Family Harmony And Filial Piety

Published Date: 02 Nov 2017

Michelle R. Palu

University of Southern California

Professor Murad

Individual Assessment

Introduction

In the traditional East Asian cultures, high value is placed on family harmony and filial piety. There is also an expectation elders will be honored and obeyed. Growing up with these cultural beliefs and values shape how elders identify their role and status in the family. Conflicts arise when younger, less traditional generations do not share the same cultural beliefs and values (Lee & Mjelde-Mossey, 2004). For the purpose of this assessment the multigenerational Kim family will be evaluated. Specifically, an in-depth assessment will be conducted on the Kim family paternal grandparents, Jin-Ho and Hyun-Ju, through a cultural lens, examining the incongruence in cultural traditions, values and beliefs through the generations.

Family Composition

The Kim family is a multi-generational family comprised of seven members, including paternal grandfather, Jin-Ho Kim and paternal grandmother, Hyun-Ju Kim, whose exact ages are unknown but estimated to be in their late sixties. Jin-Ho Kim helped work in the family store until recently. Hyun-Ju Kim assists with caretaking for the grandchildren and the family home. The father, Jang-Ho Kim is 45 years old and owns the family store, where he imports Korean products. The mother, Kyung-Soon Kim is 43 years old and is a homemaker who cares for her children, as well as her in-laws. There are three children in the Kim family which includes the oldest son, Jung-Hee Kim, who is a 19 year old college student. Jung-Hee also helps his father run the family store. Young-Mi Kim is the family’s 14 year old daughter who attends middle school. Jong-Su Kim is the youngest son who is 10 years old and attends elementary school. The Kim family is of Korean decent and could be defined as "working class."

Types of Problems

Jin-Ho Kim and Hyun-Ju Kim can be defined as first generation immigrants from Korea. Although their son, Jang-Ho Kim and their daughter-in-law, Kyung-Soon Kim, also immigrated from Korea, they immigrated as young adults. Jin-Ho and Hyun-Ju immigrated from Korea in middle adulthood, their mid-forties. Acculturation is the process of adapting to a new culture. Acculturation can be stressful as it requires sudden changes in immigrants’ lives including language, social status, relationships, attitudes, values and beliefs, behaviors, cognitions, personality and cultural orientation (Park & Rubin, 2012). One of the biggest issues within the family is the level of acculturation between the generations. Jin-Ho and Hyun-Ju’s relationships, attitude, values and beliefs, behavior and cognitions are formulated through their Korean culture. Disagreements arise when the grandparent’s Korean culture collides with their children, or grand-children’s, Western culture in certain aspects of their lives.

One of the most fundamental values in the Korean culture is filial piety. Filial piety is the essence of all virtue. Filial piety consists of service to one's parents and includes three important conditions: respecting parents, bringing no dishonor to parents, and taking good care of parents (Sung, 1990). Felial piety outlines the duties and obligations between parents and children which maintains harmony and order in families. It is a way of life where the group comes before self and elders are to be honored, obeyed and cared for. Filial piety also goes beyond caregiving, as it is about authority, power, transmission of knowledge and values and the continuation of family lineage (Lee & Mjelde-Mossey, 2004). Although Jang-Ho and Kyung-Soon uphold the value of filial piety by taking care of Jin-Ho and Hyun-Ju, there appears to be incongruence in upholding the values of obedience, power and authority of elders.

An elder’s position within the family reflects their position in society, as well as their own personal measure of growth. Jin-Ho and Hyun-Ju carry the cultural belief age brings obedience, honor and care. Unfortunately, due to the cultural conflict between Jin-Ho, Hyun-Ju and their children, they are now challenged to find a new role within the family, and society (Lee & Mjelde-Mossey, 2004). Jin-Ho is no longer contributing to working in the family store and Hyun-Ju and Kyung-Soon are conflicted on how to raise the grandchildren. It is difficult for Jin-Ho and Hyun-Ju to move from a position where they should be regarded as the most but now are the least.

