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SPECIAL

ARTICLES

Psychotherapy in Modern
MIN(;-GA0 CIIANCMING BA0-KuENC DoNu-MEI BERNARD LI,

Integration China
M.D Pn.D M.D. M.M.
BEITMAN, DIN;, DUAN,

YUE,

D.

M.D.

Since ern

the end

of the cultural
China and has ideas, opened

revolution itself and to Westthose practice. market of including

P
ment 300

(1966-78),

sychotherapy as a traditional ing has existed for centuries with a civilization Descriptions of and
B.C.

way of healin China, a 4,000 treatas of

influence pace
has

Western The faster


economies

psychotherapy
been

theory

country years.

of more than psychological be found opus On of the

of hfe under associated and

the new

healing in the

could magnum

as early Chinese basis

with a greater

increased need for beliefs


to

psychob)gi psychotherapy. which


and

cal problems well both with to grow

medicine,

Huang

die niejing.

Psychotherapy basic
orientation,

integration, Chinese
is likely

these descriptions and with the effort of generations of Chinese medical practitioners, some simple psychotherapeutic gradually evolved, such as cognitive ing, attention distraction, behavior tion, problem solving, and using one emotion Although the original methods therapy different theories enced therapy decades, chologists are still in China approach. of psychotherapy the development in China. methods reasoncorrec-

fits

the collectivist

continue ance clude medical from to mental


development

in influence Remaining

and obstacles

importto the inthe

in China.

of psychotherapy profession,
problems

in China skills stigma


for

lack of psychotherapy doing psychotherapy,

within profit attached

suggestion/hypnosis, to control another. elements of these modern psychoshape through a philosophy and have greatly influof modern psychoDuring the last few and psyefforts to

lack of potential by the masses,

in practice, has taken Western

and failpsychoPractice

ure to define basic requirements therapy training and practice.


(The and Journal 1994; of Psychotherapy 3:277-283) Research

Chinese medical workers have made unremitting

learn Western ideas and to integrate them into the treatment of the mentally ill through

Received

February

24,

1994;

revised

April Medical

26,

1994; University, Address

ac-

cepted May 10, 1994. From China Shenyang, and UniversityofMissouri-Columbia. correspondence to Dr. Beitman, try and Neurology, University Three Hospital Copyright Drive, 1994 Columbia, American

Department of Psychiaof Missouri-Columbia, MO 65201. Press, Inc. Psychiatric

JOURNAL

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278

PSYCHOTHERAPY

INTEGRATION

IN CIIINA

psychological cultural factors in the

methods. Many political have created ups and process of modern

and downs psy-

developmental

chotherapy. But overall, apy has gained recognition mode of treatment difficulties.
RECENT

modern psychotheras an alternative mental illness and

cians in other specialized areas, such as internal and external medicine, gynecology, and pediatrics, gradually joined the team providing psychotherapy. This marks the beginning of the healthy development of modern psychotherapy The in China. Chinese Clinical its convention convention, about were After Psychology every other in December Associyear. 1980, by the

for

psychological

HISTORY

ation holds At the first there were started Union was in a therapy. Most neurologists. quantity tions on the of theme these sixth the

30 presentations

on psycho-

Modern the heavy China. therapy early

psychotherapy 1950s political Throughout theories when and the

in China Soviet cultural the 50s, China

case analyses authored that first step, both of convention increased in 1991, and much also more proposals

influence on Russian psychoas part of the

and quality psychotherapy convention, 900 presentation

presentasteadily. At than had half the of

entered

general movement of scientific information. In 1958, physicians and psychologists in the Psychology Research Unit of the Chinese Academy of Science applied and modified the Russian methods and term eclectic psychotherapy treat neuropathy. was very successful. journal treatment developed a shortapproach to treatment of eight

of psychotherapy, presentations was Journal publication the

the quality improved. demonstrated and

the development chology after

of psychotherapy Cultural Revolution.

psyIn ad-

Reportedly the The publication

dition to the Chinese Psychology Journal, which had to stop publication during the Cultural Revolution, quently logical appear Science articles on psychotherapy freas PsychoResearch, Journal of ChiMental of the Acof in newjournals such Newsletter, Psychology Health, Journal Chinese the quality constantly. the number

articles reporting the success of this marked the beginning of modern so-called political brought was Cultural movement the nalaunched

psychotherapy in China. Unfortunately, the Revolution, a nationwide that tion lasted for disastrous

