Busiol 2015

590419
research-article2015
APAXXX10.1177/0003065115590419Diego BusiolPsychoanalysis in Hong Kong, Mainland China, and Taiwan
ja Pa
Diego Busiol 63/3
Factors Affecting the

Understanding and Use of
Psychoanalysis in Hong Kong,
Mainland China, and Taiwan
The majority of Western psychotherapies are known and practiced in

Hong Kong, while psychoanalysis still has little resonance. A recent
study finds that psychoanalysis is perceived neither as ineffective nor as
necessarily in conflict with Hong Kong Chinese values. Nevertheless,
Hong Kong Chinese culture influences how psychoanalysis is received
and understood, when compared to Mainland China and Taiwan. It is
argued that a better reception in the latter two was possible because
of different social and historical backgrounds, different clinical back-
grounds of those who receive training, and the more active role of
Western psychoanalysts.
Keywords: Hong Kong, Mainland China, psychoanalytic training, Chinese

culture, psychoanalysis
H istorically, Chinese culture has been rather impervious to the

influences of foreign cultures and has evolved quite indepen-
dently. First of all, it has developed a very different attitude toward
speech than has the Greco-Christian tradition. In Christianity, the gospel
of John begins by saying that in the beginning was the Word, and the
Word was with God, and the Word was God. In contrast, Confucianism
emphasizes societal structure and the relations among individuals.
Confucius in the Analects (Lunyu ) reduced language to a tool for
communicating, recommended using it sparingly, and explicitly excluded
Postdoctoral Fellow, Department of Applied Social Sciences, City University of

Hong Kong; private practice of psychoanalysis, Hong Kong.
Submitted for publication December 29, 2014.
DOI: 10.1177/0003065115590419
Downloaded from apa.sagepub.com at Mount Royal University on July 21, 2015 411
Diego Busiol
eloquence from the qualities that define the goodness of a person

(Slingerland 2003). Still today, a general distrust toward speech emerges,
particularly where Confucianism is strong; speaking is perceived not as
beneficial or necessary, but as something potentially harmful because it
can disrupt social harmony. Because the wellbeing of the community is
so important, the use of words tends to be rather utilitarian and instru-
mental. Talking often becomes a medium for addressing a request rather
than for starting a conversation. In Chinese contexts communication
must be effective; everything that is said is said for a reason, and any-
thing more remains unsaid (Gu 2003). This may in part explain why
Chinese societies have long been indifferent to counseling theories in
general, and to psychoanalysis in particular.
Psychoanalysis and the majority of Western counseling theories orig-
inated from, and in part still rely on, the concept of catharsis (Powell
2007). The term catharsis, from the Greek , was originally used
by Aristotle in the Poetics to describe the effects of tragedy on the specta-
tor (particularly, the purgation of fear). Since then the term has become
popular in theories of drama and in the humanities more generally (Scheff
2007; Belfiore 1992). As Western cultures are sometimes described as
cultures of guilt, in contrast to Chinese cultures as cultures of shame
(Creighton 1990; Bedford and Hwang 2003), the idea of catharsis seems
to match better with Western cultures, since feelings of guilt demand the
need to be recognized, express oneself, atone for a misdeed, and be for-
given, while feelings of shame occasion no desire for the source of the
embarrassment to be recognized. In Chinese culture, since one would
wish to hide the source of shame, it cannot be processed through cathar-
sis. Indeed, it might be that Chinese culture has never produced anything
similar to catharsis, and instead has favored other mechanisms. For
instance, it is often reported that Chinese teachings focus on the repres-
sion rather than the expression of feelings and emotional vulnerability
(Ots 1990). The pioneering work of Kleinman and Good (1985) showed
that Chinese tend to manifest distress primarily in the somatic realm.
Tseng (2004) has observed that Westerners might consider some defense
mechanisms used frequently by the Chinese as immature, although
these mechanisms can be adaptive in a Chinese society. Yu (2006)
found that among a sample of Hong Kong undergraduates, participants
were more inclined to the neurotic and immature defense styles, and were
more likely to use such defenses as somatization, dissociation and autistic
412 Downloaded from apa.sagepub.com at Mount Royal University on July 21, 2015
Psychoanalysis in Hong Kong, Mainland China, and Taiwan
fantasy (p. 170). In contrast, he observed that among Westerners humor,

anticipation and rationalization are ranked highest on average. Finally,
he found denial clearly higher among Hong Kong Chinese than among
their Western counterparts. Cross-cultural studies (Maxwell and Siu
2008; Chun, Moos, and Cronkite 2006) indicate that Hong Kong Chinese
show a greater proclivity for using avoidant strategies, which suggests
that people may want to ignore their problem or think about something
else entirely. Selmer (2002) found that Hong Kong people, more than
Americans or Germans, tend to minimize anxieties through physical or
verbal withdrawal from the situation or by avoiding the problem.
P s yc h o a n a ly s i s i n t h e C h i n e s e C o n t e x t
Between 1920 and 1949 psychoanalytic ideas were well received in