Another issue faced by the Kim family is Jin-Ho’s forgetfulness. Jin-Ho has been working in the family business until recently, when he had a series of problems at the store, including going out for lunch and not being able to find his way back and not remembering long-time customers. Hyun-Ju attributes Jin-Ho’s forgetfulness to no longer being able to work in the family store. This causes further confrontation between Hyun-Ju and Kyung-Soon as Hyun-Ju blames her daughter-in-law for the reason her husband is no longer working in the family store and now having issue with his memory. Unfortunately, Jin-Ho may be experiencing symptoms of Alzheimer’s disease.

Alzheimer's disease is a gradually progressive disease of the brain which is defined by impairment of memory, and in time can lead to disturbances in reasoning, planning, language, and perception. Warning signs of Alzheimer’s disease in which Jin-Ho exhibits includes disorientation to time and place, misplacing things and memory loss (Shiel, 2013). In the Korean culture symptoms of Alzheimer’s disease can be incorrectly attributed to signs of normal aging. Furthermore, Alzheimer’s disease itself is not recognized as a disease, and again, is attributed to normal signs of aging (Chee & Levkoff, 2001). It is evident Hyun-Ju would disagree Jin-Ho could be experiencing early symptoms of Alzheimer’s disease, as she believes his memory could be restored if he returned to the family store. Intervening in this aspect of the family dynamic may be challenging, as culturally, the family views Jin-Ho’s memory impairment as a normal part of aging.

Family Strengths

Although the family’s Korean culture is a source of conflict within the family, it is also a family strength. East Asian cultures are considered to be among the highest in familism (Knight, Robinson, Flynn Longmire, Chun, Nakao, & Kim, 2002). Closely connected to the value of filial piety is family orientation. Every person must be able to maintain their responsibility to the family and think of family first (Sung, 1990). Although there appears to be cultural incongruence within the family, there continues to be a sense of familism. The children maintain a sense of filial piety by taking care of Jin-Ho and Hyun-Ju by having them move into their family home when the family’s uncle passed away.

The Kim family also possesses a strong work ethic. For most Korean immigrants, their American dream includes establishing stability in order to build the future well-being of their children, measured by educational and occupational achievements (Yoo & Kim, 2010). Jang-Ho works long, hard hours in the family store in order to provide for the family. Because of their strong work ethic, Hyun-Ju finds it especially important for her husband to continue to work in the family store to help contribute to the success of the family.

Internal and External Environment

The internal boundaries within the Kim family are unclear, inflexible and conflicted. Internal boundaries are the family’s development of networks and relationships between coexisting subsystems. It is important these boundaries are flexible, stable, well-defined, and allow exchange of resources between members of subsystems (Hepworth, Rooney, Rooney, Strom-Gottfried, & Larsen, 2009). Contributing to the unclear and conflicted boundaries between family members, especially between Kyung-Soon and Hyun-Ju, is the cultural practice of the eldest son's wife mainly taking responsibility for caring for the elderly parents, because the eldest son is physically and financially responsible for his parents. This type of relationship between caregiver and care receiver produces an emotionally distressful relationship (Knight, et al., 2002). Korean daughters-in-law may have affection for their elderly parents, but they are more likely to be carrying out caregiving duties as a formal fulfillment of filial piety responsibilities (Chee & Levkoff, 2001).

Individual Intervention

For the purpose of suggested interventions for the Kim family, this section will focus on an intervention to serve directly for the paternal grandparents, Jin-Ho and Hyun-Ju. As stated before, Jin-Ho is suffering from memory loss and disorganization. These could be early signs of Alzheimer’s disease, but according to the family’s Korean cultural beliefs, they view his symptoms as normal signs of aging. Jin-Ho’s forgetfulness has become a source of conflict within the family, exhibited by his inability to work in the family store and Hyun-Ju attributing his memory loss to the fault of her daughter -in-law. The proposed intervention will address Jin-Ho’s Alzheimer’s disease and include a pscyhoeducactional group focused on providing information and education about dementia and Alzheimer’s disease, increasing social support and problem solving skills.

The psychoeducational group intervention includes components of education and support. This intervention focuses on increasing group participants’ social support systems and providing education and information about relevant skills and topics. The effectiveness of the psychoeducational group intervention on dementia patients and caregivers has been well recognized, as it has shown to be effective in decreasing caregivers’ burden and increase well-being (Lee & Yim, 2013). In addition to providing education, increasing support and problem solving, it will be imperative for the psychoeducational group to also include the Korean culture into the context of the group.

