The purpose of this article is to discuss and analyze the application of Cognitive-Behavioral Therapy (CBT) to counsel Chinese. The analysis of the potential strengths and weaknesses of applying CBT in the treatment of Chinese clients are delineated based on the compatibility between the characteristics of CBT and Chinese culture. Modifications of CBT aiming at enhancing its effectiveness for Chinese within their cultural context are discussed. The study offers implications for clinical practice, training, and research.
Accounting for approximately one quarter of the world's population, 1.5 billion Chinese people represent the largest population in the world. Over the past two decades, these people's lives have been changing drastically in political, financial, social, and cultural realms (1). These radical changes have generated adjustment and other psychosocial problems in Chinese societies (1). Professionals now identify an increasing need for psychological services to help Chinese cope with these changes (2).
In order to effectively help Chinese, therapists speculate upon the counseling styles, theories, and techniques that might work best with Chinese clients. The profession must be cautious, however, when applying Western approaches to Chinese clients since these views are based on Western psychology and society, which are rather different from those held by most Chinese. Efforts should be devoted to selecting and modifying Western counseling approaches, and/or developing indigenous styles to best serve Chinese populations (2-6).
Psychotherapy experts have recognized that incompatibilities and conflicts arise when traditional Western treatment philosophies, theories, concepts, skills, and techniques are applied to non-Caucasians populations who come from different ethnic and cultural backgrounds (7). For example, a traditional Western phenomenological, individualistic, and futureoriented approach has been criticized as inappropriate for counseling Chinese as well as other Asian populations (8).
As shown in Leong's (9) review of counseling with Asians, Asian clients (including Chinese) tend to have less tolerance for ambiguity, and prefer structured counseling sessions with practical, immediate solutions to their problems. Chinese prefer therapists who employ a directive, rather than a nondirective approach when addressing emotional adjustment problems (10). Directive counseling approaches, such as CBT, have been perceived as more effective than nondirective, insight-oriented or facilitative counseling approaches when used with Chinese clients (2).
CBT has been widely applied when counseling Chinese. A survey completed by Wu & Cherng (11) revealed that next to eclectic therapy (42.4%), 29.5% of helping professionals in Taiwan identified CBT and its derivations (e.g., behavior therapy, rational-emotive therapy, and cognitive therapy) as their main theoretical approach when working with Chinese clients. Another survey study indicated that 53% of Taiwan therapists resorted to CBT and its derivatives in clinical practices (12). Many Chinese helping professionals prefer CBT (11) and recognize it as one of the most popular counseling approaches in Taiwan (12).
Conceptual articles have supported the potential of CBT to counsel Chinese (e.g., 13). Additionally, empirical studies generally have associated positive outcomes for Chinese clients with the use of CBT (e.g., 14). For example, after a group intervention employing a rational-emotive counseling framework, 12 Chinese university students in the experimental group reported a significant progress in career preparation (14). Another study revealed that therapists using CBT reported a 62% improvement rate for Chinese clients with neurotic and psychotic disorders (15); 79% to 87% for those with neurotic disorders (e.g., obsessive-compulsive disorders, phobias, and anxiety disorders); and 82% in crisis interventions of suicidal ideation (6). …