Mainland China (Blowers 1997; Gerlach 2003; Larson 2009). Leading intel-
lectuals used and discussed psychoanalytic concepts in their work (Zhang
2003), and some of Freuds works were translated into Chinese (Zhang
1992). It was during the thirties that China had its first psychoanalyst,
Dr.Bingham Dai, a psychiatrist of Chinese origin who received his training
from Harry Stack Sullivan in New York and from Leon Saul in Chicago
before returning to China to work at the Peking Union Medical College from
1935 to 1939 (Blowers 2003; Varvin and Gerlach 2011). Psychoanalysis
was becoming popular in China, likely more as an instrument for pointing
out the weaknesses of society than as a therapy. Some intellectuals like
Zhang Dongsung had tried to introduce psychoanalysis in China in the
1920s, imagining that it could serve in building a new society. But unfortu-
nately, in the effort to adapt psychoanalysis to Chinese society and culture,
they distorted it, proposing sublimation as a way of social reform, or claiming
that the goal of psychoanalysis was to eliminate human desires (Blowers
1997). With the founding of the Peoples Republic of China in 1949, psy-
choanalysis was no longer seen as politically useful; criticized as an element
of bourgeois ideology, it was rejected for many years (Larson 2009). As
happened in the Soviet Union, psychoanalysis in China was criticized, with
Pavlovian experimental psychology being adopted as the official doctrine
for explaining human behavior (Larson 2009). Only after the intellectual
reopening in the 1980s did psychoanalysis begin its revival (Zhang 2003).
During the 1980s Freud fever broke out again, with some replay of ideas
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and interpretations that had been popular in the 1920s (Larson 2009).
Currently there is a new openness to psychoanalysis.
In Taiwan, for several years, psychoanalysis has been present in uni-
versity departments of literature and philosophy, as well as among thera-
pists and psychiatrists (Rascovsky 2006). According to Liu (2013), in the
last four decades psychoanalysis has been drawing increasing attention
from intellectuals in Taiwan, and some medical students and young psy-
chiatrists have translated some of the classic works of Freud into Chinese.
Hong Kong represents an unknown. Here the majority of Western
psychotherapies are known and practiced, while psychoanalysis still has
little resonance. Indeed, the word psychoanalysis means little to most
people, while the term counseling is far more common. Chan and Lee
(1995), studying psychologists in Hong Kong, reported that their most
commonly endorsed orientation was behavioral/cognitive, followed by
existential/humanistic. Two years later, Cheung (1997) confirmed that
psychoanalysis was not very popular in Hong Kong, although most pro-
fessionals did claim to have a general understanding of it, and some could
even make use of psychoanalytic concepts in their practice. However,
almost none had a strong foundation in psychoanalysis or operated purely
as psychoanalysts.
R e s e a r c h S t u dy: M e t h o d s a n d F i n d i n g s
A recent study of mine aimed to assess the penetration of psychoanalysis

among Hong Kong professionals, and to test a number of factors that may
affect its understanding and development. Because only a few individuals
practice as psychoanalysts in Hong Kong, participants were selected
among the population of counseling professionals. In Hong Kong coun-
seling is most often practiced by social workers, followed by psycholo-
gists and counselors, and at times even by teachers (Yuen, Leung, and
Chan 2014). There is a shortage of psychiatrists, especially in the public
mental health sector (Ng and Li 2010; Wong 2013). Currently there are
only about 280 psychiatrists serving a population of over seven million
people (WHO 2011), whereas the Social Workers Registration Board has
more than eighteen thousand members. In short, social workers account
for a disproportionate number of those who counsel clients in Hong Kong.
Participants in this study were social workers (N = 115), counselors (N =
36), and psychologists (N = 26) who deliver counseling as part of their
routine practice and have at least two years of work experience in

counseling.
After background information was collected, participants were asked
to complete three new self-report measurement tools: the Psychoanalytic
Attitude to Clinical Work Scale (PACWS), the Psychoanalysis Use/Non-
Use scale (PUNU), and the Conflicts with Chinese Culture scale (CCC).
The PACWS assesses the degree to which counseling professionals may
operate psychoanalytically, without being aware of it and without
expressly referring to psychoanalysis. It includes three subscales: trans-
ference (seven items, = .74), unconscious (seven items, = .82), and
floating attention (six items, = .75). The PUNU measures specific fac-
tors that might hinder the understanding and development of psychoanal-
ysis. It comprises twenty-five items in five domains: perceived
ineffectiveness of psychoanalysis (six items, = .86), perceived
complexity of psychoanalysis (five items, = .78), eclecticism (four
items, = .70), psychoanalytic training (four items, = .74), and solution-
oriented approach (six items, = .75). Finally, the CCC is a unidimensional
scale (six items, = .85) designed to determine whether respondents think
that psychoanalysis is in conflict or not with local cultural values. All items
were assessed on 6-point Likert scales, ranging from 1 (Strongly disagree)
to 6 (Strongly agree), thus having a theoretical midpoint of 3.50. The con-
fidence interval shows the range of answers to the survey questions; scores
from 1 to 3 were considered to be in the Disagree range, scores from 4 to 6
were considered to be in the Agree range, and scores ranging around the
midpoint were considered to be uncertain.
These self-report questionnaires were designed specifically for this
study. Content validity, construct validity, and external validity were
established in the following manner. Scales were constructed following
standard criteria for the development of valid and reliable questionnaires
(MacKenzie, Podsakoff, and Podsakoff 2011; Worthington and Whittaker
2006). For each scale, an initial list of items based on the literature review
was compiled by the main researcher, a licensed clinical psychologist and
psychoanalyst. These initial lists were then subjected to expert judgment
for redundancy, content validity, and clarity. The experts, both Western
and Chinese psychoanalysts and counseling professionals, were informed
about the purpose of the list and asked to give their opinions regarding the
validity of the items. At the end of this process some items were deleted
and others reworded. The reduced lists of items were then presented to
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participants in the study. When the questionnaires were returned, the