In the Korean culture there is an emphasis on family harmony, in which the elders are incorporated into the entire family dynamic and their behavior affects everyone in the family. The emphasis on "harmonized relations" may influence families not to receive formal services for demented patients due to the belief these services may disrupt the family cohesion. There is also a cultural practice of "saving face" where family issues are purposely hidden from the community. By limiting access to outside support, families are fulfilling their filial piety responsibilities while avoiding criticism (Chee & Levkoff, 2001). It will be vital for the participation of Jin-Ho and Hyun-Ju to feel as though their cultural beliefs, values and attitudes are taken into account in order for them to share sensitive and personal information with others, as well as, utilize formal supports.

The pscyhoeducational group intervention for Jin-Ho and Hyun-Ju will include three important components: education, social support and problem solving. In this group, the education component can include information about dementia and dementia caregiving, anger management and coping skills, and community resources. The support component can include discussion about the meaning of dementia caregiving in their cultures, developing active coping skills in a culturally competent way, and emphasizing the positive aspect of caregiving (Lee & Yim, 2013). The starting point for this psychoeducational intervention will be to ensure the family has a basic understanding of Jin-Ho’s illness and the treatment and care options which are available (Zarit, 2007).

A lecture on dementia will be provided in which the definition, types, etiology, and treatments of dementia are introduced. Relevant reading materials and resources on dementia will be provided, as well as ensuring materials will be available in the Korean language. The group will have time to ask questions, address concerns and discuss ways in which to manage the disease. Dementia caregiving skills will also be discussed, as well as the importance of and skills for maintaining mental and physical health of family caregivers (Lee & Yim, 2013). One of the most important types of information which will be provided will be addressing the family member, or members, understanding of Jin-Ho’s illness. Families often misunderstand or make incorrect attributions to the person’s behavior, which can lead to family stress (Zarit, 2007). It will be important for Hyun-Ju to participate in this educational piece, as she may begin to learn how her husband is feeling and where he is coming from, as well as begin to recognize her daughter-in-law cannot be at fault for his forgetfulness.

The second treatment technique which will be used in the pscyhoeducational group will be social support. In order to prepare for the challenges they will face, families will need to be able to access support from family, friends and formal service providers. Through this component of the intervention, the clinician will assist group members in exploring ways in which to access support. Group members will also identify reasons for their reluctance in accepting support (Zarit, 2007). The role of social support with dementia caregiving will be discussed. Group members are encouraged to review their support systems and think of ways in which they can increase the quality of that support (Lee & Yim, 2013). Group members will be presented with community resources for their area, including information about adult daycare centers and nursing homes for Korean speaking dementia patients, and information on legal and financial issues relating to dementia caregiving. Group members will also be provided with culturally relevant resources, such as Korean churches or services provided by Korean providers.

The last technique will be problem solving. Through this component of the intervention, group members are taught how to handle the dementia patient’s behaviors, as well as other stressors in their lives. Before giving up, group members are encouraged to find out if there is something else they can do to improve their situation. Through this problem solving technique, group members can identify triggers or a series of events and discuss alternative ways to handle situations (Zarit, 2007). This part of the intervention could go beyond just the care for Jin-Ho. It could also assist Hyun-Ju in developing alternative responses and actions to other issues that are occurring within the family. Furthermore, the group will be provided behavioral modification skills training. Effective skills to managing difficult behaviors will be discussed. The group will also address the importance of maintaining mental health during caregiving for a dementia patient.

In addition to problem solving and behavioral modification techniques, cognitive-behavioral therapy will be provided to group members. Family members will review their preconceived beliefs and adjust the dysfunctional idea into an adaptive healthy result. The group will also discuss coping skills they currently use, as well as discuss the importance of using healthy coping strategies on a daily basis (Lee & Yim, 2013). As a part of the coping skills discussion, effective communication skills will be introduced. Effective communication skills will include asserting themselves and expressing needs and concerns to other family members or formal service providers. This component of the group will also be beneficial to Hyun-Ju as the communication within the Kim family is strained and conflicted. This will help Hyun-Ju begin to communicate more effectively between all of her family relationships. This technique will also be powerful for the rest of the Kim family to utilize as well.

