Introduction

Systemic family therapy as an essential paradigm for treating couples and families has gone global since its initial rise to popularity (Ng 2003). Systemic family therapy is a therapeutic approach that addresses people not only on the individual level but also works with families to foster change (Nichols 2012). It is a paradigm that views changes in term of systemic interactions between each person in the familial and societal contexts (Nichols 2012).

During the last decade, this type of therapy has become one of the most prominent theoretical approaches in several non-western countries, such as China (Lim et al. 2010), Malaysia (Ng 1998), India (Mittal and Hardy 2005), Kenya (Nwoye 2006), Singapore (Sim 2012), and Macau (Chan 2013), just to name a few. However, there has been evolving conversations about the transportability of systemic family therapy from the West to the East. These conversations highlight the need to examine culturally relevant approach to family therapy that fits cultures outside of Western countries. This article explores the experiences of Chinese family therapists-in-training through qualitative focus group discussions on their perspectives in adapting systemic concepts and family therapy ideas to the local Chinese context.

Family Therapy in China

China has signaled a strong desire for training in systemic family therapy when psychotherapy from western ideology was first introduced to Chinese clinical practitioners and academia in the 1980s (Sim and Hu 2009). Even though this mode of mental health service is a foreign import to China, the surge in interest for Western psychotherapy grows by leaps and bounds. A growing number of training programs and workshops in family therapy were held in various cities—Qingdao, Hangzhou, Kunming, Shanghai, Beijing, Shenyang—in China (Lim et al. 2010; Sim and Hu 2009). Western family therapy books are translated into Chinese language. At the same time, many Chinese practitioners and instructors of family therapy are influenced by western-based training (Epstein et al. 2012).

Because of the extensiveness of cultural and contextual variations between the West and the East worldviews, a question that emerges from experiences with family therapists in China concerns the applicability of family therapy theories to the Chinese context (Deng et al. 2013; Miller and Fang 2012). For example, despite their openness toward Western influences, Confucian virtues are highly endorsed by Chinese families and remain dominant within the Chinese societies (Chen 2003). These virtues continue to govern the social relationships. Even though the central tenets of systemic family therapy such as the interconnectedness, wholeness, intergenerational process, and contextual views of problems seem to fit well with social expectations and historical environment of China (Miller and Fang 2012; Wang et al. 2014), the obvious question then is to what extent do western-based family therapy approaches need to be adapted to fit the local context in China.

Previous researchers have concluded that western-based family therapy is insufficient to guide applications in other countries with different social, economic, and political foundations (Blake 1991; Kwan 2009; Sim 2012). Therefore, it has been suggested that family therapists should translate concepts and principles before using them (Quek and Storm 2012). Epstein et al. (2012) support this notion of adapting western-based therapy models to meet the cultural norms of China. In their study, they explored the application of western-developed family therapy models in China using students from couple and family therapy training programs from China and the United States. They concluded that, “unless therapists are familiar with Chinese values, relationship roles, traditions, communication styles, and expectations for therapy, there may be obstacles to engaging families in therapy and motivating them to try new approaches to their problems” (Epstein et al. 2012, p. 235). While many of their recommendations are helpful, they are inferred from role-play therapy sessions between students during a graduate seminar, and not “real” clients or “experienced” therapists. Questions continue to be raised with regards to different circumstances in real-life clinical scenarios.

Therefore, another useful way to study applicability of family therapy models is an in-depth exploration of the ways Chinese family therapists-in-training are using them locally. This research project recruited sixteen practicing family therapists-in-training from China to provide the narratives that became the basis for systematic analysis of adaptations and dilemmas they encountered. Specifically, this study examined how Chinese family therapists-in-training who have been practicing for at least 2 years construct and reconstruct systemic family therapy and concepts to fit their cultural and societal contexts. Attention was given to both the content of the therapist–client interactions and the processes of understanding these interactions.

Methodology

A qualitative focus group format was considered appropriate in this area of investigation because it allowed for discussion of opinions, feelings and personal responses on the utility of Western therapy models with Chinese clients residing in China. Using focus groups was an effective way to capture communication between participants as its interactive nature enabled them to compare attitudes, values and understanding in their area of service (Patton 2014). Additionally, focus groups served as an efficient and appropriate format for understanding the success or failure of a particular modality where the goal was to generate theories or explanations (Morgan and Krueger 1993; Krueger 1994; Knodel 1993).

