Counselling and psychotherapy are flourishing in China’s major cities, with throngs of people rushing to gain their counsellor certificate or to learn more about therapy through a variety of courses organised by private training agencies. Many therapists start off in private practice, working either individually or in counselling centres (similar to group practice), which has created a vibrant private practice scene.
It’s in stark contrast to just 15 years ago when psychological treatment could only be found in some hospitals and university counselling centres, all of which were public institutions. The transformation from 30 or 40 years ago is even greater, as psychotherapy and psychology were banned during the Cultural Revolution of 1966 to 1976. Today therapy forms not only an independent occupation, but a rather popular one that attracts a lot of candidates and enjoys a prominence in popular culture.
This trend, which began at the start of the 21st century, has gone hand in hand with the commercialisation and expansion of China’s popular media (in this article, ‘media’ means broadcast and new media). While the state keeps watch over what can be said about politically sensitive issues, the Chinese media have morphed into a vast, diverse and largely market-based industry over the past two decades. They cater to the desires and tastes of ordinary citizens with an emphasis on the urban middle class. You need only spend a few hours watching Chinese television to realise how adept dramas and entertainment programmes are at propagating thoughts, images and lifestyles that are closely linked with cosmopolitan consumerism. In fact, today’s Chinese media regularly borrow ideas, formats and even plots from advanced capitalist countries such as the US, the UK, South Korea and Japan.
The Chinese media and the emerging community of therapists discovered each other as potential partners almost instantly. The media find therapy and psychology a fresh, exciting subject that appeals to urbanites whose lives have become more stressful. Therapists for their part are eager to make themselves and their expertise known to the public via the channel of mass communication. Similar phenomena have, of course, occurred in many Western countries before, and discussions about the benefits and challenges born of such a collaboration have yielded many insights for both parties. However, in China they have emerged in a short space of time and the situation is changing very quickly, leaving those involved little time to reflect on what has happened.
Therapy on screen
The daily late-night show Psychological Interviews (xinli fangtan) is often seen as the inauguration as well as the archetype of the collaboration between television and therapists in China. This programme – which is still airing – began at the end of 2004. Although it is not the first TV programme to feature psychological experts, the channel it is on – the predominant state broadcaster China Central Television – carries paramount symbolic value, and it was the first such programme to attract national attention. When I started to study the rise of psychotherapy in China, around 2008–2009, most of the therapists I met cited this programme as being one of the three factors that paved the way for the flourishing of psychotherapy in the country. The two others were the state’s promotion of psychological aid in its response to the 2008 Sichuan earthquake, and counsellor certification, run by the Ministry of Human Resources and Social Security, which made psychotherapy training far more accessible than it had been previously. Certification began in 2002, as a trial, and became official in 2005, just after the launch of Psychological Interviews.
Psychological Interviews immediately caused a sensation. At that time, the talk show genre was quite new to the Chinese audience, and a programme that purported to disclose the therapeutic process seemed particularly novel and interesting. Its format was simple: three people would sit around a table in the studio – a therapist, a client and a host. Sometimes the client would bring one or two close family members or friends. Each 20-minute episode began with the host greeting the client and introducing him or her to the therapist, followed by a two-minute video clip prepared by the production team. Typically this included shots of the client’s home and neighbourhood, punctuated by comments from the client’s family and friends. It was intended to offer background information to the audience. Then came the interview between the client and the therapist, which always appeared like a super-efficient, stand-alone consultation. In no more than 15 minutes it would have passed through history-taking, the client’s catharsis, assessment and diagnosis, intervention, and finally the client’s relief.
Perhaps few people realised that they were watching edited versions of interviews. The original ones were longer and less dramatic. The show, on the other hand, stressed authenticity and expertise. The clients were said to be people who were really suffering; they came from various parts of the country, joining a long waiting list to be on the programme. They presented with relational or adjustment problems, and sometimes mental disorders, which have become more and more common in China’s rapidly changing society. The two doctors who appeared most often – Yang Fengchi and Li Zixun – were graduates of the Sino-German Course (zhongde ban), which is credited as being the cradle of Chinese psychotherapy,1,2 and both of them became household names. The programme saw education as its primary aim, and for several years it was the most influential medium through which the public could learn about psychological problems and their treatment as well as hear psychological perspectives. It also turned psychotherapy from something that few people knew of into something ‘real’ within the shortest time possible.
