Concept of Clinical Psychology
Definition of Clinical Psychology
Clinical psychology is an
integration of the science, theory and clinical knowledge for the
purpose of understanding, preventing, and relieving
psychologically-based distress or dysfunction and to promote
subjective and behavioral well-being and personal development
(Society of Clinical Psychology; Plante, 2005). Central to its practice are psychological
assessment and psychotherapy, although clinical psychologists also
engage in research, teaching, consultation, forensic testimony, and
program development and administration (Brain, 2002). In many countries, clinical psychology is
regulated as a health care profession.
Characteristics of Clinical Psychology in Mainland China
Compared to the concept “Clinical Psychology” in North America,
the “Clinical Psychology”
in Mainland China is a relatively vague notion. It is always mixed
up with other subject names , such as,
Counseling Psychology, Medical Psychology, Psychosomatic Medicine,
Healthy Psychology, Behavioral Medicine, etc. In psychology
department of university, most of clinical or counseling related
curriculums are set under Applied Psychology, a subordinate
discipline of Psychology, with diverse course names. Most people
who work in the area of clinical or counseling psychology have
different training or education backgrounds. And many of them have
not got a Master or Ph.D. degree. However, those professors or
experts with Ph.D. are primarily devoted
to teaching and research, but not clinical service.
Those people who provide psychological
services are often called “psychological
doctor ”. Because of the influence of traditional Chinese
culture, people who are going to see a psychiatrist in psychiatric
hospital or mental health center believe that they will be
discriminately treated as “psychosis” or “insanity”. By contrast,
it’s much better if they see a “psychological doctor” in a
community based or college based clinics. Hence, the notions of
psychiatry and psychology greatly differ from each other. The
concept of psychiatric disorders is much discriminated by the
society, while the concept of “Psychological disorders” is
relatively much friendly accepted.
Given the limited space available, we
are not to introduce the development of clinical psychology in Hong
Kong, Taiwan or Macau.
History and Development
There existed rich ideas and practices
related to clinical psychology before modern clinical psychology
was introduced into China at the beginning of the twentieth
century. In general, the development of clinical psychology can be
divided into four phases as follows.
Before 1949 : Initial Spread of Modern Clinical Psychology
Before the establishment of Republic of
China (1911), it was the preparatory period of Chinese local
clinical psychology. A variety of Traditional Chinese Medicine
(TCM) classics ,
such as Treatise on Febrile and
Miscellaneous Diseases (伤寒杂病论) and Invaluable Prescriptions for Ready
Reference (千金要方), recorded many psychosomatic diseases,
interpreted the relationship of mind and body, and developed some
corresponding treatments. In addition to TCM, witchcraft,
divination and praying magic figures were also used to provide
treatment in this period (Chen, 2012).
During the period from 1912 to 1949,
modern western clinical psychology entered China and began to
develop. The normal pavilion of Peking Imperial University, i.e.,
the predecessor of Beijing Normal University, first offered a
psychology course in 1902, involving a variety of topics related to
general psychology, experimental psychology, child psychology, etc.
The first psychology lab was established in Peking University in
1917. In 1920, the first psychology department appeared at Nanjing
Higher Normal School which changed to
National Southeast University later. From 1923 to 1928, departments
of psychology were founded in a few other Chinese universities
including Beijing Normal University and Peking University. These
psychology departments gave a number of clinical psychology
courses, such as abnormal psychology, abnormal child psychology,
principle of mental health, applied psychology, and so on (Gao,
2005). Moreover, mental health
courses were also provided in some medical colleges in this
period.
The Chinese Psychological Society (CPS)
was founded in
1921 in Nanjing, and Chinese Association for Mental Health (CAMH)
was founded in
1985 in Taian. Some hospitals, schools, child welfare organizations
and medical research departments began to open mental health
clinics, providing psychological assessment and counseling/therapy
by professional psychological workers and social workers (Sun &
Ji, 2010). The first mental health
congress took place in 1948 in Nanjing
(Gao, 2005).
From 1949 to 1976 : Stagnation of Clinical Psychology
In the period from 1949 to 1965,
western psychology, particularly social psychology, psychological
testing and mental health, was criticized and even denied (Gao,
2005). Psychological therapy work
was done only to a limited extent. For example, the Institute of
Psychology of the Chinese Academy of Sciences (CAS) and Beijing Medical
College cooperatively developed a rapid comprehensive therapy,
combining medical treatment, physical exercises, thematic lectures
and group discussions, for individuals with neurasthenia,
schizophrenia and some psychosomatic diseases like hypertension and
canker (Qian & Wang, 2006).
During the Cultural Revolution period
(1966–1976), psychology was declared pseudoscience, and psychology
courses were stopped nationwide. It cancelled the Institute of
Psychology of CAS as well as psychology teaching and research
sections in department of psychology of universities, resulting
in the complete stagnation of
psychology.
From 1977 to 2000 : Restoration and Development of Clinical Psychology
The Institute of Psychology of the
Chinese Academy of Sciences was restored in June 1977, and CPS
resumed activities later in November 1977. In the following years,
departments of psychology were reestablished in several
universities including Peking University and Beijing Normal
University. The Ministry of Health of the People’s Republic of
China (CMH) proposed to offer medical psychology course at medical
colleges, and to establish psychological counseling clinics in
mental hospitals and comprehensive hospitals, providing
psychological service. According to the regulations issued by the
CMH, one of the rating criteria for comprehensive hospitals (first
class hospitals) is whether a psychological counseling clinic is
established or not. As a result, psychological counseling clinics
are now available in thousands of first class hospitals
nationwide.
Since 1984, psychological counseling
centers have been set up one after another in universities,
offering free counseling service for students (Huang, He, & He,
2008). In the following years,
professional psychological counseling organizations were
established in Chinese justice department (e.g., armed police,
jails, and drug rehabilitation center), social service system
(e.g., Disabled Federation, Women’s Federations, and communities),
and enterprises as part of corporate training (Huang et al.,
2008).
However, a great number of problems
and challenges have emerged whether in psychological counseling
clinics of medical institutions or psychological counseling centers
of the higher education system, of which the primary is the
majority of mental health service staff lacks systematic and
standard professional training.
From 2001 to Today : Rapid Development of Clinical Psychology
Former Chinese Ministry of Labor (CML)
released the
temporary national qualifications for psychological counselors in
2001. The first qualification examination was carried out in 2002,
and psychological counselors, as a new career, can conduct related
psychological counseling only when they received the qualification
certificate. In addition, the CMH incorporated psychological
therapy into the qualification examination system for medical
professionals. Individuals who passed the examination will receive
the psychological therapist qualification certificate, which is the
only qualification certificate approved by the CMH, in addition to
psychiatrist, for conducting professional psychological therapy.