10 years and consequences,

Journal of Chinese Psychological of Chinese Psychological Hygiene, nese Clinical Psychology, and HealthJournaL2#{176} articles cording articles greatly published to Zhong Moreover, improved Yo Bin,

in 1966. Psychology was labeled as fake science and became a target of criticism on the grounds that it did not promote dialectical materialism. one dared worse, in The 1978. For the next 10 years to talk about psychology psychotherapy. Revolution the approval officially of the or so, no or, even ended governrethe of

on over In terms can

psychotherapy has increased the last 14 years (Table 1). of theoretical orientation, these

mention Cultural With

articles treatment It must of the different therapy plication

be categorized by the dominant method that was applied (Table 2). be noted, however, that the majority treatments Western methods, of the described and/or old or dominant have integrated Chinese psychonew, into approach. China began the apAs

ment, The gained

psychology as a science reappeared. Chinese Psychological Association its energy in Clinical was born. and 1979. held At the Psychology In 1980, its second convention, Association the Division annual

convention Chinese

(CCPA)

psychotherapy matured, many

in modern professionals

gradually to incorand been

Psychotherapy At first most sion of Following

was formed within the CCPA. members of CCPA and the Diviwere neurologists. leadership, physi-

Psychotherapy the neurologists

porate components of diverse schools, the approach to conflicting schools has moving from eclecticism to integration. In most of these studies

of psychother-

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Li

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279

apy,

patients

were

selected

from

the

clinics

chotherapy.

The

effect

of this

policy in

on

psy-

and hospitals with which the authors were affiliated. The research methods included observation, controlled study, and comparative study. Many articles are simply case reports On advanced entific China or records the whole, of the the quality process of the of interaction. studies is not sciin not artiin in

chotherapy is reflected both societal need for and acceptance therapy provide The and increased the service. need professional

increased of psychoability to par-

for psychotherapy

became

or well developed because true psychotherapy is just beginning and aspects of major theories are understood. these realities 800 patients However, these of psychotherapy were studied

ticularly apparent after Chinese people were exposed to foreign, particularly Western, politics, economics, culture, ideology, and customs. The changes from a planned economy for load comindibeto a market economy, which encourages petition, created much more stress viduals. and the The pace of life was greatly psychological individuals

sufficiently cles reflect China. 159 articles.

About

increased,

POlITICAlREFORM

China late adopt

started 1970s. One

so-called product foreign

political of this policy,

reform reform which

in the was to allows intellecAfter

came heavier. Moreover, many traditional cultural values were attacked by Western cultural ideology. Thus, more and more people started experiencing stressors, which were not as common affairs, before, and such as divorce, and extramarital teacher-student Westernization, cal problems parent-child

an open

political, economical, tual exchanges with

cultural, and foreign countries.

China had been closed for so many years, this open-door policy was greatly welcomed and and
TABLE

conflicts. With increasing acknowledging psychologibecame more acceptable;

provided professional
1.

an

impetus disciplines,

to many

scientific psyjour-

stigma declined somewhat. In addition, clinicians became more knowledgeable about psychiatric readily diagnoses and open to treatment therefore options. more As a confound paranoia, to

including
in Chinese

Articles on psycho nals (1979-1992)

therapy

sequence, the have depression,

number of people anxiety, phobia, pathology with the brought

Year 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989
1990

Number

1 2

and other psychological cally increased. Finally, ment of living standards economic reform ideas, individuals with ber has psychotherapy. of individuals been steadily This increased sionals to support more have seling

dramatiimproveabout by

and newly learned Western became more comfortable In recent years, the numwho seek psychotherapy increasing. need motivated profespsychotherapy. Since 1985, and psychologists clinics and counthe quality of the or

4 2 2 7 10 17 18 24 31 39 Total 159 Zhong Yo Bin.11 Reprinted by

and more physicians opened psychotherapy centers. To increase

1991 1992

service, many professionals, experienced new to the profession, committed themselves with great eagerness to receiving reeducation and studying techniques. and experiences

Note: From permission.

psychotherapy theories and Western psychotherapy theories contributed significantly to

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PSYCHOTHERAPY

INTEGRATION

IN CHINA

Chinese professionals ment. The Chinese ical Hygiene and

intellectual developAssociation of Psychologthe Chinese Clinical very responsive among profesvarious

They retical suited the ing

try to absorb the essence approach and make the to the Chinese founding psychotherapy cultural of the Chinese
Association

of each treatment background.

theobest At

Psychology Association were to the hunger for knowledge sionals. They have been

Psychotherapy

Counseling and in 1990, promotwas the focus The experts of different as well and differlimited out between those views and pointed

sponsoring

integration expert addresses. unique strengths schools and differences

training programs and hosting scholarly exchanges and conferences at different training levels. Many universities that have clinical psychology departments experts and sending countries ing. For are inviting foreign professionals to foreign for train8 years, the sent 7 into study of 7 shortin 11

of multiple acknowledged psychotherapeutic as similarities among ences by

of thought

to increase opportunities instance, during the last University different but also not only countries held a total

them. They regarded as the result of peephole perspectives

individual

China Medical dividuals to psychotherapy, term China.

