Abstract
The breathless pace of market reform in China has brought about profound ruptures in socioeconomic structures and increased mental distress in the population. In this context, more middle-class urbanites are turning to nascent psychological counseling to grapple with their problems. This article examines how Chinese psychotherapists attempt to “culture” or indigenize (bentuhua) three imported psychotherapy models in order to fit their clients’ expectations, desires, and sensibilities: the Satir family therapy, cognitive behavioral therapy, and sandplay therapy. It addresses three interrelated questions: What is the role of culture in adopting, translating, and recasting psychotherapy in contemporary China? How is cultural difference understood and mobilized by therapists in the therapeutic encounter? What kind of distinct therapeutic relationship is emerging in postsocialist China? Data presented here are drawn from my semistructured interviews and extensive participant observation at various counseling offices and psychotherapy workshops in the city of Kunming. My ethnographic account suggests that it is through constant dialog, translation, and re-articulation between multiple regimes of knowledge, cultural values, and social practices that a new form of talk therapy with “Chinese characteristics” is emerging. Finally, I reflect upon what this dialogic process of transformation means for psychotherapy as a form of globally circulating knowledge/practice.
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Notes
This statement may be a bit too sweeping since part of traditional Chinese culture (such as Confucianism) also encouraged self-cultivation, but the point is that this focus on personal emotions represents a significant shift in recent Chinese history.
I have done extensive research on this issue, but there are no reliable data available at this point on the actual number of help seekers. Statistics on mental health hardly exists in China. However, the Chinese Psychological Society and the Chinese Psychotherapy Networks all claim that the demand is increasing rapidly. My interviews with the therapists in Kunming also indicate that they have more clients every year. Some have doubled or tripled the number of clients over the past 5 years.
Throughout this article, I mostly use the term “clients” (zike or laifangzhe) rather than “patients” (bingren) to refer to those who seek counseling and therapy from practitioners outside the hospital setting because this is how they are called in China due to the strong stigma attached to mental patients.
Although the concept of “assemblage” has been largely associated with the work of Deleuze and Guattari (1987), in this article I draw more specifically from the analysis of “global assemblages” developed by Collier and Ong (2005) and emphasize its ability “to speak of emergence, heterogeneity, the decentered, and the ephemeral in nonetheless ordered social life” (Marcus and Saka 2006, p. 101).
Susan Brownell (1995) develops a different notion of somatization: Chinese people are often caught in a web of social interdependency, which is often expressed in conceptions of the body.
See also Cristiana Giordano's discussion of translation and difference in the context of making migrant subjectivities and citizenship in Italy (2008).
Again, this is based on Chinese researchers’ observation, and no specific numbers are available.
Elsewhere (Zhang 2011), I explain in greater detail why so many people flock to counseling training, yet so few become a full-time therapist.
The most prominent magazine is Psychologies (Xinli), specifically catered to urban middle-class women.
Skype is a new Internet service that offers free calls and video-conferencing. The China American Psychoanalytic Alliance (CAPA) established in 2006 conducts some of its psychotherapy training programs via Skype for mental-health professionals in Beijing, Shanghai, Chengdu, Wuhan, and Xi'an.
According to a 2009 survey by Michael Philips et al. (cited in Cyranoski 2010), 17.5 % of Chinese have some form of mental illness. Yet, the mental-health infrastructure is severely under-developed. The ratio of psychaitrists to the population is 1.5 per 100,000 people (Cyranoski 2010), and the ratio for counselors to the population is 2.4 per 1 million people (Lim et al. 2010). Michael Philips, Huaqing, and Yanping Zhang suggest that China’s suicide rate (largely among rural women) is one of the highest in the world today, and one of the reasons might be the lack of treatment for persons with depressive illness although they also point to other important social factors that contribute to the high suicide rate (Philips 1999).
In China, there are two terms commonly used to refer to those practicing psychological counseling: counselors (zixun shi) and therapists (zhiliao shi). Although the latter carries slightly more medical weight than the former, they are not clearly differentiated and often used interchangeably in everyday conversations among Chinese people.
Compare Amy Borovoy’s fascinating study of Japanese psychiatrist Takeo Doi’s early attempt to develop an “indigenous” form of Japanese cultural psychology that can bridge ideas of relationalism and individualism, Japanese particularism, and Western humanism (2012). See also Rong-Bang Peng’s investigation into the indigenous psychology movement in Taiwan (2012).
I translated all the documents and the application for this firm, and thus had the opportunity to gain deeper knowledge of how this process worked and what motivated Chinese therapists to engage in the Satir Model.
For example, the American Psychiatric Association Practice Guidelines (April 2000) suggests that CBT is one of the most effective treatments for major depressive disorder.
The exchange rate as of 2014 is roughly 1 US dollar to 6.23 yuan. A few very well-known therapists would charge as high as 500–800 yuan per hour.
The application of mindfulness (originally borrowed from Buddhism) to clinical psychology and psychiatry has gained enormous popularity in the West over the past twenty years. It has been widely used in stress reduction, cognitive therapy, dialectical behavior therapy, and Morita therapy. A leading figure in mindfulness-based psychotherapy is Jon Kabat-Zinn based at the University of Massachusetts Medical School (see Kabat-Zinn 1990, 2005 for example).
One of the most compelling evidences is a collection of Jung’s writing translated by R. F. C. Hull, titled Psychology and the East (1978).
One example given with regard to cultural sensitivity is this: "Western therapists sometimes express their empathy through hugs, touches, and even kisses, but Chinese culture does not such behaviors, especially between the two genders" (National Occupational Qualification Training Textbook: Psychological Counselor Level III 2005, p. 61).
I thank one of the reviewers for suggesting this second insightful reading.
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Acknowledgments
I am grateful for the generous financial support from the John Simon Guggenheim Memorial Foundation, the National Science Foundation, and several UC Davis Faculty Research Grants. My deepest gratitude goes to the psychotherapists, their clients, and other informants in Kunming who generously offered me their time and shared their life stories and struggles with me. I am indebted to the following colleagues and friends for their insightful comments and conversations on the writing: Joe Dumit, Sara Friedman, Cristiana Giordano, Zev Luria, Tomas Matza, Mark Miller, Aihwa Ong, and Rima Praspaliauskiene. I also benefited greatly from the engaging discussions with the faculty and students at the following institutions where I was invited to present earlier versions of this article: Department of Anthropology at Stanford University, the China Center at UC Berkeley, the Jackson School of International Studies at the University of Washington-Seattle, the Asian Studies Center at UC Irvine, the East Asian Studies Program at UC Davis, and the China Center at Australian National University. Finally, I thank the anonymous reviewers and the editors at Culture, Medicine, and Psychiatry for their very helpful suggestions and comments, much of which have been incorporated into this final version and strengthened my analysis.
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Zhang, L. Bentuhua: Culturing Psychotherapy in Postsocialist China. Cult Med Psychiatry 38, 283–305 (2014). https://doi.org/10.1007/s11013-014-9366-y
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DOI: https://doi.org/10.1007/s11013-014-9366-y