In classic psychotherapy, the 'cure' comes from going through the slow and sometimes painful process of gaining insight into one's own unconscious. It is a western invention that, in its pure form, is necessarily elitist because it requires years of one-to-one sessions with a highly trained specialist. However, there are hundreds of more pragmatic and affordable forms of therapy available. The practitioners of one - cognitive behavioural therapy (CBT) - claim it is particularly suited to ethnic Chinese living in America, reports Sylvia Wen-hsin Chen, writing in the journal Psychotherapy: Theory, Research, Practice, Training. The prevalent problems among Chinese-Americans - mostly related to the gaps in acculturation between the generations - are also common among Hongkongers, who experience similarly mixed cultural influences. Typically, it is the young who first seek help when they have to make an important life decision, or when there is a change related to family, work or education - and when family attitudes clash. One key reason CBT adherents say it suits Chinese communities is that it stresses logical thinking over the more esoteric intuitions many other therapies focus on. The basis of the CBT approach is that psychological distress is largely due to 'wrong thinking'. It is not emotions that need to be addressed directly, but the thoughts associated with those emotions. Consequently, the therapy works by teaching clients a range of skills with which to change unhelpful thoughts: this, in turn, has an effect on emotions and behaviour. Roughly speaking, there are three stages in CBT. The therapist helps the client identify his or her problems; they set a goal for therapy; then jointly set a short-term schedule and a means of measuring progress. Between sessions, clients carry out exercises to change their unhelpful habits of thinking. Even CBT's staunchest supporters admit that it needs to be adapted for Chinese clients, writes M. Tung in the article 'Insight-oriented psychotherapy and the Chinese patient' in the American Journal of Orthopsychiatry. For instance, CBT's Socratic questioning method aims to force the client to examine his or her belief system in his or her own terms. It frequently ends up as a chain of 'why? why? why?' questions. This can unintentionally prompt a Chinese to try and find the 'right' reply. Chinese respond better to prompts such as 'If you don't do the degree your parents want you to do ...' Also, problems in CBT are identified by finding emotional 'hotspots' in conversation which, being reared to remain calm, Chinese may instinctively avoid. Many western therapists barely talk during sessions, let alone advise. But Chinese, according to studies carried out in the United States, prefer therapists who give clear directions. This fits well with the coaching aspect of CBT. Finally, there is the appeal of the empirical evidence - rare in therapy - that CBT works as well as any other method of treating depression and self-esteem issues. Knowing the basic differences between therapeutic approaches - and their cultural appropriateness - is a useful starting point in the quest for therapy. Jean Nicol looks at everyday issues from the point of view of a psychologist This is the last Inner Eye column 'Chinese, according to studies carried out in the United States, prefer therapists who give clear directions'
