Letting a Hundred Flowers Bloom: Counseling and Psychotherapy in the People's Republic of China

Article excerpt

Although the Chinese have been exposed to Western psychotherapies since the 1950s, the practice of counseling is a relatively new phenomenon. In this article, we trace the development of counseling in China, examine its cultural and practical relevance, and review recent advances in training and practice. Although heavily influenced by Western models, contemporary Chinese approaches to counseling reflect the philosophical traditions, cultural history, and indigenous help-seeking practices of a rapidly modernizing society. The increasing popularization of psychotherapy in China is analyzed in the context of the changing social and economic climate and the crises and opportunities that accompany Chinese life in the 21st century.


The past 50 years have witnessed China's remarkable transformation from a poor agricultural society into an emerging industrial power. With the opening-and-reform policies initiated in the 1980s, China has officially reentered the global fray, experimenting with Western ideas, markets, and institutions, including Western-style counseling and psychotherapy. In this article, we trace the development of counseling in China, examine its cultural and practical relevance, and review recent advances in training and practice.

The techniques of counseling and psychotherapy have found a home in China. However, their Western cultural origins have created problems in translation, not the least of which is their literal translation into the Chinese language. The Chinese use two terms to refer to what may be generally described as talk therapy: xinli zixun (i.e., psychological counseling or consulting) and xinli zhiliao (i.e., psychotherapy). However, the cross-cultural correspondence of these constructs remains unclear. In practice, xinli zixun encompasses a variety of counseling services, including informal supportive counseling, drop-in psychological consultation, psychoeducation, and psychotherapy. Furthermore, because academic degree programs in mental health counseling do not yet formally exist, the training and practice orientations of China's counseling professionals show considerable variation. It is important to note that this struggle for self-definition reflects the natural developmental progression in any emerging discipline from general practice to specialization. At present, the number of trained counselors remains small, necessitating role flexibility and interdisciplinary cooperation in order to advance the field (M. Li, personal communication, July 27, 2004).

If U.S. trends are any indication, we expect the boundaries between mental health counseling and psychotherapy to become more clearly delineated over time, perhaps followed by a return to more integrative approaches (Shi, Sang, Li, Zhou, & Wang, 2005). As the Chinese proverb reminds us, "Separation and integration inevitably occurs when either goes to the extreme." In this article, we use the terms psychotherapy and counseling interchangeably to reflect the fluid definitions of these emerging professional arenas in China today.


Although indigenous forms of psychotherapy have arguably existed in China for centuries, what is commonly referred to as psychotherapy today has evolved out of the country's political and academic relationships with the West. From the founding of the People's Republic of China in 1949 to the present, the development of psychotherapy may be divided into four stages. From 1949 to 1969, Chinese psychiatry was heavily influenced by Russian neuropsychiatric models with political priorities focused on maintaining public order (Qian, Smith, Chert, & Xia, 2001). In the era of the Cultural Revolution, 1966-1977, mental illness and other forms of deviance were cast as problems of wrong political thinking to be addressed through reeducation, rather than mental health care (Pearson, 1995). Political and economic reforms initiated in the years between 1978 and 1986 facilitated the revitalization of Chinese psychiatry and its reengagement with Western scientific communities. …


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