Participants and Procedure

This research was approved by the University’s Institutional Review Board. Participants were 16 Chinese family therapists-in-training (11 females and 5 males) from different provinces in North Eastern China. All participants were aligned with the local requirements to service the community. Their experiences ranged between 2 and 5 years. Participants were informed about the study and invited to participate during their 1-week scheduled training in supervision. All of them have received training in systemic therapy modalities that are grounded within the Western frameworks. All participants provided informed consent to participate through consent forms. Participation in the focus groups was voluntary. Participants were informed that they were allowed to remove themselves from the study at any stage.

They were organized into two focus groups of 8 participants each. Two moderators were assigned to each group to ensure open discussion regarding the phenomena of interest. One moderator from each group was bilingual in Mandarin and English. Discussions were conducted in Mandarin and English. All data were obtained from two focus groups of approximately 90 min duration. Data were audio recorded with names changed to ensure anonymity. Based upon the research aims outline above, the following questions were used to structure the discussion: “Tell us about the family therapy models you have chosen to use in your cultural contexts,” “what do you do when the family therapy models contradict the cultural and social values” and “how do you deal with patterns of communication and/or language promoted in family therapy sessions that may be culturally different?” Moderators frequently asked clarifying questions and expanded on issues that surfaced during the interview.

Data Analysis

Thematic analysis served as our analytic approach for understanding the participants’ experiences in practicing marital and family therapy in the China (Braun and Clarke 2006). Themes emerged directly from the participants’ responses using inductive coding. Procedurally, thematic analysis entailed (1) becoming familiar with the data (2) generating initial codes (3) searching for themes (4) reviewing themes (5) defining and naming themes (6) reporting the final thematic concepts (Braun and Clarke 2006). Data were analyzed by two researchers from Asian descents. The principal researcher is from Singapore who collected and analyzed the data. The second researcher who was not involved in the data collection but participated in the analysis of the data is from Taiwan. Both of them are fluent in Mandarin and English languages. The primary and secondary researchers jointly performed a content analysis for common themes emerging in response to the questions. These themes surrounding the phenomena of interests were then ascribed codes. Then each researcher independently re-assessed the recordings again and then a comparison of codes were made against the initial coding. The final stage of the analysis involved the researchers reviewing the themes and subthemes again until consensus was reached and to also ensure that the analysis was reasoned, logical and valid.

Results

The Chinese therapists-in-training in this study reported that they combined a mixture of therapeutic techniques from different theoretical orientations and rarely adhered to any particular clinical treatment model strictly. All of them expressed challenges in adapting specific theoretical concepts in the Chinese social contexts. Additionally, they emphasized that the interaction between the application of family therapy models that originated from the West and the systems of the changing Chinese family structure must work harmoniously in order to enhance the goodness of the familial system within the evolving Chinese society in the twenty-first century. The following section expanded three domains of conversation that emerged from the data. First, we explored two ways that these participants practicing family therapy in Chinese context: (1) emphasis on self-orientation, and (2) differences in Chinese sub-cultures. Next, we explored three ways these participants incorporate cultural meaning in traditional family therapy concepts: (1) use of day-to-day language, (2) use of culturally relevant metaphors and (3) exploration of emotion expression in therapy as a means to cultural flexibility.

Family Therapy Orientations and Practices in Chinese Context

Emphasis on Self-orientation

All participants reported from their observations and interactions with clients that the Chinese people are not a uniformed whole but they differ in their values and attitudes due to their social and political interaction within differing political regime. As such, the Chinese clients from different generations are construing themselves differently. More specifically their orientation to self falls along a continuum of values emerging from different eras of the Chinese history. For example, participants mentioned the Cultural Revolution (1966–1976), a social-political movement launched by the chairman of Chinese Communist Party Mao Zedong to “stem out what he perceived as the country’s drifting away from socialism and toward the ‘restoration of capitalism’” as having an impact on how self was understood (Joseph 2001, p. 264). The social construal of the self resulting from the Cultural Revolution included the traditional self, the conflicted self and the individualized self.