the need Thus, they integration different

for overcoming one-sided views. strongly advocated psychotherapy to utilize what is common to the approaches and absorb the unique optiis conwill be to develop position by integration

psychotherapy To improve

training the quality

programs of training,

psychotherapy the United to lecture


trainees have

theorists States and for these


participated

and educators England were More


in them.

from invited than 300

strengths of each approach mal treatment systems. This sistent view that with and supported psychotherapy of the modern of been

Beitmans2

programs.

the direction

psychotherapeuintemany

PSYChOTHERAPY

I
Since the

N T E C R A T 1 0

tic enterprise. The promotion gration has also psychother-

psychotherapy supported

by

beginning

of modern

clinical efforts in China. For has been made to integrate

instance, effort the Japanese psychoanaand Chinese to form Psychology University has apapand a

apy, Chinese practitioners menting with integrating and


TABLE

have been experidifferent Western approaches.


by dominant (1979-1992)
Number

Morita method with the Western lytic and cognitive approaches traditional
modified

Eastern 2.
Articles theoretical

psychotherapy
on psychotherapy
orientation

behavioral
Morita.

The

correction Medical Medical

Department

in China

Orientation Behavioralism Psychoanalysis Cognitive Client Morita Biofeedback Music Fair.ily Hypnosis Supportive Total Note: From permission. Zhong Yo Bin therapy therapy therapy centered

also tried to integrate the proach with psychoanalytic proaches in treating various psychotic patients. grated approaches than widely China.

client-centered and cognitive neuropathic

52 32 26 2 11 15 4 3 3 12 159 Reprinted by

Reportedly, have been

these intemore powerful integration is in fits the

any single approach. The idea of psychotherapy accepted Psychotherapy among integration

professionals

guiding Chinese into two and dross belief proaches and that select

philosophy that a person should the essence.

one divides discard the ap-

It is a common

different psychotherapy present different biases-one-sidlimitations an as well integrated as unique approach,

edness and strengths-whereas

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which makes be superior Moreover, acceptable istic (as

use of the essence to any individual

of each, can approach. is more collectivorienta-

ing

Many criteria

Chinese therapists use in selecting theories

the followand tech-

the integrated approach in China because of the opposed to individualistic)

niques: 1. 2. 3. Simple
practice.

and

easy

to understand

and

tion in its social and cultural environment. Integration is generally more favored by collectivistic culture than different individual schools The in China tegration. ported bound ing are of thought. state of the nation and of the culture inim-

Helpful Useful The

in understanding patients. for change in patients. common schools are concepts the selected from

also necessitates psychotherapy Many psychotherapy theories from foreign and limited. necessary countries Modification when these are

Western 1.

following: experiences psychological patients context. and during funcin

culturally and tailorare goal For has of differ-

The effects childhood tion. The their

of early on later

theories

applied in China. One way to reach this is through psychotherapy integration. these reasons, psychotherapy integration been and will continue in China. therapists to be the have direction psychotherapy Different

2. 3. 4.

need to understand specific cultural effect action

Stimulus Cognitive tion.

on behaviors. on behavior emo-

adopted

ent concepts and techniques of Western psychotherapeutic schools. Many factors can influence therapists selections, such as the school they first encountered, about with their level of understanding first experience and popular These factors that where ance. came influence training Because into China policy, psychotherapy, their successful treatment,

The Western 1. 2. 3. 4.

common therapies

techniques selected are the following: of cognitive distortions. situation. conflicts. behavioral

from

Correction Exposure Analysis terns.

to a feared of intrapsychic of new

articles about psychotherapy. are much different from those therapists experience various almost in the United States, importschools time as is bethe is of great conflicting at the same

Reinforcement

pat-

There is no to select particular patients. Many importance of seeking common develop ing the therapy we can say that

system for determining how techniques for particular therapists are not aware of the psychotherapy research, of factors in therapies so as to framework, to the also or of defindiagnosis. integration If in according psychotherapy we must integration

the open characterized tween United nizations but therapy period and

psychotherapy by having less the schools

in China solid walls than in

among

a theoretical

States, for

where there psychotherapists theories and did not among integration the West.

are different orgawith differing, practices. Psychogo through the various schools, is less On the probother

similar,

in China of struggle in

China has begun, no more than an not of theory.

say that it is of techniques,

so psychotherapy lematic than

O D
Although a new life

B S T A (; L E S

hand, psychotherapy is hampered because sufficient understanding approaches from them. to abstract

integration in China therapists do not have of the different the common factors

PSYCHOTHERAPY E V E 1. 0 P M E N

psychotherapy and made

in China a great deal

has gained of progress

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PSYCHOThERAPY

INTEGRATION

IN

Ci

IINA

in recent its future. obstacles

years, There

it is not are

free still and

from a number

doubt

about of major psy-

therapy. stigma

Moreover, against not the seek Parents have

the

societal

prejudice ill still

and exists.