items were analyzed again and some were removed. To test the factor
structure and determine the construct validity of each scale, parallel anal-
ysis and factor analysis were performed. Parallel analysis, one of the most
accurate methods for determining the exact number of factors to extract
(Hayton, Allen, and Scarpello 2004), defined how many subscales (fac-
tors) are in each scale; factor analysis then revealed the distribution of
items across factors and the magnitude of item loadings, indicating what
items were to be included in what subscales. When a clear factor structure
emerged, factorial validity was interpreted as evidence of the usefulness
and validity of the proposed scale. Finally, the external validity for each
scale was assessed by performing independent sample t tests among dif-
ferent subgroups. This procedure determines whether a scale can discrim-
inate among groups based on variables such as academic major, age,
gender, history of therapy, work experience, and number of clients.
Statistical details of the scales construction and validation process are
available in specific publications elsewhere.1
Almost all study participants (92.8%) reported using two or more
counseling approaches. Those most commonly endorsed were cognitive
behavioral therapy (CBT) and/or cognitive therapy and/or behavioral
therapy (72% of respondents reported at least one of these approaches,
with 56% reporting CBT, 28% cognitive therapy, and 27% behavioral
therapy), person-centered therapy (44%), narrative therapy (29%), posi-
tive psychology (27%), play therapy (27%), group therapy (24%), sys-
temic therapy (23%), brief therapy (21%), attachment therapy (16%), art
therapy (16%), task-centered therapy (15%), psychoanalysis (11% but,
more specifically, only 8% among social workers, against 17% among
those with a degree in psychology or counseling; and gestalt therapy
(10%). (This survey does not reveal the level of training of any of these
counselors.) No counselor in the sample reported psychoanalysis as an
exclusive therapeutic approach. Less than one third of respondents (31%)
had themselves received counseling in the past or were receiving it at the
time of the study (24% among social workers, 40% among those with a
degree in psychology or counseling).
1Initial findings from this research were presented and discussed in 2012 at the Seventh
Annual Conference of the Asian Studies Association held in Hong Kong (Busiol 2012c) and at
the Chinese Psychoanalytic Congress held in Shanghai (Busiol 2012a). A book based on this
research will be published by Routledge in 2016 (Busiol in press).
P e n e t r at i o n o f P s yc h o a n a ly s i s Am o n g
C o u n s e l i n g P r o f e s s i o n a l s I n H o n g Ko n g
Psychoanalytic attitude. Results from the PACWS showed that most Hong
Kong professionals scored above the theoretical midpoint on floating
attention and transference, but below the theoretical midpoint on the sub-
scale unconscious. Because psychoanalytic theory and techniques were
not much used by this sample, low scores on the unconscious dimension
were not surprising; the concept of the unconscious is not native to
Chinese culture (Zhang 1992) and could be provided only by specific
training. Conversely, higher scores on floating attention and transference
suggested that these two important components of the psychoanalytic
attitude are already embedded in the Hong Kong Chinese culture.
Factors affecting the reception of psychoanalysis.Results from the
PUNU showed that psychoanalysis is not perceived among this sample as
less effective than other approaches: the majority of respondents reported
that they do not perceive psychoanalysis as an obsolete and inadequate
method. Apparently, if they have received only minimal or no training in
psychoanalysis it is not because they are unwilling, or have biases against
psychoanalysis; it is more likely due to the lack of training opportunities
locally. Indeed, if such training were made available in Hong Kong,
counselors would tend to be interested. However, psychologists, social
workers, and counselors alike reported that they consider psychoanalysis
a complex and long-term approach. Another factor weighing against the
reception of psychoanalysis is the professionals attitude toward eclecti-
cism. Indeed, subgroups analyses have confirmed that eclecticism is
common among all professionals, regardless of other variables, showing
that this is a culture-specific trait and not merely the result of lack of
training among counselors. This also confirmed findings by Chan and
Lee (1995) and Tsoi and Lam (1991) that therapeutic practice in psychol-
ogy in Hong Kong is best characterized as eclectic. An eclectic approach
is based on what works, that is, on pragmatic rather than theoretical
grounds. Only the latter would seek explanations for why or how
various techniques are efficacious.
Conflicts with Chinese culture. Results showed important subgroup dif-
ferences: for social workers the confidence interval lies completely above
the theoretical midpoint of the CCC (in the Agree range), meaning that
the great majority of social workers think psychoanalysis is in conflict
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with Chinese values, whereas for psychologists and counselors it lies

