Category: Asian American

Using the Filipino Practice of Shared Inner Perception in Psychotherapy

Posted on by Psychotherapy.net Team

Pakikiramdam (Shared Inner Perception)

Shared Inner Perception is the essence of the Filipino core value of Pakikiramdam. It is the sensing and attunement that occurs when people interact. Although I speak of it within a Filipino cultural context, many other collectivistic cultures share a similar value. And from an ancestral anthropological viewpoint, we were all collectivistic at one point in our histories.

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Pakikiramdam is a Filipino core value that is antithetical to the Western philosophy of directly stating what one feels or needs. The word “stating,” makes all the difference. Through Pakikiramdam, the Filipino — usually the immigrant or in the first-wave generation — is able to state or communicate far more without words than is typical or even comfortable for those solely dependent on the literal word for communicaion.

In mixed-generational or mixed-racial families, these two styles of communication often clash, leading to instances where the intent of the speaker becomes lost on the listener, while the listener feels out of touch with the speaker. In my clinical experience, this scenario often plays out in therapy with Filipino clients, leaving members of the family feeling unheard, mis-heard, or unvalued. If the therapist is not keenly attuned to the client, whether Filipino or not, the potential for miscommunication multiplies.

Shared inner perception in the therapy room starts with deep listening. It is using the therapist’s gift of intuition, attunement, collaborative projection, and co-transference. When the intuition channel of the therapist is clear, it’s like a light shone on a map that the client possesses. When the intuitive channels are unclear, ridden with ideologies and blind spots that belong to the therapist, intuition is instead like a broken compass, taking the client somewhere he intends not to be.

Pakikiramdam’s language relies on watching, listening for, and sensing non-verbal cues; paying attention to what is not said as much as to what is said. This includes paying attention to changes in vocal inflections, subtle facial and bodily movement, breathing patterns, and subvocal sounds, such as tsk, tsk, tsk.

This is not an uncommon scenario:

Ricky, a Filipino American son asked his elderly mother, “Do you want me to pass by your house before I head straight to work?” “His mother replied, “Oh no, just go right ahead.” And so the son did. A few days later, he realized that his mother experienced Tampo (having her feelings hurt, although not completely angry or upset, by someone they care about). Why?

Here’s the other part of the conversation from the mother’s perspective:

“No, just go right ahead. Oh, by the way, I remembered I have to call the plumber because I can’t flush my toilet. I had a stomachache yesterday, I guess I used too many toilet papers. Now, I don’t have a single roll. Gosh, I need to go because my neck is starting to ache holding onto the phone. Bye.”

It would’ve been more useful for the son if the mother had clearly and directly articulated her needs, even though he did repeat his request to her to stop by. Let’s explore this scenario.

Self-Soothing Versus Collective Coregulation

The “rules” for communication in individualistic and collectivistic cultures differ widely. Individuals and family members in cross-generational, or mixed cultural/racial families often experience scenarios similar to that of Ricky and his mother.

Systems of care in a particular culture are influenced, in large part, by the self-soothing strategies that are part of that culture’s value system. In America, grandparents can babysit their grandchildren but more formal out-of-home, out-of-family care, like daycare or school, provides American families with the stability and consistency of care that the parents need to manage their livelihood and parenting responsibilities.

In non-Western, collectivistic societies, cooperative care is the social norm, through which children are raised by non-family “trusted-others.” These informal resources allow primary caregivers to pursue much of the same goals parents have across cultures, that is, to pursue economic opportunities and navigate parenting with ease. In these collectivistic cultures, Filipino included, parents emphasize the importance of being part of a system, which includes relying on others and being someone to rely on.

In the Filipino culture (in the Philippines), preparing and rehearsing children to read non-verbal cues are taught almost instinctively by adults from birth. The words, iyak-iyakan (pretend crying), galit-galitan (pretend being mad), sakit-sakitan (pretend being hurt), may be used in a playful, teasing way with young children so they can read real situations when they arise.

