Culture and the therapeutic relationship: Perspectives from Chinese clients

Abstract

Culture and therapy 2 Culture and the therapeutic relationship: Perspectives from Chinese clients AbstractChinese people in the UK and USA underutilise mental health services and, when they do seek help, may find that therapy does not meet their needs. In response to calls in the literature for naturalistic studies of therapy with people of Chinese background, this study used a qualitative, multiple case approach to examine clients' individual experiences in depth and detail. Semi-structured interviews were conducted with eight Chinese clients. The aim was to investigate how culture might play a role in the therapeutic relationship. Qualitative analysis yielded four key themes concerning clients' and therapists' awareness of culture and how this impacted on their working relationship: "cultural encapsulation", "cultural formulation", "cultural liberation" and "culture is not important". Although participants' perceptions of therapy showed similarities to those reported by clients of European-American descent, culture entered into the therapeutic relationship in complex and diverse ways. The findings have implications for delivering culturally sensitive therapies. Culture and therapy 3 Culture and the therapeutic relationship: Perspectives from Chinese clientsChinese people in the UK underutilise mental health services (National Institute for Mental Health in England, 2003) and have been described as an "invisible population" (Department of Health, 1993). A similar picture exists in the USA, where Asian Americans 1 are under-represented in counselling and therapy services, and, once they do seek help, tend to terminate prematurely (Atkinson, Morten, & Sue, 1998; U.S. Department of Health and Human Services, 2001). Obstacles to seeking help may include language barriers and a lack of awareness of services, as well as perceptions of therapy as an unfamiliar or undesirable means of resolving mental health problems (Li & Logan, 2000;Li, Logan, Yee, & Ng, 1999;Nagayama Hall, 2001). Indeed, within Chinese culture, the stigma of mental health problems and the concepts of shame and "losing face" may make it particularly difficult to seek help (Li et al., 1999;Lin, Tseng, & Yeh, 1995;Uba, 1994). Those who do seek help may find that therapy does not appropriately meet their needs.Differences in values and belief systems of Eastern and Western cultures are frequently cited as one reason that Chinese clients may terminate therapy prematurely.Chinese cultural values include an emphasis on collectivism, the centrality of the family, filial piety, hierarchical relationships, academic achievement, humility, and emotional selfcontrol (Kim, Atkinson, & Yang, 1999;D.W. Sue & Sue, 2003). Such values are likely to play a role in Chinese clients' experience of self and identity, how they make sense of their problems, and what they expect from therapy. However, it is also important to recognise that clients will vary in the degree to which they adhere to the values and norms of their indigenous culture. Indeed, there is great heterog...

Research on client experiences of therapy: Introduction to the special section

“…In 2007, this journal published at least five studies with client experiences of therapy as a key element (Fitzpatrick & Chamodraka, 2007;Jim & Pistrang, 2007;Nilsson et al, 2007;Ramnerš & …st, 2007;Vanaerschot & Lietaer, 2007); most of these used qualitative or mixed methods. In addition, Psychotherapy Research has also recently published a qualitative meta-synthesis of a subset of this recent literature, client experiences of the impacts of helpful significant therapy events (Timulak, 2007).…”

A qualitative study of change in obsessive compulsive disorder: a qualitative study of the impact of cognitive treatmente on the subject experience of patients

“…En este campo, durante los últimos años se ha incrementado la investigación cualitativa centrada en la experiencia subjetiva de los pacientes como un elemento clave para la evaluación de los procesos y resultados de la psicoterapia (Berg, Raminani, Greer, Harwood & Safren, 2008;Connolly & Strupp, 1996 ;Fitzpatrick & Chamodraka, 2007;Henretty, Levitt & Mathews, 2008;Israel, Gorcheva, Burnes & Walther, 2008;Jim & Pistrang, 2007;Mörtl & Von Wietersheim, 2008;Nilsson, Sensson, Sandell & Clinton, 2007;Pattee & Farber, 2008;Ramnerö & Öst, 2007;Silverstein, Auerbach & Levant, 2006;Vanaerschot & Lietaer, 2007;Williams & Levitt, 2008). Estos estudios han intentado analizar en qué medida la representación del paciente del proceso de cambio y sus resultados es relevante para una mejor comprensión de los mismos.…”

Engaging Service Users and Carers in Health and Social Care Education: Challenges and Opportunities in the Chinese Community

“…A study involved Chinese people using counselling services in the UK revealed that the provision of such an environment was vital to all participants in a therapeutic relationship so that they felt at ease to ventilate their inner feelings and conflicts (Jim and Pistrang's, 2007). Other studies also show that establishing ground rules is crucial to facilitate and support service users to share and disclose their vulnerabilities in educational settings (Frisby, 2001;Hayward, et al 2005).…”

“…This observation confirms that Chinese service users and carers often perceive clinicians / academics to be authoritative experts. They tend to adopt the role as students in a therapeutic relationship and view the clinicians as teachers (Jim and Pistrang, 2007). As the counselling sessions take place on the premises of the University of Hong Kong, an educational institution, viewing the clinician as an authoritative expert helps the couple settle more readily in a culturally familiar social role (Lin et al, 1995).…”

“…To seek outside help is an indication that the family is failing its family members and will reveal the family's weakness (Jim and Pistrang, 2007;Kramer et al, 2002). Family members will lose face in the community and it may bring shame to the family (Kung, 2001).…”