completely below the midpoint (in the Disagree range).
Correlations among variables.A correlational study revealed that
among this sample psychoanalytic training is correlated with perceived
effectiveness of psychoanalysis, but not with other variables. This sug-
gests that providing psychoanalytic training is likely to improve counsel-
ors understanding of psychoanalysis and their attitude toward it, but they
will continue to perceive psychoanalysis as a complex practice.
Psychoanalytic training is not correlated with counselors attitude toward
solution-oriented approaches and eclecticism; this might be interpreted as
confirmation that an eclectic and pragmatic attitude is deeply rooted in
Chinese culture and may not change just as an effect of training. Finally,
no association between psychoanalytic training and the CCC scale was
found, indicating that whereas the perception and understanding of a
theory is mediated by cultural values and assumptions, the willingness to
receive psychoanalytic training is not. Additionally, results showed that
the more psychoanalysis is perceived as in conflict with Chinese cultural
values, the more it is perceived as ineffective and the more counselors
will prefer a solution-oriented eclectic approach. Conversely, a simpler
and more clearly defined approach may be perceived as more effective
overall, requiring less time and involvement, and thus less in conflict
with Chinese values. This confirmed that brief, solution-oriented eclectic
approaches may be preferred as a way to offset or avoid conflicts with
cultural values.
Predictors. In the multiple regression analysis, the five PUNU sub-
scales assessing the critical factors for the development of psychoanalysis
in Hong Kong, together with the CCC, were entered simultaneously into
the regression equation to predict each factor of the PACWS. First, none
of these six variables was a predictor of floating attention, and this was
interpreted as confirmation that the particular listening profile of local
counselors is the expression of a cultural disposition; previous research
showed in fact that in Hong Kong, people are more inclined toward lis-
tening to others than toward verbalizing their own thoughts (Busiol
2012b; Rudowicz and Au 2001) and that Chinese communication is lis-
tening-centered (tinghua ) (Gao and Ting-Toomey 1998), as not
everyone is entitled to speak. In Chinese culture the ability to listen is
stressed, promoted, and rewarded in the context of hierarchy and role
relationships; here the invisible, the tacit, and the implied are privileged
over the visible, the explicit, and the articulate (Chia 2003); thus, under-
standing greatly relies on the receiver. This is quite the opposite of what
generally happens in European and American societies, where speaking
is emphasized. Second, transference is predicted first by eclecticism, then
psychoanalytic training, and conflicts with Chinese culture. The Chinese
normally place more attention on relations between people than on the
content of the communication (Gao, Ting-Toomey, and Gudykunst 1996;
Gao and Ting-Toomey 1998), and this was thought to explain why the
variable transference ranked so high among this sample. However,
although this relational inclination might be embedded within the local
culture, results showed that specific psychoanalytic training is an essen-
tial component for an understanding of transference as theorized in psy-
choanalysis. Third, the variable unconscious is predicted only by
psychoanalytic training; this is a significant finding, because, although
the concept of the unconscious is not found in the local culture, it can be
accepted nevertheless.
Further subgroup differences. Professionals who had been in therapy
(regardless of therapeutic approach) had statistically significant lower
scores on (a) perceived ineffectiveness of psychoanalysis, (b) perceived
complexity of psychoanalysis, (c) solution-oriented approach, and
(d)conflicts with Chinese culture than did respondents who had not been
in therapy. Finally, social workers had significantly higher scores on
solution-oriented approach than did psychologists and counselors.
T h e Impa c t o f Cu lt u r e
Certainly the literature suggested that the impact of Chinese culture and
Chinese values contraindicating psychoanalysis would be perceived as
strong by local professionals. Surprisingly, however, results from the
CCC showed that this was true only for social workers; psychologists and
counselors held an opposite opinion. However, the CCC can directly
assess only what respondents think about culture (their opinion), and not
the effect culture really plays on their counseling style. Then, because the
CCC was correlated with the PUNU subscales solution-oriented approach,
perceived ineffectiveness of psychoanalysis, perceived complexity of
psychoanalysis, and eclecticism, this suggested that culture indirectly
influences counselors theoretical orientation and how they understand
psychoanalysis. Thus, the impact of culture is at least threefold: (a) it may
Diego Busiol
contribute to counselors psychoanalytic attitude (as measured by the

PACWS), fostering one or more components, such as transference or
floating attention; (b) it may promote the values and beliefs that explicitly
affect the reception of psychoanalysis (as measured by the CCC); and
(c)it may indirectly influence how counselors understand psychoanalysis
(as shown by intercorrelations between the PUNU and CCC scales).
Findings from this research showed that psychoanalysis could be received
in this context (the impact of a and b against psychoanalysis was
limited, or even positive); however, results also imply that the eclectic,
pragmatic attitude of the Hong Kong Chinese may limit their interest in
psychoanalytic theory; as Osnos (2010) has commented, China is more
likely to absorb the most practical of Freuds ideas and discard the rest, as
it has done with Marxism, capitalism, and other imports.
I s T h e r e P s yc h o a n a ly s i s I n H o n g Ko n g ?
Simply considering data from the background information, one may think
that at least some psychoanalysis is being practiced in Hong Kong.
However, there are serious issues regarding the availability of effective
training, and how psychoanalysis is actually practiced: (1) several other
techniques are mentioned more frequently, and none of the respondents
report having adopted psychoanalysis as their sole modality; (2) at pres-
ent teaching about psychoanalysis is limited to some introductory courses
in local universities; and (3) a lack of psychoanalysts means that profes-
sionals cannot usually undergo a personal analysis or receive psychoana-
lytic supervision.
In addition, local professionals have been shown to be listening-
oriented and receptive to the relational dimension in counseling; how-
ever, because the concept of the unconscious in the Freudian sense is still
foreign to most of them, it may be that their listening means listening to
the other person rather than to the unconscious; this is very different from
psychoanalytic listening.
Today, several translations for the term unconscious exist in Chinese
and are being used indiscriminately (Plnkers 2013), but none of them is
satisfactory (sometimes it is translated as nonconscious , as
opposed to consciousness; at best, it is translated with or
, both meaning subconscious). Interestingly, according to the histo-
rian of psychoanalysis Hannah Decker (1977), even in Western contexts
the issue of the unconscious was a greater barrier to the acceptance of