These government measures promoted the popularity of psychological
counseling and therapy service in public. However, problems still
remained regarding psychological counselors/therapists’
professional training, continued education and management.
The Committee of Clinical and
Counseling Psychology was set up in CPS in 2001. In 2007, the
executive committee meeting in Beijing approved two important
documents: Chinese Psychological
Society Registration Criteria for Professional Organizations and
Individual Practitioners in Clinical and Counseling
Psychology and Chinese
Psychological Society code of Ethics for Clinical and Counseling
Practice. The Clinical and Counseling Psychology
Registration System (CCPRS) of CPS was founded to conduct quality
control and self-discipline.
The Chinese Mental
Health Act was launched in 2013. It first made a clear
distinction between psychological counseling and psychotherapy
service, regulating that (1) psychological counselors can only
provide professional counseling service for the public outside of
mental hospital system, but cannot conduct psychological therapy or
mental disorder diagnosis and treatment; (2) mental disorder
diagnosis should be made by certified psychiatrists ; and (3) psychological therapy should be
conducted in medical institutions.
Professional Condition of Psychological Counseling and Therapy
Professional Training Systems
The Discipline Subordination of Clinical and Counseling Psychology
According to the rules of Chinese
Ministry of Education (CME) and the Academic Degrees Committee of
the State Council, Psychology is the first-level discipline and
Applied Psychology is the second-level subject, while Clinical and
Counseling Psychology is the subordination of Applied Psychology.
Since 1998, China has set up Applied Psychology (4 years) as
one of major of undergraduate, granting “Bachelor of Science”. So
far, the number of colleges which set up Applied Psychology as a
major is more than 200, and some universities opened courses named
applied psychology.
The Training Provide in Normal or Comprehensive Universities
The department of psychology in
universities resumed to recruit student in 1978. Since then
clinical/counseling psychology related majors have been always
welcomed by students. There are a lot of courses of applied
psychology, but less practicum activities in department or school
of psychology in university system. The school attaches great
importance to scientific training, and the requirement of
graduation for Master graduates is to publish paper on Chinese core
peer review journals as first-author, and for Doctoral graduates is
to publish paper on foreign core peer review journals as
first-author. Only after publishing articles and finish their
thesis, can students, whom no matter what programs they are, be
qualified for the final oral defence. By contrast, there is no
requirement of clinical related practice training by university,
such as lacking of systematic, normative clinical/counseling
training program and standards of practice and internship for
students. As those clinical or counseling psychology professors
working in university system have a whole lot different training
background, most of them no clinical or counseling psychology
system training, they offer no psychological service. Hence, what
clinical training the students get from their schools depends on
what their advisors or supervisors prefer to. In general, because
of being short of practicum, internship and supervision, and other
reasons, most graduates cannot be engaged in psychological
counseling- or psychotherapy work.
Even so, some or a small number of
clinical psychology professors themselves still insist on clinical
work weekly, such as therapy sessions, supervisions and clinical
intervention research and related practice, by overcoming all kinds
of obstacles. Meantime, their students are required to get some
clinical training and practice as much as they can. However, for
various reasons, clinical or practical training for students is
still limited.
It is worth mentioning that, in recent
years, a few universities have started to pay attention to the
clinical psychology program enacted by CCPRS which has already put
up with a definite provision about courses, academic, practicum and
internship requirements, hoping great progress and breakthrough
could be made
in the near future.
The Training Provide in Medical Schools
Unlike North America and other
countries, in Mainland China, CME approved to set up applied
psychology as a specialized subject for undergraduate student in
nine medical colleges in 2001 which breaking through the situation
that applied psychology major was only open for students in
normal/comprehensive universities. By the end of July 2009,
according to the official information from the website of CME, over
50 medical colleges have set up psychology or applied psychology
major (not including psychiatry) (Shen & Tao, 2005; Wang & Du, 2010). Graduates majored in applied psychology
from normal or comprehensive universities can not work in hospital
system because of impossibility to acquire physician certificate,
while those graduates from medical schools are qualified for
acquiring
it.
The Training Provide in Social Institutions
Since last early 90s, several
influential training programs have been successively introduced
into mainland China, such as “Sino-German Advanced Continuous
Training Program for Psychotherapist” (also the first continuous
training program introduced into Mainland China), the counseling
training program conducted by Professor Mengping Lin (learn from
Carl Rogers) from Chinese University of Hong Kong in Beijing Normal
University. Most of the trainee from those programs later become
the professional leaders in the field of psychological counseling,
bringing great influence for the initial development of provision
of psychological service in mainland China.
In recent a few years, more and more
training programs of different schools gradually become
systematical, such as “The China American Psychoanalytic Alliance
(CAPA)”, “China-Norway Continuous Training Program for
Psychoanalytical Therapists and Supervisors”, “Satire’s Family
Therapy Continuous Training Program”, “Cognitive-Behavioral Therapy
(CBT) Continuous Training Program” by Professor. Jianping Wang of
Beijing Normal University, “China-German Advanced CBT Continuous
Training Program”, etc. To a large extent, above training programs
offset the deficiency of the clinical practice in universities, and
improved the level of psychological service. Whereas, on account of
the lack of resources of qualified supervision and solid
theoretical foundation, the number of clinician with enough
training to offer psychological service independently is very
limited. Therefore, CCPRS has established several supervision
working points in some provinces (so far about 10) where exist
registered supervisors and psychological counselors or
therapists.
However, besides the existence of
those long-term programs, there still are many short-term trainings
(a few days) in different skills or approaches in various forms.
Some training teachers come from foreign countries, and some are
from Hong Kong or Taiwan. On the whole, the professional level of
training is still low (Yao,
2010).
The Training Program for Professional Master Students
The training program including applied
psychology or mental health education for professional master
degree began in 2011 for the undergraduate entrance, which is a
2-year full-time schooling education. Nevertheless, the admission
standard and graduation criteria, comparing with the one for
academic master degree are relatively low. The training program has
no clear requirement for practicum or internship. Additionally,
although some of students have acquired the Certificate for Psychological Counselor
granted by the CML before or after their graduation, they are still
not able to do the work like psychological counseling or therapy.
Since 2013, some universities start to admit part-time professional
master students, majoring in Psychological
Counseling, Employee Assistance Program, Family education or
Therapy and so on. And in 2016 fall semester, School of Psychology
of Beijing Normal University is starting to conduct systemic
professional clinical and counseling psychology training program,
including practicum, internship and supervision hours
for professional master students.
