Professional Documents
Culture Documents
for
the
future
development
of
Eastern
and
Western
Psychotherapy.
2. Assimilation of Western Psychoanalysis and Psychotherapy in Asian
Countries
According
than guilt-oriented. This tendency means that real acceptance in actual life
situation is more important than their intrapsychic perspective for Japanese
patients. Japanese patients tend to have expectation on cognitive intervention
by therapist, e. g. advice, reassurance.
Far earlier than that, in 1984, on the occasion of the meeting of the
pacific Rim college of Psychiatrists in Shanghai; Nishizono also stressed that
during psychoanalytic therapy with Japanese patients, he usually dealt with
the patients external relation rather than his intrapsychic material. To this,
American audience reacted, that couldnt be called psychoanalysis.
Nishizono (1995) also cited opinions of Yamamoto and Eng-Kung Yeh on the
occasion of the symposium, therapy for Americans and Asians, during the
140th APA in 1987. Yamamoto said, insight therapy is difficult for the
Americans of Japanese descent and empathy therapy is what they need. Yeh
of Taiwan reported that dynamic psychotherapy is not of general interest in
Taiwan.
After dr. Okonogis presentation on the history of Japanese
psychotherapy, on the occasion of the Kyoto Regional Symposium of WPA in
1984, Prof. Rhee asked a question, I heard that in Japan Dr. T. Doi only can
effectively do psychotherapy, and how is it in recent days? after some
silence of embarrassment, one of them reported, later, we will confer with
outselves and you will have the answer. Since then, Prof. Rhee says he
didnt have any answer from him till now.
According to A. Gerlach (2005), Western medicine was first introduced
into China in the 19th century and its spreading was due primarily to Christian
missionary societies. The first psychiatric clinic was opened in Canton in
1989. There were fewer than 50 trained psychiatrists in the whole of China in
1949.
From 1935 until 1939 Dr. Bingham Dai, a psychiatrist of Chinese
origin, worked at Peking Union Medical College; he had received a
psychoanalytically oriented training in psychotherapy from H. S. Sullivan in
New York and from L. Saul in Chicago and passed on his experiences in the
psychoanalytical
thought
was
not
introduced.
Yet
included
both
suggestive
and
appellative
forms
of
the
in Taopsychotherapy, one can empathized not only with psychotics but also
with everything in the world as evidenced by the Chinese character for Sage.
Lastly, we have many reactions of western psychotherapists, to the
audio-visual- demonstrations of Prof. Rhees therapy. C. Brenner (1994)
wrote me, he is very quick to the essential issue of the schizophrenic
patient. G. Taylor (1997), remarked, Prof. Rhee asks patients feeling, what
were your feelings (not, what did you think about it). there is also
laughter between the patient and the therapist. Prof. Rhee employs a
number of techniques and intervention which seem, from a western
perspective, to be based on an integration of cognitive-behavioral therapy,
learning theory, and psychodynamic understanding,
G. Rodin (1997) remarked, overall, the clinical material demonstrates
a seamless interview., this in an excellent example of what might be termed
sustained empathic inquiry. Etc. some patients who had therapy experiences
with Prof. Rhee would tell, Dr. Rhee does neither want to give (any), nor not
to give. He also neither take nor not take. other patient expressed, Dr. Rhee,
when I am with you, if you do not say a word, I am good.
It is very remarkable when Prof. Rhee says, my question to patient is
not for what I want to know. I let them to say what they want to say.and he
predicts in the future the word interpretation will disappear. Only directly
pointing at the human mind/heart, with live word will be mutatively
effective for the patient.
5. Conclusion
In this paper, the author had an anecdotal, sketchy overview on the
assimilation of western psychotherapy and psychoanalysis in some Asian
countries, with an emphasis on practice and experience.
Its seems that in Asia countries, the western psychotherapy did not take
firm roots in their cultural soil up until 1970s or1980s. of this phenomenon,
this aouthor thinks, we need futher study and discussion.
