking about systems interacting and coming together and all that. Many systems are at work in our world such as capitalism, communism, and various philosophical systems. We need to look at how they interact in and shape our globalized existence.

I’m not saying that this is the only direction to go, but I think in our training as marriage and family counselors, we can push ourselves a little bit farther in helping ourselves understand the real macro dimensions of what is happening in the world and how do we play a role within our culture as well as across cultures. Because now we don’t have to take a plane to go to another place, we can just hit Skype, or dial, or call to cross borders via information technology. Cross-cultural interactions and influences take place technologically in an instance. How do American marriage and family counselors contribute to the world at large, as well as, you have no choice but by osmosis, absorb influences from other cultures? How do we learn and gain from other cultures and no posture ourselves as the expert because we are from North America, or not just North America, but the United States of America. Because we have done family counseling forever, so here we come to tell you how to do family counseling in your country. As we value what we bring to the table, we also need to encourage and value participation from practitioners in other countries and cultures. These practitioners from other cultures have much to bring to the table as well. We can learn from each other. Because somehow the world is lopsided in terms of political and economic power, the West is still in control. Like it or not, the power differential is there. So, it is incumbent upon us to be humble and work toward empowering family counselors from other cultures/societies who might experience themselves as less than because of how the power differential has played out through the centuries. Many have looked to the West for the panacea, for ideas to help them. I think we need to respectfully help them see that they have so much to bring to the table. So, I would like to see this: That we would truly respect all cultural systems; we neither demean ourselves or others. We come together and see how the synergy can actually help push and expand and bring good to humanity; and to make globalization not a bad word, but something that can benefit all of humanity. This doesn’t mean we don’t challenge the system when it’s oppressive and inequitable. All cultures have good and bad elements in them. How we go about challenging and changing them in respectful manner is what we need to explore.

What I like about what you said is that I think a lot of people think internationalization is about us from the United States going and spreading our word, the gospel of counseling, but it really needs to be a two-way street or it’s not going to work. Honoring other cultures, other systems, that they have so much to bring to the table too. I think that’s a great point.

I appreciate what some Western psychologies and counselors have done in embracing the ideas and practices of mindfulness and meditation. There are a lot of Eastern ideas that are grounded in philosophies and systems of thoughts, for example, the yin and yang principle. I use this dialectical perspective frequently in helping myself understand and explain to my clients some of the dilemmas they experience. I also use it to help students understand some of the concepts they struggle with. For example, I use yin and yang to explain the concept of differentiation within couples therapy which David Schnarch’s model is based on. The struggle for autonomy and closeness is like a yin and yang struggle; how do we balance between closeness and autonomy? The yin and yang idea contends that within the yin there is a little of yang and vice versa. Likewise, we should consider that within closeness, there should be autonomy and within autonomy, there should be closeness. Balance and harmony is the goal. The process is dynamic and ongoing. Both have equal value. This then challenges the idea that autonomy is more esteemed in individualistic cultures than is closeness, but closeness is more esteemed in collectivist cultures instead. I’m glad dialectical thinking is being used in therapy such as dialectical behavioral therapy. It is a systemic concept.

I wish counselors and practitioners in the non-Western countries could learn to value their own traditions and how they can actually contribute. So when I go to other places, like China or Turkey to do training, I’d tell them that a lot of what I was saying to them were Western ideas, but they have their own ideas that are grounded in their culture. I’d invite them to talk about how we could make what was presented work sensibly in their culture. What from their culture can they incorporate into what we have learned today?

Thanks, Dr. Ng. Please describe your research interest in working with families.

My research interests…Because I am a Malaysian by nationality, a lot of my research concerns with marriage and family issues in Malaysia. But, my research interests go beyond marriage and family issues, for example, counselor training. Because of my interest in positive psychology, postmodernism, and social constructivism, my research tends to gravitate toward that direction. I have been studying subjective well-being, marital satisfaction, life satisfaction, attachment, solution-focused, and narrative therapy. I will continue my research in these areas in the foreseeable future. I have also recently developed some interest in neuroscience and therapy. I will also continue to do more work in internationalization.

