The application of bowen’s family system theory (BFST) to the malay population in malaysia

THE APPLICATION OF BOWEN ’ S FAMILY SYSTEM THEORY BFST TO THE MALAY POPULATION IN MALAYSIA RABA’ATON ADAWIAH BINTI MOHD YUSOF Diploma in Islamic Studies, Advanced Diploma in Islamic S

THE APPLICATION OF BOWEN ’ S FAMILY SYSTEM THEORY (BFST) TO THE MALAY

POPULATION IN MALAYSIA

RABA’ATON ADAWIAH BINTI MOHD YUSOF

Diploma in Islamic Studies, Advanced Diploma in Islamic

Studies, Master in Guidance and Counselling

Submitted in fulfilment of the requirements for the degree of

Doctor of Philosophy

Centre for Learning Innovation Faculty of Education Queensland University of Technology

[October 2011]

KEYWORDS

Bowen Family System Theory, Family counselling, multi-cultural counselling, Malaysia, Social problems

ABSTRACT

The rapid economic development and social changes in Malaysia recently have led to many psychosocial problems in young people, such as drug addiction, child sexual abuse and mental illness The Malaysian government is beginning to focus more attention on its social welfare and human service needs in order to alleviate these psychosocial problems Although counselling is accepted and widespread in Malaysia, the practice of family therapy is not as accepted as it is still a widely held belief that family problems need to be kept within the family However, changes are imminent and thus the theoretical basis of family therapy needs to be culturally relevant Bowen‟s Family Systems Theory (BFST) is already one of the major

theories taught to tertiary counselling students in Malaysian universities The main

member of the family is well differentiated High differentiation levels in the family allow a person to both leave the family‟s boundaries in search of uniqueness and to

continually return to the family fold in order to establish a more mature sense of belonging The difficulty, however, is that while Bowen has claimed that his theory

is universal nearly all of the research confirming the theory has been conducted in the United States of America The only known study outside America, however, did

show that Bowen‟s theory applied to a Filipino population but, one of the theory‟s

propositions that differentiation is intergenerational was not supported in this American sample The American sample that was compared to the Malay sample

non-was taken from Skowron and Friedlander‟s (1998) study One hundred and

twenty-seven faculty staff in an American university completed the Differentiation of Self Inventory (DSI) to measure level of differentiation of self This thesis therefore, set

out to determine whether Bowen‟s theory applied to another non-American sample,

the Malaysian community The research also investigated if the intergenerational effect was present in the Malaysian sample as well as explored the role of socio-

hundred and seventy-four families completed four measures to examine these research questions: the Differentiation of Self Inventory (DSI), the Family Inventory

of Life Event (FILE), the Depression Anxiety and Stress Scale (DASS) and the Connor-Davidson Resilience Scale (CD-RISC) The results of the study showed that differentiation of self is a valid construct for the Malay population However, all four subscales of the Differentiation of Self Inventory (DSI); emotional reactivity (ER), emotional cut-off (EC), fusion with other (FO) and I position (IP), showed significant differences compared to the American sample from Skowron and

Friedlander‟s (1998) study The Malay sample scored higher in emotional reaction

(ER), fusion with other (FO), but lower on emotional cut-off (EC) and I position (IP) than the American sample The intergenerational effect was found in the Malay

population as the parent‟s level of differentiation correlated with their children‟s

level of differentiation It was found that stress as measured by the Family Inventory

of Life Event (FILE) and as measured by the Depression Anxiety and Stress Scale (DASS) were not correlated with the level of differentiation of self in parents

However, gender had a significant effect in predicting the level of differentiation among parents in Malay population with females scores higher on emotional reactivity (ER) and fusion with other (FO) than males An additional finding was that resilience can be predicted from the level of differentiation of self in children in the Malay sample There was also a positive correlation between the level of differentiation of self in parents and resilience in their children Findings from this

study indicate that the concept of differentiation of self is applicable to a Malay sample; however, the implementation of the theory should be applied with cultural sensitivity

