Amer. J . Orthopsychiat.

58(1), January 1988

ETHNIC FACTORS IN GROUP PROCESS:

Cultural Dynamics in Multi-Ethnic Therapy Groups
Philip Tsui, M.A., M.S.W. and Gail L. Schultz, Ph.D.

A framework is presented that was generated by clinical experiences with Asian

clients in predominantly Caucasian therapy groups. Focus is on the impact of
difering perceptions of power, authority, interpersonal boundaries, and family
process on group dynamics. The applicability of this ffamework to other ethnic
minorities is evaluated.

hen one conducts group therapy with
W members of different ethnic and ra-
cia1 backgrounds, what are the clinical im-
plications? When most psychotherapy
groups are composed of a majority of Cau-
casian clients with Asian, Latin, or black
clients in the minority, what does the role
of cultural difference play in the process of
such groups?
A survey of the literature has revealed
only vague references to the first question
and none at all to the second. Yet, as Comas-
Diaz and Minrath (1985) pointed out:
The therapeutic work can progress only if reality is
acknowledged from the start of treatment, and the
manifest and symbolic meaning of socio-cultural
factors carefully explored and worked through.
Drawing on the authors’ experience while
working with Asian clients in predomi-
nantly Caucasian therapy groups, a frame-
work for understanding the manifest and
symbolic meaning of socio-cultural factors
in the group process has been developed. It
is presented here along with analysis of the
extent to which it is applicable to such work
with other ethnic minorities.
THE TRADITIONAL GROUP
Power and Structure
As Davis (1979) has indicated:
. . . perceived differences in regard to skin color and
racial categories-at least in America-follow an
all-or-none principle. If any racial difference is
established, it implies differences in other categories,
such as class, attitude and beliefs.
He further suggests, based upon the results
of another study, that:
. . . a person’s race becomes more important to us
than his own attitudes as the possibility of intimate
social contact with that person becomes greater.
Nowhere, with the exception of mixed ra-
cial families, is there a level of social con-
tact as intimate as that of a therapy group
wherein members often express and act out
their innermost thoughts and feelings.
Because ethnic and racial groups that are
cultural minorities are also numerical mi-
norities in most therapy groups, the latter
become microcosms of the larger society;
~~

Submitted to the Journal in June 1987. Authors are at: Asian Treatment Program, Pacific Presbyterian
Hospital, San Francisco (Tsui) and Alemany Day Treatment Center. San Francisco (Schultz).

136 0 1988 American Orthopsychiatric Association, Inc.

TSUl ET AL
in them the power relationships among var-
ious racial and ethnic groups are re-enacted
dynamically. Since the issues of race and
color are emotionally loaded concerns in
our society, therapists, whatever their ra-
cial or ethnic group, may repress their own
personal stereotypes and fail to work through
them. Such unresolved bias is an important
variable that can have a negative impact on
the therapeutic work of the group.
Thus, before therapeutic work with mixed
racial groups starts, the power relationship
between the minority and the majority must
be understood; such an understanding is nec-
essary before attempting to deal with cul-
tural differences. The group norms com-
prising the so-called therapeutic milieu are
actually Caucasian group norms that, in
themselves, resist intrusion and disruption
from minority cultures. In this regard, it
would be naive to assume that a minority
group member would not react nega-
tively-either on a conscious or subcon-
scious level -to a majority of Caucasians
who all share common values and behavior
and are trying to assimilate the minority
member into what they see as the therapeu-
tic milieu. Attempts to engage an Asian
client through premature requests for per-
sonal disclosure, comments on group pro-
cess, or requests to provide feedback to other
members in relation to delicate issues, might
be experienced as demands by the powerful
collective and, most certainly, as rude in-
trusions on personal boundaries-a form of
domination.
THE ASIAN CLIENT
As the authors have suggested else-
where:
Asian clients comprise a heterogeneous group of
peoples: Chinese, Japanese, Filippino and other
ethnic groups as well, each with unique characteris-
tics . . . our clinical experience has nevenheless
confirmed the existence of sufficient common charac-
teristics among the diverse cultural values of these
peoples to warrant discussing them as a group. Their
cultures tend to emphasize great deference to
authority, more restrained modes of expression,
137
strong family bonds, well-defined social and role
expectations, communal responsibilities, and a prag-
matic view of life and interpersonal relationships,
(Tsui & Schulrz, 1985)
Asian clients are frequently confused by
traditional group therapy with its emphasis
upon verbalization and its confrontation of
internal and interpersonal conflict, individ-
uation and autonomy. It is a therapeutic
system paralleling the mainstream cultural
values of Caucasian America. Asian cli-
ents, coming as they do from families of
comparatively clear role differentiation and
structure (as in the Chinese extended fam-
ily), or much less differentiated familial or-
ganization (as in the Filippino “commu-
nal” family) are often at a loss to relate to
the differing experiences and values of Cau-
casian clients from nuclear families. They
may experience intense anxiety in this
strange new environment, with its empha-
sis upon diversity, as they attempt to inte-
grate new philosophies of being, thinking,
and feeling in order to be a part of the ther-
apeutic process.
The difference in culture must also color
the Asian member’s expectations, sense of
the reality of the group, and types of rela-
tionships within the group. Asian members
tend to introduce a disparate set of cultural
norms and may find the group’s focus on
process and analysis and the group work-
er’s expectations for self-revelation quite
shocking and antithetical to traditional val-
ues in which the Asian is never expected to
disclose family or personal matters to out-
siders. It may also be extremely difficult
for an Asian member to relate to the group
worker as a facilitator of group process
rather than as an authority figure who will
behave in a parental fashion.
Thrown into a strange culture in which
traditional modes of behavior appear inap-
propriate, the Asian is being asked to man-
ifest new behavior without even rudimen-
tary education about the process of group
therapy, the relationship of the group worker
to the group, or what is expected of partic-
138 MULTI-ETHNICTHERAPY GROUPS