psychoanalysis than was the issue of sexuality. This might indicate that
psychoanalytic training cannot be limited simply to academic teachings,
as a general knowledge about the unconscious is not enough to have an
understanding of psychoanalysis or to produce psychoanalysts. Thus, it
may be that the key to introducing psychoanalysis among counselors in
Hong Kong is to have them experience the unconscious in a personal
analysis.
P s yc h o a n a ly t i c T r a i n i n g
Psychoanalytic training grounds itself on a tripartite system: (1) theoreti-

cal seminars; (2) the personal (training or didactic) analysis; and (3) clini-
cal supervision. While other therapeutic approaches rely primarily on
academic teaching, the transmission of psychoanalysis is greatly impaired
if any of these three pillars is missing. First, the function of the seminars
is to provide candidates a toolkit of psychoanalytic knowledge. The lack
of psychoanalytic education in Hong Kong is confirmed by reviewing the
programs for the current and coming academic years of the various bach-
elors and masters programs in psychology, counseling, and social sci-
ences of the University of Hong Kong, the Chinese University of Hong
Kong, Hong Kong University of Science and Technology, Hong Kong
Polytechnic University, Baptist University, City University of Hong
Kong, Lingnan University, and Shue Yan University. Only the last offers
introductory courses dedicated specifically to psychoanalysis. Outside of
academic circles, training opportunities are generally scarce and are lim-
ited to sporadic events. This imposes a serious limit on the development
of psychoanalysis in Hong Kong. Second, the notion that an aspiring ana-
lyst should first be analyzed was advanced in 1918, at the Fifth
International Psychoanalytical Association Congress. Two years later,
didactic analysis became the training standard, mandated at the first
psychoanalytic institute in Berlin (Wallerstein 2010). Functions of this
training or didactic analysis are (a) to analyze internal conflicts, blind
spots, and potential neurotic problems of the candidate; (b) to experience
the therapeutic forces of the method, particularly transference, which is
the engine of the therapy; and (c) to experience how a therapeutic set-
ting is established and maintained, how feelings are tended to, and how
latent material is interpreted. As emerged from the study described above,
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respondents who had been in therapy reported a more favorable disposi-

tion toward psychoanalysis, indicating that psychoanalytic teaching can
enhance the perceived effectiveness of psychoanalysis, but a personal
therapy is most likely to lower the perception of psychoanalysis as a com-
plex method. This is important, as it underscores the centrality of receiv-
ing therapy (particularly for a counselor-to-be) as a way to understand the
therapeutic process. A personal analysis is fundamental in psychoanalysis
for becoming a psychoanalyst, whereas it is not always mandatory in
other psychotherapeutic or counseling orientations. Third, psychoanalytic
supervision is deemed essential, as (a) it provides an understanding of
psychoanalysis in action and (b) is an opportunity for in-depth analysis of
the candidates own analytic work (Zachrisson 2011). And of course lack
of psychoanalytic supervision is yet another serious obstacle to the recep-
tion and understanding of psychoanalysis in Hong Kong.
P s yc h o a n a ly t i c T r a i n i n g i n H o n g Ko n g ,
M a i n l a n d C h i n a , a n d Ta i wa n
Psychoanalysis has been of interest in Taiwan and Mainland China, where

today it is increasingly drawing the attention of both clinicians and intel-
lectuals, but it remains largely unknown in Hong Kong. This is particu-
larly striking, because Hong Kong, long a colony of Great Britain, has
been (and still is) greatly exposed to Western culture.
Although originally sharing the same culture, over the last century
Hong Kong, Mainland China, and Taiwan have undergone very different
historical trajectories. The recent history of Hong Kong is both more
stable and less traumatizing than that of Mainland China or Taiwan (Jaffe
2011; Park 2011).
In less than a century Hong Kong transformed itself from a fishing
village to an industrial center and subsequently to a postindustrial finan-
cial hub. While Mainland China was undergoing the Cultural Revolution
(19661976), Hong Kong was a British colony with an annual economic
growth rate of 7 percent, fifth highest in the world. Still today, Hong
Kongs economy is the freest in the world (Heritage Foundation 2014).
From its inception, Hong Kong has been a society of immigrants and
refugees. Some 750,000 people entered Hong Kong between 1937 and
1941 to escape the Sino-Japanese War (Young 1992); after that, massive
flows of illegal immigrants occurred repeatedly in 19491952,
19581962, 19671973, and 19791980. They were in search of refuge