Finally, the Tao Psychotherapy of Prof. Rhee is beyond concepts so that
we should have similar experiences of him self in the realm of Tao practice
and psychotherapy. Only then, we will fully understand what he advocates in
the Tao Psychotherapy.
or
psychoanalytically
oriented,
humanistic
existentialist,
Next thousands years after that era, most Indonesian people were deeply
complied with what was mentioned in their belief system which was from Hindu
and Buddha in their personal and the communitys life and in valuing the
communitys traditions. The tendency to look at a person in transpersonal or
relational terms in reflected in all aspects of the culture. But some of them in east
Indonesia, such as Maluku, Papua, Celebes, and also in Java, are Christians. The
cultural which inherited from their ancestral were mixed with what they belief in
those religions, therefore, for instance, the Hindu in Bali, is different from Hindu
in India, for the reason that is also affected by the culture beside its rules and
pattern in the religion.
After Islam entering Indonesia (It was around the year of 1500), people
thoughts, behavior and activities were affected by Moslem belief. It transpired in
around 90% of Indonesian people. The cultural standard of moral and ethnics had
not been totally changed, except their belief system that the communitys gods
that previously plural, then it becoming single; they only believed in one God. A
Muslim is one who resigns himself to God and thereby professes the faith of alIslam. In order to be a true Muslim there things are necessary: faith, action
according to that faith and the realization of ones relation to God as result of
action and obedience. Most of that Moslem people than seemed to obey and
follow the rules. The communitys traditions afterward were gradually following
the belief system too, although it seemed that it had not totally changed, but it
becoming mixed with the previous one.
According to this condition, some of psychotherapists, specifically
psychiatrists, were tend to blend their approaches dealing with their patients,
between what they have learned from training which based on Western theories
with what they face and experiences in the field with their eastern patient. For
instance, with depressed patient, theories mentioned that we usually do not allow
to give advice or reassurance if the patient is still in his or her rage or very
depressed condition; but in fact, the patient usually asked the therapist to give
advices, because according to what they have been raised by culture and religion,
that surrender to the powers or the all mighty is greater than the self, and it is
better than individual effort. To response to this situation, many of therapists were
not able to stick on the psychotherapeutic principles, and they afterwards give
their advices. Fortunately, the patient responded well, he or she then seemed to be
in a better condition than before.
The current situation in Indonesia
In doing psychotherapy in our area, as well as in other country, is necessary to
consider the cultural standard of moral and ethics and social role of the patient.
As the amount of psychiatrists are too few compare to the total population, the
helping action towards mentally unstable and disturbed persons had been done
also by psychologist, counselors (who mostly have based training on educations),
udstadz (Islamic teacher who give lessons in guiding Islamic principles in life and
also teaching in reading Quran), priests (for Christians, Buddha, Khong Hu Chu,
and Hindu), and paranormals (who usually named as dukun or orang pinter).
Fortunately among those professions there looked as if not any conflict happened,
as if each of them had known their position, portion, and responsibilities. The
psychiatrics, Psychologist and counselors doing their job based on their so-called
Westernized knowledge and skill, where udstadz and priest worked based on rules
written and mentioned in the religion, on the other hand, paranormals do their
work based on traditional cultural belief systems which inherited form the
ancestral.
As trained in Westernized resources and medical sciences, psychiatrics in
Indonesia are in a dilemma, because beside bond to the technical principles of the
psychotherapeutic approaches, they also have to adjust the mind, thoughts,
perception to those in the patients, which affected also by the cultural and religion
belief system. They are not only have the virtue of not questioning that because
the patients are usually basically want to ask advice, but they themselves as
therapists also have to distancing themselves from what they have been given and
raised as Eastern persons. Therefore in practice, they have difficulties applying
kind of counseling often with a religious tinge, or outright religious or else resort
or pharmacotherapy, perhaps with some non specific reassurance gestures. As the
consequences it built resistances in psychotherapy, both in patients, and also in the
therapists. Fortunately, the patient changed to a better condition after therapy, its
possibly because of the good therapeutic alliance, and could also be the
transference cured condition, beside the effect of pharmacologic agents as well.
iii.
psychotherapeutic practice
The need for a distinctively Asian psychotherapy
Much of what I have to say would touch on the ethics of therapheutic practice
as well. This is unavoidable as the reader would appreciate. I would like to begin
with a note of caution when we talk of diverse cultural and religious groups.