When conducting a psychoeducational group with families of Korean decent, it is important to incorporate the Korean culture into the context of the group. For Jin-Ho and Hyun-Ju, they hold more traditional Korean values, beliefs and attitudes. Also, the value of filial piety is extremely important in the lives of the Kim family. The value of filial piety influences the definition of the needs and ways in which these needs are to be met in the Korean elderly. This social value is essential in the planning and delivery of services for the Korean elderly (Sung, 1990).

Group as a Whole

Increasingly, family therapists are faced with working with families who are culturally diverse. The younger generations tend to adopt more Western cultural traditions, while the elders tend to remain loyal to their traditional culture (Lee & Mjelde-Mossey, 2004). In regards to the Kim family, the strong traditions based on family interactions and contribution to the group may conflict with more Western values, which would find these actions meddlesome and controlling. Strain has developed between the generations in the Kim family as they attempt to coexist in an environment that requires them to adapt to one another (Lee & Mjelde-Mossey, 2004).

Group Assessment

Culturally, East Asian populations do not seek formal help due to the fear of shaming the family name or loosing face (Lee & Mjelde-Mossey, 2004). Recognizing members of the family may be resistant to formal support, the therapist will meet initially with the Kim family in their home. The therapist will use a solution focused approach in order to assess and intervene with the Kim family. The solution focused approach incorporates empowerment and a strengths perspective.

Keeping with cultural sensitivity, the therapist will recognize and respect the intergenerational hierarchy within the Kim family and address the oldest male in the family first (Lee & Mjelde-Mossey, 2004). The therapist will gather from Jin-Ho’s perspective he feels useless within the family because he is no longer working in the family store. Culturally, Jin-Ho’s position in the family reflects his position in society, as well as measure of personal growth (Lee & Mjelde-Mossey, 2004). Jin-Ho also feels nervous in regards to his forgetfulness and disorientation. Although, culturally he views these symptoms as normal signs of aging, he is baffled at the early onset of these symptoms as he is only in his late sixties (Chee & Levkoff, 2001).

Hyun-Ju also shares her husband’s concern of him no longer working in the family store and feels frustrated and annoyed her daughter-in-law is keeping him from working. Hyun-Ju is also concerned about her husband’s forgetfulness and attributes his forgetfulness to not working in the store. Hyun-Ju also expresses feeling devalued as she feels her son and daughter-in-law are not living up to their filial piety obligations of honor and obedience. Hyun-Ju feels their conflicted relationship could be resolved if her daughter-in-law followed traditional cultural values and obeyed her suggestions regarding the family.

Next, the therapist would assess Jang-Ho’s perspective of the family dynamics. Jang-Ho reveals he does not necessarily agree with receiving the family therapy, which is common in Eastern Asian cultures to not feel the need in seeking mental health services (Bentelspacher, DeSilva, Goh & LaRowe, 1997). During the assessment Jang-Ho admits to feeling stressed due to different reasons. One stressor Jang-Ho describes is the pressure of being the financial supporter to his parents and children in one household. He especially feels this way due to his father, Jin-Ho recently not being able to help at their family owned store because of his memory loss. Jang-Ho also expresses his expectations of his oldest son, Jung-Hee contributing his hours at the store. According to filial piety, Jang-Ho’s respect in honoring elders and their wishes is important in understanding his expectation of his son’s duties at the store. Jang-Ho’s other concern is his daughter’s recent delinquent behavior. Overall, Jang-Ho feels he is letting down his family by not living up to their expectations of being the primary supporter (Bentelspacher, DeSilva, Goh & LaRowe, 1997).

The therapist assesses Kyung-Soon following her husband’s assessment. During her assessment she seems nervous to be the one to seek mental health services and worried about how her family would react to the therapist being in the home. She describes feeling stressed with the responsibilities of caregiving to her in-laws and parenting her 3 children. Kyung-Soon also discloses that she feels her communication and relationship with her husband and mother-in-law is poor. She is open to participating in therapy if it will help the overall function and harmony in her family.