mentally treatment of young psychological

to improving

popularizing

chotherapy as a means disorders. Some of these to the lack of knowledge apy and political some are restrictions. related

of treating mental obstacles are related about psychotherto cultural and

Many will humiliation. apparently

out of fear of people who disorders

often try to hide the problem. no treatment will be sought cannot function. Even treatment when the has been problem those psychotherapy prematurely functioning Another

In many cases until the person who do receive

One of the major traditional biomedical medical field in China. apy ical still the is generally unit, the do not neurology structure, viewed majority department

obstacles is that the model dominates the Although psychotheras a branch of medical (which, be a potential of a medpersonnel Even in in the site of the in

tend to terminate appearance of good attained. is the lack of a system

believe

in psychotherapy. should

for controlling fessionals who 1988, numerous

the qualifications of the proprovide psychotherapy. Since psychotherapy clinics and

Chinese

for psychotherapy), physicians would treatment. psychotherapy to practical Psychotherapy cine in China, in apy will Although model logical, has This

less than one-tenth apply psychotherapy

counseling centers have been opened. In Beijing, there are more than 10 of these facilities. Among the professionals who are offering treatment in medicine those and facilities, some do not; some some understand understand some have psychotherapy

is not only due to the lack of knowledge and skills, but also concerns about profit making. is much and doing the toward and verbal faces the affects major and cheaper more than mediprofit. medical psychother-

psychology gone through and some or

and some do not; some training in have not. Unavoidindividuals counseling. psychotherapy are In offerthe

turn affect the proposal

hospitals that the

ably, some unqualified ing psychotherapy hands times tion, of these people,

should move psychological, gained much still

integrating biosocial treatment support, many development is the bias There its difficulties. of held are im-

some-

becomes mere support advice giving, or teaching.

and consolaEven worse, sometimes problems have was condrawn

plementation This, of course, psychotherapy. by the several pricing the cost portant by talks very (about much apy. low. one-hour A second people

psychotherapy could be and misused to fool people. The cerning therapist qualifications attention within the profession. to correct this chaotic situation, Clinical Psychology Association sion the of Psychotherapy Regulations. time, regulations present jointly chotherapist fessional support. ment, merely government The

obstacle the government.

manifestations medical services of instruments


criterion.

of this bias. First, in the government uses employed and charge session that does have prefer thus for not doubts medicine as an
is provided

In an attempt the Chinese and the Dividrafted the Psyat by pro-

im-

Unfortunately, drafted

Psychotherapy

and The

behavior, standard a fee for many and people much

is priced a regular is 3 yuan provide about or

psychotherapy 25 cents), incentive

organizations do not have political Without the governments involvethe Psychotherapist Regulations is a scrap main of paper. But when will the intervene? points drafted as follows: of psychotherapy from college must have received We cannot tell. of the Psychotherapist by professional organiza-

performing

psychother-

Second,

psychotherapy

Regulations tions 1. are

other instrumental means of treatment. In addition, many institutional insurance programs do not cover psychotherapy costs, which also discourages the interest in psycho-

Providers graduated

and

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283

the Bachelors Philosophy. 2. 3. 4. These rience They the They Because acted status, hope. by the they people

Degree must have

of Medicine training dedicated exam. are have the not no

or expeto The future

N C L t S I 0

appears in influences China.

bright support

for

psychotherapy culture and of inte-

in psychotherapy. should be loyal enterprise must pass these represent the

integration and qualifying Western grated stacles. enlegal

Chinese

the growth

of psychotherapy.

psychotherapydespite As exchange programs

manydiflicultobbetween China

regulations and only

government

and the West continue to develop, Chinese psychotherapists may find that their perspective on Western thought may provide more efficient therapy and effective ways of defining for the world. psychointegration

professionals

1. Shandong and Hebei about Huang Publishing

School of Chinese Medical School: di#{128} nie jing. Company,

Traditional Questions

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Answers

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1982
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with emotional Journal 10. Wong clomipramine Mental 11. Zhong China.
1992;

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1992; 6:29-Si Huiliang: for 30 children Bin: Psychology of Chinese Structure Guilford,

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an introduc2:104-108 treatment Health in the

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1992; 6:138-139 psychotherapy Hygiene PsychotherPsychological of Individual 1987

Li: Morita

of 10 neuroses in a hospital. Chinese Journal 1988; 2:205-208 6. Xiangping theory on Liu: A brief introduction neurosis. Chinese Mental

Mental

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12. Beitman apy. New

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