Theory Schools of Psychological Counseling
The western
theories of psychological counseling or therapy, like dream
interpretation and free association, were initially introduced into
China at the beginning of the twentieth century, later followed by
behavioral therapy in 1930s. Thus, psychoanalytical and behavioral therapy were the
earliest approaches introduced into mainland China.
The real development of psychotherapy
began in the late 1980s, with a few books on psychological counseling or therapy, primarily the works
of Sigmund Freud, being translated into Chinese. In the 1990s, some
psychodynamic therapists have already begun to independently offer
psychological service. Until now, in mainland China, there are four
psychotherapist certificated by International Psychoanalytical
Association (IPA ) , and six psychoanalyst certificated by
International Association for Analytical Psychology (IAAP)
.
It is worth mentioning that Dr. Youbin
Zhong, the native psychotherapist in mainland China, pioneered
Cognitive Insight Therapy, also known as Chinese
Analytical Psychology , which combines the principles of
psychoanalysis with Chinese national conditions and traditions.
Cognitive Insight Therapy is a short-term technique and is suitable
for social anxiety and anxiety disorders (Qian & Zhong,
2012). Moreover, there is another
technique worth mentioning, i.e., Imagery Conversing . It is a psycho-therapeutic technique developed by Dr. Jianjun Zhu in the
beginning of 1990s. Based on psychodynamic theory, this technique
creatively incorporates dream interpretation, hypnosis, humanistic
psychology, and eastern culture into one application. It can be
used for obsessive-compulsive disorder, school phobia, depression
and other symptoms (Li & Zhang, 2011).
Behavioral
Therapy was initially introduced
into China in 1930s, not being widespreadly applied until the
1980s. It was not until the 1980s, Cognitive
Therapy was introduced into
Mainland China, and some works of Aaron T. Beck and Albert Ellis
were translated as a main source of teaching materials. At that
time, most people learned cognitive therapy by reading books
themselves, and then used certain cognitive skills in the process
of psychological counseling, and thus they classified themselves as
cognitive therapist. Consequently, the data showed that the number
of people who using cognitive techniques is the largest. And many
of them consider it easy to learn and not necessary to attend a
systematic training program to be a CBT therapist. Different from
what is expected, many trainees finally found that it is far away
from being a cognitive behavioral therapist after participating in
my CBT training workshops (first author of this chapter).
Therefore, the real Cognitive-Behavioral Therapy is not developed until
recent years. So far, only three CBT therapist have acquired the
certificate issued by the Academy of Cognitive Therapy (ACT) and
one approved as an ACT’s Fellow (first author of this chapter) in
Mainland China.
Although family education or therapy
started relatively late in Mainland China, however, it has
developed a little bit faster. The number of family counselors or
therapists is only less than that of
psychodynamics. In April 2007, the Ministry of Human Resources and
Social Security of the People’s Republic of China permitted to
grant Marital and Family
Counselor as a new career. Later in June 2009, the first
career certification exam for marital and family counselor was
conducted. Wai-Yung Lee, the member and supervisor of American
Association of Marital and Family Therapy, now is the chief
director of the Hong Kong University Family Institute. She is the
only Chinese disciple of Dr. Salvador Minuchin who is the founder
of Constructed Family Therapy, contributing herself into the
application and development of marital and family therapy both in
Hong Kong and Mainland China. In mainland, Marital and Family
Therapy Institution of Beijing Normal University run by Dr. Xiaoyi
Fang is the earliest professional research and therapy
institution.
Quite a lot of theoretical ideas and
basic techniques of humanistic psychology have been the basis of
other schools. Until now, related humanistic-existential psychological trainings ,
also some of the Chinese version of books written by Irvin Yalom,
have already been introduced into mainland. Since 2014, the first
successive 2-year professional certification course for “Humanistic and Existential Psychological Therapy
”, cooperating with International Institution of Existential and
Humanistic Psychology, was introduced into China. The aim of this
course was to assist domestic psychological counselors and
therapists to better know the essence of existential-humanistic
psychology and apply it to their clinical work.
In the year 2015, among the whole
applicants in CCPRS , more than 70
persons applied for psychoanalyst or psychodynamics, ten applied
for family therapist, only three applied for CBT, and one applied
for narrative therapist. Obviously, psychoanalyst applicants leaded
an overwhelming margin.
Mental Health Service Market
Service Providers
It was estimated that there were about
16 million persons with severe mental illness, about 39 million
with depression, and about 130 million with various mental
disorders in Mainland China (Qian, 2009). At present, the mental health service providers mainly consist of the following ten
categories of professional or nonprofessional persons ,
which partially overlap.
Category 1: Psychiatrists
. There are 1650 mental health
professional organizations, 228 thousand psychiatric inpatient
beds, and more than 20 thousand (author note: about 22 thousand)
psychiatrists (Centers for Disease Control and Prevention (CDCP) of
National Health and Family Planning Commission of the People’s
Republic of China (NHFPC), 2015).
In terms of location distribution, most resources are in eastern
and urban areas; and there are no professional mental health
organizations in a total of 37 cities (mainly in western areas),
around one third territorial area and 41.9 thousand population
covered (Guo et al., 2008). Most
psychiatrists have a medical background and lack systematic and
standard psychological therapy training. They primarily provide
mental disorder diagnosis and medication treatment, and only a few
can provide systematic and regular
psychological therapy service.
Category 2: Psychological therapists.
Since the
first psychological therapist qualification examination in 2002,
nearly 3000 persons have received the therapist qualification
certificate, most of whom work in medical institutions to offer
psychological therapy service (CDCP of NHFPC, 2015). Moreover, a variety of training programs
have been introduced from Germany, the U.S., Norway and other
countries, which improved a number
of psychological therapy professionals’
technical skills and service quality.
Category 3: Psychological
counselors . By the end of
the first half of 2016, over 1.5 million persons participated in
the national counselor qualification examination, and more than 900
thousand persons received the counselor qualification certificate
(Level 2 and/or 3). Certified counselors are widely distributed in
various industries, such as education, health, justice,
labor/youth/women’s organizations, and the army (police) system.
However, due to the low entry standard in early counselor
qualification examinations and candidates’ various educational and
professional backgrounds, even though the requirements for
examination registration become stricter in recent years, the
majority of certified counselors have had only a short-term course
without practicum or internship training so that they can hardly
provide professional counseling. A recent survey in Beijing,
Shenzhen, Anhui province, Shandong province and other regions
revealed that 1 year after receiving the certificate, about 8%
counselors were still engaged in psychological counseling service,
and no more than 3% were professionally
engaged in counseling (CDCP of NHFPC, 2015).