The assessment of the Kim children will begin with the oldest, Jung-Hee. The assessment will focus on his roles and responsibilities as a member of the Kim family. Because Jung-Hee plays an important part in the lineage of the family and the future of the family business, the therapist will assess Jung-Hee’s personal and professional goals. The therapist will also evaluate Jung-Hee’s perception of culture and how it plays a role in his family. He will withhold any disparaging remarks about the elders in his family. Jung-Hee will also discuss how he feels he cannot discuss his sexuality internally and how this causes problems with his relationships outside of his home. He states he is afraid of "coming out" because in Korea the word for gay translates to "being hidden" (Leong, Leach, Yeh & Chou, 2007; Nakajima, Chan, & Lee, 1996; Sohng & Icard, 1996).

His younger sister, Yong-Mi is open to talking to the therapist because she does not associate with the same cultural values the elders and even her older brother hold. She expresses her parents do not understand her and they are racist because she is not allowed to see Hector. She explains even though she hates her mom, she respects her because she never told her father about her run in with the police. Yong-Mi does not want to disappoint her mother or embarrass the family.

Jong-Su is very quiet and shy. He does not say much and is more comfortable with his mom present during his assessment. He does not talk about himself but is focused on discussing a video game he plays on his computer. He is an expert about his game but cannot answer any personal questions about himself. Mom shares a letter she received from the school, but does not understand what and IEP is or why he needs one.

Group Intervention

Collaborating with the family in the therapeutic process, the therapist now moves the family to define goals, using the family’s strengths and resources. This solution focused approach is also compatible with the value of saving face. This non-confrontational technique holds family members accountable for solutions rather than focusing on problems (Lee & Mjelde-Mossey, 2004).

After the initial assessment, Jin-Ho and Hyun-Ju find they are equally concerned about Jin-Ho’s memory loss, disorientation and lack of work in the family store. Through collaboration with the therapist Jin-Ho and Hyun-Ju agree to access assistance from a psychoeducational group focused on providing information and education about dementia and Alzheimer’s disease. The solution focused intervention aligns with the Kim’s family values. Although there are cultural differences between the generations, the Kim family, as a whole, values group success and family harmony. Effective communication will give them the tools to be able to maintain their family harmony across the generations. The family learning effective communication may be one of the most beneficial components of this intervention.

The suggested intervention for the Kim parents Jang-Ho and Kyung-Soon is in home Psychoeducational family therapy through a family systems approach (Bentelspacher, DeSilva, Goh & LaRowe, 1997). The intervention fits the Kim couple since it is time-limited for Jang-Ho’s busy schedule at his store and at home treatment will allow Kyung-Soon to continue her caretaking duties. It is also suitable because the therapist is culturally sensitive with the multiple and sensitive issues within the family dynamics (Bentelspacher, DeSilva, Goh & LaRowe, 1997; Chisholm, 1999).

This will begin to strengthen relationships, especially between Kyung-Soon and her mother-in-law Hyun-Ju. If this skill training is successful, both women and caretakers to the children working together could allow smoother parenting to occur. Lastly, stronger relationship building among the Kim grandparents and parents could have a positive effect on the 3 children through displaying stability where they can begin to feel their home is a more steady and harmonious environment (Bentelspacher, DeSilva, Goh & LaRowe, 1997; Chisholm, 1999).

The three children will participate in cognitive behavioral therapy (CBT) individually. CBT encourages the change in behavior through the social learning theory and fits Asian cultural values because it integrates important customs and expectations (Hodges & Oei, 2007). Filial piety encourages the younger members to exhibit greater emotional care to their parents and grandparents (Hsu, & Wang, 2011).

The theory of solution based therapy suggests the client is an expert in their own problems (Hsu, & Wang, 2011). The Kim children will be encouraged to share their view of traditional "authoritarian" role of elders in the Asian community and how this perspective effects their identity development (Hsu, & Wang, 2011). The Kim children can propose having the entire family attend the local Korean festival to participate in cultural rituals together. The younger Kim’s can also encourage watching contemporary Korean language films at home with the family as an activity.