The Traditional Self

Participants stated that clients born before the 1960s were immersed in more conservative Chinese culture and seemed to demonstrate a more traditional self. The groups further elaborated that a traditional self embraced a network of significant others who are tightly linked to each other relationally. In other words, they equated the traditional self as more conforming to the collectivist mindset. Participants Wei, Juan, and Jie from Focus Group 1 (FG1) mentioned several characteristics that highlighted this cohort’s focus on the collective self, such as the emphasis on the benefit of the family as a whole, respect for the elders, and sacrifice. Participants Xiu-Yin and Xia-Feng further expanded on the importance of hierarchical relationships and collectivist ways of thinking. Some quotes supporting those ideologies were “always family first,” “when becoming a mother, you are not allowed to think for yourself, you think for your family—your kids and husband,” and “only parents’ opinions count, not the kid’s.” Participants from FG2 concurred because when clients were asked to reflect on themselves, they often referenced what their family members said about them. Participants remarked that not only do they “focus mostly on the collective self,” they could not understand the concept of “individual self” with personal opinion so much so “even [their] marriages can be arranged (by communist governors).”

In rationalizing their understanding of the traditional self, the participants posited that the traditional philosophical view, influenced by Confucianism and Buddhism, saw one’s troubled emotions as originated from the needs and wants from the individual self. Either the success or failure of pursuing personal desires created anxiety and suffering. Instead, one should work on “捨” (abandoning) the individual self. “Without the individual self, there is no problem,” Xia-Feng remarked. Another cultural value associated with the traditional self discussed by participants of FG2 was “逆來順受.” Literally this means a way of dealing with adversity or interpersonal conflicts (parental, marital conflicts, etc.) with obedience and endurance. Clients who embraced the traditional self tended to “abandon the concept of individuality and persevere and endure any kind of misfortune that bestows upon the family”—Shu-Xing added. In honoring others before self, participants Xiu-Yin, and Jie-Yi reported clients’ concerns about social perception: “[Clients] are afraid of talking about the concept of ‘self’ as they were taught to dismiss individual self.” Yen-Xia added “if you focus on yourself, others might think you are selfish, snobbish, or showing off. You get criticized.” Relationally, this generation was taught to follow the overall concepts of 天地君親師 (the use of three cardinal guides: ruler guides subject, father guides son and husband guides wife) or 三綱五常 (the five constant virtues: benevolence, righteousness, propriety, wisdom and fidelity as specified in the feudal ethical code) as their traditional cultural expectation regarding interpersonal relationships. This traditional view of self obviously differed from the western worldview.

The Conflicted Self

Participants reported that clients born in the early 70s often demonstrated a conflicted self. Clients of this age cohort were mostly raised in a traditional family and have experienced the Cultural Revolution when they grew up. One of the stated goals of Cultural Revolution was to rid of remnants of capitalist and traditional elements from the Chinese society and to impose Communist ideology and Maoist thoughts as the dominant ideology (Wu 2014). Therefore, the generation of the 1970s received mixed messages and conflicting teachings about their culture. When asked to reflect on themselves, they might or might not adopt a traditional cultural view. Some participants described this generation as “traditional inside but westernized outside.” Some of them learnt to behave appropriately in order to survive the Cultural Revolution, regardless of their true feelings about their traditions and or the social movement of that era. Xiao-Ling in FG2 said, “after the Cultural Revolution, everything changed.” However, Xia-Feng responded with a doubtful tone, “really?” Obviously while participants agreed that change has happened, not everything has changed in ideology or behaviors. Thus a sense of conflict prevailed within and between individuals. The lingering effects from that era cannot be negated. Participants acknowledged the need to provide space for critical narratives of the psychological trauma of those who lived through the Cultural Revolution.

The Individualized Self

Participants further described clients born after the 80s as less traditional and more westernized, and seem to be demonstrating more characteristics associated with an individualized self. This generation has not experienced the Cultural Revolution personally but has been under the heavy influences of foreign social media, globalization, and Western cultures. It seems the entry of Western ideas and values has been occupying a greater presence in the younger Chinese generation. They are often the only child of the family and have received undivided attention from their parents. These contextual factors coupled with changes within the family structure have fostered the evolving self of this generation as being more individualized, compared with their parents and grandparents. The specific impact of the change of the family structure will be discussed in later paragraphs.