ipants; nor is information available about time with discussion of mundane and irrel-
what to expect or what will be gained from evant issues.
such participation. Usually, the Asian cli- The impetus in such a situation is for the
ent is too polite to inquire, since this might group worker and group members to guard
imply criticism of the attending authority- the boundaries of the group. Instead of lis-
the group worker-and may wait to be tening with patience, the group worker may
drawn out by the leader, avoid self-dis- attempt to set limits with such clients, re-
closure with polite nods or smiles, or at- direct or restructure their comments, or in-
tempt to focus upon the trivial as a way of terpret them in such a way that they will fit
participating without violating cultural in with the current focus of the group. The
norms. In addition, the impact of this be- group worker may do this in a way quite
havior on the rest of the group may be pro- unacceptable to the Asian, who will feel
found. misunderstood, unheard. The group worker
has, in effect, maintained Caucasian group
The Initial Presentation norms by siding with the majority in a power
struggle to maintain their dominance. The
Many Asian group members remain quiet
Asian client is either silenced by the group
and withdrawn even when language profi-
or driven out. The group worker and Cau-
ciency is not the issue. Frustrated by the
casian members might then conclude that
failure of a few initial attempts to engage
cultural differences between themselves and
them, both group members and group work-
the Asian member are so immense that it is
ers tend to relegate their failure to “cultural
impossible for Asians to benefit from the
differences” based on assumptions that
group process. They fail to realize that the
Asians are intrinsically quiet, inscrutable,
silent, withdrawn presentation is a defense
clannish, and possibly unavailable to group
against boundary intrusion. Verbosity is the
treatment. As the Asian member sits pleas-
Asian’s way of struggling with the more
antly through session after session, hiding
verbal, active majority to gain control over
frustration and perhaps anger about feeling
the group process; it is a valiant attempt by
alienated from the group, the therapist may
the Asian member to define the group ex-
collude with other members by simply tol-
perience in a way that is comprehensible
erating the Asian’s presence. Attempts by
from that member’s cultural vantage point
the Asian to communicate may be met with
and allows participation in the group.
interpretation, translation, and even assump-
Since this client is a minority member,
tion of role on the part of other group mem-
the chances of affecting change that will
bers, often patronizingly.
engender group support and eventual ben-
Alternatively, the Asian member may be-
efit are nil without the assistance of an ac-
come extraordinarily verbose, talking su- tive, culturally sensitive group worker.
perficially and perhaps tangentially about Without such assistance, the balance of
the issues at hand, but with little reference power in such a group is too lopsided.
to the therapeutic work of the group. Other
members may react with surprise; cer- Defensive Maneuvers
tainly, they will struggle to maintain order Projection. As the Asian client feels and
and coherence. The Asian member in this becomes more out of place in the group, the
case is not only viewed as inappropriately resultant withdrawal and silence create an
monopolizing the group, but also as unso- amorphous, somewhat mysterious figure.
phisticated and obstructionistic, as well as Group members may react to such a pre-
dysfunctional, ignorant, or simply an im- sentation by projecting unwanted aspects of
pediment to the group process, taking up themselves upon this shadowy figure and
TSUl ET AL
then relating to the projected characteristics
instead of to the actual person. The Asian
member may become the “identified pa-
tient,” labeled by the other group members
as sicker, more dysfunctional than they; or
the Asian may be treated as a helpless,
slightly dull, frustrating group member to
be tolerated or ignored.
In disowning their own painful feelings
through projection, group members are re-
lieved of the need to experience such feel-
ings. Often, the group worker, unaware of
the powerful process that is being gener-
ated, cannot comprehend what is happen-
ing; thus, an important event is ignored,
unanalyzed, never dealt with in such a way
that group process could be illuminated. If
this is allowed to continue, the group image
of the Asian client as helpless, dysfunc-
