The Present Status Of The Theoretical Approachs Of Mental Health Practice In China

Mental health service approach system is an important part of mental health service system. It refers to the methods and strategies which mental health service providers apply to improve the mental health levels of their clients. The most common mental health theoretical approaches in China include psychodynamic therapy, cognitive therapy, behavioral therapy, CBT, family therapy, psychodrama, Morita therapy, Gestalt therapy, narrative therapy, cognitive insight therapy, imaging communication therapy, and so on. Most of those approaches were developed in western culture, and only a small part of them were developed by native therapists. The most influential native theoretical approaches included cognitive insight therapy developed by Zhong Youbing and imaging communication therapy developed by Zhu Jianjun. Comparing to the important roles which mental health theoretical approaches played in fulfilling the mental health service targets, researches on this aspect are obviously inadequate. More systematic researches and methodological researches are needed. The aim of this research was to investigate the present status of theoretical approaches in China. The better understanding of the mental health approaches would facilitate the development of mental health service training system and the optimization of resource distribution.The dissertation consisted of5studies. Study1was aimed to investigate the present status of practice approaches in primary prevention service with a literature content analysis of primary prevention intervention reports published from January,2000to December,2010in China. In study2,2133mental health practitioners including counselors, therapists, clinical psychologist and so on from30provinces and districts in China were surveyed. Those practitioners were working in schools, hospitals and other social institutes. The survey was aimed to gather the information which was about the frequency of their usage of different theoretical approaches and the influential factors. In-depth interviews were conducted to22mental health practitioners in study3. Practitioners were asked about their choice on theoretical approaches at the beginning of their relationships with their clients, how they changed their choice and why. The purpose of this investigation was also to identify the influential factors which impacted the current clinical practices of a broad range of mental health providers, as well as the influential factors of their adoption and sustained use of new practices. The same22mental health providers were interviewed in study4to investigate their cultural adaptation strategies in their clinical practices. Cultural adaptation strategies refer to the adaptations practitioners made to make the western theoretical approaches suitable for Chinese clients and the cultural background. To make further investigation in those strategies,10counseling sessions were analyzed in study5with qualitative method. In conclusion, the purpose of the serial of researches was to answer3questions, that were, what approaches practitioners chose to use in their clinical practice and the reason for their choice, what influenced practitioners'adoption and sustained used of new approaches, and what adaptation strategies practitioners used to meet the special demands in their practice in Chinese cultural background.The results of the above researches showed that:1. The mental health practitioners in China mainly used theoretical approaches in two ways, separately or integratively. The most frequently used approaches in the separate way were cognitive therapy, CBT, behavioral therapy, rational emotional therapy, psychoanalysis therapy, client-centered therapy and family therapy. The most frequently used approaches in the integrative way were cognitive therapy, psychoanalysis therapy, client-centered therapy and behavioral therapy. The native approaches which were developed by Chinese therapists were used less frequently than the other14western approaches, but more frequently than hypnotherapy.2. Demographic factors such as gender, age, educational background, major and professional factors such as practice years, professional certificates and training experience had influenced the practitioners'adoption of the theoretical approaches. It was found that practitioners who were working in schools, majored in psychology or medicine, younger than30, and had a bachelor degree were more likely to adopt cognitive therapy, rational-emotional therapy, client-centered therapy, behavioral therapy and Morita therapy. Practitioners who had a doctoral degree, older than45, and majored in psychology were more likely to use approaches in an integrative way. Practitioners who had no professional certificates were more inclined to adopt interaction analysis therapy and musical therapy. Besides, the use of musical therapy was significantly correlated to the practitioners'personal experience rather than professional training, which might infer that the practice of musical therapy in China was lack of systematic training.3. Three categories of factors influenced the approach adoption process of practitioners, which were client factors, practitioner factors and environmental factors. Practitioners took the client factors as the top factors to be considered, especially the clients'problems and their personality characteristics.4. Practitioner inclined to learn new theoretical approaches which were helpful for solving the clinical problems in their practice and which could help them with their personal growth. Most practitioners learned new approaches by attending short-term workshops or by self-teaching. The most common obstacles practitioners encountered in practice were inadequate training, complicated practice demands of the approach, and the mismatch between the new approach and the practitioners'theoretical orientation or cultural background.5. Practitioners used cultural adaptation strategies intentionally or unintentionally in the process of providing mental health service to Chinese clients. Practitioners showed their awareness of cultural adaptation in the counseling sessions.6. The results of the in-depth interviews in study4and the counseling session content analysis in study5showed that there were three aspects of the practitioners' cultural adaptation strategies, namely, counselor-client relationship, case conceptualization, and intervention ways. Practitioners in China inclined to employ more authoritative strategies to develop counselor-client relationships. In case conceptualization, practitioners used traditional culture, social phenomenon and psychosomatic bonding in Chinese traditional medical theories to conceptualize case, and taught the clients knowledge about psychotherapy and counseling. In the ways of intervention, practitioner in China used more instructive intervention.7. Comparing to other psychotherapists, the famous therapists adopted more cultural adaptation strategies. They used strategies to close the distance between them and their client rather than to show their authority. Famous adopted cultural adaptation strategies in the case conceptualization process with depth, which were demonstrated by their ways of collecting information (by asking about how the family spent traditional festivals) and explaing the intervention ideas with culturally accepted concepts. The famous therapists also put emphasize on giving clients some specific behavioral advices to bring about some positive changes in the client's life.8. The existing problems which were faced by Chinese mental health service system were classified into2kinds. The first kind was about the theoretical approach system itself, which involved the lack of approaches rooted in Chinese culture. The second kind was about the ways practitioners applied their theoretical approaches, which included that some practitiones lacked the awareness of the cultural adaptation of their approaches, some approaches were potentially abused due to the inadequate training, and cultural adaptation of the practitioners were inadequate and lack of depth.9. The advices on the development of Chinese mental health practitioners' theoretical approaches were divided into two categories. The first category was on the policy level. The government should set up a specific administrative department for mental health practice, draw up rules and regulations on professional qualification, and emphasize on the quality control of training systems. The second category was about the professional development of mental health practice. Emphasis on cultural sensitivity should be added to the training systems. Professional guidance should be introduced to the mental health practitioners to help them gain more awareness of their professional development and personal growth. Industrial associations were also recommended to push the cooperation and communication in the industry. To improve the efficiency of the mental health service in China, more application researches on evidence-based interventions and cultural adaption would be needed.There were innovations both in the theory and the methodology in this dissertation. In terms of theory, the result of the studies updated the existing knowledge of Chinese mental health theoretical approaches because the large scale survey had a better representativeness. The results of the systematic researches on the adoption of theoretical approaches and the influential factors renewed and expanded the theories of mental health services in China. The study on cultural adaptation strategies was the first attempt in empirical research in this domain, and the results were inspiring.In terms of application value, the results of this study could provide reference for training and management on mental health service providers as well as for service providers'self-improvement.This study was a preliminary exploration on theoretical approaches of mental health services providers. The future study should take a more comprehensive stratified sampling and develop a coding system on cultural adaptation strategies in counseling sessions to bring about improved and in-depth researches on cultural adaptation stategies of mental health services providers.