Category 4: Registered clinical and counseling
psychologists . CCPRS of
CPS was founded in 2007 to explore better professional management
mode. By the end of 2014, a total of 13 professional mental health
service agencies registered in the system; the number of registered
clinical and counseling psychologists was 726 (CDCP of NHFPC,
2015); to include registered
assistant psychologists and supervisors, the total number is still
less than one thousand.
Category 5: School counselors
. The CME launched documents in 1999 and
2001 to promote the training and certification of school counselors
in primary and secondary schools as well as colleges and
universities. The requirements for candidates are teachers and
owning at least bachelor degree in education or psychology. There
are about 60 thousand school counselors. They mainly help students
to deal with developmental and some psychological problems.
Category 6: College instructors
. First as political instructors in
1952, the role of college instructors has been largely extended,
particularly since 2004, to help students in dealing with study and
life problems, including emotional distress, interpersonal
relationships, career planning, and so on. Due to the close
relationship between college instructors and students, they are
often quite aware of potential mental health problems among
students, take first action like communication with students,
contact students’ parents, help arrange counseling for students at
university counseling center, and keep following up. Surveys showed
that students preferred to ask help from
college instructors with psychological problems, compared to
psychological counselors (Chen, Wu, Zhao, & Ma, 2010). In recent years, more universities support
and organize their college instructors to
participate in continuous psychological therapy training programs
in order to improve their professional capacity .
Category 7: TCM Practitioners
and
non-psychiatric doctors .
A survey (Shi et al., 2000) in
Shanghai Mental Health Center showed that only 50% (9/18) patients
with bipolar disorder visited department of psychiatry first, and
the ratio was 37% (51/138) for schizophrenia, 12% (11/91) for
depression and 7% (5/74) for neurosis. Most patients received first
TCM or other western medicine treatment, and about 10–28% patients
received Qi Gong or Superstition treatment. One important reason
why patients visited comprehensive hospitals first was the
existence of accompanying physical symptoms, and other reasons
included that patients or relatives lacked in mental health
knowledge and viewed first-episode psychiatric symptoms as common
thought, character and emotional problems, or that they were
unwilling to visit psychiatric hospitals out of fear for social
stigma (Shi et al., 2000).
It is noteworthy that the role of TCM
in mental health service has drawn more attention in recent years.
At present, applied psychology specialty has been set up in over
ten colleges of TCM, and some colleges have even master and doctor
degree programs in TCM psychology. Some TCM hospitals established department of psychological
counseling and neuropsychological rehabilitation ward in Beijing
and other
cities.
Category 8: Religious persons
. Due to some psychiatric symptoms
associated with strong religious superstition characteristics, the
Chinese people are likely to attribute the cause of schizophrenia
to supernatural forces like ghost and thus turn to religion or
superstition for treatment (Huang, Shang, Shieh, Lin, & Su,
2011). Previous studies showed
that 21.0–70.7% patients with schizophrenia asked for certain form
of religious or superstition help (see Deng et al., 2012). Folk religion has much more influence in
rural areas where mental health resources are generally
insufficient, and most studies used samples from urban areas, the
(positive and negative) role of religion and superstition in rural
and remote areas might be more significant.
Category 9: Social workers
. The evaluation system of professional
standards for social workers was set up in 2006. By the end of
2013, about 760 thousand persons participated in the qualification
examination, and over 80 thousand persons received assistant social
workers and social workers certificates. In addition, there is not
mental health social worker training or specialty. So far, a few
mental health agencies in Beijing, Shanghai and other cities have
founded the hospital system of social work, established independent
department of hospital social work, and
equipped
professionals to offer psychiatric social work service (Liu &
Zhu, 2011).
Category 10: Family, friends and others
. There were only pharmacies where TCM
practitioners also gave disease diagnosis in ancient China. In
general, patients received treatment at home and the practitioners
visited them regularly. In nowadays, patients receive treatment at
hospital, but family members must usually stay there to take care
of them. The same is true in open psychiatric ward. Patients under
the age of 40 were mainly took care of by parents, and those older
than 40 were usually by spouse, adult children, or siblings (Bian
& Xie, 2002). Thus, family
members and friends provide very important assistance in mental
health service.
Moreover, local government
organizations in urban communities and subdistrict as well as in
rural villages play an important role in mental health service.
Actually, these organizations get involved in various problems of
residents, if not everything, including couple conflicts, child and
old people related problems, financial difficulty, organization of
various public activities, and so on. Although these organizations
often deal with mental health related problems, there are few
mental health professionals employed in them. Thus, to better
understand the situation of mental health service in Mainland
China, it is necessary to include the contribution of these
non-professional mental health resources, also including volunteers
in local organizations (e.g., street aunts), police (e.g., when
family violence occurs), and even leaders in work place.
Service Sites
As noted above, there is currently a
great lack of psychological counseling and therapy professionals,
and a great number of non-professionals are engaged in mental
health service. These professionals and non-professionals mainly
work in the following seven areas.
Site 1: Psychiatric hospitals
. It is the major force in Chinese
mental health service. Psychiatrists provide treatment, in the
forms of diagnosis and medicine treatment, for patients with a
variety of mental disorders. Since 2002, psychological therapists
began to offer psychological therapy service, as supplementary to
medicine treatment, for some patients (e.g., with depression,
anxiety disorder) at these hospitals. The
Chinese Mental Health Act (2013) requires that specialized
medical institutions for mental disorder diagnosis and treatment
should also be equipped with psychological therapy professionals.
Shanghai Mental Health Center has now an independent building for
psychological clinic, suggesting some recognition of the importance
of therapy service .
Site
2: Psychological clinic
at comprehensive hospitals
. The CMH required that first class
hospitals must establish psychological counseling clinics in 1987.
Thus, the number of such psychological clinics is very large, but
they receive actually little attention from hospitals. They also
generally provide medicine treatment because of incapacity to offer
professional psychological service.
Site 3: Education system
. At present, the comparatively highest
level of professional psychological service in Mainland China
should be available in psychological counseling centers at
university. Universities and colleges pay much attention to
students’ mental health, particularly the prevention of suicide.
Counseling centers were set up nationwide in all universities and
colleges, and were equipped with full-time and part-time
professionals. Nevertheless, only 30 thousand professionals are
available to offer service for a total number of over 24 million
college students (Kaiwen Xu, interviewed by Health News on July
25th, 2015). Most professionals are certified counselors, whose
professional quality and skills are generally limited due to lack
of systematic professional training. In recent years, psychological
counseling centers have been also established in primary and
secondary schools, or even kindergartens in Beijing, Shanghai,
Guangzhou and other cities with rich mental health resources.