Given the multiple perspectives to the understanding of ‘self’ arising from different eras of Chinese history, many of these clinical participants talked about how important it is to decipher the concept of self in the therapy room. For example, members from FG1 and 2 identified that one possible therapy goal was to “help clients understand their ‘selves’ in context as well as the social environment where differing influences are becoming prominent”. Participants also endorsed the need to validate clients’ sense of self regardless of the traditional, conflicted, or individualized orientation.

Differences in Chinese Sub-cultures

Participants from both groups highlighted the changing dynamic of the cultural ecological context in China as a relevant domain to gain new knowledge in order to stay current in working clinically with the Chinese people. Globalization of China has impacted its economy positively and it has an effect on familial relationships. Increasingly, the new socialization patterns of the Chinese create shifts in family structure and relational power as well as develop generational differences related to family matters.

Generational Differences in Family Matters

Some participants from FG1 reported generational differences in overall “values, self-worth, parenting, and money issues.” For example, some Chinese couples hold different values and views on parenting with their own parents. Xia-Feng explained “younger couples value ‘science’ and have adopted new ways of parenting. They do not think they have to follow all the traditions and do everything their parents tell them to do [to take good care of their children].” Younger couples’ preferences for ‘scientific’ knowledge are seen as being less obedient to their elders. This has created tension between the generations. Participants Wei, Ping, and Jun reported that their clients often see this “as a familial and interpersonal conflict unrelated to environmental changes, such as modernization of China, technological influences” Xui-Rue offered story from her clinical couple in Beijing to illustrate how societal change has challenged family relationship:

There have been conflicts between the couple and the mother-in- law (husband’s mother) since the family moved to a newer and bigger house. The mother-in-law had constantly complained about the couple closing the door to their bedroom. This door closing did not happen previously in their older and smaller home where they had only curtains between spaces. No doors were ever closed with all rooms (except for the entrance door to the house). The mother-in-law felt very much rejected due to the couple’s closing their door to the bedroom and would often enter the couple’s bedroom without knocking.

This illustrated tension between the new and older generations caused by the change of the new environment. The closed door at the new place could be either a spontaneous behavior or a request from the younger couple for privacy and boundary setting. The in-law, who saw herself as the parent of the household, was obviously not happy about this change. Indeed, moving into a house with rooms and doors challenged the boundary between the couple unit and the extended family. The younger Chinese couple disagreed with older adult’s idea of space and boundary.

Another generational difference reported by participants of FG2 was that “older generations tend to emphasize more on the cohesiveness of the family and expect their adult children to take care of them when needed.” However, younger Chinese nowadays do not necessary fulfill this role and appear to be more occupied with the pursuit of individual success. Some older parents, as a result, see their adult children as failing to fulfill their family responsibilities—Participants Jing and Xui-Rue. This clearly is a cultural shift and generational divide between the older and younger Chinese. As family therapists, participants Guo-Li and Na reported, they “often have to promote communications between two parties and try to find a common ground.”

Shift in Relational Power and Family Structure

Participants reported an increase of nuclear families after the 80s due to the influence of the modernization and an overall economic growth in China, especially in the urban areas. For example, Xui-Rue commented that younger professional families have more purchasing power. They can afford to purchase their own condominium and have decided to move out of their parents’ home. However, participants noted a distinction between urban and rural family structures and its associated shift in relational power.

Urban and Rural Differences

Most participants described families from the rural areas as generally more traditional. This means that the male side of the family has greater dominance, the interests of parents from the husband are given priority and greater importance. At marriage, a wife is transferred to her husband’s lineage. This aligns with the Chinese emphasis on the centrality of patrilineal and social hierarchy. “However familial structure within the urban society is surfacing more and more, such that “absolute power from the older parents and in-laws” are slowly shifting to the younger generations.” Many participants who are in agreement to this shift remarked, “some older parents listen to their adult children more. The younger generation is taking the lead.”