TABLE OF CONTENTS

Keywords i

Abstract ii

Table of Contents v

List of Tables viii

List of Abbreviations ix

Statement of Authorship x

Acknowledgments xi

Introduction to the thesis 13

Thesis outline 16

Chapter 1: Background 18

Growing social problems in Malaysia 20

Malaysia, Malay and Islam 23

Malaysia‟s attempts to solve the problems 25

Summary 27

Chapter 2: Literature Review 28

Counselling and culture 28

Cross-cultural counselling 31

Family counselling 37

Family counselling in Malaysia 39

Bowen‟s Family System Theory 41

Differentiation of self 45

Differentiation of self and research 50

Bowen‟s theory and universality 53

The intergenerational transmission process 54

The family projection process 58

Bowen‟s theory and gender issues 60

Bowen‟s theory, life stress and economic status 62

Resilience and Bowen‟s theory 66

Implications for counselling 70

Research questions and hypotheses 71

American sample 73

Summary 73

Chapter 3: Research Design 77

Methodology and Research Design 77

Methodology 77

Method 81

Measures 85

Procedure 92

Adult demographics 93

Child demographics 94

Summary 95

Chapter 4: Results 97

Data cleaning 97

Descriptive statistics for each of the measures 98

Reliability of the measures 99

Parental measures 99

Child measures 99

Summary 108

Chapter 5: Discussion 111

Discussion 111

Limitations 122

Implications 123

Recommendations 125

References 129

Appendices 142

Appendix A: Participant information sheet (English version) 143

Consent form (English version) 145

Participant information sheet (Malay version) 146

Consent form (Malay version) 148

Permission letter from the District Officer 149

Appendix B: 153

Survey instrument for parents (English version) 153

Demographic questions 153

Differentiation of Self Inventory 154

FILE 156

DASS21 158

Survey instrument for parents (Malay version) 159

Soalan kaji selidik (penjaga) 159

Differentiation of Self Inventory 160

DASS21 163

FILE 164

Appendix C: 167

Survey instrument for children (English version) 167

Demographic questions 167

Differentiation of Self Inventory 168

Connor-Davidson Resilience Scale 170

Survey instrument for children (Malay version) 171

Soalan kaji selidik (anak) 171

Differentiation of Self Inventory 172

Connor-Davidson Resilience Scale 175

LIST OF TABLES

Page

Table 1 Descriptive statistics for parental measures .98 Table 2 Descriptive statistics for children measures 99

Table 3 Reliability of the measures 100

Table 4 Results of the test of significance comparing the means of the

DSI full scale and subscale score for the Malay and European

American samples 102

Table 5 Multiple regression analysis of demographic variable; gender,

educational status and income as predictor to the parents‟ level of

differentiation of self 104

Table 6 Hierarchical regression analysis for FILE and DASS in explaining

variance of the DSI in parents over the demographic variable of gender,

income and educational status 105

Table 7 Hierarchical regression analysis for CD-RISC in explaining variance

of the DSI in children over the demographic variable 107

LIST OF ABBREVIATIONS

SES : Social economic status

DSI: Differentiation of Self Inventory

DASS: Depression, Anxiety and Stress Scale

FILE: Family Inventory of Life Events

CD-RISC: Connor- Davidson Resilience Scale

ER: Emotional reactivity

EC: Emotional cut-off

FO: Fusion with other

IP: I position

STATEMENT OF AUTHORSHIP

The work contained in this thesis has not been previously submitted to meet requirements for an award at this or any other higher education institution To the best of my knowledge and belief, the thesis contains no material previously published or written by another person except where due reference is made

Signature :

Date : 05 October 2011

ACKNOWLEDGMENTS

In the name of Allah, the most gracious and merciful

Doing a PhD is like a dream within a dream for me It really needs patience, intuition, resilience, support and faith in God I have nearly given up when faced with the obstacles, but there were my family, my supervisor, my friends and the most important one, God, who always gives me strength Even though there is everybody around me, a PhD is still a lonely journey that I have had to travel alone Emotional supports from family, guidance and lots of help from supervisors, encouragement and sharing from friends and confidence from God have helped me to proceed till the end

I would like to express my deepest gratitude to Associate Professor Marilyn Campbell, my principal supervisor, who has always been patient with me, especially with my English language Her support, guidance and assistance along this lonely journey are really appreciated The same goes to my associate supervisor Professor Ian Shochet, who gave his valuable time and effort in providing consultation in completing this project

Special appreciation goes to my family especially my husband, Hussin, who willingly took care of our two heroes while I was struggling with my study; I really owe you Thank you for staying with me, giving me emotional support and having confidence in me when I really need it To my heroes, Haziq and Hanif, I want each

of you to realise that I am doing this for both of you For my mother, and all of my siblings, your prayers are really valuable to make sure I will complete this journey successfully

To all my friends, Dilla, Zrett, Cik As, Elizabeth, Hossein and Lutz We will fight till the end and yes we can do this! Thanks for being such good friends to me To CLI staff, Jennifer Yared; thanks for making me feel comfortable even though I am far away from my mother You always offered me a shoulder to cry on which I really appreciated Alicia Alan who helped me with thesis writing and Janine Beck who helped me with statistical analyses, thanks a lot

Finally, without the gracious and merciful strength from God, I would not have been able to complete this project Thanks Allah for giving me this opportunity and

INTRODUCTION TO THE THESIS

Bowen‟s Family System Theory (BFST) is regarded as one of the most fully

developed theories emerging from family therapy (Nichols & Schwartz, 2005) Bowen conceptualises the family as an emotional unit where a child learns and grows

in an emotional environment This unit links individuals in the family together as a system but this system may be unstable unless each member of the family is well differentiated (Bowen, 1978; Kerr & Bowen, 1988)

