Addressing Cultural Issues in Grief Counseling with Immigrants: the Case of a Bereaved Filipino Family Following Homicide
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The European Journal of Counselling Psychology ejcop.psychopen.eu | 2195-7614 Special Thematic Section on "Social Justice Issues for Counselling Psychologists in Greece" Addressing Cultural Issues in Grief Counseling With Immigrants: The Case of a Bereaved Filipino Family Following Homicide Ioanna Giannopoulou* ab, Paraskevi Bitsakou b, Eleftheria Ralli b, Fedon Chatzis b, Danai Papadatou ab [a] Kapodistrian & National University of Athens, Athens, Greece. [b] Merimna Childhood Bereavement Counselling Centre, Athens, Greece. Abstract This article discusses cultural considerations and approaches to working with bereaved immigrants who cope with traumatic loss. A clinical case is used to elaborate on issues related to cultural identity, level of acculturation as well as religious beliefs and rituals among Filipinos living in Greece. Considerations for clinicians, who provide services to culturally diverse families that experience traumatic deaths, are discussed. Keywords: bereavement, homicide, Filipino family, spirituality, traumatic grief The European Journal of Counselling Psychology, 2018, Vol. 7(1), 200–210, doi:10.5964/ejcop.v7i1.149 Received: 2017-06-29. Accepted: 2018-08-01. Published (VoR): 2018-10-31. Handling Editors: Kalliope Kounenou, Department of Education, School of Pedagogical and Technological Education, Herakleion, Greece; Maria Malikiosi-Loizos, School of Education, National and Kapodistrian University of Athens, Athens, Greece *Corresponding author at: 2nd Department of Psychiatry, Attikon University Hospital, Rimini 1, 12462 Athens, Greece. Fax: +30 210 5326453, Tel: +302105832426. E-mail: [email protected] This is an open access article distributed under the terms of the Creative Commons Attribution License (https:// creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Greece has been traditionally an emigration country but this has changed during the last three decades, by an increased inflow of legal and irregular migrants, and asylum seeker refugees. As from the beginning of the 1990s, Greece started receiving large inflows of immigrants from Albania. The 2011 census (Hellenic Statistical Authority, 2011), indicates an ethnically diverse population of migrants including immigrants originating mostly from countries of Europe and Asia. The 2012 Organization for Economic Co-operation and Development (OECD) report on international migration trends estimated the total of all foreigners among the Greek popula- tion at 7.1% (OECD, 2012). According to the 2011 national census, Filipinos comprise a small community ac- counting for 1.08% of the country’s total immigrant population. More specifically, 9,807 Filipinos were registered living in Greece, of whom 9,616 (98.1%) were holders of a valid stay permit and 9,115 (95%) worked legally in Greece, thus, paying their health insurance (Triandafyllidou, 2014). Of Filipinos working in Greece, 2.2% are in industry, 1.1% in agriculture, 0.7% in construction, 8.3% in trade and tourism, and the remaining (87.7%) in oth- er occupations (e.g. household service; Embassy of the Philippines, Athens, Greece, Republic of the Philippines, 2017). Giannopoulou, Bitsakou, Ralli et al. 201 Large influxes of asylum seeking refugees and irregular migrants, who view Greece as the main gateway to Europe, created a humanitarian crisis in 2015. More than one million crossed the Greek borders and headed for central and northern Europe. However, after the closing of the Balkan route in February 2016, and the Euro- pean Union–Turkey refugee agreement in March 2016, arrivals by sea have significantly decreased but still an approximate number of 40,000 asylum seekers (and/or irregular migrants) are stranded in Greece waiting, ei- ther to relocate or indeed integrate in the country (Triandafyllidou & Mantanika, 2016). The increasing phenomenon of cultural diversity requires that mental health practitioners acquire knowledge and understanding on how cultural issues affect responses and meanings attributed to loss, adversity, and life experiences. These may significantly differ from the clinician’s. Cultural, religious and spiritual beliefs affect be- reavement, and, as a result, clinical assessment of a person’s grief should always consider individual, family, social, and religious factors, including the client’s level of acculturation. Such in depth exploration shapes the professional’s approach and choice of interventions as to address the person’s or family’s needs (Brutus, 2009). The available literature on the support of traumatically bereaved Filipino families, comprising first- and second- generation immigrants, is sparse. Only a