Academic journal article New Zealand Journal of Psychology

Cultural Considerations in Using Cognitive Behaviour Therapy with Chinese People: A Case Study of an Elderly Chinese Woman with Generalised Anxiety Disorder

Academic journal article New Zealand Journal of Psychology

Cultural Considerations in Using Cognitive Behaviour Therapy with Chinese People: A Case Study of an Elderly Chinese Woman with Generalised Anxiety Disorder

Article excerpt

The under-utilisation of mental health services amongst Chinese people is a well-known fact. This article describes a case study using a Western therapy model, cognitive-behavioural therapy (CBT), with a Chinese client. A CBT model, modified for working with Chinese clients, is depicted with reference to Chinese practices and behaviours, and this is then applied to a case study with an elderly Chinese woman. CBT was shown to be useful with this Chinese client. Challenges to the use of CBT with Chinese people are discussed with implications for clinicians working in this area.


It is frequently noted that very few Chinese people, here and overseas, utilise mental health services and even less will self-refer (Ho, Au, Bedford, & Cooper, 2003; Netto, Gaag, Thanki, Bondi, & Munro, 2001). If help is sought, it is often when a crisis occurs and, if treatment is initiated, terminated prematurely. The factors associated with low utilisation and high dropout rates in mental health facilities have long been recognised (e.g., Ho et al., 2003; Williams & Cleland, 2006; Williams, Graham, & Foo, 2004; Yip, 2005). Traditional Asian beliefs liken mental illness with insanity and, as such, there is much stigmatisation attached to having such problems and seeing a mental health practitioner. It is not surprising, therefore, that this not only leads to denial of the existence of a problem but also creates barriers to help-seeking.

The low rate of attendance at mental health facilities may lead to erroneous assumptions that Chinese people do not experience mental health problems. A literature review by Ho and associates (2003), in fact, revealed that the prevalence rate for mental illness of Asian people in New Zealand was no different from that of European New Zealanders. Recent migrants experienced even higher levels of mental health problems, presenting with high levels of post-traumatic stress symptoms, clinically diagnosable depressive symptoms, and greater levels of anxiety and emotional distress. Many of these psychological symptoms could be attributed to immigration and the process of adjustment into a foreign culture (Ho et al., 2003; Mak, Young, Wong, & Zane, 2005).

Despite the growing literature on cross-cultural counselling and the ethical concerns surrounding competency and training of psychotherapists working with multicultural clients (Pedersen, 2003), little attention has been given to the therapeutic framework that could be used for counselling Chinese people (for exceptions refer Harper & Stone, 2003; Higginbotham & Tanaka-Matsumi, 1981; Hong & Domokos-Youngg Ham, 2001; Tanaka-Matsumi, Selden, & Lam, 1996). Due to the stigma and shame surrounding mental illness there is often reluctance to seek help for mental health problems. External explanations, whether it originates from organic or moral/spiritual sources, has far greater acceptance than psychological explanations, and thus psychological distress is commonly manifested in somatic symptoms for Asian people. Consultations with medical practitioners or traditional Chinese healers for somatic complaints often legitimises help-seeking for problems which may have psychological origins. A therapeutic framework that was compatible with the expectations of Chinese people may encourage utilisation of mental health services and in improving treatment outcomes.

It is frequently noted that Chinese people favour treatment that is directive, structured, and short-term (Young & Davenport, 2005), as this conforms to the expectations of professionals as authoritative experts. It was found that this style was more effective in treatment outcome with Chinese people than with a non-directive person-centred approach (Chu, 1999). Cognitive-behavioural therapy (CBT) is an evidence-based, explicit, structured, and problem-focused short-term psychotherapy. The principles and practice of cognitive-behavioural therapy (CBT) would appear to be compatible with the expectations favoured by Chinese people as it promotes self-help and is psycho-educational; teaching new coping skills to manage distressing emotional problems. …

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