Bowen introduced eight interlocking concepts as a base for this family theory These concepts are: (1) differentiation of self - the ability to differentiate the intellectual process from the feeling process within oneself; (2) triangles - the process of including a third person when there is stress between two people in a family; (3) the

in a single generation; (4) the family projection process - the process of stress projection onto one child; (5) emotional cut-off - the way of dealing with stress by emotionally withdrawing from the family; (6) the intergenerational transmission process - the process of transferring differentiation of self from generation to generation; (7) sibling position - birth order can possibly have an impact on the functioning of children within family (Sharf, 2008), and (8) societal regression - the concept of differentiation in the family has been extended to the society As this is a

preliminary study to investigate the implementation of Bowen‟s theory in the Malay

population in Malaysia, only concepts that relate to differentiation of self; the family projection process and the intergenerational process will be examined

From all of those concepts, differentiation of self is regarding as the key concept of

Bowen‟s theory According to Bowen (1978), differentiation is learnt in the family of

origin and passed down through the intergenerational transmission process via the family projection method across generations within a family (Bowen, 1978; Kerr & Bowen, 1988) Differentiation of self refers to the ability to balance on two levels; first, the intra-psychic level which is the ability to differentiate between one‟s feeling

and thinking processes, and second, the interpersonal level, which is the capability to distinguish between togetherness and autonomy in relationships (Kerr & Bowen, 1988) It is the ability to be yourself while still connecting with others in the family

Bowen argues that the differentiation of self is also a product of the intergenerational transmission process Different levels of differentiation of self in children are largely predicted by the differentiation levels of the parents (Bowen, 1978) This transmission process occurs at an emotional level through the „family projection process‟ and normally levels of projection vary among children according to how

differentiated their parents are (Kerr & Bowen, 1988)

Although Bowen‟s Family System Theory (BFST) was developed in the Western

world, specifically in United States, it has spread to Eastern cultures because of the interest and development of counselling skills and theories in these countries to combat their problems and because Bowen (1978) assumed that his theory was universal and applicable to all cultures Bowen does not seem to have considered that different cultures might have different family structures and processes which could alter the application of his theory and ultimately affect its successful implementation

kin and neighbours who live nearby and help in the child raising process This definition of family may vary in other cultures and certainly does in Western cultures which emphasis the individual over the group (Harun & Hamzah, 2006) However, Bowen could be correct and his theory might be universally applicable to all cultures Nonetheless, at the present time, only limited studies have been conducted to examine this proposition (Chung & Gale, 2009; Peleg, 2005; Tuason & Friedlander, 2000), and no studies have been done, to date, taking Bowen‟s theory in the context

of Malay families and family dynamics

Because of economic development and more exposure to the Western world, changes are becoming evident in Malay families‟ approaches to problems within the family

In the traditional Malay culture, the family is considered to be sacrosanct and is heavily influenced by religion Family problems are not to be talked about outside the family (Ng, 2003) making family counselling often unpalatable to many Malays who seek assistance when they have concerns However, as explained below, the Malay culture is changing and counselling is being sought more often (Kling, 1995)

On the other hand, cultural and religious issues are still involved in family counselling and these issues need to be handled sensitively For instance, Malay speakers tend to be very careful about commenting on and opposing another person‟s

views especially when they are about family members (Goddard, 1997) This reluctance could cause misinterpretations in family counselling if the counselling is not culturally sensitive

Bowen‟s Family System Theory (BFST) is one of the major theories that is taught to

Malaysian university counselling students, in relation to family counselling

However, there is no evidence that Bowen‟s theory and the subsequent family

counselling practices are applicable to and appropriate for the Malay population Therefore, this thesis examined the validity of the major components of Bowen‟s

theory in Malaysia to a Malay population; namely, the concept of differentiation of self and the intergenerational process of differentiation of self

Chapter 2 reviews the related literature on counselling in general and family counselling specifically The cultural aspect of counselling and the relevant research are discussed The implementation of family counselling in Malaysia and its expected benefits are presented This is followed by a discussion about the research

that has been conducted relating to Bowen‟s Family System Theory and the concept

of resilience

Chapter 3 discusses the research methodology used in this study including the justification for using quantitative research methodology The measures are

described including the way in which the measures were translated and piloted tested

Chapter 4 describes the results of the study The data was analysed by SPSS

Chapter 5 discusses the findings of the study in relation to the literature reviewed, concludes the thesis by discussing the findings in the context of Malay culture and presents implications for counselling and counsellor training in Malaysia Limitations and recommendations for future studies are then presented