Site 4: TCM hospitals . Many people with psychological, psychosomatic,
or even severe mental problems prefer to visit TCM hospitals and
believe in the treatment effect of TCM. In ancient China, TCM has
indeed played the role of psychological counseling or therapy to
some extent. However, there exists some problems in the current
development of TCM itself, and TCM practitioners vary greatly in
their professional quality and skills. As a result, the potential
effect of TCM on mental health problems is much reduced and thus
very limited. Recently, a few TCM hospitals in Beijing, Guangzhou,
Hangzhou and other cities have established department of
psychological counseling, but its service quality is hard to be
guaranteed.
Site 5: Enterprises . A number
of large enterprises set up Employee Assistance Program (EAP)
or similar
section, and engage psychological counselors on site to offer
counseling service for employees. However, many these counselors
are often in lack of systematic professional training and
sufficient professional skills.
Site 6: Private agencies and psychological
hotlines . In recent
years, private psychological counseling agencies are gradually
increasing, varying in scale. Professionals are generally certified
counselors with various education backgrounds. They primarily
provide psychological counseling and hotline service for community
population with psychological problems. There is little quality
management and its service quality is hard to guarantee .
Site 7: Private foreign
hospitals . For example,
Chindex International engages certified professionals from the
Europe, the U.S. and China to provide mental health services, using
the American hospital standards including high price
standards.
Service Delivery
Form
1: Traditional face-to-face individual session . At present, it is
still the primary service form of psychological counseling and
therapy.
Form 2: Online video counseling
. Due to the lack of mental health
resources and concentration in Beijing, Shanghai and other big
cities, more and more psychological counselors and therapists
provide mental health service via online video for distant
visitors. In general, most counselors will not use online video to
complete the whole counseling process, but rather use it as
supplementary in emergencies when face-to-face session is not
available. Moreover, online video is used more widely to conduct
group supervision. Given the very limited supervision resources,
this form of supervision plays a particularly important rol
e. Sure, its
effect is not as good as face-to-face supervision.
Form
3: Provision of psychological counselors via the Internet
. It is a
new trend, combining the Internet convenience into professional
psychological counseling. Take the website “Jiandanxinli” for
example, it is a platform which provides a list of selected
psychological therapists with a detailed professional background
introduction. The website users could make a face-to-face or online
video counseling appointment with counselors via the
platform.
Form
4: Hotlinecounselin . It is usually used as crisis intervention
hotlines, and is also able to provide psychological counseling
service. For example, the Maple Women’s Psychological Counseling
Center Beijing offers both face-to-face and telephone counseling
service for people in need. As regard to price, telephone
counseling is 30–50% cheaper than face-to-face session.
Form
5: Information provision via the Internet . Recently,
universities and colleges have all established their own mental
health websites, and more and more medical institutions,
enterprises and even individuals are setting up similar websites.
The majority of these websites provide general mental health
knowledge for the public, playing the role of mental health
education. Many websites offer free online information service,
primarily giving answers and advices to users’ questions in the
form of text via BBS, Email and QQ (similar to MSN) (see Wang,
Tang, Wang, & Maercker, 2012).
It is actually a kind of consultation, rather than counseling. The
users will be advised to visit professional mental health
institutions for face-to-face sessions when needed. Some websites
also provide individual counseling via telephone or QQ phone with
very low price.
At present, there are still few
Internet-Based Interventions (IBI) in Mainland China, i.e., providing
systematic self-help or therapist-assistant psychological
intervention via the Internet for specific mental problems. The
authors of this chapter have recently introduced an IBI program for
trauma recovery and achieved positive effects (e.g., Wang, Küffer,
Wang, & Maercker, 2014; Wang,
Wang, & Maercker, 2013).
Service Fee
Medical insurance
system is complicated in mainland China. It covers certain
kinds of medication fees (e.g., some medicines excluded and
completely self-paid) and other medical costs in different
percentages for different populations. Service
fee is charged in various forms , mostly self-pay, and vary
greatly across institutions. In general, private agencies charge
highest fees; the education system offers free psychological
service for their own students, but some professionals provide paid
service for outside persons; the EAP service is paid by
enterprises; and the psychological therapy price in hospital system
is set very low so that no counseling or therapy professional is
willing to do it. For example, while the price of individual
face-to-face session is 120 Yuan per 50 min (about 18 U.S.
dollars) in the Wuhan Hospital for Psychotherapy, local private
psychological counseling or therapy agencies charge 500 Yuan per 60
min (about 77 U.S. dollars) (Jun Tong, interviewed by Health
News on July 25th, 2015).
Compared to the price at Wuhan
Hospital for Psychotherapy, the medical institutions in other
regions charge even lower therapy fees. For example, the price is
30 Yuan per 50 min (about 5 U.S. dollars) in Beijing and 72
Yuan per 50 min (about 11 U.S. dollars) in Shenzhen (CDCP of
NHFPC, 2015), but some private
agencies in Beijing charge 3000 Yuan per 60 min (about
462 U.S. dollars) for psychological counseling/therapy. A
psychiatrist and registered therapist and
supervisor , in communication with the first author of this
chapter, charged 200 Yuan (about 31 U.S. dollars) when he
spent half a day doing 3–4 therapy sessions, but he could have
charged more than 200 Yuan in a minute if he would prescribe
medication.
Moreover, although Chinese medical
insurance covers the medication fees for mental disorders, poor
families can still hardly afford the systematic treatment due to
the insurance’s limited coverage and low level of funding. Some
severe mental health problems (e.g., suicide) and treatment methods
(e.g., psychological therapy) are still
excluded from the medical insurance coverage; recently published
Essential Drug List also
includes very few psychotropic drugs (CMH, 2009), which is completely impossible to meet
the need of offering basic treatment for psychiatric patients
(Xiao, 2009). Thus, family
is still the primary provider of
psychiatric patients’ life and treatment fees. Insufficient medical
insurance remains an important obstacle for psychiatric patients to
receive timely and systematic treatment.
Clinical Assessment and Research
Tests/Scales Revision and Development
Modern testing and assessments were
introduced into Mainland China in the 1910s. In the following
years, some important western scales, tests and questionnaires were
revised, such as the first revision (1924) of Binet-Simon Scale by
Zhiwei Lu. Chinese psychologists also developed some tests, such as
a Moral Will Test by Shicheng Liao (1922) (Gao, 2005). With regards to clinical assessment,
Rorschach Inkblots Test and Thematic
Apperception Test (TAT ) were applied (Qian, 2011).
Since 1979, psychological testing has
been rapidly developing, resulting in a number of revised or
developed tests on intelligence, personality and capacity.
