Body-language and nonverbal communication

Seeing clients in China

Seeing clients in China

While in China, where I was from, I saw clients at the Shanghai Mental Health Center in both the outpatient and inpatient units. Most of the patients are walk-in patients without scheduled appointments. I did not know who to expect to see before they came in the door. Patients were usually accompanied by their family members who sat with the patients during the visit to provide collateral information. As most patients had severe psychopathologies, besides observation of the patients, I relied heavily on the information on symptoms and medication provided by family members. While on the inpatient ward including a locked unit, I was assigned a few patients with diagnoses ranging………………… from schizophrenia and schizoaffective disorder to bipolar disorders. My work was closely supervised by the attending psychiatrists on the ward.

The experience with the Counseling Center at Zhong-shan Hospital was quite different. Zhong-shan Hospital is one of the top general hospitals and the clients seen there are mostly with neurotic disorders. However, clients with early-stage schizophrenia were often seen there as well. Many families prefer to go to a general hospital rather than a mental health center which is less private and more stigmatized. The patients waited outside the room. The nurse gave them symptom measures such as SCL-90 and BDI for new clients before the psychiatrist saw them.

All of the therapists in the Counseling Center were psychiatrists. I first worked with my supervisor, Dr. Jun-mian Xu, observing him doing therapy. Most of the time, he prescribed medication as well, both Western and herbal medicine. He wrote the prescription on the patient’s record book (patients at the outpatient clinic kept their own medical record at that time) and I then copied them onto the prescription paper.

Most of Dr. Xu’s clients were scheduled in advance through the outpatient registration. He had to limit the number of patients he could see in one afternoon. I still remember we were always the last ones leaving the outpatient building on Saturday evenings around 7 pm. He saw 10 to 15 clients for an average of about 25 minutes each. Later on I started to see clients independently and discussed cases with senior colleagues, i.e., attending psychiatrists. However, there was no formal supervision when I worked there in the early 1990s.

Around that time, three or four of Dr. Xu’s graduate students, including myself, were learning Cognitive Behavioral Therapy and we all did our dissertations related to CBT, e.g., validating Beck’s Hopelessness Scale, studying the cognitive style of Chinese who were depressed, etc.

During my work there, I did not feel that it was difficult connecting with patients though I worried that I was much younger than the majority of my clients. I found that discovering commonalities between myself and patients was often a big help to bridge the differences between us and build an alliance. For example, one of my male clients, much older than I was and a well-established engineer who just returned from Britain, insisted that we use English in our work. I gladly tried that as I’d been interested in language as well and it readily made him feel comfortable and open

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