There is a tendency to lump a people who belong to a subgroup together as if
they are homogenous. This often arises because we tend to at the modal
characteristics of the group, that is, when we take a summary statistic (the
average value for that group) of a particular variable (2). This ignores individual
variability and gives rise to stereotyping ( all Asians, or al Westerners, are like
that). The truth is there is considerable variability between individuals belonging
to the same cultural subgroup. This, I have observed, is a particular problem when
the therapist and the patient belong to the same subgroup. In such a situation the
patients expectation of the therapist is not met and the therapeutic relationship
becomes a problem. Conversely a therapist who is very religious may impose his
values and approach on to a patient who is not quite ready for it. There are many
things that divide Asians. Their religious belief is a case in point. Asians who are
Hindus and Buddhist may hold very different approaches to life when compared
to Asian Christians and Muslims. Needless to say, within these groups too, there
are enormous differences. It must also be noted that sometimes the social class
differences between the patient and the therapist could be very significant. It
might even be the case that an upper class Asian might be closer to an upper class
European than to his lower class Asian neighbors. This of course, is not peculiar
to the Asian setting.
i.
their worldview would make deep inroads into how a person develops priorities
in life. If I may use an example from the Cristian perspective, conservative
Cristians would agree that their Faith set three basic priorities the priority of
seeking God, the priority of caring for others an of sharing theirs faith. Other
religious system might have somewhat similar ideas too. This would be, quite
early antithetical to the humanistic approach to life. The Secular Humanist
Manifesto, for example, has religious skepticism as one of its 10 main points.
Therefore a therapeutic approach that seeks to apply western forms of therapy
without an appreciation of the religious/cultural milieu of the patient would not be
in the latters best interest.
Since the late 1950as an early 60s the rises of postmodernism has dented
the influence of modernism somewhat but healing practices continue to be based
largely on the theories of its founders. In contrast religious/spiritual ideas heavily
influence the Eastern way of life and thought. Orthodox Asian religious adherents,
including those of the revealed religions. Take their religious belief very
seriously indeed, so much so their identity and their way of life are to a great
extent inseparable from their religion. An insult to their emphasis on individual
rights and freedom and, perhaps a different postmodern view of truth. [Some of
the so-called civilizational clashes we have seen, over issues of free speech and so
on, are partly do this completely different ways of thinking.]
Western approaches place great emphasis on the individual. I do appreciate
that not all Westerners are individualistic, and it is just as true that there are large
numbers of Easterners who are highly individualistic. The attainment of
individual goals, the idea of becoming independent from ones parents by late
adolescence, and other aspect of personal autonomy are almost sacrosanct for
many western oriented people. Their self-image and self-esteem are often tied to
it. Much of are anathema to the Eastern mind where interdependence is highly
valued. It is not uncommon for community is highly valued. I remember a
western-trained therapist being roundly criticized by colleagues for describing a
Malaysian male patient as being overly dependent on his parents on the grounds
that he was still living with them. The extended family system, however, is not
without problems and there are many couples in my practice who suffer because
of interfering in-laws.
I think long before the rise of postmodernism in the West, some sections of
Eastern society has always, to the certain extent, been post modernistic. The
Eastern mind is more comfortable with contradictions. What the Western trained
person would consider to be mutually contradictory may not necessarily be so the
Easterner. This may partly explain the enormous popularity of many traditional
treatments. It might even be an expression of refusal to face or outright denial of
the real problems. Much of this popularity is due to the closeness of the traditional
healers approach to the worldview of the patient, whereas the Western-trained
therapists approach is seen as somewhat alien. However, let me say at this point
that this Eastern practices are not always helpful. The Asian patient is sometimes
better helped by a ood dose of rational, thesis versus antithesis, type of thinking. A
short case vignette will illustrate this.
A young couple, both university graduates, sought marital therapy because
of frequent disagreements leading to the wife experiencing depression. They
found the task of working out their differences tough-going. In between therapy
sessions they sought the help of a religious-based traditional healer (a bomoh)
who, by rolling an egg on the torso of the wife, divined thet she had been
charmed. She was given holy water to drink and lime juice to bathe in. for the
next three days she felt very well but all her difficulties gradually resurfaced after
that. However they continued to hold firmly to the belief in the validity of the
traditional healers diagnosis, when in actual fact he might have only postponed
their facing the truth about the causes for their frequent disagreements. In that
sense their visit to the bomoh, while heaving a placebo effect, was actually
harmful.