tional, or mysterious and unreachable, is
reified. Group members may, then, re-
spond only to their own projections in their
treatment of the Asian.
If the “helpless, passive” Asian is fe-
male she may become a “China doll,” pa-
tronized, patted on the head, or casually
flirted with; most certainly, she is not treated
with dignity. If male, the Asian may be
devalued, considered dull and limited in
mental capacity, treated in a patronizing
fashion by other members. They may joke
about him but, “He knows I’m just kid-
ding.” Racial jokes may begin to emerge;
the Asian’s language may be mimicked.
Members of the group may be totally un-
aware of the process at this point, and the
Asian client may not acknowledge any neg-
ative feelings towards the offenders, fear-
ing that such acknowledgment would pre-
cipitate confrontations publicly humiliating
to self or to others-anathema in many
Asian cultures.
As the process continues, group mem-
bers may begin to speak for the Asian cli-
ent, to bully the client through inaccurate
interpretation, to attribute nonexistent
thoughts and feelings to this client, finally
to alienate the Asian from the rest of the
139
group. The Asian feels painfully dehuman-
ized and reacts with increased withdrawal,
eventually leaving the group. Most impor-
tantly, this group member is denied the
opportunity to grow, to achieve important
insight, truly to experience the group pro-
cess. The experience becomes counter-
therapeutic.
Intellectualization. Often the group
reaches a plateau in its work and members
may attempt to avoid dealing with their own
resistance by utilizing the Asian client as an
object of study. The Asian’s silence may
become a topic for discussion or lively con-
versation may emerge about Asian cul-
tures, native dishes, and “interesting” ac-
cents (quite possibly followed by requests
for lessons in Cantonese, Mandarin, or Ta-
galog). The group worker must be able to
sense the resistance; it can be recognized
from the intellectualized, avoidant quality
of the group interaction and the omission of
pertinent, anticipated topics-if, for in-
stance, after the suicide attempt of a mem-
ber, the topic of the next session turns to
preparation of rice. This, of course, is an
extreme example; however, the phenome-
non often occurs, usually on a much more
subtle level. Under the pretense of “genu-
ine curiosity,” the spuriously vague intent
of enhancing “global mutual understand-
ing,” the group can often delude itself that
it has completed serious work when noth-
ing of that nature has taken place.
Displacement. Sometimes, frustration
arising during the group process may turn
into anger toward the group worker or to-
ward other members. This anger may then
be displaced upon the Asian clients, who-
because of their courteous demeanor-may
be considered safe targets. Thus, Asians
may be derogated, scapegoated, accused of
being noncontributing members of the group
(“why do we have to have him in this group,
anyway? He never contributes to the pro-
cess.”). An Asian member may be rudely
confronted or subtly terrorized. The sudden
manifestation of undeserved anger needs to
140
be dealt with by an astute clinician, other-
wise the Asian will experience the group as
an assault against which no defense is avail-
able. Worse, the experience will never be
analyzed, and thus will never make sense.
If such a situation persists, the targeted mem-
ber may start to generalize and come to
expect attack on all fronts and for no dis-
cernible reason. Such a process is antithet-
ical to the goal of the group to provide a
safe milieu in which one’s thoughts and
feelings can be shared and understood so
that, with the support of others, the quality
of one’s life can improve. Part and parcel
of this therapy process is to develop a sup-
port group, to grow close to peers, and to
trust.
Polarization. As the group falls prey to
these mechanisms and resistance is allowed
to proliferate within the group without ap-
propriate interpretation by the group worker,
the group is apt to become split along racial
lines, widening the gulf between Asian and
non-Asian members. At this point, mem-
bers tend to divide into camps, the Asian
members sitting together on one side of the
table, the rest of the members on the other.
The dominant group, usually the racial ma-
jority, will assume greater control; the mi-
norities will become increasingly silent. The
group process becomes totally obstructed-
a “them or us” stand-off. The damage has
occurred because the process has not been
appropriately analyzed. Defensive mecha-