However, this shift may not be occurring to all younger Chinese couples because it “depends on who has money!”—Participant Juan. Money is power. Not only does it give family security, money, in many circumstances, can become the dominant value in decision making in the family. Financial status plays an influential role in familial relationship and could be the deciding factor if a young couple can live an “independent” life. Living an independent life means setting up their own family unit apart from their parents. Yet these young family units recognize their needs for their parents’ support. For example, FG2 discussed how expensive it is for a young couple to live by themselves in some cities in China and why one would decide to co-reside with their parents. Participant Gen shared, “among my friends, there is a tendency to buy houses nearer to their parents, as in the same building but different floors so that they can visit them and seek their assistance in childcare and housekeeping matters.” Xiao-Ling agreed, “…the older parents can help with household chores and provide free and trustworthy childcare.” The positive outcome with this arrangement is that not only do the two generations share resources, they also maintain some degree of personal space. FG2 participants described this as a new and unique definition of interdependence and independence based on the current context of China—a combination of modern communism and traditional culture. Overall, despite generational and geographical differences, most participants reported that understanding urban and rural differences as good background information to have while working with Chinese multi-generational families.

Family Therapy Concepts with Different Cultural Meanings

The responses from the focus groups indicated that systemic family therapy and ideology suit the Chinese context because system thinking raises awareness of issues to the families as a whole and seeks to provide social good and harmony to the whole. These ideas are consistent with Chinese values. However, given what both focus groups have reported concerning the effects of cultural and societal shifts and how the Chinese people differ in their sub-culture values and attitudes, the Chinese therapists-in-training responded to the current narratives by employing system thinking that allows for fluidity in the therapeutic process. Fluidity in the therapeutic process suggests the interplay between the systems of the contemporary Chinese family structure and the adaptation of family therapy models that originated from the West. This is their attempt to bring harmony to two seemingly comparable systems for the betterment of the Chinese families. We elaborate on the strategies for relationally relevant service and family therapy models the participants referred to in the following paragraphs.

Use of Day-to-Day Languages

Focus groups were prompt in sharing interventions used in sessions. First, use daily language and examples to explain professional terms with your clients. Participants noted that family therapy models come with a Western worldview. Even though these therapy concepts are translated into Mandarin, such concepts often need further clarification from the therapist for clients to fully understand the ideas as well as its application to the clients’ family. Furthermore, China as a big country, which nurtures different subcultures and dialects, has variations of meaning and interpretation of one exact word according its locality and dialect groups. Therefore, participants empathically recommended family therapists to make certain that clients understand the meaning of the word they used.

Use of Culturally Relevant Metaphors

Discuss the cultural meanings attached to the terms used in session and include relevant metaphors to further clarity. Members of FG1 illustrated their point:

For example, “boundary.” Boundary implies distance and separation from one another in interpersonal relationship. But the concept of “界線” (boundary) in Mandarin is an uncommon idea that is rarely discussed in Chinese family relations. Therefore, therapists should explain “界線” and contextualize it to the family background, be it urban or rural.

Shu-Xing, a member from FG2 further elaborated on the cultural meaning of boundary:

Given that the Chinese family values cohesiveness, creating a boundary between interpersonal space is uncomfortable but necessary. As a case in point, working adults from Chinese families who have moved away from home are expected to call home several times a week. Family members perceive those who call home only once a week as distancing themselves. However, these working adults seem to think that it is a ‘good and necessary boundary.’

Behaviors of appropriate boundary are defined differently according to how clients are socialized. For example, “closing one’s door to the room” may be considered rigid boundary for an older Chinese who values the concept of porous space, while a younger Chinese might consider it as appropriate boundary for one’s privacy. Therefore, therapists should explore such issue from the contemporary Chinese cultural framework and pay attention to clients’ generational and individual differences.

Emotion Expression in Therapy as a Means to Cultural Flexibility

Members of FG1 also mentioned that when conducting therapy in China, the emphasis on “an open, direct, and sincere way of communication is important.” This communicative stance applies to the therapeutic and family systems. Core generic communication skills for good human relationships are endorsed wholeheartedly by all the participants. Specifically, the “use of open questions instead of closed up ones or yes/no questions… asking open questions and enactment are helpful too”. However, Na cautioned several “non-verbal behaviors such as holding hands and praying together may not be appropriate for some Chinese clients because some clients’ love languages may not be touch. Touch may not be appropriate for those clients who have traumatic experiences about inappropriate touching or when the therapeutic relationship has not been established yet.”

Which Systemic Theories Fit Better in China and Why?

