Body-language and nonverbal communication

Cultural factors and psychotherapy in China

Cultural factors and psychotherapy in China















Regarding emotional or psychosomatic difficulties or problems we talk about I was asked to say more about how to handle this in daily life and or in therapy. Here is some comment:

What is the culture of psychotherapy in China? What makes up the thinking and feeling processes in the typical Chinese client? Understanding these questions gives us a beginning of how to understand and make trusting alliances with the Chinese patient. Several factors play a large role in the Chinese culture and character that affect attitudes toward seeking help and dealing with emotional difficulties.

Other-centered culture: Many Chinese people see their own problems as coming last compared to the welfare of others. While this is adaptive and socially valuable for the culture at large, it also keeps ………………….people from seeking help for themselves and taking a constructive approach to emotional and life problems. The Chinese client often thinks they are troubling the counselor with trifles and are more concerned about the therapist’s welfare than their own well-being. Knowing and appreciating this feeling as normative can also help move the focus to the client in a respectful and therapeutic way.

Culture of therapy? In China, there is almost no culture of therapy that is comparable to the Western culture of therapy. Indeed, there is a great mistrust among Chinese people toward authorities in general, perhaps going back to the cultural revolution and the intimidations and damage done to openness and trust during this time. Most people do not discuss their emotional turmoil with anyone, as they will lose face. In China there is a high degree of anxiety about judgement, criticism and evaluation by the state and other people. This, as you can imagine, makes it very hard to separate social norms from inner feelings. And it adds an extra layer of caution and suspicion when the client comes to see the counsellor.

Face: A crucial thing for the Western therapist to understand is that the Chinese client before them is not going to tell the truth in a direct manner due to the issue of face. This is not uncommon even among more free-thinking Western patients. However, for the Chinese this goes deeper. Face means not being put in a position of shame. In the culture as a whole, the taboo of mental illness is high. People will not admit to anyone that a family member has a problem of this kind or that they themselves are mentally unhealthy. The awareness of shame is very high and controls the daily aspects of business, government, and personal behaviour. A man whose wife is cheating on him will simply complain of headaches to the doctor and request some medicine to help him. To admit that this is in fact stress would be to admit weakness of character—so in turn the physical complaint is easier to cope with and address.

How shame and face affect therapy: First, even if you can get the person into a therapeutic relationship, they will avoid opening up about their concerns to avoid losing face in front of you. This then requires the therapist to begin sessions with an open honest approach to talking about shame and face directly to the patient. The client will instantly understand your meaning and seek a non-judgemental attitude from the therapist in return. It still may take several sessions for the client to trust the therapist before a real exchange of information based on the true nature of their problems comes forth.

Relationships and favour: In China the word relationship carries with it the factor of favour—that is, a relationship is about what you do for each other. Often, it is to one’s advantage that a person does a favour for you. In return, at some future point, you will return that favour—often many times bigger than the original favour. This system of relationships works through government, business, and in daily life.

For example, a university student is failing his course, so the father makes a generous contribution to the University building program, and the boy’s papers are then marked higher. In the West this is corruption, in China just a relationship being confirmed. In the future, the student may become successful; in turn one day he may be asked to contribute; he will feel under obligation to do so. It is this ongoing sense of obligation that causes a great deal of unhappiness in China. In England, we have the old-boys network: the inside practice of people from Oxford or Cambridge University giving jobs and promotions to those who, like them, went to the so-called right places. In China they have these forms of relationships born out of favour and return. Understanding this helps the therapist avoid being shocked and confused when favour is played out so directly.

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