nisms and resistance have reigned su-
preme. The group worker may feel the pull
to minimize tension and side with one group
or the other; alternatively, feeling quite un-
connected to either group, the worker may
begin to withdraw in frustration and what
remains is a fragmented group. In effect,
the reality of each participant is sacrificed
to the reification of numerous projections.
GENERAL ISSUES
In summary, the Asian client integrated
into a traditional therapy group is faced with
a formidable power structure-a collective
MULTI-ETHNIC THERAPY GROUPS
of therapeutic and cultural norms that man-
ifest themselves through the group process
and yet are not conscious and are not, there-
fore, available to analysis. The group worker
conducting a multi-racial or multi-ethnic
group is faced with the awesome task of
bringing such norms to group conscious-
ness and establishing a new set of norms
that take cultural variables into account and
unite rather than separate along cultural or
racial lines. Paradoxically, normative cen-
trality can only be achieved through con-
sideration of the cultural and racial differ-
ences that divide peoples and, then, through
their inclusion into the therapeutic group
process.
In the foregoing discussion, we have fo-
cused upon the Asian client for illustrative
purposes, to point out the dynamic process
generated by inter-group differences. The
content of racial and cultural differences
among various groups might differ, but the
general issues of power relations, i.e. in-
group vs. out-group, majority vs. minority,
the struggle for inclusion and, at times, dom-
inance of the group, are inevitable out-
comes of the group process arising from
mixed group composition as well as the
group’s mirroring of certain realities of ra-
cial relationships in American society. As
long as racial and cultural differences are
perceived as significant and emotionally-
laden issues in our society, one will ob-
serve stereotyping, scapegoating, displace-
ment, intellectualizing, and ultimately
polarization along cultural and racial lines-
all in the service of avoidance of self-
reflection and critical analysis of painful
substantive issues. A therapy group merely
reflects, accentuates, and amplifies this pro-
cess because of the intimate and intense
nature of the members’ interactions.
GUIDELINES
The following guidelines are offered to
help the group worker in overcoming the
problems outlined above and to aid in the
TSUl ET AL
use of cultural differences for the therapeu-
tic benefit of the group.
I. Group workers must be in touch with
their own biases toward certain racial or
ethnic groups before beginning to work with
a new group. This calls for an honest ap-
praisal of the way in which they have been
conditioned to think of other racial or eth-
nic groups, discarding the notion that an
academic qualification grants therapeutic
neutrality and understanding that will tran-
scend cultural differences. Group workers
should be aware of possible countertransfer-
ence issues, such as feelings provoked by
silent minority clients. (The silent client is
hardly a new phenomenon and group work-
ers are educated to deal with them; how-
ever, add the variable of a different cultural
background, and the group worker may feel
quite perplexed. What does a silent presen-
tation in this context mean, and how does
this differ from the silence of a client from
one’s own culture?) Workers need to antic-
ipate their own reactions and those areas of
bias that might contaminate response. Such
preparation will diminish potential areas of
difficulty and allow construction of appro-
priate interventions. In addition, group
workers must be willing to work through
similar issues with group members and,
most importantly, be able to serve as role
models for all members. The workers’ abil-
ity to stand firm, contain anxiety, and mold
a group norm of openness, acceptance of
individual difference, and willingness to in-
tegrate a variety of cultural experiences in
the group process will counteract the ten-
dency of the group to polarize along racial
or cultural lines.
2. Group workers should elicit com-
ments from group members about their per-
ceptions of group therapy -what the group
process is all about, and what they expect
from the group. Group workers should take
an active role in generating a set of group
norms which is by and large consonant with
the varying cultural backgrounds and per-
sonal expectations of the group members.
141
The role also includes educating members
of the group as to their function in the group,
the behavior expected, and the nature of