Recently, with mental health drawing attention in Chinese society,
the number of scales and questionnaires, for the use of assessing
general mental health as well as various specific psychiatric
symptoms and mental health problems, is gradually increasing. Until
now, the most common scales used are still those translated from
the West, such as Symptom Checklist 90 (SCL-90), Self-Rating
Depression Scale (SAS) , Self-Rating Anxiety Scale (SAS), and
Hamilton Rating Scale for Depression (HRSD) (Qian, 2011). The most authoritative Chinese testing
book is Rating Scales for Mental
Health (enlarged edition; 1999) published by the Chinese
Mental Health Journal Publisher.
In general, although psychological testing is used to screen for
mental disorders in Chinese medical institutions, these tests have
actually played a lesser role. It is in research rather than in
counseling and therapy practices that psychological tests play a
major role.
To strengthen the management of
psychological testing, the CAMH founded
the Committee of Psychological Assessment in 1991. In January 2008,
the Committee of Psychological Testing, founded in CPS, launched a
psychological testing management document, authorizing the
committee to register and evaluate psychological tests, to issue
and manage psychological test qualification certificates, and to
certificate the organizations that publish, sell tests and offer
training.
Diagnosis Tools
Chinese mental health professionals
generally use three diagnosis and classification systems for mental
disorders: International Statistical Classification of Diseases and
Related Health Problems (ICD), Chinese
Classification and Diagnostic Criteria of Mental Disorders
(CCMD) , and Diagnostic and Statistical
Manual of Mental Disorders (DSM) . Among them, ICD-10 is the
national standard for mental disorder diagnosis in Mainland
China.
However, the usage of ICD-10 is less
common than that of CCMD-3. Firstly, Chinese psychiatrists prefer
to use CCMD-3 in clinical diagnosis of mental disorders. For
example, a survey (Zou et al., 2008) revealed that among 192 Chinese
psychiatrists, 63.5% used CCMD-3 as diagnosis standards, 28.7% used
ICD-10, and 7.8% used DSM-IV. Second, reviewing the Chinese mental
health literature, CCMD-3 is used more often than ICD-10. During
the period from 2004 to August 2007, the usage ratio was 78.1% for
CCMD-3, 8.6% for ICD-10, and 13.3% for DSM-IV in three top Chinese
mental health journals (Chen, 2007). DSM-IV is the primary diagnosis standard
in the English mental health literature by Chinese researchers.
Third, since 1992, the majority of published Chinese textbooks and
monographs in psychiatry more or less introduced ICD-10, and some
compared the CCMD system with the DSM system in details; in
chapters of specific mental disorders, however, most books used the
CCMD system to illustrate the diagnosis of a particular mental
disorder (Tang, 2009). Note that
DSM-IV is the primary diagnosis standard in the English mental
health literature by Chinese researchers.
It is noteworthy that since CCMD-2-R
(1995), the CCMD system has started gradually adapting to the
international classification of diseases, while retaining those
mental disorder classifications with Chinese characteristics. The
descriptive parts of CCMD-3 actually referred to the Clinical Descriptions and Diagnostic
Guidelines of ICD-10, and the diagnosis parts of CCMD
-3 referred to the Diagnostic Criteria for Research of
ICD-10 and DSM -IV. As a result, the
classification of diseases in CCMD-3 are greatly similar to those
of ICD-10, and thus ICD-10 has a profound indirect impact on
Chinese mental health professionals and practices. Given the
increasing similarity between the CCMD system and the ICD and DSM
systems, and more mental health professionals use the ICD system in
recent years, some even question whether it is necessary to
continue revising and using the CCMD
system.
Research
Since the 1980s, the number of
clinical psychology publications has been consistently increasing
(Fu, Huang, Yin, Zhang, & Su, 2010). Besides the growth in quantity, the
development over 30 years shows some significant trends.
Trend
1: On research methods , clinical
trials are increasing and case reports are relatively decreasing.
Take the top clinical psychology journal of Chinese Mental Health Journal for
example, in the period from 1987 to 1997, it published about 130
articles related to psychological therapy, among which 34.6% were
single case reports, 26.9% were reports of a group of similar
cases, only 3.8% used the control group design to test therapeutic
effect, and other 23.1% were theoretical studies (Zeng,
1997). From 2000 to 2009, the
journal published 381 articles related to psychological therapy,
among which 50.1% were empirical studies (66.0% of them using the
comparison group design), 38.6% were theoretical studies, and 8.1%
were case studies (Mao & Zhao, 2011).
Trend
2: On research themes , while the
majority of mental health publications are on therapeutic effect,
only a few on therapeutic process. For example, among the 191
empirical psychological therapy publications published in the
Chinese Mental Health
Journal from 2000 to 2009, 84.3% were examination of
therapeutic effect, and only 2.1% were related to therapeutic
process (Mao & Zhao, 2011).
The Chinese Journal of Clinical
Psychology, another important journal in Chinese clinical
psychology field, published 204 articles on counseling and therapy
from 1993 to 2007, of which 41.7% were related to therapeutic
effect, and only 3.4% were related to therapeutic process (Hou,
Gong, Yu, & Chang, 2008).
Although therapeutic effect studies
are currently dominant in quantity, these studies are still at
relatively low level. First, most empirical studies used pre- and
post-intervention comparisons, but much less adopted the Randomized
Controlled Trial (RCT) design (Qian, 2011). Second, most of empirical studies
reported the statistical significance (SS) to examine therapeutic
effect. Recently, some studies reported the effect size (ES).
However, few studies reported the clinical significance (CS). Given
that a high proportion of clinical patients have comorbid disorders
and therapeutic process is hardly standardized as in research,
further research should explore new ways in which clinical
practices could more benefit from the findings in RCT studies
(Wang, Wang, & Tang, 2011).
Third, a majority of empirical studies used scales and
questionnaires to test therapeutic effect, and less studies used
other assessment methods, such as physiological indicators and
behavior observation. A few professors’ research groups have been
engaged in experimental clinical psychology all the time, and has
cooperated with other research groups in brain science field to
combine multiple indicators (e.g., emotional experience
self-report, behavior change observation, brain function change) in
experimental studies of clinical
psychology (e.g., Wang, Lin, & Sun, 2002; Yan, Wang, Tang, Wang, & Xie,
2015).