CHAPTER 1: BACKGROUND

Malaysia consists of three major ethnic groups; Malay, Chinese and Indian These groups are not only separated by their historical background, but also by their way of life In the present study, only the Malay people as the largest ethnic group in Malaysia will be examined This is not only because they are the largest ethnic group

in Malaysia but also because of the uniqueness of the Malay traditions that are more susceptible to modern day challenges and changes This is especially true of the differences in religion As stated in the Malaysian constitution, all Malays are Muslim by definition and in practice (Kling, 1995) As a result of British colonial policy, Malays historically were mainly engaged in agriculture and fishing and lived

a rural way of life, whereas non-Malays, Chinese and Indians were involved in business and entrepreneurial activities (Crouch, 1996) However, after the implementation of the National Economic Plan (NEP) in 1970, changes in the pattern

of life within the Malay ethnic group have been increasingly observed The Malays have been encouraged to avail themselves of the opportunities provided by the government to become involved in business and further their professional studies (Mastor, Jin, & Cooper, 2000) The new economic policy has changed the attitude of Malays and stimulated economic development among Malays, thus leading to a better quality of life

Along with the development of the economy, however, there have been a number of difficulties and negative outcomes such as social problems among young people

Malaysia‟s transition from a British colony to an independent country in 1957

brought a range of changes and challenges As a third world economy, Malaysia has experienced a very rapid economic development in the 1990s before the East Asian

economic crisis One of the biggest challenges resulting from this developing economy is the change in the traditional family institution (Harun & Hamzah, 2006; Zaini & Rahman, 2006) For example, in the traditional Malay family, the father is the breadwinner and the mother is a full time house-wife who raises the children and runs the household However, with the economic improvement often both parents now are working and have less time with their children This could be one of the factors contributing to the increased social problems among the Malay‟s young

people

(Goulet, 1992) As well as the quantitative aspects of development in the form of wealth creation, qualitative aspects which are non-economic in form also need to be considered (Amin, Yusof, & Haneef, 2006) For example, the change from an agriculturally-based economy to an industrially-based one has had many benefits for

Malaysia, especially in the reduction of poverty and enhancing the population‟s

quality of life

While economic development has provided substantial opportunities for growth in Malaysia, it has not been generally accompanied by an improvement in human well-being Young people have been identified as an important indicator that determines the quality of life of a society because they possibly can impede the progress towards attaining further development in the future (Cartwright, 2000) Therefore, to improve the quality of life and achieve social well-being in economic development, social problems that exist in society especially involving young people need to be reduced (Amin et al., 2006)

Growing social problems in Malaysia

Rapid economic development and social changes have lead to many psychosocial problems in Malaysia The increasing number of social problems such as drug addiction, child sexual abuse and mental illness, particularly among Muslim (mainly Malay) teenagers in Malaysia has the potential to impede economic development and the creation of a well-balanced society in the future For instance, criminal cases involving juveniles have increased by 62 percent from 2408 cases in 1980 to 4012 cases in 1995 In the period of 1990-1995, 60 percent of the juvenile cases involved teenagers aged between 16 and 18 years (Malaysia, 1997) Drug addiction, child sexual abuse and mental illness are commonly reported in the daily news These psychosocial problems are major challenges faced by community leaders, parents, teachers, college and university educators and also the helping professionals in Malaysia at present To ensure a better quality of life for present and future generations attention needs to be directed at today‟s teenagers and their mental

health It is imperative that the problems and mental health issues faced by adolescents are addressed

Present day young people have been the first generation to grow up in the era of globalization in Malaysia They have been exposed to all kinds of modern technologies from the West that afford them many advantages compared to previous generations They have more regular primary education, greater access to different styles of thinking and have more information about people around the world However, being the first generation that has been exposed to the new technologies

and new „role models‟ has also brought a certain degree of culture shock which

continues to challenge their parents, society and the government Exposure to

information from the West is having an influence on traditional values such as ways

of dressing, communicating, behaving and thinking As mentioned before, ethnic Malays in Malaysia are Muslim As a result, traditional values are generally based on religious beliefs and are different from those in Western societies

One of the major social problems in Malaysia, especially amongst young people is drug addiction The total number of drug users recorded for the period of 1988 to

2006 was 300,241 (NADI, 2005) However, this number included only those individuals who were caught by or reported to the authorities This is still

approximately 1.1% of Malaysia‟s total population of whom 70% are youths aged

between 19 to 24 years-old Most of these young addicts are dependent on heroin (NADI, 2005) Close geographical proximity to the Golden Triangle and other Southeast Asian countries that produce heroin is the major reason given for the increasing number of domestic drug users

However, drug addiction is not only a problem itself, it also relates to an increasing HIV problem in Malaysia This is because needle sharing is the most common means

of HIV transmission (Mazlan, Schottenfeld, & Chawarski, 2006) There were 61,641 detected cases of HIV from 1986 to September 2004 (Ministry of Health, 2005) giving Malaysia, after Vietnam, the second highest HIV prevalence among adult populations in the Western Pacific regions As well as the medical burden presented

by high rates of HIV, this situation has cascading effects leading to homelessness, crime and missed work or problems with keeping a job The situation is crucial for Malaysian society and Malaysian families