for political reasons (e.g., anti-Communist Kuomintang officials in 1949),
capitalists, or simply people pushed by specific events in China (Ma
and Cartier 2003; Ku, 2004). These immigrants had a sociocultural pro-
file very different from that of most people in China; further, they had
very concrete exigencies of survival (e.g., they had to rely on themselves
in adjusting to the new environment), so that their values were different
from those of their counterparts on the Mainland. Some have suggested
that materialism (a concern for economic security and basic needs above
social ideals) and a utilitarian family-ism (the tendency to place ones
familial interests above the interests of society or other individuals and
groups) ran rampant in the economically driven Hong Kong, and were not
counterbalanced by the spiritual and moral values so pervasive in tradi-
tional China (Lau and Kuan 1988). For instance, when in Hong Kong
elites started to emerge, they were made up of contractors, merchants,
government servants, compradors, and missionaries. However, quite con-
trary to the state of affairs in Mainland China, elite status in Hong Kong
was not based on cultural accomplishment (for example, distinction in
Confucian learning), moral excellence, or political achievements, but,
rather, on economic success (Lau and Kuan 1988, p. 36). Confucian val-
ues continue to influence Hong Kong society, but these are maintained by
social customs and family socialization rather than by any institutional
underpinnings. Kwan and Ng (1999) have observed that during the 1960s,
1970s, and 1980s the expenditure on tertiary education in Hong Kong
was dismal when compared with that of Taiwan, Singapore, and South
Korea. Ting and Chiu (2000) observed that in this context education
served more as a means for social success than for moral development.
These trends began to change in the early 1990s when the decolonization
process gained momentum (p. 23). Today Hong Kong aspires to be a
regional education hub, and in its eight universities (four of which are
ranked among the top hundred in the world) English is the primary teach-
ing medium. These universities are known mostly for their highly
regarded programs in finance, accounting, banking, law, tourism manage-
ment, and science and technology. In recent years, however, in conjunc-
tion with the handover to China in 1997, the transition to a postindustrial
economy and the consequent increase in social inequality and job insecu-
rity, a gradual change in Hong Kong values has been observed, particu-
larly among the younger generations. Several indicators suggest a shift in
Diego Busiol
values from basic needs issues to self-expression and political participa-

tion, as well as a greater concern for quality of life issues such as environ-
mental protection, education, and health services (for a review, see Ma
2011).
Since the end of the Cultural Revolution, Mainland China has under-
gone probably the most remarkable period of reform and open policies in
its history (Zhong 2011; Yiling 2011); the rigidly planned economy col-
lapsed, and a one-child-per-family policy was implemented. Society, hav-
ing not yet recovered from the wounds and traumas of the Cultural
Revolution (Plnkers 2011), was once again beset by deep and large-scale
economic and social changes.
In Taiwan, a Japanese colony before being occupied by the
Kuomintang, society has not yet recovered from a recent history of inva-
sion, occupation, war, suppression, separation, and loss (Roy 2003). It is
likely that traumatic historical events, rapid changes in society, and crises
provide openings for psychoanalysis, more than stability and conserva-
tism (Makari 2008).
These different heritages have directly or indirectly influenced how
psychoanalytic and counseling training has been received in these three
contexts. In particular, four facts emerge: (a) Hong Kong, having devel-
oped stronger connections with Western academics, has imported many
therapeutic approaches, but not psychoanalysis; (b) in Mainland China
psychoanalysis has had a stronger reception thanks to a more general
psycho-boom, after having been culturally isolated for many years; (c)
psychoanalysis in Mainland China and Taiwan has been received by a
population of mental health professionals very different from those in
Hong Kong; and (d) Western psychoanalysts have been very active in
promoting psychoanalysis in Mainland China, but not in Hong Kong.
The Rise of Counseling and Psychoanalytic Training
Hong Kong was for many years a British colony, and has developed
an inclination, an admiration, indeed almost a fascination, for the cultures
of English-speaking countries (Tsang 2004). Many professionals offering
and teaching counseling today in Hong Kong were trained abroad, in such
places as the United States, Canada, Europe, and Australia (Leung, Chan,
and Leahy 2007). These professionals have therefore imported to Hong
Kong the theories and knowledge they have acquired during their training
abroad. Since we are referring mainly to English-speaking countries, such
theories would first of all be behavioral therapy, cognitive psychology,

person-centered (Rogerian) therapy, and rational emotive behavior ther-
apy (REBT), as these are in the academic mainstream. It is unsurprising,
then, that these orientations, and others derived from them, are today
more widely known and practiced in Hong Kong than psychoanalysis is.
By contrast, the reception of psychoanalysis in China occurs within a
more general rise in the appetite for psychology books, counseling theo-
ries, psychological idioms, psychometric methods, and training in psy-
chotherapy: a psycho-boom, as it has been called by Arthur Kleinman
(2011). Although some (e.g., Yang 2013) observe that this sudden empha-
sis on counseling simply promotes a cultivation of fake happiness
yoked to a political project, as do several television counseling programs,
Kleinman (2011) thinks that this represents a shift in mentality, as in the
past talking about oneself would have been regarded as selfish and ego-
centric, whereas today many are learning to appreciate the psychological
dimensions of experience.
Different Mental Health Professionals Reception of Psychoanalysis
Psychoanalysis in Hong Kong has been received differently among

various groups of mental health professionals. Social workers from this
sample were found to prefer a more directive and solution-oriented
approach than did psychologists and counselors; they are less likely than
psychologists and counselors to have had their own therapy, are less
receptive to psychoanalysis than are psychologists and counselors, and
perceive psychoanalysis as more in conflict with local cultural values. It
is not entirely clear, however, what explains this critical attitude toward
psychoanalysis. When the two subgroups are examined regarding their
training, the populations they serve, and their work settings, some differ-
ences emerge. For instance, the majority of psychologists and counselors
reported having received training at the Chinese University of Hong
Kong or the University of Hong Kong, whereas social workers were
trained primarily at the City University of Hong Kong or Hong Kong
Polytechnic University. The percentages of reports of orientation toward
various approaches did not differ greatly among the two groups, except
that psychoanalysis (17%) and person-centered approaches (60%) were
more common among psychologists and counselors than social workers
(8% and 40%). The great majority of social workers (89%) reported
working for NGOs, twice the percentage of psychologists and counselors
Diego Busiol
(44%); in contrast, a higher number of psychologists (35%) than social

