appropriate and more effective. Most American treatment modalities rely heavily on verbal

therapies that require direct verbal emotional expression and a high level of personal disclosure.

Many substance abuse treatment programs favor a confrontational approach, and many

HIV/AIDS programs favor support groups and psychotherapy. These treatment approaches,

unless modified for Asian and Pacific Islander clients, are often unsuccessful because they

violate Asian and Pacific Islander cultural norms. By American standards, Asians and Pacific

Islanders tend to communicate more indirectly, often by telling stories and discussing what

happened to themselves and others. Their feelings and opinions are implied rather than directly

stated. Asians and Pacific Islanders are also less likely to provide direct verbal expression of

their feelings by using "I" statements than are members of other groups. Providers should expect

to reveal personal information about themselves if they want clients to disclose their own

problems. Asians and Pacific Islanders may prefer to keep strong feelings under control so that

they will not become disruptive. Caring is often demonstrated by physical support such as by

giving money, cooking favorite foods, or giving advice rather than by verbal expression or

physical affection.

A problemsolving approach rather than an intrapsychic one is more effective with Asian and

Pacific Islander clients. Problemsolving enables a counselor to provide information, educational

materials, and referrals without probing for more personal information and pushing a client to

express feelings. For Asian and Pacific Islander clients with somatic complaints, suggest

relaxation and breathing techniques, meditation, qigong, yoga, massage, acupuncture, tai chi, or

biofeedback. It is generally not helpful to discuss underlying feelings because it is not only

culturally unacceptable, but many Asian and Pacific Islander clients do not see the emotional -

physical connection. In problemsolving, providers should actively give suggestions and if

necessary, be directive rather than let Asian and Pacific Islander clients struggle to figure out

what options are available to them.

Asking personal questions about substance abuse and sexual risk factors, especially early in the

helping relationship, could be viewed as intrusive and disrespectful. Asian and Pacific Islander

clients may not answer truthfully, if at all, and may not return. It is best to start with the least

intrusive or nonthreatening questions during the intake and explain why the information is

needed. If clients seem uncomfortable with certain questions, ask them at a later date.

Making an effort to connect with clients outside actual treatment appointments when they come

to the agency for other activities or via followup calls is also helpful. Asian and Pacific Islander

clients may not initiate contact when they have a problem because of cultural tendencies to

minimize problems to reduce stigma and because they do not want to be intrusive and

bothersome. In all interactions, it is helpful to minimize the stigma Asian and Pacific Islander

clients attach to their HIV/AIDS status and substance abuse disorders. Counselors should not

refer to themselves as HIV/AIDS, mental health, or alcohol and drug counselors unless they

know the client is comfortable with this. These titles imply the client has an unacceptable

condition and can increase stigma. Clients may be more receptive to treatment for HIV/AIDS

and substance abuse issues if they are combined with other, less stigmatized health issues.

Group interventions can be effective if everyone speaks the same language well enough and if

the group is centered around an unstigmatized activity, social gathering, or education session.