To help the Asian, one must understand her worldview and take into
account her concerns about God, spirit sin, and forgiveness. Western
psychotherapy might doff its hat in this direction but has, in my experience, little
pace for seriously addressing these concerns. We Asian therapists must seriously
consider this to make therapy more acceptable.
ii.
reasons. Boundary violations adversely affect the course of therapy and may harm
patients in very serious ways and may even permanently scar them. So there are
very cogent reasons to be circumspect about therapeutic boundary. But in the East
patients tend to see the doctor/therapist as more than a fee-for-service practitioner.
The therapist, like the traditional healer, is part of the community, and the is seen
as being equally accessible. Her presence is sought at community functions such
as weddings of patients children; her advice is sought on areas outside of the
immediate concerns of therapy. She is plied with gift during festivals, and
declining to receive them is deemed to be insulting. Some patients of course,
might abuse this, and use the friendship of the therapist as a reason to avoid
bringing up difficult issues, or to seek favors that might impinge on the therapists
time ets. So the Asian therapist needs to walk a tight time protecting patients from
harmful boundary violations.
How then shall we protect our patients, maintain reasonable boundaries and
still manage not to appear stand-offish? The therapist must wisely decline to
advice patients on areas that are beyond their expertise, even when such advice is
sought. We must refuse the seduction of the inherent flattery when our advice is
sought on subject far and wide. Patients must be redirected to relevant experts. We
must also anticipate situations that may lead to the crossing of proper boundaries.
There are Ethical Codes in each country. Those who belong to the medical
profession are subject to the Code of Conduct of the profession which is legally
enforceable. In many countries counselor and non-medical psychotherapists have
governing bodies to provide and enforce guidelines. Therapist who work with
government agencies are subject to the rules and regulations of service. We note,
of course, that rules and regulations not with standing, abuse of patients, trust
does take place. I have a patient now who, while staying overseas in a developed
country where the psychiatry is highly regulated, was abused by a senior therapist,
iii.
therapy rather than see the latter as inimical to our practice situation. We may
benefit from both the techniques of therapy and the increasingly scientific
approach to testing their efficacy/effectiveness; while we may ignore. Some antireligious bias in them. Some Asian therapists claim to have formulated
specifically Asian therapies. Some of them are based on specific religious beliefs
which do not appeal to followers of other religions. Even Yoga, as widely
practiced as it is, is not acceptable to all religious groups. Furthermore any truly
new system of therapy should provide a comprehensive formulation of human
personality and psychopathology, not merely consisting of a series of techniques. I
do not see this at yet, though I stand to be corrected.
Psychotherapy is a much sought after treatment modality in many Asian countries.
Recently a Malaysian consumer association urged that Malaysia psychiatrists
should provide more therapy for depressed patients rather than prescribe
antidepressants (4). To meet this need we need to make therapy more acceptable,
more in line with the worldview of the patient and make adjustments in the way
we practice.
References
1. Bergin AE, Garfield SL (1994) Overview, Trends and Future Issues, In:
Bergin AE, Garfield SL (Eds.) Handbook of Psychotherapy and Behavior
Change; 4th edition,
2. Inkeles A, Levinson SJ (1969) National character: The study of modal
personality and social cultural systems. In G. Lindzey & E. Aronson
(Eds.), The Handbook of Social Psychology. Reading, MA; AddisonWesley.
3. McLemore CW (1987) Counseling and Psychotherapy: An Overview. In:
David G Benner (ed.) Psychotherapy in Christian Perspective. Michigan,
Baker Book House.
4. New Straits Times (March 17, 2008) Use only in serious cases. Letter
to the Editor.
influenced by cultural forces. Thus, in clinical practice, psychodynamic tenets coexist 2ith Filipino values and have evolved into a distinct perspective.
