Novice Counselor's blog

Cognitive Behavioral Therapy (CBT) is especially useful in treating Chinese clients. It is frequently noted that Chinese people favor treatment that is directive, structured, and short-term, as this conforms to the expectations of professionals as authoritative experts. CBT is an evidence-based,

explicit, structured, and problem focused short-term psychotherapy. The principles and practice of CBT appear to be compatible with the expectations favored by Chinese people as it promotes self-help and is psychoeducational; teaching new coping skills to manage emotional problems. The CBT framework also takes into account the client’s problems in relation to cultural factors such as the impact of immigration, somatic complaints, interpersonal relationships,and other areas of importance (Williams, Foo, et al., 2006).

Mental Health problems and seeing a mental health professional hold much stigma in the Chinese culture. As such, psychological distress is commonly manifested in somatic symptoms for Asian people (Williams, Foo, et al., 2006). This can be seen in the case of David Chan and his complaints of insomnia, headaches, and indigestion.

Williams, Foo, et al., (2006) state that Chinese people regard professionals as authority figures, knowledgeable, and to be respected. Thus it is be preferable to adopt a more instructive and didactic style early in the therapeutic relationship, with less emphasis on empiricism and guided discovery. Once rapport has been firmly established then guided discovery and collaborative empiricism can be used. This will increase confidence and trust in the therapist’s ability to help and develop a therapeutic alliance.

Chinese culture values the virtues of moderation and proper conduct, restraint of strong emotions
and excessive behaviors, the avoidance of interpersonal conflict, and the suppression of self-xpression.
Chinese people have a strong sense of responsibility and obligation to the family, with great importance attached to academic and occupational achievement This can be seen in David’s concern to not disappoint his parents and his reluctance to let them know his dislike of his college major.
The emphasis on emotional restraint, moderation and control of one’s feelings and emotions will make
disclosure and sharing one’s inner feelings uncomfortable for a Chinese person. Disclosing private feelings can feel strange and there is generally a reluctance to discuss personal details with someone perceived as a “stranger”, even a professional (Williams, Foo, et al., 2006).

Talking about somatic complaints or issues of a more practical nature, such as academic problems would probably be easier for David than expressing mental health symptoms. This presents potential problems as identification of emotions is central to CBT. To overcome this barrier, instead of expecting David to verbalize and express feelings, it may be more useful to focus on the somatic symptoms and use problemsolving strategies early in therapy.
As emotional and cognitive reactions may not be spontaneously expressed, direct inquiry into psychological symptoms can be applied. Organic symptoms relabelled or reframed into psychological terminology may become more acceptable as rapport and trust develops (Williams, Foo, et al., 2006).

The CBT therapist may begin working with David by establishing the goals of therapy (Capuzzi & Gross, 2007). These would include decrease of depression and anxiety, anger management, improvement in academic performance, and improvement of physical symptoms, which are probably related to the depression.

The counselor will develop a working hypothesis by establishing when David’s problems began and exploring his self-thoughts. The counselor would identify David’s strengths, which in this case would include intelligence and hardworking nature.

The counselor would possibly make a referral for medication therapy after discussing this with David.

The counselor would explore with David the possibility of changing his major to something that is more in line with his talents and interests. This would include identification of David’s wants and interests, how he spends his time, and what he does for fun.

David would benefit from learning assertive behavior with his parents and other people, especially if it becomes apparent that he should tell his parents about his unhappiness with his major and a plan to change it.

The counselor would help David identifying cognitive distortions such as all-or-nothing thinking, disqualifying the positive, and catastrophizing. David would learn to implement interventions to congnitive distortions such as thought stopping and use of positive self-statements.

In using Reality therapy, the therapist can implement the WDEP system (Capuzzi & Gross, 2007):

W – Explore wants, needs and perceptions.

D – Explore direction; For example the therapist could ask David: “Where do you think you are going if you continue on the same path?” The therapist then can explore with David specific actions.

E – stands for Self-Evaluation; the therapist can explore how David spends his time and discuss fun activities; the therapist can explore how David feels trapped in the career his parents chose for him.

P – stands for Planning; David and the therapist can come up with a plan to implement David’s wants.

References:

Capuzzi, D., Gross, D. R. (2007). Counseling and psychotherapy: Theories and interventions (4th ed.). Upper Saddle River, NJ: Prentice Hall. ISBN: 0131987372.

Williams, M., Foo, K., Haarhoff, B. (2006). Cultural Considerations in using Cognitive Behaviour Therapy with Chinese People: A Case Study of an Elderly Chinese Woman with Generalised Anxiety Disorder. New Zealand Journal of Psychology, 35(3), 153-162.