I had the interesting experience of a being a kindergarten teacher both in the Philippines and in America. The stark difference in the use of teasing as part of the group dynamics with children and the adults was notable.

Teasing is defined as making fun of someone in the English language. While I am neither proposing or advocating for teasing, I am referring to a type of teasing where someone who is teased can tease back. In fact, this is not an uncommon strategy of parents in the Philippines to teach their children to tease back playfully when teased. In this instance, the teasing becomes a communal act, as does the soothing.

It’s also not uncommon that such teasing can be used to lighten up an embarrassing moment. For example, if a child trips in front of his friends, his friends might start laughing, not as a way to ridicule him entirely but to elicit laughter so that child does not feel embarassed. Again, rather than burdening the fallen child with soothing themself, that burden is shared by the group and soothing becomes an act of community based on that groups ability to sense or intuit that child’s distress.

Shared Inner Perception in Parenting

In the following illustration, I contrast the Filipino and American orientations to the goals of parenting.

The American parent’s goal is to teach their child to self-regulate, to be independent, and to be self-sufficient. In the individualistic, nuclear family system, there simply aren’t as many helpers that can assist in informally raising the child. A good child is one that can self-soothe, articulate their needs, and do things on their own.

The Filipino parent’s goal is to teach their child to enter group settings successfully. This means teaching children to read non-verbal cues, including watching for subtle changes in facial and bodily movement, as well as tone of breathing and voice. A good child is one who can collectively receive and give coregulation, can share their space, and do things with others.

To contrast self-regulation, coregulation, and collective coregulation (a term I made up to explain this phenomenon), I’ll use the umbrella metaphor:

In individualistic culture, it’s essential that an individual learns to build and toughen their own umbrella so that when rain comes, they won’t be drenched. This is self-regulation. When the rain turns into a storm that surpasses the umbrella’s protective capacity, the individual may seek the company of other umbrellas. After all, two umbrellas are better than one. This is coregulation.

In the therapy room, when trauma, or a client’s deepest hurt, is akin to the rain that turns to storm, deep attunement to that client’s need for the protective umbrella, so to speak, of the therapist becomes crucial. Self-regulation yields to coregulation.

Shared Inner Perception in the Therapy Room

Returning to Pakikiramdam, shared inner perception values the following for the purpose of connecting with others: Pangangapa (to grope), Pagtatantiya (to estimate), Tiyempuhan (to wait for the right time), Tiyakin (to ascertain), Pagsusuri (to investigate), Pakikibagay (to deal with), Pakikisakay (to catch/ride on), Timplahin (to blend or season to the right taste), Singhot (to smell or sniff).

It would be daunting to rely on the therapist’s intuition as a treatment plan. Intuition without a framework can put that therapist in a position of a guru who must rationalize that they were only following their intuition when they have led a client to themselves.

A useful tool is a sense of wonderment which gives way to collaborative projection. In that, the therapist’s projection is likened to a doctor who is giving an intravenous injection. The doctor has seen many veins, good and unsuitable candidates for a shot; they project based on their professional experience. When they finally choose a vein, that projection is essential, and yet they watch for a slight twitch and nuance because only the client can tell that a good vein is actually good.

The therapist who diligently engages in the practice of observing their clients can begin to wonder about the subtle unspoken reactions and changes in their client that serve as guiding cues for therapeutic involvement and intervention. This process of wonderment is not the same as interpreting, since the therapist must constantly check that their projections are in agreement with the client’s and not the other way around.

Shared inner perception is an openness to co-suffering, not just as a mere strategy for treatment but as a human experience that the suffering and the witness (therapist) are both touched by what was shared in the therapeutic relationship. As the client grows in therapy, so does the therapist and vice versa. It is a thread where the beginning and the end are indistinguishable.

It is a dance to take the experience of the client at face value, leaving space that there may or may not be more. In other words, that a no response from a client may be a camouflaged yes and a yes, a polite way of saying no. The therapist who hones their shared inner perception skills doesn’t read their clients like an x-ray, but understands that the x-ray may reveal very different results depending on how it is held.