It sounds like that’s what your projected research will be.

I will continue to do that as well as explore the interaction between multiculturalism and systemic knowledge. I think a lot of us still have a lot of blinders. So, even though we might say we are very systemic, very multicultural, we still have blinders. We need to examine the cultural biases embedded in the existing marriage and family therapy models and encourage the development of marriage and family models that reflect the values and practices of the local community.

Right, so there’s that need to diversify the profession in general.

I definitely think that internationalization and globalization are important to our profession. Using a systemic framework to guide our efforts in internationalizing counseling training and practice will help us achieve our efforts in a reciprocal manner. So, we don’t go across border to convert other people to our ways of doing counseling and training.

Say for example, you are an international expert, or trainer, going into someone else’s system just like a counselor “barging into” a family. From the perspective of second-order cybernetics, you bring in your stuff, your assumptions and presumptions, all that you bring into the encounter. And then after 1 week you leave. When you entered into the system, you stirred up something. You tipped their homeostasis. So we have to realize the impact we exert when we go into another system temporarily. We will leave an impact for better or for worse I believe we need to be more responsible about the process; not just the content, what we bring to them, but also the process, how we interact with them. Do we go in as an expert or as an equal? Do we sit with them at the table as equal or have them sit on the floor while we sit on the chair, metaphorically speaking? So, we can use systemic principles to help us understand our role when we cross borders. We can go into another culture in ways that perpetuate the perception that we from the West and are better than them. That would be a negative feedback, cybernetically. Here I come to I teach you and you follow me. Or, we can go in to another culture and invite and encourage them to learn together, look at our similarities and differences, our strengths and areas that need improvements, and how we can grow together. This is positive feedback, cybernetically.

Understanding this is a two-way street.

Yes. Let’s return to my interest in attachment theory and cross-cultural attachment research. In the last few decades, so much work has been done. There are now a lot more people are looking at cross-cultural issues in attachment. We have learned enough to know that some things are universal and some are not. We need to continue this line of inquiry. The field really needs more refining, so the theory can be revised and be more generalizable across social settings. I would like to continue to do more work in this area. I would also like to look at developing attachment-based interventions that are informed by cross-cultural findings, so the interventions are culturally responsive and can meet indigenous needs. Attachment isn’t just a biological system for security but also a system that sets the stage for other learning, other developments such as emotional development, cognitive development, behavioral development, and social and interpersonal development. So, I think attachment framework has huge utility across cultures.

Again, it’s another one of those basic assumptions. You use attachment theory to understand and inform your practice and research across cultures.

I think we don’t need to argue that every individual, every culture wants to survive. That is a given, a presupposition that we don’t even have to question. As humans, we want to survive. So, the assumption that the attachment system is for survive is universal. But the expression of attachment orientation differs across social settings. The value of attachment differs across cultures. The question is how do we use the theory to benefit people across the world?

Based on the review of your resume, would you say you are one of the top people interested in marital satisfaction among Asian people?

I wouldn’t say that I am one of the top people interested in marital satisfaction among Asians, though I do some research in this area. There a number of researchers in Hong Kong and Taiwan who have produced a lot of work in marital satisfaction among the Chinese. There are hundreds of people groups that are lumped together as “Asians.” From that perspective, my work on marital satisfaction among Asians is still quite limited.

So, for example, I wanted to invite a speaker to come and talk about, marital satisfaction, and family therapy specifically within the Asian culture, would you be a good resource for that?

I would say yes and no. Yes, because not that many researchers in the United States have done research in the area like I have. I also have done some work in China and Malaysia. In my writing, I have come across works in this area written about other Asian people groups. As such, I have a knowledge base on marital satisfaction in Asians in general. No, because there are so many Asian groups which have yet to receive research attention. I really don’t know about most of them specifically.

That sounds when you talk about Asians you are not limiting it to the Asian American population. You include people from other Asian countries.

Thank you for sharing your insights with us Dr. Ng!

Yes, thank you.

Thank you for this opportunity!