workers (1%) worked for the Social Welfare Department. Finally, psy-
chologists and counselors reported a higher incidence of private practice
(19%) than did social workers (6%). Concerning the target population,
82% of psychologists and counselors reported working with adult clients,
whereas only 54% of social workers did so; by contrast, the latter group
reported a higher percentage of clients among the elderly (31% vs. 18%).
Both groups reported an equal distribution of children (42%) and youths
(52%). Almost all respondents work with individuals (94% for both
groups), but psychologists work more with couples (58%) than do social
workers (38%). Both sets of professionals treat families and groups with
similar frequency. Lastly, when the incidence of variables such as number
of clients, years of work experience, and religion are examined, no sig-
nificant differences among the groups were found.
Research from Yip (2002) has shown that most social workers in psy-
chiatric services in Hong Kong are concerned with patients immediate
problems and providing them with concrete solutions. Basically, social
workers largely give advice and guidance to their patients rather than
performing counseling (Yip 2002, p. 39). They lack specialized training
and skills in in-depth counseling and, though supported by their agencies,
report insufficient theoretical backup from colleagues and supervisors.
Although some might mention a particular psychotherapeutic approach
as being relevant to their practice, or might even claim to be psychothera-
pists, Yip (2004) describes social workers as lacking sufficient knowl-
edge, understanding, or experience to conduct psychotherapy, which puts
their practice at risk of being labeled superficial. Social workers from this
sample reported a less positive attitude than did other clinicians toward
practicing psychoanalysis. Thus, psychoanalysis might not be well
received where counseling is delivered mainly by social workers; it may
be, however, that psychoanalysis will be better received as standards of
counseling education and training improve, and if more psychoanalytic
ideas are introduced into training.
Contrary to the situation in Hong Kong, psychiatrists, neurologists,
general practitioners, and psychologists in Mainland China generally prac-
tice counseling in clinical settings (Shi et al. 2005). Thus, psychoanalysis
in China has been received by a population of mental health professionals
very different from that in Hong Kong (Varvin and Gerlach 2011; Chang
et al. 2005; Yang 2011; Xu et al. 2011; Yiling, 2013). In the last twenty
years, the German-Chinese Academy for Psychotherapy, the Sino-Norway

Continuous Training program for Psychodynamic Psychotherapy, and the
China American Psychoanalytic Association have mainly been training
Chinese psychiatrists and psychologists (mainly from hospitals and uni-
versities) in cities like Shanghai, Beijing, Guangzhou, Kunming, Wuhan,
and Chengdu. Further, the training has been offered mainly at institutions
like the Anding Hospital (Beijing), the Shanghai Mental Health Center,
and the Tongji Medical University (Wuhan). In Taiwan, too, psychoanaly-
sis has been received mainly by psychiatrists and academics (Liu 2013).
Thus, it is likely that in these settings psychoanalysis has reached a differ-
ent audience. It is not clear to what extent such differences in underlying
mental health training and practice have influenced the reception of psy-
choanalysis in Hong Kong.
The Desire of the Analysts
Since the beginning of the 1980s, Western psychoanalysts have been

very active (often as volunteers) in promoting psychoanalysis in China,
organizing conferences, training programs, and study groups and visiting
the country several times a year. At present, psychoanalytic training in
Mainland China is conducted by a few recognized and well-established
organizations. By contrast, training in Hong Kong is offered much more
occasionally, by professionals acting individually.
Teaching under the auspices of an accredited association has a radi-
cally different impact. To students, it might guarantee greater continuity
in education and give the impression of greater authority and profession-
alism. To professionals it can guarantee larger audiences and allow them
to work directly with institutions. This kind of activism (which has never
affected Hong Kong) is remarkable, and it has largely contributed to the
reception of psychoanalysis in China. Nevertheless, it does not come
without consequences. For example, it has been observed that the Chinese
psychoanalytic associations that have been set up have not yet developed
an independent institutional life, and this has been interpreted as a conse-
quence of a lack of independent thinking in China (Plnkers 2011). This
might be partly true, and this resistance could be interpreted as simply
a minor obstacle on the path to the ultimate success of psychoanalysis in
China, an obstacle due perhaps to aspects of Chinese culture. Alternatively,
this small detail could allow for a different understanding of the prem-
ises guiding how psychoanalysis is being exported to and received in
Diego Busiol
China. Namely, this detail is informative not only of the transfer of psy-
choanalysis to China but, more important, of the transference of both
Western and Chinese psychoanalysts. Then, rather than considerations of
cultural differences, which could be biased by a Western perspective, it is
suggested that two other issues be considered that might help explain the
apparent passivity of the Chinese in this matter: (1) the reasons that psy-
choanalysis is appealing to the Chinese today are largely ignored, and
may be different from the reasons it appealed to Western psychoanalysts
in different contexts and periods; (2) the passive role assumed by the
Chinese might be a consequence of too much activism in their Western
counterparts.
On the one hand, the myth of the Chinese learner as passive has been
questioned (Mok et al. 2008; Watkins and Biggs 2001); rather than sig-
nifying a lack or deficiency in Chinese culture, this apparent passivity
may arise simply from the fact that Chinese professionals have different
reasons for becoming psychoanalysts (perhaps the desire for a better pro-
fessional career, or the belief that being a psychoanalyst is more presti-
gious), reasons that do not require the development and diffusion of
psychoanalysis. Or perhaps because they perceive psychoanalysis as a
Western theory, they might not yet feel ready to make their contributions
and instead expect the Western experts to give them direction. These
questions should be further investigated and are revealing of a surprising
gap in the literature.
On the other hand, probably the most significant questions for
Western psychoanalysts (also ignored in the literature) are the following:
Why is China fascinating to them? What has led Western psychoanalytic
organizations to Mainland China, but not to Hong Kong? Where is the
desire of the analyst? Snyder (in Osnos 2010) observes that there is much
enthusiasm about psychoanalysis in China, and that the Chinese have a
passion for psychoanalysis the way people were in love with it in New
York during the fties and sixties. She also reports that many Americans
conducting analyses in China are semi-retired, and the work with their
Chinese patients allows them to prolong their working lives (Snyder
2009). According to Osnos (2010), it is fascinating for Western psycho-
analysts to teach in China, where they are considered experts, even as
their profession is under attack at home (Nagel 2011; Scull 2011); in
China it is likely they will find more respectful and less critical students.
Many psychoanalysts have also been fascinated by what they perceive as