Final Thoughts

Marco Iacaboni’s research on mirror neurons and the process of co-internalization distinguishes between the self and the other, suggesting that our neurobiology puts us “within each other.” In this vein, interpreting facial expressions and social exchanges becomes a mirroring process, a thread that connects both the therapists and the client, and not merely a strategy “done to” a client.

Although the concept of Pakikiramdam in this article was introduced through the Filipino cultural lens, its tenets are not exclusive to this culture. In addition, its therapeutic use is not reserved for this population. There are modalities in the Western culture that purport a similar framework to healing.

For example, J.L.Moreno’s work on psychodrama encourages therapist spontaneity and flexibility. The other characters in the drama can utter words that the protagonist (client) dare not speak, giving timely voice and necessary silence when appropriate.

Various other modalities rely on creative expression — the sand tray, movement, art, and music — all become powerful mediums through which to explore healing without tripping into the trappings of language that often mean different things to different people. Language in all its forms, spoken and otherwise, is at the heart of the therapeutic communication.

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The therapist, therefore, listens deeply like a dancer listening to the rhythm of a tune for the first time, aligning her moves to the serenade of the music. Every beat counts and every beat missed becomes an opportunity to recalibrate the dancer to waltz back to the therapeutic relationship.

How to Successfully Navigate Cultural Challenges with Filipino Clients

Posted on by Psychotherapy.net Team

Linda came into the office with an anguished look on her face, lamenting that her mother had given her the “cold shoulder.” The reason: Linda hadn’t taken her children to see their lola (grandmother in Filipino) for weeks. Through a wrinkled brow she continued, “my mom thinks I owe her a visit even though we’re trying not to catch COVID. I know she took care of the kids when they were younger, but she makes me feel like my obligation is a string that is never to be broken. I’m grateful to her, but…” 

In Filipino culture, the sense that a past or recent good deed or favor must be remembered (and repaid) is called utang na loob. Utang is “debt” and loob is “inner self.” Filipinos are collectivistic in nature. The physical proximity that exists (the bubble) between two people is so much closer than is customary in American culture. The young American child is taught to articulate her needs and to orient herself within her own space. That child is taught to say, “Johnny, I got this toy first. Wait your turn.” On the other hand, the Filipinx child’s orientation is to empathize, which may or may not result in her sharing the toy with Johnny. But if sharing takes place (“Here’s the toy, Johnny”), positive reinforcement is given. The adult smiles approvingly at the behavior of the mabait na bata (kind kid). Often, the adult in Filipino culture also teaches the child empathy by narrating non-verbal cues and gestures: “Look at Johnny, he’s very sad. He wants to play with the toy too.” 

The Filipino American in Session

One of the challenges to the Filipinx American is to reconcile cultural opposites. I remember when I first immigrated to America, I saw a popular Filipina student from my school soften her otherwise deep, bright, red lipstick in the school bus each time we were on our way home. I later realized that she was struggling to bridge the cultural divide, attempting to appear American to the outside world and Filipina inside her home—a daunting task, especially for a young adult who is trying to make her way in the social realm. 

It might be easy to assume that a Filipino has assimilated into the American culture once they have learned the language—most are bilingual. However, this bilingualism also creates myriad possibilities for miscommunication, not just in the therapy room but in the Filipino home. While a born-and-raised Filipinx American client may be more comfortable with English, their older relatives may not. Such was the case with Linda’s mother, her grandmother and her uncle. To help Linda in her familial struggles around utang na loob in the therapy room, I had to make space for the conflicted familial energy that came with the linguistic and cultural divide separating the generations.

