Psychotherapy in China – Privacy Rights?

I recently returned from a Chinese Mental Health Summit in Wuhan, PRC.  A blog can’t provide the space to fully describe the breadth of the experience, such as how finely we were hosted (17 course meal…) and the impressive caliber of my colleagues and new friends.  I have been pondering my growing pile of notes, marveling at the near book-length material generated from a mere two week journey.

 

Many of our hosts admitted that the professional field of psychology in China is decades behind other countries.  This was largely due to the political strife of years past when psychology was largely seen as unfavorably Western-biased (actually a legitimate criticism of much traditional academic psychology).  For a long gap in time, the field was not pursued if one valued their political and vocational livelihood. 

Fast Forward to 2009.  China is a rising giant in multiple fields and psychology is no exception.  Chinese hospitals and psychology departments are aggressively expanding their skills and knowledge at the same astonishing rate as China has bounded into other fields.  Us “Overseas Chinese” participants in the summit were welcomed as honored guests.  We were eager to exchange knowledge with our colleagues, and learn about cultural adaptations and mental health practices in China. Or at least within Hubei Province, where we were staying.

 

It was a little nerve-wracking for us to discover that what were billed in the programs as “roundtable discussions” or “ informal panel discussions” turned out to be jam-packed occasions often numbering well over 100 audience members.  My vision of cozy, interactive dialogue evaporated.  Nonetheless, we were honored that so many would be interested in our presentations.

My afternoon didactic covered Clinical work with Anxiety Disorders, primarily using a cognitive behavioral therapy (CBT) approach, and including case examples and discussions of Chinese American clients.  My audience was engaged, polite, intelligent.  They were patient with my rather limited Mandarin vocabulary, and fascinated by the notion of psychotherapy in general.

Yet we had a serious divergence. Before getting into psychotherapy, I emphasized the importance of confidentiality.  I explained how the case examples I presented were all composite characters or contained disguised personal traits – for the protection of client privacy. 

“Confidentiality”, I explained “is a basic right necessary for psychotherapy. It is essential that a person feels completely safe to disclose their emotions and pressures if we are to address deep rooted issues.”  

Their expressions were stunned when I explained that if I, the psychotherapist, violated client confidentiality – I would be liable for potential jail time and huge financial fines.  Doctoral degree or not, I was responsible even to a peasant or laborer.  Silence.  I added that of course, there were exceptions for true emergencies such as dangerous psychiatric crises, or abuse of children.  Puzzled looks. 

 

My audience was not opposed to the concept of confidentiality. But they were understandably flustered.  They were ambitious learners who wanted to practice psychotherapy and help others.  Was I implying that they’d be unable to do so within their current framework?

 

So this, is my current mental knot.  I believe that practices such as confidentiality, child abuse reporting, patients’ rights and clinician accountability are essential to doing this work safely and effectively.

Is psychotherapy as I understand and practice it (in line with the ethical codes of conduct taught by American graduate schools and upheld by the American Psychological Association), possible in a country that does not provide a right to privacy?  I do no believe that the desire for privacy is solely a Western phenomenon.  I have had numerous clients hailing from Asia who expressed their relief upon learning about strict U.S. confidentiality laws.

They say things like:

 “This has been so helpful, but I would never do it in China because everyone would know.”

“We would never have brought our son for treatment if we thought people/institutions could find out.”

It’s a culturally biased conceit to think that China is incapable of developing and practicing psychotherapy which works within their own country.  Yet I realize now, more strongly than ever before, how the formalized professional practices we practice are based on fundamental cultural and political values.  It is quite possible to assist clients even without confidentiality, but not in the manner with which psychotherapy is practiced here.  

I mean, we are talking about a place where I was unable to access simple sites such as facebook or Youtube.  Could I, or any Chinese citizen, come to trust that personal health information would be uncensored and unrevealed?

Comments

[Mina]

Good job for doing this! It must have been such an eye opener and a rewarding experience.
Mina

[Pei]

Calling privacy a cultural trait is like saying misogyny is a cultural trait. Some have called me "Americanized" to adopt the ideals of ethical behavior... but I do believe that there are truths in life. One's right to privacy is one. I think the definition and boundary of privacy can be discussed, but the fact that it's a human need and right is clear to me.

[Dr. Hsu]

Thanks for commenting! I agree Pei that many values and rights can not be excused as mere cultural quirks. I always talk with my graduate students about our challenge: to balance respect for clients' cultures and beliefs without becoming total cultural relativists who excuse/accept any behavior.