Sexual abuse is also a growing problem in Malaysia There is an increasing number

of sexual abuse cases reported each year From 2002 to 2006, there were 6861 cases

of child abuse reported (Department of Social welfare, 2007) While previously most sexual abuse cases involved adults, at present there is an increasing incidence of sexual abuse of children and even babies Most sexual abuse cases occur within the family household with the perpetrator being well known to the victim (Kassim & Kasim, 1995) Child sexual abuse is known to have long term negative consequences with adult survivors more prone to depression, anxiety, low esteem (Ullman, 2003), alcohol and drug addiction, psychosexual and relationship difficulties and suicidal ideation (Tyler, 2002) A history of sexual abuse or rape is related to a variety of HIV risk behaviours and to an increase in the total number of such behaviours between adolescence and young adulthood (Tyler, 2002)

Mental illness is also a significant and rapidly escalating problem in Malaysia at present In Malaysia, mental illness is not regarded as a disability but is viewed as a purely medical problem Sufferers from mental illness such as anxiety, depression and schizophrenia are commonly linked with crime and deviance (Crabtree & Chang, 2000) Mental health can be considered as a reflection of healthy or positive

behaviour on the part of the individual and also in relation to one‟s culture (Haque,

2005) Every culture and every person may have a different perspective on what constitutes mental health According to the National Policy on Mental Health

Malaysia, mental health is defined as “the capacity of the individual, the group and

the environment to interact with one another to promote subjective well-being and optimal functioning and the use of cognitive, affective and relational abilities,

towards the achievement of individual and collective goals consistent with justice”

(National Policy of Mental Health Malaysia, 2000, p, 12)

Approximately 1% of the Malaysian population suffers from schizophrenia (Rosli, 2008) According to the Malaysian Health Minister, one in four Malaysians suffers from stress-related problems Also, six in one hundred Malaysians have suicidal tendencies, with 16 to 24-year-olds forming the biggest group (Thye, 2008) People with a mental illness will face numerous problems which are sometimes beyond their abilities to cope They will depend on other people to help them with their lives In this situation they find it difficult to make a contribution to society and are often a burden to their families When services are not available mental illness has a negative impact on society, especially in remote regions

Malaysia, Malay and Islam One of the reasons for the breakdown of traditional society in Malaysia is the weakening of religious practices especially in family systems In Malaysia, Malays in past years had always been Muslim In fact the Malaysian Constitution clearly defines Malay as:

“ a person who professes the religion of Islam, habitually speaks the Malay

language, conforms to Malay customs…” (Malaysia: Federal Constitution,

160(2))

Thus for Malays, Islam guides all of their decisions throughout their lives and is an important socio-cultural value in Malaysia (Varma & Zain, 1996)

Within the Malay family, traditions and religion are tied together in people‟s

everyday lives Children listen and obey their parents according to Islamic rules Traditions (adat) and Islam have a function as structural principles around which society is organised The constitution of basic social institutions in politics, economy, kinship and family are developed from these traditions and religion (Kling, 1995)

The structure of kinship and family systems is extremely strong in traditional Malay families Relatives will help to look after the children like their own children and the children will always behave even though their parents are absent This system seemed to control social problems and strengthened the community and society in general in the past

This traditional system has been challenged, however, by new ideas introduced from the West Existing social relationships within the community and the family have been weakened by Western ideology, which promotes individual freedom especially among teenagers (Timimi, 2005) Influenced by Western principles of autonomy and separation from the family, present day, young people in Malay society want more freedom from their parents and from the strictures of community practice Thus, there is a crisis in Malay society with the young people relinquishing the traditional values that have previously bound families and communities together in Malaysia (Bajunid, 2004)

The strong religious background that has been adhered to previously has been rejected and resisted in many instances by young people within their families and

communities According to Bajunid (2004), the Malay collective identity and culture developed from a strong emotional attachment to Islam as a religion and a way of life

However, despite the Islamic consciousness and the growth of Islamic associations and institutions in Malaysia, there has been a sharp increase in negative behaviours involving Malay and Muslim teenagers such as drug abuse, alcohol usage, sexual abuse and social problems which are against Islamic principles A drastic decline in family values has also led to symptomatic social illnesses such as drug abuse and mental illness Strengthening family values has been seen as the solution to rescue society from future disasters (Stivens, 2006)

Malaysia’s attempts to solve the problems

Penalties including fines, prison and execution have been used as attempts to combat the problem of drug and sexual abuse However, more recently, the Malaysian government is focusing more attention on its social welfare and human service needs

in order to cope with these psychosocial problems

The Malaysian government has shown its commitment to these newer forms of solutions by providing more training for counsellors for drug rehabilitation (Scorzelli, 2009) and mental health Treatment and rehabilitation centres are also being provided by the government as a solution to these serious problems However, the overall success rate of these centres remains low as they are not being utilised by the Malaysian people (Deva, 2004) According to Scorzelli (2009), the lack of

professionally trained and knowledgeable counsellors contributes to the lack of successful outcomes from drug rehabilitation centres