A Westen-trained therapist might immediately focus on supporting a client like Linda by assisting her in setting boundaries and helping her to assert herself in the face of what she regarded as her mother’s unrealistic demands. While doing so might be a reasonable route to take later in therapy with her, it could very well backfire while working within her collectivistic familial system. Borrowing from Emotional-Focused Therapy, discovering our loved ones’ emotional longing can transform how we respond to them. However, this can be tricky because it’s important not to put your clients in a position where they carry the burden of changing the familial system by accommodating and flexing their emotional muscle at the expense of their own psychological well-being. I didn’t want to do that with Linda and her family. 

The Linearity of the English Language

To help Linda set boundaries with her mother and other family members, it was important for me to further explore the concept of utang na loob with her. As a debt, utang is typically a quantifiable exchange, such as a defined amount of money that both parties agree upon. In contrast, although it is inextricably linked to external exchange, or debt, loob describes the inner workings of the Filipinx psyche, an unquantifiable. The phrase lakas ng loob roughly translates as “persistence on the inside.” But the word “inside” gets lost in translation. Sensing (pakiramdam in Filipino) is a core value rarely explored in Filipino American psychology. Pakiramdam is to sense someone beyond their verbal assertion and articulation.

In Filipino culture child-rearing, there is rehearsing that occurs between caregiver and child, which teaches the child that communication relies not solely on explicit language, but also, and deeply, on bodily movements such as the motion of the eyebrows, the breathing pattern, and bodily posture. Trained in Western notions of communication, a therapist might initially be curious as to why their client can’t just speak directly to mitigate misunderstanding—in this case, Linda with her mother. The assumption that verbal assertion trumps all other types of communication is the equivalent of seeing the world from a particular cultural perspective that in this case does not represent the Filipinx worldview or practice.

The history of the Philippines is complex. It ancestral roots were embedded in the rites of animism prior to colonization by the Spaniards. I believe that a history of oppression teaches the colonized to communicate implicitly with each other to maintain freedom of expression and to avoid imprisonment, both literal and emotional. Jose Rizal, the national hero of the Philippines spoke in codes through his literary manuscripts because it was safer to do so during its colonialization by Spain. Executed at 35 by firing squad, his work is studied to date by students who learn to decode his writings for their true underlying meanings. Speaking in code was a functional way to adapt to psychological threats, real and perceived. But it’s also a way to speak when people are in closer proximity. Despite Filipinxs’ bilingualism, concepts that aim to be translatable into English—in this case, utang na loob—can, and very often do, lose their meaning. 

Lost in Translation

A debt can be paid with a simple, explicit transaction, often, at least from a Western perspective, by a transfer of money. While utang literally translates to “debt” in Filipino, the word used in the native language rarely means “to pay” but to tanaw. Tanaw in Filipino means “to glimpse back on, to look back and not forget.” Regarding the immigrant who leaves the motherland in search of greener pastures, the young Filipinx American often carries a sense of obligation or burden to repay favors done for them by their elders. And because loob is the unquantifiable sense of the otherwise measurable utang, immigrants often bring with them and carry the unsettling feeling of not knowing the extent of the debt—how much and how long they need to pay for it, or what the repayment was—when they didn’t ask for or agree to the loan in the first place. They are simply expected to remember that they are in debt, and despite their gratitude and wish to honor their parents, struggle with the indeterminate nature of that debt.

It is as if upon leaving the motherland, the immigrant is given a rope with which they can metaphorically climb the steep mountain ahead of them. The rope is securely tied to the parent, who hopes their child will use it to the best of their abilities in the new land by striving for the highest goals, perhaps in the form of receiving straight A’s in their new schools. This rope is the bond between parent and child, and in essence ties the child to the parent in debt, utang na loob. This binding translates, so to speak, into an honoring through appreciation; a thank you and even a showcasing and sharing of one’s financial accomplishments.

This can be a deeply unsettling experience for the immigrant or Filipinx American who views this material—and sometimes immaterial and unmeasurable—tabulation as superficial. However, it’s important to remember what the material transaction represents. It allows the immigrant to satisfy their emotional needs (the sense of honoring the debt to the parent) and to feel like a hero in the parent’s eyes. When, on the other hand, the parent, who is still holding tightly to the rope feels forgotten or their generosity or sacrifice diminished, they often become sour, passively resentful, and pull out a lengthy list of all they’ve done for their child who is now successful in their new life and the new world because of what they provided. In turn, the now-grown child feels confused and attacked. 