Trend
3: On therapeutic approaches ,
the integration of different western therapeutic theories and
approaches is common, and new or revised Chinese therapeutic
theories and techniques emerged. A review (Fu et al.,
2010) on 475 therapy and
counseling publications in 11 Chinese professional journals from
January 2000 to October 2009 showed that 93.7% used western
theories, 4.4% used theories originated from the West but revised
(e.g., cognitive insight therapy, Zhong, 1988; Taoism cognitive therapy, Zhang &
Yang, 1998), and 1.3% used new
Chinese therapeutic theories (e.g., TCM psychological therapy, Xu,
1994). Among the studies with
western theories, 37.2% used two different theories (mainly
cognitive and behavioral theories) or three and more theories
(mainly cognitive, family and Morita therapy), 9.3% used cognitive
theory, 8.6% used behavioral theory, and 8.4% used rational emotion
theory.
Note that many publications gave a
very general description of their psychotherapeutic methods;
although named as some therapy approach, it could hardly be worthy
of the name; in many studies it was just positive attention,
explanation and support. It is particularly true for cognitive
therapy and behavioral therapy that are common in Chinese mental
health publications. Most of so called “CBT therapists” name
themselves as CBT therapists as they just simply practice some
single cognitive or behavioral skills. But they actually what they
did could not be regarded as a real cognitive therapy or cognitive behavior therapy.
Trend
4: On target population , more
and more mental health publications provide psychological
interventions for non-clinical populations. For example, among the
therapy and counseling publications in the Chinese Mental Health Journal from 1987
to 1997, subjects were primarily psychotic patients and psychiatric
disorders dealt with were obsessive compulsive disorder, phobia,
anxiety, and so on (Zeng, 1997).
During the period from 2000 to 2009, 61.5% provided interventions
for clinical patients and 38.5% for non-clinical subjects (Mao
& Zhao, 2011).
Professional Societies or Associations
CPS ,
initially established in 1921, is a non-profit and academic social
organization, and becoming a member of the International Union of
Psychological Science in 1980. It has 20 professional branches that
cover a wide range of specialties, including Medical Psychology,
Counseling Psychology. The purpose of CPS, in order to stimulate
the development of psychology, is to unify national psychological
workers, take academic activities, and enhance academic
research.
CAMH aims
at unifying national scientific workers from the institutes of
mental hygiene, psychology, medical science, sociology, and
education to conduct various forms of psychological education or
service related activities. Since founded in 1985, there are almost
20 thousand members, and 28 local branches, subordinated by 16
professional committees, including children mental health,
psychological counseling and therapy and psychological assessment.
In 1997, the Committee of Psychological Counseling and Therapy of
CAMH, as a group member, joined in the World Council for
Psychotherapy.
Chinese Psychiatry Association (CPA)
, a
subordinate organization of Chinese Medical Association, is the
most important and influential academic society in the field of
psychiatry. Its predecessor was the Neuropsychiatry Society of
Chinese Medical Association which was established in 1951. Later,
it separated from Neurology Society in 1994, and then became an
independent institute. By the end of 2015, it has had more than 20
thousand psychiatrist members.
NHFPC has 21 organizations, one of
which is the unit of mental health. In July 2015, NHFPCPRC with
other related institutions together launched the National Mental
Health Working Plan (2015–2020), aiming to train professional
mental health clinicians including social workers, conduct
standardized mental health training programs for psychiatric
residents, provide continuous training programs for clinical
workers, increase the number of psychiatrists, and set or improve
grassroots mental health systems.
Besides above professional
psychological organizations, the Ministry of Education and local
Department of Education from provinces or cities also offer support
and help for people or institutes in form of providing
psychological services in school setting. The
Department of Education is a government agency governing
primary schools, middle-high schools and universities. So far all
universities in China have their own psychological counseling
centers, which provide psychological services for all students
without any payment.
Professional Rules and Regulations
Entrance Criteria
At present, the industry entrance
criteria recognized by Chinese mental health professionals are a
series of criteria set up by CCPRS of CPS, based on the document of
Chinese Psychological Society
Registration Criteria for Professional Organizations and Individual
Practitioners in Clinical and Counseling Psychology,
including: (a) registration criteria for master’s/doctoral degree
training programs, (b) registration criteria for internship agency,
(c) registration criteria for clinical and counseling
psychologists, (d) registration criteria for supervisors, and (e)
registration criteria for continuing education projects (see
http://www.chinacpb.org, for more
information). Note that these criteria are not established by the
government and thus receive only voluntary application from
individuals and institutions.
Regulations
The document of Chinese Psychological Society code of Ethics
for Clinical and Counseling Practice, launched by CCPRS of
CPS, offers professional ethics for the clinical and counseling
psychologists registered in CPS as well as a basis for processing
ethical complaints and inquiries initiated against the registered
clinical and counseling psychologists. The professional ethical
codes include seven areas in practice: (a) the professional
relationship, (b) privacy and confidentiality, (c) professional
responsibility, (d) assessment and evaluation, (e) teaching,
training and supervision, (f) research and publication, and (g)
resolving ethical issues (see http://www.chinacpb.org, for more
information).
The Professional Ethics Committee
dealt with the first name-identified ethical complaint against one
registered psychologist (supervisor) in CPS in 2014, based on this
Code of Ethics. It aroused a big repercussion in the public. By the
end of 2015, the Professional Ethics
Committee has received five to six cases of name-identified
reports, suggesting an increasing impact of the Code of Ethics in
counseling and clinical practices. Also, a number of rules are
currently being tested and improved in
actual practice.
Mental Health Act
The Chinese Mental
Health Act was issued in 2013,
which has gone through 27 years of planning. The Mental Health
Act (2013) caused great repercussions in the society. On one hand,
it plays a positive role in mental health work. For example, it
recognizes the importance and necessity of psychological
counseling, provides the law guarantee for certified counseling
practices, and also offers some rules to regulate involuntary
hospitalization, guardian rights and other problems (Liu, Tong,
& Zhao, 2013). On the other
hand, there is a lot of controversy over it among professionals,
leaving many parts to be improved in future. For example, the
Mental Health Act (2013) requires that psychological counselors
cannot conduct psychological therapy or make diagnosis and
treatment, but it is hard to accurately distinguish between
counseling and therapy in practice; and it requires that
psychological therapy should be conducted in medical institutions,
so that it might be suspected “illegal medical practice” to offer
mental health service for persons with mental disorders in the
counseling centers of schools and communities.
At present, due to lack of
professional title for psychological therapists in medical
institutions, there has occurred brain drain in the industry. Thus,
how to foster the healthy development of psychological therapy in
the framework of the Mental Health Act (2013) has become an urgent
problem to
resolve.
Local Regulations
Over the period when the Chinese
Mental Health Act (2013) was drafted and argued, some local
regulations have been developed. For example, the first local law
of Shanghai Mental Health Act was issued in Shanghai in 2001. From
2006 to 2011, local regulations on mental health were also
developed in Ningbo, Beijing, Hangzhou, Wuxi, Wuhan, Shenzhen and
other cities (Xie, 2013).