The programme had another effect that was probably not intended in the first place – it stimulated popular interest in psychotherapy training, which had just become available with the initiation of state counsellor certification. Drs Yang and Li offered an iconic image of therapists on Chinese television: both were middle-aged male physicians with eloquent, wise and charming personas – characteristics that corresponded exactly with what therapeutic training agencies, which in China are mostly private commercial companies, were trying to portray: a Western-style, urban and respected profession.
In the early days of my research many therapists and trainees were enthusiastic about the programme; they would have serious discussions about the techniques employed in each episode, and many training agencies would screen selected episodes to use as classroom ‘demonstrations’ for their trainees.
From education to entertainment
In the years that followed the appearance of Psychological Interviews, emotions and the individual’s psyche increasingly became of great interest to urban middle-class Chinese, and psychotherapy training became popular, even fashionable, among this quickly expanding sector of the population. Although only a small proportion of the people who signed up for training seriously considered pursuing a career as a therapist, the number of therapists did begin to increase exponentially, and the public came to see psychotherapy as a rather ‘cool’ occupation. This perception was partly due to the explosion of television programmes that featured therapists or various kinds of psychological experts. When I lived in Beijing, between 2009 and 2011, virtually every channel had at least a couple of such programmes, and often more. Together they made up a fairly large genre – the so-called ‘psychological’ or ‘emotional’ programmes.
This new wave of programmes was quite different from Psychological Interviews. While the latter stressed an educational role, the former leaned heavily towards entertainment. Many of these programmes were reality shows that highlighted the individual or interpersonal conflicts of the guests. The stories they brought to the studio and the ways they presented these were often theatrical and intense. Not infrequently they would have emotional outbursts or serious quarrels. The psychological experts functioned as facilitators, commentators or mediators rather than engaging in a therapeutic process, as their predecessors in Psychological Interviews had done. Other programmes put more emphasis on the banter between the experts, the hosts, and the guests. Needless to say, all three parties had to be articulate and sharp witted.
Some therapists moved swiftly to seize these new opportunities. With a large number of therapists entering the market in a short period of time, most of them found developing an adequate clientele challenging. Marketing became crucial. The most common strategy for individual therapists and counselling centres was to set up websites, sometimes in the form of blogs, offering lots of health information, so that potential clients could find them. Some would even pay Baidu (the dominant search engine in China) to bump up their rankings in the search results. However, these strategies were not that effective. In comparison, appearing on TV seemed more beneficial for one’s publicity. It was also a valuable credential, as ordinary people might assume that those hired by television programmes had to be the top experts in the field.
Shortly afterwards these programmes began to cause controversy. Commentators often railed against their being too sensational and detached from reality. It was said that many of the guests were professional actors, and their stories, along with the interactions between the guests, the therapists, and the hosts, were scripted. These problems were not exclusive to those involving therapists or psychological experts, but existed on all kinds of Chinese talk shows and reality shows. In June 2010 the State Administration of Radio, Film and Television issued a directive that called for tighter control of emotional programmes. This crackdown targeted the dating game shows that had become extremely popular since the beginning of that year, but it affected other programmes as well. One of two programmes that were ordered to stop was Closed-Room Healing (mishi liaoshang) on Jiangsu Satellite TV, which featured, as its producer claimed, ‘professional therapeutic process’. It put the guest in a room with huge LCD screens mounted on all four walls. The screens would show video clips that simulated the guest’s traumatic memories, which could bring him or her to the brink of emotional collapse. The therapist communicated with the guest from outside the room throughout the process. This programme was considered by some to be too brutal, so perhaps it is no wonder that it was the first casualty under the new policy.
These scandals prompted many therapists to be more cautious about collaborating with television programmes. Several of my therapist friends in Beijing had been invited onto these popular talk shows but they very soon pulled out when they found that they had to say or do things that were inappropriate from a professional standpoint. Therapists and psychological experts continue to have a rather prominent presence on Chinese television today, but closer scrutiny would reveal that many of these media psychologists do not specialise in counselling or clinical practice.