The Shadow Side of Utang Na Loob

I’ve found that there are many reasons for the giving of favors. While kagandahang-loob (a Filipino core value of inner goodness shared with others) stands out, it is not always the case that favors are altruistic. I have seen generosity through giving favors used as emotional and financial investment (“You owe me money or gratitude for what I have given you or sacrificed for you”), a means of controlling the recipient, and as an ensnaring that keeps someone close at all costs. When the recipient of a favor is perceived by the giver (usually a parent or other close relative) as being successful in navigating the American culture by virtue of a stable job or possessions, including home ownership, that “giver” may expect something in return, either materially/financially or emotionally, such as in dependence or a never-ending thanks and the return of favors or satisfaction of demands or expectations. 

In general, Filipino immigrants learn to self-soothe through connection, as opposed to Americans, who seem to do so through independence and materiality. When an immigrant learns to navigate the American culture through self-care and self-soothing strategies, they can, in turn, better assist their own children in exploring their own worlds, rather than fostering in those children a sense of indebtedness or a thirsting for parental attention and affection. When, however, that parent begins to experience disconnection from their now independent-thinking child, they may invoke utang na loob to counter that sense of emotional distancing. They may, in turn, come to rely on their children to define their own happiness, in essence putting all their emotional eggs in one basket, and fear that the independence of their children may mean an empty emotional basket. 

In Linda’s case, any “sensed” or “felt” lack of appreciation by her mother was experienced as resentment, typically passive in nature. In all likelihood, Linda’s mother felt forgotten when COVID separated her from her child and grandchildren. For the mother, Linda’s disconnection (actually because of COVID) was felt as a personal rejection, and she reacted with resentment toward her daughter for a lack of gratitude. Verbally appreciating her mother and telling her how much her help meant went a long way in bridging the gap that had developed between Linda and her mother. Repetition of and consistency in communicating her appreciation became that much more important in shoring the rift. In a culture where politeness and kindness towards the debt holder supersede directness and self-assertion, repetition is critical and interpreted as sincerity. 

Because Linda hadn’t shown this “gratitude with sincerity” in a while, she decided to give it a shot, although she knew it was not likely that her mother would readily or eagerly accept it. She was more likely to give Linda a hard time following the first few attempts. It was also likely that when she called home, her mother would sound aloof and even sarcastic, so it was up to Linda to reach out with consistency to give her mother and the relationship the chance to pivot. Oftentimes, this is all that is necessary for Filipinx clients in a comparable situation. 

It’s possible that despite her consistency and expression of affection, Linda and her mother had become trapped in a negative emotional cycle from which it became difficult to escape. At the point when Linda came to see me, I believed that it was important to give her a gentle nudge in the direction of exploring the setting of healthy boundaries while discussing utang na loob with her. 

Final Thoughts

The concept and evocation of utang na loob has evolved over time; however, Filipinos may continue to use it in attempt to reel someone in or collect an explicit or implicit material or emotional debt in the name of a cultural or familial norm. However, from the depths of its ancestral roots and its connection to the culturally derived, deep unspoken sensing of “the other” (pakiramdam), it has also served the purpose of helping to maintain the integrity and survival of the Filipinx cultural ecosystem across the diaspora. In the process, this deeply-rooted belief and practice, despite the familial tension it can engender (as it did in Linda’s case), also encourages the child to give without concern about exchange or debt—with the faith that doing so will be remembered in one form or another today or into the future, keeping family members connected.

Author Note: Articulating the nuances of utang na loob for a clinical audience has been a feat. I tried to provide service to my fellow-practitioners/healers but am also mindful that my description of this dynamic concept continues to breathe and change with and for each Filipinx American client and their family.