The Malaysian government also has initiated a campaign to promote the „my home

my heaven‟ campaign to help strengthen family values The aim of this campaign

was to provide a harmonious family environment for children Additionally, this campaign also aimed to act as a prevention for sexual abuse in society by providing information (Stivens, 2006) The key concept used in this campaign was happy families building a happy nation by observing family values in everyday lives However, this campaign is still running and there has been no evaluation to measure the effectiveness of this program (Stivens, 2006)

A healthy life style campaign devoted to mental health has also been launched by the Malaysian government The main purpose is to improve public awareness on mental health, illness and available treatment Information has been disseminated in both

print and electronic media to improve the public‟s awareness Although a wide

variety of topics have been covered to date, the impact of this campaign has not been evaluated (Deva, 2004) More recently, the theme of a „caring society‟ has been

strongly promoted in Malaysia Information which relates to mental illness and how society involvement can help to reduce the burden was the main focus of this campaign Nevertheless, without sufficient funds allocated to this campaign it does not seem to have helped family members with a mental illness This initiative requires commitment from Malaysian society to help people in need and from individuals to assist their own family members (Crabtree & Chang, 2000)

Summary

Current social problems among youth in Malaysia are challenging their parents, society as a whole and the government The situation is steadily deteriorating with an increasing number of youth becoming drug addicted, sexually abused and suffering mental illness Penalties such as fines, prison and execution have been used to combat these problems but without a great deal of success At present, the Malaysian government has shifted its attention to different approaches which take into account social welfare and human services There is an increased commitment shown by the Malaysian government to providing more training for counsellors and for building rehabilitation centres However, to date there is no measurable alleviation of these psychosocial problems In the next chapter, Western society‟s solutions to these

problems will be explored

CHAPTER 2: LITERATURE REVIEW

Counselling and culture

As previously discussed in chapter one, Malaysia is facing many problems with young people Part of the solution that the government is implementing is the introduction of more counselling services to combat the problems of drug addiction, sexual abuse and mental illness Because of the widespread introduction of counselling services, it is important to examine the evidence base on which counselling is predicated to solve these problems

Davis and Fallowfield (1991) define counselling as “a means of assisting people to

understand and cope effectively with their problems” (p 97) The keywords here are

„assisting‟, „understanding‟ and „coping‟ Counselling is about the process of helping

people to help themselves (Laungani, 1994) Assisting people to understand what is

going on and how to cope with their situation can help them to gain understanding and try to improve themselves

Counselling has been shown to be a very effective treatment for problems with drug abuse A research study with 330 clients in 26 outpatient drug treatment programs in Los Angeles found that more frequent counselling was associated with lower levels

of relapse (Florentine & Anglin, 1996) The first step usually in this type of counselling is motivational interviewing where clients are challenged to examine their motives for continued use and are prepared to begin counselling to address their issues Drug abuse in Malaysia, as elsewhere, often leads to HIV because of the

sharing of needles Therefore, the demand for counselling as a prevention strategy for HIV has also increased in the country There is strong evidence that counselling can help promote behaviour change by educating people in matters such as the implication of drug users sharing needles By providing support to adapt to positive living and accept the fact that they have to live with the presence of an infectious disease (HIV), counselling can help HIV patients gain back their self-confidence (Gregorich, Kamnega, & Sangiwa, 1998) Soon and Barnard (2002) found that people with HIV identified four major benefits of counselling They reported that counselling provided reassurance and comfort for them by being immersed in a caring and committed environment Second, counselling as a process enabled them to obtain information and education related to HIV Third, counselling acted as a positive mediator between themselves, their families and friends, and lastly counselling provided assistance to accept the reality of who they were now

Counselling sessions also have been highlighted as being the most helpful tools to those who have experienced sexual abuse Individual counselling has been used to facilitate the growth of self-confidence and awareness with abused victims (Warne & Mcandrew, 2005) As the impact of sexual abuse is long–term and can be

devastating, support from counselling is required to help victims realise that it is not their fault and at the same time overcome their trauma toward that experience

In the management of the most prevalent mental health problems, such as anxiety and depression, counselling has also been shown to be the most evidenced based practice From the meta-analyses conducted by Bower, Rowland and Hardy (2003), counselling programs have been shown to lead to clinically statistical significant

improvements in psychological distress beyond that seen with usual general practitioner care Their study indicated that clients receiving counselling had significantly lower levels of anxiety and depression than clients who received usual general practitioner care

Besides individual counselling, family counselling also has been used to overcome psychosocial problems The results of a major analysis conducted by Stanton and Shadish (1997) indicated that family based therapy is more effective in reducing drug abuse than individual therapy By involving families in treatment, the client is more motivated to engage in the treatment process and to remain committed Additionally, new patterns of family functioning may develop to support a drug free lifestyle For sexual abuse victims and those with mental illness, family therapy has also been shown to be the most effective approach to help alleviate these difficulties (Carr, 2000; Warne & Mcandrew, 2005) Support from family members enables people with these problems to regain their sense of confidence and to motivate themselves to change