Ventures into new media
The media landscape in China is rapidly changing with the advent of new media that is mostly internet based. Although global leaders in social media and social networking, such as YouTube, Facebook and Twitter, are blocked by the Great Firewall, the country has seen the burgeoning of native platforms that have similar functions but are more attuned to the habits of local people. The most successful ones – for example, Youku, Weibo and WeChat (weixin) – have gathered several hundred million users, despite not being very well known outside China. The younger generation – those born after 1980 – is heavily dependent on these channels for gaining information, interacting with friends, networking and for making their voices heard. People look to these channels to find the latest, most exciting, and uncensored news and stories.
Therapists in China began to colonise the internet very early on. In 2007, before I began my field research, I had already identified a prominent presence of psychotherapists in the virtual world. There were thousands of websites set up by individual therapists or counselling centres; a huge amount of information was being circulated, including articles written by ‘celebrity’ therapists who had achieved fame and fortune from teaching psychotherapy courses. Several discussion boards specifically for therapists and trainee therapists existed, and each day they were visited by tens of thousands of people. Later my research revealed that many therapists spent a lot of time socialising with each other on the internet. Thus, when Weibo (a Twitter-like micro blogging website) rose to prominence around 2011/12, many therapists were enthusiastic about tweeting, and their tweets were followed by fellow therapists as well as people from outside the profession.
In the past two or three years, the concept of ‘we media’ (zi meiti) has become fashionable in China. While originally it referred to citizen or grassroots journalism,3 the Chinese adaptation puts particular emphasis on personal ownership or control of media content and the business potential this could create. The internet offers ample opportunity to realise this ideal. Recently, digital radio and podcasting have become hugely popular. Also, as WeChat replaces Weibo as the country’s pre-eminent social networking app, many people are shifting to this new platform. Particularly appealing is its ‘public account’ special function, which allows the account owner to deliver information to his/her subscribers.
Therapists are among those who are leading these trends. One of the most publicised was Jane Li, a young therapist who has become a big name in the field due to her start-up project jiangdan xinli (literally ‘easy psychology’), an online platform where the public can find competent therapists and book an appointment with them. Jane, who has a master’s degree in cognitive neuroscience from University College London, used to be a university counsellor. In 2012 she began answering the questions of netizens at Douban, a social networking site distinguished by having numerous interest groups on intellectual matters, literature and the arts. Within a year she had gathered many followers and was receiving dozens of emails seeking help or referral every day. This made her realise that a lot of potential clients didn’t know how to find reliable therapists, and that technology might be able to bridge this gap. The project materialised during her study at Draper University, an entrepreneurship programme in Silicon Valley in the US, in early 2014. It was launched later that year with financial backing from a number of eminent venture capitalists. She also launched a podcast show and a WeChat public account. The platform now exists in both website and mobile app forms.
Conclusion
This article is just a brief sketch of some of the interesting developments within a large and complicated picture. When it comes to the development of counselling and psychotherapy in China, people tend to focus on the issue of indigenisation, or how to adapt therapy imported from outside the country to suit the local culture. What is often neglected is that China, a developing country that has become the world’s second largest economy, may sometimes, if not often, face similar situations to Western countries. The encounter between therapy and the media is one such example. In fact, the psychotherapeutic profession in China might be ahead of many Western countries in terms of use of the internet and new media – and that in itself could very well be what will define therapy there.
Hsuan-Ying Huang is a post-doctoral fellow at the Australian Centre on China in the World at Australian National University. Originally trained as a psychiatrist in Taiwan, he later became a medical anthropologist. Hsuan-Ying has been studying the development of psychotherapy in China since 2008.
References
1. Simon FB, Ha-Wiesegart M, Zhao X. The Sino-German course or how psychotherapy came to China: history and analysis of a cross-cultural adventure. Heidelberg: Carl-Auer-Systeme Verlag; 2011. [Published in German].
2. Huang HY. From psychotherapy to psycho-boom: a historical overview of psychotherapy in China. Psychoanalysis and Psychotherapy in China 2015; 1(1): 1–30.
3. Bowman S, Willis C. We media: how audiences are shaping the future of news and information. [Online.] Reston Va: The Media Center at the American Press Institute; 2003. http://www.hypergene.net/wemedia/download/we_media.pdf (accessed 6 August 2015).