Reprinted from the "CBT" issue of Visions Journal, 2009, 6 (1), p. 23
SUCCESS is a multi-service agency with a mandate of promoting the well-being of all Canadians and immigrants. The organization has offered counselling services to the Chinese community for over 30 years. Cognitive-behavioural counselling (CBT) is widely used by our therapists because it works well with many clients of Chinese cultural background.
CBT and the Chinese population
Most cognitive-behavioural therapies have the following characteristics:
emotional response is looked at from a cognitive or thinking perspective
therapy is brief and time-limited
therapy is structured and provides direction and guidance
therapy uses a teaching–learning approach
facts and rational interpretation are used to help clients understand issues
it’s practical—clients are asked to do homework and assignments
All these characteristics work well with most Chinese families. Very often, Chinese clients who come to counselling expect a quick fix to their problems, expecting practical and immediate solutions. They are also more used to an analysis of their problems based on concrete evidence rather than the sharing of deep-seated feelings. Many Chinese clients don’t have experience talking about their emotions. Emotions tend to be conveyed in terms of physical complaints or complaints about family members.
Chinese families also have great respect for experts and authority. Because of this, a directive counselling approach by an authority figure is well received. Moreover, Chinese clients prefer an educational model because they are used to playing the “student” role while the therapist plays the “teacher” role.
Changeways: adapted for SUCCESS
Changeways (changeways.com) is an evidence-based group program, originally developed by Vancouver psychologists in 1991 for patients who had recently received hospital care. Changeways has since been revised and is now offered to seriously depressed people by hospitals (on an outpatient basis) and community agencies like SUCCESS.
Its approach is primarily cognitive-behavioural, and the program uses an adult education model to teach participants a variety of self-care skills. These include setting sustainable goals, relaxation techniques, assertiveness skills and rebuilding their social network. The program covers a range of topics, including the CBT aspects of the interconnected triangle of thoughts, emotions and behaviour, and styles of distorted thinking. Stress and depression, sustaining lifestyle and assertiveness are also covered. They help the individual develop positive thinking and behavioural outcomes.
Changeways Clinic director Dr. Randy Paterson assisted in training our facilitators. He also endorsed our recommendations for making the Changeways Core Program for depression culturally more relevant. The program content was slightly modified to suit the learning style of Chinese participants, and culturally relevant metaphors were added (see sidebar).
We offered the program to the adult Chinese community from 2000 to 2007, calling it the Changeways Stress Management Course. To address stress, relaxation exercises from the Changeways Relaxation Program were added to each session.
We ran five groups for men and seven groups for both men and women. We targeted the program more at men because it’s generally much harder to engage them in training programs. We also wanted to encourage them to develop social support; women generally have less problem reaching out to others.
Participants used a slightly adapted version of the Changeways participant handbook that was translated into Chinese.
Feedback from the participants—from self-reporting forms that are integral to the Changeways program—revealed that many aspects of the program were very relevant to their needs.
The practical relaxation exercise in each session, the facilitated group discussion, participant manuals in Chinese and “teaching” how to overcome negative thoughts were all rated highly.
The introduction to the concept of assertiveness—a concept that has no direct translation in Chinese—was highly relevant to participants’ needs. We framed it as “standing firm” with one’s opinion and values while not offending others. Immigrant participants also found it very helpful to evaluate the experience of having a shrunken social network.
The SUCCESS experience: a good fit
The program received overwhelmingly positive response from the community. Most groups were full, with a waiting list.
In our estimation, Changeways has been well-received by the Chinese participants because its psycho-educational model fits well with their preferred “student” role and learning style. The relaxation exercises they learned in the session and practised at home were practical. The paper-and-pencil exercises in the participant handbook were another concrete activity. The ‘lectures’ on facts, theories and specific topics provided a concrete base from which participants could draw on relevant personal life experience and take part in group discussion.
Since Changeways is CBT based, it follows that CBT is compatible with the expectations of our Chinese clients. CBT is psychoeducational (helps people learn about mental illness) and promotes self-help. Chinese clients welcomed the teaching of new coping skills to manage stress problems. The flexible structure of CBT also allowed us to incorporate the many factors related to cultural background and immigration that affect the psychological well-being of our clients.
It’s never our intent, however, to generalize our observations to the diverse Chinese population in Vancouver. Many factors, such as years of living in Canada, place of birth, level of integration and former exposure to Western education may all affect how clients interact with different counselling approaches.
SUCCESS could not fund the Changeways program after 2007, but we plan to offer it again if we can find a funding source. We consistently receive requests for this program.
For more information on the counselling programs currently offered at SUCCESS (which include counsellors who use CBT), visit www.success.bc.ca and click on “Counselling” or “Family.”
About the authors
Mary is a clinical counsellor. She is the Senior Manager of SUCCESS Family and Youth Services Division in Vancouver. Mary also provides frontline clinical counselling to immigrants.
Kelly joined SUCCESS in 1992 as a Program Director, heading the largest Chinese-speaking counselling team in Western Canada. He conducted the first Changeways stress management program for immigrant men in the Chinese community. Kelly is currently on the Child and Youth Advisory Committee for the Mental Health Commission of Canada