Both focus groups agreed to the usefulness of Satir Model (Satir and Baldwin 1984), Emotional Focused Therapy (Johnson 2004), Structural Family Therapy (Minuchin 1974), Bowen Family System Theory (Kerr and Bowen 1988), and Metaframework (Breunlin et al. 1997) with Chinese clients and their families. Focus Group 1 discussed the concept of congruent communication from Satir Model and agreed upon its fit for treating Chinese clients’ issues with interpersonal relationship. Some members from FG2 also reported that Satir Model works well because of its focus on congruent communication. Aspects of self-worth from Satir model help balance the individual variances associated with the concept of self and further support individuals to express their thoughts and feelings in a non-threatening way. In exploring self-worth, Guo-Li said “I try to understand why clients are who they are today. I also try to see their contexts and family backgrounds.” These questions are important because “part of the low self-worth and incongruent communication may be maintained by the traditional Chinese cultural expectations and their relations toward each other.” Focusing on an individual’s emotions may be considered as “selfish” by older Chinese people, thus exploring self-in-context becomes more significant which aligns with systemic thinking.

Focus Group 2 identified Emotional Focused Therapy as another beneficial model when working with Chinese people because of its focus on experiences and emotions. Participants Wei, Ping, and Jun reported that “while the Chinese culture discourages their members’ expression of certain emotions, these theories (Satir Model and Emotional-Focused Therapy) open up spaces for Chinese clients to talk about these issues with the therapist and their families” and in doing so they were able to reflect on the emotional side of their family life from a different angle. Jie further analyzed, “the Chinese people strive to perform in other aspects of life to seek emotional security in relationships.” For example, a father may work hard and be successful financially and expect his family’s love and respect in return. Indirectly the father wants emotional support from his family. “But these theories promote a direct working with emotional needs.”

From a different view about being expressive, Shu-Xing from FG2 remarked “Chinese people are often not emotionally expressive” because the theoretical focus on how emotions are communicated and expressed from these theories conflicted with the Chinese way of expressing themselves. Therefore in therapeutic practices, it becomes more difficult for therapists to implement. Similar challenge applies when using the technique of “enactment” of Structural family therapy with Chinese clients. Wei who practices family therapy in China for more than five years shared his clinical experiences: “although Structural family therapy in general, fits the traditional expectations of interpersonal relationships, and is consistent with cultural values on family structure and multi-generational relations, it is difficult for therapists to implement the signature Structural intervention (enactment) in session. Clients often shy away from acting out the scenes or communicating certain emotions directly.”

Two other theories that are popular with this group were Bowen family system and Meta-framework theory. Several participants in FG2 mentioned Bowen family system theory because of its systemic view on intergenerational relationships. Xia-Ling stated that “Genogram is very useful” because this intervention provides a visual image of multi-generational connections and patterns. Also, several individuals from both groups identified Meta-framework as a useful model because it addresses the influences of various social contexts. “Meta-framework theory helps me assess the clients’ family, context, and culture. It highlights the values and assumptions embedded,” Xui-Rue explained.

Nevertheless, participants’ reports indicated that one size does not fit all, as several family therapists in this study were adopting few models and were responding to the various concepts and challenges they encountered with their chosen models. They reported flexibility when adopting different theories and would be consistently checking in with their clients: (1) Ask the clients what does or does not work for them and adapt their opinions into later treatment; (2) Seek to incorporate theories to fit the context of their clients; (3) Consult with colleagues and supervisors; and (4) Refer clients to other therapist if needed. Most participants employed a client-centered approach that focuses on contextual data clients bring.

To sum up, the Chinese therapists in this study were implementing a systems therapy model that embraces fluidity in therapeutic process and treatment design. Although they preferred system models such as Bowen, Satir, Emotional Focused Therapy, Structural, and Meta-Framework, they were aware that those models do not perfectly fit their work. Concepts on boundaries, differentiation and independence must be modified to include differing cultural meanings. In addition, couple and family therapists practicing in China must take into consideration the urban/rural communities, generational and individual differences. The interplay between the systems of the changing Chinese family structure and of the application of family therapy models that originated from the West must work harmoniously in order to enhance the goodness of the familial system within the evolving Chinese society in the twenty-first century.

