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Creating Trust and Rapport With Foreign-Born Clients

By: Shirlene Elledge, CPM, CNHP

Imagine—you just walked into a new client’s home to ascertain needs for food assistance. You notice an elaborate shrine boasting a bronze Buddha. Several plates of fruit and rice are sitting on the shrine, along with fresh flowers on either side. What goes through your mind? Are you wondering why they need help with food if they have enough to leave lying out to spoil? Are you wondering why you should help them if they are wasting what they already have? While talking with the family, you learn they just took a day trip to a neighboring town to visit the Buddhist temple and donated some food and clothing to the presiding monk. Now, what goes through your mind?

    The situation above would be a challenge for many social workers. Yet, it would also be a common occurrence if you are working with a Thai family. It may be easy to judge this family as having poor money management, being greedy, or being wasteful. But a culturally aware social worker will recognize these behaviors as religious customs rather than poor money management.

    I became acquainted with these customs embedded in Thai culture while traveling the country and living among its people. My travels enriched my perspective and clarified my professional responsibility to foreign-born clients.

    The Code of Ethics requires social workers to value the worth and dignity of all individuals. Working with foreign-born clients requires a certain level of understanding in regard to country of origin history, norms, and values. Lessons I learned through my experiences in Thailand can be helpful for all social workers working with foreign-born clients. There is a systematic way to prepare for an ethnic client whose background might be unfamiliar to you. You can follow a simple KNOW system:

Know Some Country of Origin Basics

    The first part of KNOWing your client is to understand how national origin contributes to one’s values and perspectives (Kirst-Ashman & Hull, 2009). Consider this: You enter the home of a Thai client and acknowledge a picture of King Bhumibol Asulyadej, which brings a generous smile from your new client. Instant rapport has begun. Thai people love and revere 82-year-old King Bhumibol Adulyadej, the world’s longest reigning king. He is considered a friend of the poor, was born in Massachusetts, and is a jazz musician. Wearing yellow on Monday—the King’s birthday—is a way of honoring him. Most every home in Thailand, regardless of class, displays the king’s picture, and to acknowledge a picture of him would be meaningful to your client. Be certain, however, that you do not point to his picture—to do so is highly offensive. I innocently insulted my Thai escort the first day in her country as I pointed to a large billboard of the king. These minor bits of information are meaningful to foreign-born clients, because most first generation immigrants remain loyal to their countries of origin (Parillo, 2009).

    Thai people have a strong sense of national pride stemming from the fact that Thailand is the only nation in its region never to have been conquered by a European power (CIA, 2008). Thai people are very proud of this independent heritage, as well as their unique culture from all other Asian countries, and do not want to be confused with Taiwan or the Philippines, a common occurrence (V. Rall, personal communication, September 7, 2009). All countries have unique aspects that translate into national pride. Poke around, discover what it is, and use your knowledge to create rapport.

Notice Social Norms

    The next part of KNOWing your client comes through understanding meaningful social norms. Thai culture, as with most Asian cultures, is highly respectful. The most significant Thai ritual is the traditional greeting—the Wai. The gesture is made by bringing hands together—think of the Christian praying hands. While holding hands together in that fashion, raise hands about chin high, forming an inverted Y or praying hands. As you greet, lower your head slightly as if to touch the tip of your nose to your finger tips. Waiing is considered a highly respectful gesture and is unique to Thailand.

    Shortly after returning from Thailand, I was shopping and noticed a female Thai employee. Deciding to “make her day,” I accepted a sample from her and thanked her by waiing her while saying, “Korp-kun-ka,” pronounced “cob-coon-caw” (thank you—feminine). She lit up as though we were old friends and began speaking to me in Thai. As I walked away, I again waied her and said, “Sa-wat-dee-ka” pronounced “su-woddie-caw” (hello or goodbye—feminine), to which she laughed and returned the farewell. In Thailand, even Ronald McDonald is seen in Bangkok posed giving a wai to passersby.  

    Thai society has been deeply influenced by centuries of Theravada Buddhism, also the state religion, resulting in a distinctly unique combination of easy-going attitudes coupled with individualism (Limanonda, 1995). Attitudes and practices embrace tolerance, acceptance, harmony, hospitality, individualism, and karma. With these in mind, consider this: You recognize the need to help a client learn to verbalize wants and needs in an intimate relationship. After some resistance, your client shrugs his or her shoulders and says, “Mai-pen-rai,” pronounced “my-ben-lie,” meaning, “It doesn’t matter.” “Mai-pen-rai” is a well-known saying and attitude in Thailand (V. Rall, personal communication, September 7, 2009). Imagine, too, a client seems to accept abusive language from his or her teen and resists attempts on your part to teach appropriate relationship boundaries and consequences. You learn through further discussion that your client was once very disrespectful to a parent and accepts the current situation as manifest karma. Both scenarios of accepting undesirable circumstances through mai pen rai or karma can be barriers to empowering a client. Building on strengths of the independent Thai culture, a social worker could focus on individualistic strengths—also a Thai attitude—to overcome limiting beliefs.