For next 30 minutes, I will develop this message using the following
outline:
1. Pattern of boundary setting in Filipino psychiatrists clinical practice
2. Influence of culture on the application of boundary setting practice
3. Integrating psychotherapy within Filipino culture
Pattern of Boundary Setting in Filipino psychiatrists clinical practice
In 2003, I conducted among 56 Filipino psychiatrists from all over the
Philippines to ascertain the pattern of boundary setting in clinical practice. From
this survey, I gathered that Filipino psychiatrists apply particular boundary setting
practices in their clinics in varying degrees or consistency. Moreover, I learned
that the practices were applied consistently if they jibed with cultural rooms. If
certain practices contradicted cultural factors, then, they were not applied or at
best, inconsistently applied.
1. Particular boundary setting practices are consistently applied. These are:
Giving advance notice of anticipated absences.
Enforcing a time limit to session.
Outlining the benefits, risks and alternatives for proposed treatment
approaches to patients.
No sexual activity with the patient.
2. However, some boundary setting practices are inconsistently applied.
These are:
Non-disclosure of personal problems to patients
Removing all possible sources of personal information from the
office
Not taking repeated phone calls from patients
Confronting an exploitative patient
No barter of patients service for therapy
3. A number of boundary setting practices are not applied. These are:
No complementary treatment for colleagues, religious, friends and
relatives.
Refusing gifts from patients
So you can see that Filipino psychiatrists apply boundary setting in their
clinical practices varying degrees of consistency.
Most of the respondents opinions on boundary setting match the
Western norm. However, their opinion on six practices diverge from the Western
standard.
Filipino psychiatrists opinions converged with the Western norms on the
following practices:
1. Not engaging in sexual activity with the patient
2. Outlining the benefits, risks and alternatives for proposed treatment
approaches
3. Giving advance notice of anticipated absences and enforcing a time limit
to session
4. Not discussing the patient with his own family and friends
5. Not disclosing their personal problems to patients
6. Not taking repeated phone calls from patients
Filipino psychiatrists opinions diverges from the Western norm on the following
situations:
1.
2.
3.
4.
Not taking repeated phone calls from patients reinforces the boundary
issue on self-protection and self-respect. This principle is necessary to protect
clinicians from abusive patient as well as to model fairness in relationships to the
patient. Filipino psychiatrists appreciate the psychodynamic underpinnings of
these practices. However, it is inconsistently applied because more respondents
put more weight on the impracticality of taking repeated patient phone calls
because these calls are time-consuming.
Abstinence from direct forms of pleasure such as touching or sexuality
in the course of their interactions with the patients is consistently applied. In
psychodynamics, when the therapist has sexual relations with the patient, he
appears to violate the patients trust in him as the parent who is more interested in
his patients health rather than his gratifications. The respondents unanimously
adhere to the boundary practice on sexual abstinence. This psychodynamic
interpretation not with standing, the moral dictum against engaging in sex outside
of marriage may very well have determined this value.
Filipino Culture
Filipino psychiatrists are aware that the function of non-disclosure of
personal problems to patients and removing all possible sources of personal
information from the office reinforce the boundary issue on anonymity to prevent
role reversal and seducing the patient. But they refrain from divulging their
problems or remove all sources of personal information from their offices because
they are wary of the Filipinos culturally determined tendency to personalize
relationships (Jocano, 2001). And because culture is the driving force behind their
behavior, they tend to apply it inconsistently. Because they are
Filipinos, they
per household, small number of rooms, and cultural factors related to privacy
(Church, 1985).
So you see that boundary setting is a set of techniques for an individually
oriented intervention. Is it any wonder that it is inconsistently applied in a
collectivist.
Summary
others.
Culture, along with psychodynamic consideration strongly influence
boundary setting practices. In situation where the western practice
Action Steps
The question of the applicability of western concepts in psychotherapy to
Philippine culture has long been playing in the minds of Filipino academics in
psychology. The clamor for the modification of western psychological models to
suit the Filipino culture Church, 1990; Salazar-Clemena, 1998) was sparked bay
Virgilio Enriquez, whose work serve as the foundation of Filipino psychology.
The literature has accounts of indigenous Filipino psychotherapies
(Bulatao, 1999; Jagmis- Socrates, 1998); as well as forms of psychotherapy that
are considered applicable to Filipinos (tanalega, 1998). How ever, the search for
the culturally relevant form of psychotherapy continues.