a new frontier for psychoanalysis in China: a challenge, but a place to
colonize as well. It is possible that Hong Kong does not occupy the same
place in the Western imagination, as it may be perceived as not culturally
distant and mysterious enough. These motivations are legitimate and can-
not be ignored. Specifically, do these premises support the idea that the
Chinese should become active and independent? An American analyst
and ex-trainer in China is critical toward what he calls expansive pro-
grams that likely cover colonialist impulses, and warns against the
perils of a psychoanalytic evangelism (Saporta 2011). Namely, if the
goal is only to export psychoanalysis and teaching to the Chinese
(Schlsser 2009), cultural differences might be an obstacle to such a mis-
sion, and large organizations in particular will tend to neglect rather than
acknowledge this (Saporta 2011).
Historically, Europeans and North Americans have for centuries been
fascinated by China. The first to come to Macao and China were the
Jesuits Alessandro Valignano and Matteo Ricci, four hundred years ago.
Having come with the intention of evangelizing the country, they soon
realized that they needed a more culturally sensitive approach (Busiol
2013). The writings they left us, the first accounts of cultural differences
between East and West, are memorable considerations that remain quite
relevant for psychoanalysts coming to China today. More recently,
Kleinman, an anthropologist, has found that the otherness of Western
culture to clinicians in China and Taiwan has helped them question and
rethink much about Western psychiatry. His research on depression,
somatization, expression of pain, and mental health has shown that what
once was generally accepted as universal is probably not.
It seems that psychoanalysis is simply going from the West to China
(a one-way transfer of knowledge), regardless of cultural differences, and
regardless of reflections on what this can imply for psychoanalysis itself.
But can psychoanalysis develop from encounters with Chinese thought?
Can this become a chance for rethinking psychoanalysis? I argue that this
is the chance for psychoanalysis to develop. To simply wonder how to
export psychoanalysis is not very farsighted; if that road is taken, it is
likely that after the initial enthusiasm psychoanalysis will be criticized
and eventually rejected in China.
Diego Busiol
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Diego Busiol 63/3

Factors Affecting the

The majority of Western psychotherapies are known and practiced in

Keywords: Hong Kong, Mainland China, psychoanalytic training, Chinese

H istorically, Chinese culture has been rather impervious to the

Postdoctoral Fellow, Department of Applied Social Sciences, City University of

eloquence from the qualities that define the goodness of a person

fantasy (p. 170). In contrast, he observed that among Westerners humor,

Between 1920 and 1949 psychoanalytic ideas were well received in

A recent study of mine aimed to assess the penetration of psychoanalysis

routine practice and have at least two years of work experience in

participants in the study. When the questionnaires were returned, the

with Chinese values, whereas for psychologists and counselors it lies

contribute to counselors psychoanalytic attitude (as measured by the

the issue of the unconscious was a greater barrier to the acceptance of

Psychoanalytic training grounds itself on a tripartite system: (1) theoreti-

respondents who had been in therapy reported a more favorable disposi-

Psychoanalysis has been of interest in Taiwan and Mainland China, where

19581962, 19671973, and 19791980. They were in search of refuge

values from basic needs issues to self-expression and political participa-

The Rise of Counseling and Psychoanalytic Training

theories would first of all be behavioral therapy, cognitive psychology,

Different Mental Health Professionals Reception of Psychoanalysis

Psychoanalysis in Hong Kong has been received differently among

(44%); in contrast, a higher number of psychologists (35%) than social

years, the German-Chinese Academy for Psychotherapy, the Sino-Norway

The Desire of the Analysts

Since the beginning of the 1980s, Western psychoanalysts have been

Many psychoanalysts have also been fascinated by what they perceive as

Korea, Taiwan, ed. M.T. Hooke, A. Gerlach, & S. Varvin. London:

Roy, D. (2003). Taiwan: A Political History. Ithaca: Cornell University

Zhang, J. (1992). Psychoanalysis in China: Literary Transformations, 1919

City University of Hong Kong

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