few articles and unpublished dissertations explore how spirituality in- fluence the way individuals construct meaning(s) of life events and cope with life challenges, including the loss of a loved one (Macabulos, 2015; Shimabukuro, Daniels, & D’Andrea, 1999). The present paper seeks to contribute to the bereavement literature in three distinct ways: (a) by presenting a short overview of the key issues that clinicians must bear in mind when working with bereaved immigrant adults, adolescents and young children, (b) by describing a clinical case of a Filipino family that sought grief counseling after the homicide of a senior family member (due to confidentiality, all names have been changed), and (c) by sharing some of the challenges in providing support to this population. Cultural Identity Culture, according to sociologists and anthropologists, refers to the “social heritage of a community”, that is the sum total of the possessions, ways of thinking and behavior, which distinguishes one group of people from an- other and is passed down from generation to generation (Parkes, Laungani, & Young, 2015). Identity refers to one's perception of self or how one views self as unique from others. Racial, cultural, and ethnic identities form part of one's identity, and that identity changes with development both at a personal and social level, including migration and acculturation (Bhugra, 2004a, 2004b). A person’s cultural identity is affected by one’s religion (spiritual beliefs and rituals), rites of passage, language, history, dietary habits and leisure activities (e.g. music). These components ensure the person’s belonging to his or her culture while living in a different cultural context, and may or may not change during the acculturation process (Bhugra, 2004a). Acculturation is a multidimensional reciprocal and dynamic process resulting from the interaction of a migrant’s culture of origin with the culture of a new homeland, and refers to the changes in cultural values, customs, be- liefs, attitudes, language and behaviors that result from constant intercultural contact (Berry, 1997). It has been proposed that two independent dynamics underlie acculturation: one is focused on cultural maintenance of the heritage culture, and the second involves the interaction with the culture of the host society (Berry, Phinney, The European Journal of Counselling Psychology 2018, Vol. 7(1), 200–210 doi:10.5964/ejcop.v7i1.149 Cultural Issues in Grief Counseling With Immigrants 202 Sam, & Vedder, 2006). According to this model, minority group members have either strong or weak identifica- tions with their own or mainstream cultures, thus, giving rise to at least four types or modes of adaptation: as- similation, integration, separation and marginalization. The social and cultural qualities of one’s identity are typi- cally more resistant to change and are usually last to adjust during acculturation (Bhugra et al., 1999). The level of acculturation reflects the degree to which an individual adheres to the cultural norms of the dominant society, whereas, the level of enculturation refers to the degree to which people retain the norms of their culture of ori- gin (Kim & Omizo, 2006). Cultural Issues in Bereavement Each culture has its own traditions, rituals and ways of expressing grief and mourning. It is important for clini- cians to understand the religious and spiritual beliefs about death, as well as the cultural background of their clients, in order to foster empathic understanding. Knowledge of beliefs about death, as well as of burial cus- toms, funeral and mourning practices aiming at honouring, respecting, and remembering the deceased, are all aspects of paramount importance that guide assessment and choice of therapeutic interventions (Neimeyer, Klass, & Dennis, 2014). It must be born in mind that all individuals belonging to the same culture or religious group are not “similar” and do not necessarily share identical values, life styles, or socio-economic and educa- tional backgrounds, nor abide to the same beliefs, rituals, and practices. Level of acculturation should be con- sidered, as this may be an added stressor throughout bereavement. Research findings suggest that higher lev- els of reported “acculturative” stress (i.e. the distress effects of adapting to a new culture) are associated with decreased quality of life, including physical and mental health well-being (Belizaire & Fuertes, 2011). Beliefs About Death From a Filipino Cultural Perspective Filipino immigrants’ funeral and mourning practices have been influenced by the combination of Christian and animistic beliefs associated to death and afterlife. Memorial rituals vary according to one’s family, economic sta- tus, and level of acculturation to the host country (Shimabukuro et al., 1999).