Current research suggests that counselling is an effective way of both preventing and intervening in cases of psychosocial difficulties among young people Counselling, especially family counselling, have their roots, however, in Western and not Eastern cultures Accordingly, the validity of counselling, especially family counselling to the Malay population warrants examination

While culture is the unwritten laws that are well known to all members of the society, ethnicity refers to the symbols of the group Culture is learned, transmitted from each previous generation, uniquely belongs to a particular society and acts as a tool that defines reality for its members (Chung & Bemak, 2002) Ethnicity on the other hand, refers to the symbols of the group (Sue & Sue, 2008), which include religious symbols, country of origin or any other ritual passed down to the children (Brammer, 2004) It is also an important part of family identity (McGoldrick, Preto, Hines, & Lee, 1991) Ways of thinking, feeling and behaviour are all transmitted through the family immersed in the wider cultural context of daily activities

Although each individual culture is unique, there are many similarities among Western cultures as a group and similarly among Eastern cultures These two cultural groups, however, are often very different from one another These differences are not

only in geographical areas but mainly about the cultural group‟s way of practising

values in life One of the significant differences between cultures, which are pertinent for this study, is that Eastern cultures emphasise family over the individual more than in Western cultures Members of Eastern cultures are more collectivist in orientation and define themselves as social beings more than individuals and place greater emphasis on their connection to their larger community than Western cultures (Aponte & Wohl, 2000) In the study by Pong (1996), the education of children from single-mother families in developing countries was examined and significantly different findings were shown between the United States and Malaysia In Malaysia, children whose parent was widowed did not drop out of school which is significantly different from those children in the United States One explanation for this difference

is the cultural effect, as in Malaysia children of widows receive support from their extended families (Pong, 1996) This study provides support that culture plays a role

in the family structure

Malaysia as an Eastern culture, is mainly a collectivist society which emphasises family and group affiliation rather than the worth of the individual (Jamal, 2007) Values such as respecting elders, the promotion of harmonious relationships, indirect communication style and emphasis on religious orientation are embedded in Malay society For example, in the value of respecting elders, a specific posture needs to be adopted when passing between elders who are seated This behaviour is to show the respect and politeness towards elders Most Malaysians tend to think in terms of the good of the group over the good of the individual (Talib, 2010) This „we‟ orientation

clearly defines teamwork and collaboration which is a prime value of collectivist societies (Hofstede, 2001) Even though Malaysia is made up of diverse cultures

(Malay, Chinese, and Indian), as a result of history and co-operation, all these Eastern cultures blend together making Malaysia a rich society of blended cultures

Culture is often expressed by language which is an important concept for counselling (Sue & Sue, 2008) Communication structures in the Malay community often show great respect for elders or authority figures Normally this is based on a hierarchy in which the older person or somebody from a higher social status is given respect as a right by those who are younger or of lower social status Also in Malaysian culture, specifically in Malay society there is less emphasis on verbalisation in communication compared to Westerners Being assertive is less valued as it shows

no respect and silence is traditionally more appreciated (Talib, 2010) Politeness and the need to be polite are extremely important in Malay society Being direct is viewed as inappropriate in most situations even though to Westerners this might be seen as appropriate to express an opinion or give a comment (Zawawi, 2008)

Thus culture affects counselling in many ways, as culture affects how people value themselves and others, how they appreciate their family, their life and their beliefs and how they express this in language (Laungani, 2004) The application of counselling theories therefore needs to consider not only universally effective techniques but also culturally specific elements to ensure they are suitable and effective for each culture (Norsworthy, Heppner, Aegisdo'ttir, Gerstein, & Pedersen, 2009)

In each counselling session care should be therefore be taken to consider an individual‟s cultural background so that approaches or solutions that are culturally

appropriate are used This may involve some changes in the way therapies or sessions are conducted to suit the clients‟ background (Ivey, D'Andrea, Ivey, &

Simek-Morgan, 2007) and could also affect the way basic theories of counselling are applied

Counselling and psychotherapy practice in Malaysia is still in its infancy even though some counselling has been practised since the 1950‟s (Mey, Othman, Salim,

& Din, 2009) Historically, counselling and psychotherapy theories and approaches have been developed in Western cultures (Talib, 2010) However, many of these theorists believe that their basic theory has universal applicability, which explains why Western theories of counselling and therapy have been used in virtually all parts

of the world (Laungani, 2004) But transferring Western-based counselling theories and research models completely to another culture could result in ineffectiveness especially if there has been no thought given to any cultural modifications (Norsworthy et al., 2009)

Several studies have been conducted to examine the general applicability of Western counselling approaches to Eastern cultures (Chung & Gale, 2006; Skowron, 2004; Tuason & Friedlander, 2000) These findings have shown that Western approaches to counselling may lead to negative consequences or misunderstandings if cultural differences are not taken into account (Raney & Çinarbas, 2005)