    Thai culture upholds a societal hierarchy as follows: king, monks, royal family, military/government, teachers, elderly, and wealthy (V. Rall, personal communication, September 7, 2009). This societal hierarchy or vertical society is a Buddhist inspired attitude, and is therefore deemed meaningful (Limanonda & Bahassorn, 1995). Understanding Thai societal hierarchy helped me better appreciate why my Thai friend refers to her American husband, who once taught English in Thailand, as “Teacher James” (T. Fritzinger, personal communication, October 8, 2009). It is typical for Thai immigrants to carry the vertical or classist societal attitudes and values here from their homeland (V. Rall, personal communication, September 7, 2009). Positioning yourself in the teacher or educator role will establish credibility with your Thai client.

Observe Family Values

    A significant portion of generalist social work practice is in understanding and working with families (Kirst-Ashman & Hull, 2009). KNOWing some common Thai family values will be helpful in identifying family strengths and needs. Suppose you are interviewing a Thai client and learn that Dad, Mom, and two grade school-age daughters all sleep in the same bed. What goes through your mind? In this scenario, it is appropriate for a social worker to determine whether there is any sexual abuse, but to assume so because of family sleeping arrangements is a mistake. It is a cultural norm for Thai families to share one bedroom, if not the same bed. Research among Thai families shows bed sharing is across the board in Thai culture from the highly educated to the peasant (Anuntaseree, et al., 2008). This is part of the strong family bonding common to Thai families and can be seen as a strength if properly understood.

    Living arrangements among Thai families are ever-changing. It is highly common for elderly parents as well as a newly married couple to live with the nuclear family (Limanonda, 1995). Our U.S. individualistic society often finds multi-generational or co-residential living odd. It is important for social workers to be aware of and challenge their biases when working with foreign-born clients (Kirst-Ashman & Hull, 2009). Multi-generation residential living can be a family strength to build upon.

    Imagine you are working with a couple, and they are struggling financially. The American born husband is upset with his Thai-born wife for sending money to her parents in Thailand. Who are you sympathetic toward? Deeply seeded in Thai culture, inspired by Buddhism, is caring for parents (Limanonda, 1995). One Thai friend wires money monthly to parents, and another provides vitamins and nutritional supplements to her elderly family members on her annual visit to Thailand (V. Rall, personal communication, September 7, 2009). For a Thai person to forgo supporting elderly family would be seen as forsaking a sacred duty.

Watch for Immigration / Acculturation Issues

    The final step in KNOWing your foreign-born client is to understand the client’s current level of acculturation, because it helps significantly in evaluating needs and perceptions (Kirst-Ashman & Hull, 2009). Five questions assist better understanding of Immigration Circumstances and Acculturation Level. I call them the ICAL-5 checklist. The questions are:

    Just as a social worker would use an ecomap or genogram as a tool for assessment and understanding, the social worker could incorporate into that ecomap the answers to the above questions. The “culturagram,” a term coined by Congress and Kung (2005), incorporates the above questions, as well as the following:

    The ICAL-5 and the culturagram are valuable tools for assessing acculturation. Thai immigrants make up a relatively narrow slice of the immigrant population in the U.S. (Asian Census, 2000). Because of this, the ethnic support systems are generally limited, making acculturation important, from their perspective (T. Fritzinger, personal communication, October 8, 2009).

    The Code of Ethics tells us culture influences behavior and we have a responsibility to understand the significance of culture. We are also reminded that all cultures have strengths. Familiarizing ourselves with a foreign-born client’s country of origin and culture helps us as social workers to more effectively help clients.

Conclusion

    One of the greatest interviewers of our time, Pulitzer Prize winner Robert Coles (1990), shares a lesson learned early in his career:

The people who come to see us bring us their stories. They hope they tell them well enough so that we understand the truth of their lives. They hope we know how to interpret their stories correctly. We have to remember that what we hear is their story (p. 7).

    You can create trust and rapport with foreign-born clients by following this simple KNOW approach. Applying these tips can help foreign-born clients feel understood and validated. Understanding a foreign-born client’s point of reference helps us interpret the truth of their lives.

References

Anuntaseree, W., Mo-suwan, L., Vasiknanonte, P., Kuasirikul, S., Ma-a-lee, A., & Choprapawon, C. (2008), Factors associated with bed sharing and sleep position in Thai neonates. Child: Care, Health and Development, 34, 482–490.

Asian Census. (2002). U.S. Department of Commerce. http://factfinder.census.gov/home/saff/main.html?_lang=en. Retrieved September 8, 2009.

CIA World Fact Book. (2008). http://search.ebscohost.com.libproxy.boisestate.edu/. Retrieved November 29, 2009.

Congress, E. P., & Kung, W. W. (2005). Using the culturagram to access and empower culturally diverse families. In E. P. Congress & M. Gonzales (Eds.). Multicultural perspectives in working with families (pp. 3-21.) New York: Springer.

Coles, R. (1990). The call of stories. Mariner Books.

Kirst-Ashman, K., & Hull, G. (2009). Understanding generalist practice, Brooks/Cole: Belmont, CA.

Limanonda, B. (1995). Families in Thailand: Beliefs and realities. Journal of Comparative Family Studies, 26. (1), 67.

Parrillo, V. (2009). Strangers to these shores. Boston: Allyn & Bacon.

Shirlene Elledge, CPM, CNHP, is a student in the BSW program at Boise State University. She is a certified professional mediator, serves on the Idaho Mediation Association board, and is a certified instructor/facilitator and owner of the Adlerian Relationship Center in Boise, ID.

Acknowledgement is given to Dr. Misty Wall at Boise State University for providing mentorship and feedback through the development of this article.

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