Before the Chinese
Mental Health Act (2013) was launched, these local laws have played
an important role in regulating mental health practices. They
covered primarily the areas of mental disorder diagnosis, clinical
and experimental research, prevention of discrimination, duties of
the police, legal responsibility; and also involved some content
related to mental health service, psychiatric patient rights,
rights of family members and other nursing staff, legal capacity
and guardianship, patients’ informed consent right in agent decided
treatment, emergency conditions, constraints and limits, human
rights protection, et c. (Di
& Xiao, 2012).
Challenges and Outlook
Challenges
Since the twenty-first century,
clinical psychology has entered a period of relatively rapid
development, particularly in the past 10 years. However, there
still exist many challenges.
Challenge 1: Insufficient
professionals . As noted
above, there are currently 22 thousand or so psychiatrists, about
1.6/100 thousand on average (10/100 thousand in Britain, 20/100
thousand in the U.S.). The psychiatrists primarily receive training
in biomedical mode and have little psychological therapy training;
the psychological therapists without a medical background are
forbidden to directly receive patients in medical organizations;
and there exists an inflexible boundary between non-medical
organizations and medical organizations. As a result, the quantity
of mental health professionals cannot meet the needs.
Based on the Chinese Mental Health Act
(2013), psychiatrists and psychological therapists with a
psychological background are able to conduct psychological therapy
in medical organizations. However, persons without a medical
background must be first employed by a medical organization and
then they could have a chance to participate in the psychological
therapist qualification examination. A first dilemma are currently
no corresponding positions for such persons in either psychiatric
hospitals or comprehensive hospitals so that they cannot be
employed by medical organizations. A second dilemma is that the
rules
covering eligibility for the therapist qualification examination
are not clear so that most provinces forbade persons with a
psychological background to participate in the examination for some
reason in 2015. A third dilemma is that even though persons with a
psychological background enter hospitals to work, they can only get
a technician position title, without promotion channel like deputy
senior title and senior title. A fourth dilemma is that under the
current legal framework those qualified therapists are forbidden to
conduct therapy as long as they are not employed by medical
organizations.
In addition, the situation is also
hard for certified counselors. They vary greatly on education
background, get the certificate with very low entrance standard,
and receive management from different organizations. By the end of
2015, among 900 thousand certified counselors, 80–90% are
part-timers
and only a few really can offer counseling service.
Challenge 2: Low quality of professional
service . A survey in Shanghai in 2003 showed that
18.6% of professionals in counseling organizations did not receive
any training; and among those (81.4%) who received training, 48.8%
received less than 3 months training and 35.8% received
3–6 months training. The insufficient professional qualities
of psychological counselors and therapists lead to heavy
occupational stress in themselves (Gan et al., 2007), as well as directly influence the service
quality. A survey to one famous university counseling center (Hu
& Jiang, 2008) showed that
among randomly selected 29 cases, the average number of sessions
were four. In fact, it is common that clients visited only one to
two times. The cause does not lie in therapy approaches, but in the
fact that counselors have generally not received enough training.
Thus, it is essential for the development of clinical psychology to
consider how to provide better professional training for
professionals and how to provide better supervision for them so as
to improve the service quality of professionals.
Challenge 3: Chaotic professional
regulations . Due to lack of mental health resources,
many non-professionals without systematic training enter the mental
health service industry, such as the psychological counselors with
the (low standards) certificate issued by the CML. Also, a number
of persons are not in mental health positions, but they undertake
partial mental health service, such as the TCM practitioners or
doctors in medical organizations, the college instructors in the
education system, and so on. As a result, it becomes very difficult
to regulate the mental health service industry. There is much
confusion about the entrance criteria for professionals, service
quality, service fee, and the ethics for mental health
service.
It is an important step towards
quality control and regulation that CCPRS of CPS was founded in
2007. However, the influence of CCPRS remains currently to be
further improved in the professional field. In addition, further
studies are needed to explore how professionals with different
education backgrounds could be registered at CCPRS in a different
classification, through what channels the qualified among the
certified counselors could enter CCPRS, and how CCPRS could play a
leading role in the counseling and therapy field (CDCP of NHFPC, 2015).
Challenge 4: Policies. In recent
years, mental health work has drawn much more attention from the
government, such as the issue of Chinese Mental Health Act (2013)
and the National Mental Health Work Plan (2015–2020). However,
there still lacks the necessary policy support. For example,
medical institutions currently lack rules and regulations to
establish department of psychiatry, develop interdisciplinary
service teams, and train a fast growing group of psychological
therapists. The college graduates with a psychological background
can hardly be employed by medical organizations; and according to
the Chinese Mental Health Act (2013), those not employed by medical
organizations can neither conduct therapy nor participate in the
therapist qualification examination, leaving many persons
specialized in applied psychology unused. In sum, there is an
urgent need for policy change and
improvement.
Challenge 5: Clinical assessment and
research . Although universities and colleges offer
many psychological testing courses, few are related to clinical
assessment. The research in clinical psychology has recently much
developed. However, it has still focused on the therapeutic effect
of various (western) theories and approaches, and severely
neglected the therapeutic process and the unique experiences
related to Chinese culture in psychological counseling and therapy.
Further studies are greatly needed to examine the accountability of
western theories and the validity of western techniques in Chinese
culture, promote the localization of these western theories and
techniques, and develop new Chinese counseling and therapy
theories.
Outlook
In conclusion, the clinical psychology
receives a rich thought heritage from Chinese culture with its own
unique development trajectory. Through a long process of
development, clinical psychology is now in the phase of rapid
growing. It brings hope to clinical professionals, although they
are still facing much pressure now.
We believe that, with the support of
government and the guidance of professional associations, it’s not
far away from establishing and improving professional standards and
regulatory systems, conducting standard clinical or counseling
psychology training programs, formulating administration criteria
for psychological graduates to work in medical system, and
connecting the channels of psychological departments and medical
institutes. Additionally, efforts are under way, such as adding
more psychotherapy training into psychiatric residents’ regular
training programs, encouraging psychiatrists to get more
psychotherapy training through continuous education, in order to
enhance psychiatrists’ ability of providing psychological services.
We should allow qualified psychological professionals to do
psychotherapy and run private clinics by re-interpreting current
rules and making new related laws. We also should encourage
psychiatrists and psychological profession also offer psychological
services in general hospital, mental health center in community and
other non-psychiatric institutions (Symposium Summary,
2015).
Finally, there is a need to make
greater efforts to promote the registration criteria by Clinical
Psychology Registration Committee of Chinese Psychological Society,
including criteria for courses, internship set, supervision,
training programs, and so on.
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