Group Analysis

Introduction

For the purpose of Problem Based Learning, a task group was created in order to develop and formulate assessments and intervention plans for the Kim family. This group can be categorized as a task group as it was designed to accomplish a task and produce a product (USC, n.d.). The goals of this task group included: assessment of each Kim family member, development of intervention plans and completion of written paper with details of findings from each group member. This group can further be classified as a task group as group members had roles assigned. One group member was assigned the role of the leader. This member was responsible for disseminating weekly task assignments to group members, keep group meetings focused and on topic, and hold members responsible for completing assigned tasks. Another member was assigned the role of secretary. This member was responsible for taking notes during group meetings and providing group members with the weekly notes via email. This group can also be considered a closed group. Once the group was formed, there was not an opportunity for new members to join. This group was to remain with current members until the completion of problem based learning.

Group Development

Fortunately, for the members of the problem based learning group, they are familiar with each other from working together previously. In terms of group development, the group was able to pass through stage one, the pre-affiliation stage, without issues to resolve. The group members came into the group with a collective relationship already established and members were aware of the purpose of the group. The structure of the group was established quickly as roles were assigned without conflict (Berman-Rossi, 1993).

The group moved quickly into stage three, the intimacy stage. In this stage an agreed upon structure for work and expression of personal need begin to appear. There is an increase in goal orientation and cohesion and consensus becomes important (Berman-Rossi, 1993). It was beneficial for the group to be able to move quickly into this stage because conflict was avoided, needs were met and tasks were completed. The problem based learning group quickly developed a structure for the group and divided up the Kim family among group members. Group members were encouraged to share their thoughts and ideas in regards to the Kim family and each group member’s ideas were heard, respected and incorporated. Group members provided support to one another and were flexible when obligations came up which would alter group meetings, i.e. leave early, meet via telephone only.

The problem based learning group quickly moved into stage four, the differentiation stage. In this stage the group is a working unit and is at its most mature, productive and cohesive stage. Group norms are established and functional, and the group maintains flexibility (Berman-Rossi, 1993). The problem based learning group easily transitioned into this stage of group development and maintained positive progress with assigned tasks. The problem based learning group met weekly with assigned tasks completed. Findings were discussed and new tasks were assigned. The problem based learning group maintained a collective relationship, as well as support and flexibility with one another.

Drawing near to the end of the problem based learning assignment, the group transitioned into stage five, the separation stage. In this stage, if feelings have been positive the sense of loss can be countered (Berman-Rossi, 1993). Within this problem based learning group, positive feelings in regards to group members, assigned tasks and completed assignments remained positive throughout the life of the group. Group members were satisfied with each member’s contribution to the problem based learning assignment and the relationships among group members remained collaborative, collective and supportive. By the end of the problem based learning assignment, group members were able to share their personal benefits and appreciations to the group process.

Group Norms/Rules

Group norms can be defined as rules of acceptable behavior which have been accepted by the group. Norms describe the types of behaviors which are expected from group members. Group norms can be explicit, which are established formally, or implicit, which are established informally (Shulman, 2012). In regards to the norms of the problem based learning group, explicit and implicit norms were established. Explicit norms included: attend weekly meetings, attend weekly meetings with assigned tasks completed, and attend weekly meetings prepared to discuss Kim family, and bring up questions, concerns or suggestions. Implicit norms included: respect each group member’s opinions, thoughts, suggestions and comments, maintain supportive, collaborative, and flexible relationship with group members, and approach problem based learning assignment with critical thinking skills and academic integrity. It was important for the problem based learning group to establish norms early in the group stage. Formation of these norms assisted the group in maintaining positive relationships and successful completion of the problem based learning assignment.

Group Culture

The culture of the problem based learning group remained task orientated and work focused. Establishment of group norms and rules assisted the group in avoiding conflict and maintain professionalism within the group. Group members created a safe environment which allowed each group member to confidently share their ideas, opinions and suggestions. Group members were able to provide each other with positive feedback and constructive criticism. Again, it was beneficial the problem based learning group provided structure with assigned roles and tasks, created collective, supportive and flexible relationships by agreement and adherence to group norms and rules, and fostered a safe environment to think critically. This, in turn, created a positive group experience and an agreed upon successful completion of the problem based learning assignment.