Discussion

Findings in this study have highlighted both the content of the therapist–client interactions and the processes of understanding these interactions. Both frames of references are important elements in doing family therapy in China because how therapy is practiced (process) is, in part, influenced by client’s contextual knowledge of familial and societal environments (content). When therapists are aware of the changes in the Chinese family system, they must employ a process that is of relevance to their clients. This is a culturally relevant practice that privileges clients’ diverse background whereby they are viewed in their historical and social contexts and in their wholeness as a unique individual in their family-of-origin.

This study provides evidence supporting the use of family systems theories and interventions with Chinese families and contributes to the new emerging view that family therapy is a culturally embedded clinical practice that can be adapted to the contemporary Chinese cultural framework. The results are consistent with other studies that indicated that marriage and family therapy fits the Chinese context overall because of its systemic approach, which values relationships between individuals and sees the family as a whole (Epstein et al. 2012; Sim and Hu 2009). The results also represent a step toward considering family therapy as an adaptive model that may serve the interest of Chinese clients and take into considerations the various contexts including the influences of globalization and Western individualism (Zhang 2010).

Though the Chinese culture has traditionally been categorized as more collectivist, the findings caution family therapists from stereotyping the Chinese people as one homogenous group. Individuals are nested within increasingly more complex social environments is now a taken-for-granted rule. Thus the Chinese people must not be conceptualized as a uniformed whole due to changes in self definition, the greater receptiveness toward Western influences among younger Chinese generations, as well as the urban/rural divide (Cheung and Pan 2006; Kwan 2009). Therefore application of family therapy must vary with clients’ age, generation, and locality.

In addition, the findings indicated the generational conflict context between the older Chinese and the younger Chinese within the extended family. Similar with previous studies, the findings linked this type of conflict to value orientation and cultural identity as the older Chinese appreciates collectivist values rooted in Confucianism, but the younger Chinese are embracing more individualistic traits into their collectivist background (Kwan 2000; Shi 2006). Therefore, therapists must help clients to find a balance regarding the clash between traditional and modernity values.

Clinical Practices that Promote Harmonious Family and Society

Therapist participants provided useful suggestions as they describe the unique context of modern China and the adaptation of family therapy theories when practicing within this particular cultural environment. They suggested fluidity in therapeutic process and treatment design, which values the interplay between the changing Chinese family structure and the application of family therapy models. This effort brings harmony to two seemingly comparable systems, the East and the West, for the betterment of the Chinese families. Following guidelines deriving from the results of this study promote relationally appropriate practices in China.

Guidelines for Practice

  1. 1.

    When working with Chinese families, therapists should be aware of the historical and cultural frameworks and their influences on clients’ family systems and subsystems. China, as a changing society with numerous economic, social and political transformations, has created a shift of structure and relational power in the family. For example, despite the geographical and generational differences, there are more nuclear families. There has also been a shift in power dynamics from older Chinese to the younger generation. Therapists are recommended to identify these influences as well as clients’ external and internal cultural experiences and resources

  2. 2.

    Therapists should be aware of the influences of historical and cultural frameworks on clients at an individual level. For instance, the frameworks impacting the individuals (e.g. globalization, foreign media, the cultural revolution) have informed their definition of self. Therapists are encouraged to make the covert Chinese fundamental values overt.

  3. 3.

    Therapists are to reflect critically on their taken-for-granted assumptions and practices of family therapy and to incorporate fluidity in their therapeutic process and treatment design. This fluidity should address the use of relevant family therapy ideologies and interventions to match the unique cultural contexts. Examples of interventions include using daily language and examples to explain professional terms with clients; discussing the cultural meanings associated with therapy concepts; and emphasizing an open, direct, and sincere way of communication.

Limitations

The sample was limited in its size and geographic areas. The sixteen participants from two focus groups were from Beijing and Shenyang, two very developed districts in China. However as discussed before, China is a big country with diverse geographical differences, it is likely that data collected from different parts of the country will reflect different results. As researchers, we are aware of this limitation as well as the risk of over-generalization. Thus, future researchers are encouraged to investigate further by including a larger sample size and/or participants from different geographic areas of China.

In this study, the Chinese family therapists-in-training have indicated several traditional family therapy as their chosen modalities for practice but did not highlight any post-modern models such as narrative therapy. Narrative ideas and practices which center on clients’ stories and the sociocultural context that is affecting their lives seem to be a good fit for practice in the Chinese context. Future research may want to be more intentional in questioning the use of post-modern orientations during data collection.