members’ relationships to the group worker
and their peers. Norms that are evolved dur-
ing this process can be periodically evalu-
ated and modified as the therapeutic pro-
cess evolves. Taking this crucial step in
working with a multi-ethnic group is im-
perative because it will forestall the natural
tendency of the majority to define the is-
sues and to fashion the group process with
their dominant cultural values.
3. It is often necessary to acknowledge
and validate the unique life experience aris-
ing from the interplay between the minority
client’s cultural heritage and the realities of
our multi-racial, culturally diverse society.
This step must be taken in order to prevent
the group from treating such cultural dif-
ferences as irrelevant. Group workers must
bolster the feeling that the minority mem-
bers can and do have significant contribu-
tions to make to the group. At the same
time, the workers must help the group move
from fairly concrete discussions of cultural
differences to transcultural emotive experi-
ences, i.e. universal emotional responses to
the difficult human tragedies they all to some
degree encounter, linking such experiences
to issues at hand, such as loss, separation,
and family conflict, as they are manifested
in the different cultural contexts.
One of the major curative factors in group
therapy is the fashioning of a sense of uni-
versality of human response to very diffi-
cult and often painful situations. It is the
task of group workers to create a common
bond despite diversity. As Yalom (1985)
indicates:
. . . Universality, like other therapeutic factors,
cannot be appreciated separately. As patients perceive
their similarity to others and share their deepest
concerns, they benefit further from the accompanying
catharsis and from ultimate acceptance by other
members.
4. Group workers should avoid treating
minority clients as representatives or spokes-
142
persons for their cultures or ethnic groups,
and must assist other group members to
avoid this pitfall. Treating them as repre-
sentatives devalues their own unique life
experience. A norm must be established in
which diversity is valued rather than
shunned.
5 . When a minority client’s behavior be-
comes “problematic,” for example, too si-
lent, too withdrawn, or too argumentative,
group workers must do what they do with
any other client: facilitate the group’s en-
deavors to understand, interpret, and con-
front the phenomenon. The “problem cli-
ent” and other group members who belong
to the same ethnic group should be encour-
aged to reflect on the role of cultural dif-
ference in their behavior and on how large
a part unique personal issues play in the
presentation.
6. Group workers should become neither
overprotective of the minority client nor
overly confrontive. Unnecessary .~protection
of a client can arise from workers’ projec-
tions of their own vulnerability or re-
activation of their stereotype of Asian cli-
ents, for instance, as helpless, fragile, and
inarticulate. Such behavior encourages other
group members to treat the
clients in the same manner or to ignore and
devalue them. ~~~~~~i~~ confrontation can
when the group worker becomes
ious, frustrated, or unable to draw the client
For reprints: Philip Tsui. Northeast Lodge, 272 Ninth St.. San Francisco. CA 94103
MULTI-ETHNIC THERAPY GROUPS
into the group or establish any meaningful
participation.
CONCLUSION
Therapy groups that contain members
from different racial or ethnic backgrounds
present peculiar difficulties for the group
workers who lead them. Failure to recog-
nize the dangers endemic in these difficul-
ties can lead to structural division of the
group along the racial or ethnic lines in-
volved and to perversion of the group pro-
cess through unconscious defensive reac-
tions among group members and, probably,
on the part of the group worker as well.
These problems can be avoided if the group
worker has a proper understanding of the
dynamics of mixed cultural and racial
groups. Such understanding can, in fact,
lead to enrichment of the therapeutic pro-
cess using the very differences that might
otherwise impede it.
REFERENCES
Comas-Diaz, L . , & Minrath, M. (1985). Psycho-
therapy with ethnic minority borderline clients. psy-
chotherapy, 2, 421.
Davis, L.E. (1979). Racial composition Of goups.
Social Work, 24, 208.
Tsui, P., & Schultz, G. Failure of rapport: Why psycho-
therapeutic engagement fails in the treatment of
Asian clients. American Journal of Orrhopsychia-
try, 55, 561.
Yalorn, I.D. (1985). The theory andpractice of group
psychotherapy (3rd. ed.). New York: Basic Books.