There are several cultural biases in counselling based on Western theories which might explain this phenomenon (Pedersen, 2002) As discussed before, culture

influences an individual‟s way of thinking and acting Cultural beliefs may thus

influence the diagnosis and treatment of problems particularly when it involves families In particular, the diagnosis of mental illness differs across cultures For example in the traditional Malay community there is a belief that mental illness is caused by supernatural agents and can best be treated by the Malay traditional healer (bomoh) (Razali, Khan, & Hasanah, 1996) Differences in expressing symptoms or reactions also will be an issue when it comes to different cultural contexts

Research with mental health workers in a Japanese community who had been influenced by Western lifestyle found that an integration of culturally sensitive, indigenous methods with Western approaches to be useful and effective for Japanese clients Using only a Western approach was not sufficient in Japan (Eastern culture) because it resulted in a poor outcome (Iwasaki, 2005) This study reinforces the claim that Western theory can be integrated with Eastern theory to produce a better approach to be implemented in a cross-culture society

Keeling and Piercy (2007) indicated that in order to convince the client to participate

in therapy, there needs to be a careful balance between respect for cultural values and practices and gender relationships Their research with twenty family therapists from 15 different countries and diverse cultural backgrounds, found that therapists should learn and be familiar with specific cultural practices and values rather than assuming therapy is based on their own cultural background This finding is also supported by Singh (2009) who concluded that family therapy practice should be

used with care and adapted to suit different cultural and family contexts His research with five clinicians from South African and white British indicated that the

counsellor should learn more and be aware about their clients‟ cultural background

This is especially true when the theory that will be used in the session was constructed in the Western world and used with an Eastern background client For example, closeness between a Japanese mother and her children may be defined as enmeshment according to structural family counselling However, from a Japanese cultural point of view, such closeness is positive and is a part of the nurturing process

in Japanese family tradition (Rothbaum, Rosen, Ujiie, & Uchida, 2002)

It is therefore anticipated that this would be the case for the theory of interest in this thesis; Bowen‟s Family System Theory (BFST), which is one of the basic theories

guiding family counselling For example, in Bowen‟s Family System Theory,

differentiation of self is emphasised and considered as the main component for an individual to be a completely healthy person According to Bowen, individuals should be able to separate themselves emotionally from their families and be autonomous with the support from family members This view would seem to be contradictory to the values of clients from collectivist societies which stress sharing

and togetherness Therefore, this part of Bowen‟s theory might need to be culturally

adapted to make it useful in multicultural situations (Ivey et al., 2007)

a coach to evaluate and assist in resolving issues in families by learning more about family functioning This part of the theory could be relevant to multicultural clients

families, that Bowen‟s concept of differentiation and „I‟position is useful and helpful

in solving problems involving families in Indonesia, an Eastern culture (Piercy, Soekandar, & Limansubroto, 1996)

Not all the tenets of Bowen‟s Family System Theory could be universally applicable,

however, without modification to local cultural issues It is unknown at present whether Bowen‟s Family System Theory is applicable to the Malay population This

is despite Malaysian counsellors being taught to use Bowen‟s theory without any

modifications to suit the diverse Malaysian culture and religion It is important therefore to research whether Bowen‟s theory is practical to the Malay people

Family counselling

Family counselling is a helping process that involves all members of a family Therapy based on a family counselling/therapy framework is directed at changing the organisation of the family When the family organisation or system is changed then the life of every family member is altered accordingly (Nichols & Schwartz, 2005) Family therapy treatment is designed to bring about change in functioning within the family rather than within a single individual (Sharf, 2008)

Family therapy provides a long-term solution which may be an effective approach to assist in alleviating social problems which are so prevalent in Malaysia at present A review of studies conducted by Stanton and Shadish (1997) concluded that family

therapy can produce significantly better outcomes than non-family oriented individual counselling approaches to bring in positive changes in drug abusers

Furthermore, it has been found that family-based therapy leads to fewer drop-outs from treatment compared with other therapeutic approaches Thus, family therapy can influence adolescents to remain committed and engaged with the treatment process This is also supported by other studies that reinforce family-based preventive interventions for drug use and related behavioural problems (Hogue, Liddle, Singer, & Leckrone, 2005) A drug free environment provided by the family was shown to be the best long term solution when dealing with adolescent drug abusers (Liddle, Dakof, Turner, Henderson, & Greenbaum, 2008)

Family therapy also is important in addressing child sexual abuse Thinking about the family as a system helps to understand the role that families play in the healing process of their members following sexual abuse Abuse will affect not only the person who has been abused but also the whole family According to Macdonald, Lambie and Simmond (1995), “The major implication of systems thinking to therapy

for sexual abuse is the importance of involving the family In work with children, the response of the family is vital to healing” (p 66) Support from family members for

sexually abused children is often more comfortable for them rather than a therapist who is an outsider and may take longer to gain their confidence According to Carr (2000), family therapy is an aid to reorganising the child‟s social system so that the

interaction pattern that contributed to abuse will not happen again Family therapy significantly alters the family system, suggesting that treatment is needed for the