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MIND THE GAP

Training for counselors and therapists has boomed in China, but lack of regulation is a source of anxiety for the market

By NewsChina Updated Jun.1

A speaker at the 14th Psychologists Conference of China, Zhumadian, Henan Province, August 22, 2020

Liu Qian has been busy looking for an academic advisor for her oral dissertation, the last step of a two-year adult education program at the Institute of Psychology, Chinese Academy of Sciences (IPCAS).  

So far, Liu has not had much luck, especially compared to students in more traditional courses. 

Liu searched for the email addresses of professors on the IPCAS website and contacted them all. She got one reply from a professor in an unrelated field.  

Though she said she learned a lot from attending training programs over the past few years, Liu thinks a more comprehensive way to train counselors is necessary.  

Formal counselor and therapist training in China is far behind places like the US and Germany. Despite the increasing awareness of mental health issues and the growing demand for treatment, Chinese universities produce only several hundred graduates in counseling every year, spurring a burgeoning market for training.  

This lack of regulation and supervision has resulted in growing pains for the industry that are hurting new counselors and patients.  

Overlooked Education 
First arriving in Chinese universities in the 1920s, Western psychology was largely ignored in China after 1949 when the People’s Republic of China was founded, mainly for political reasons. 

Zhang Haiyin, who became a psychiatrist at Shanghai Mental Health Center in 1988 after graduating from The Second Medical School of Shanghai (now part of Shanghai Jiao Tong University), told NewsChina there was no proper training in psychotherapy in the 1980s. Those who wanted to learn had to read on their own or attend seminars.  

Qiu Jianyin, director of psychology at Shanghai Mental Health Center, graduated in the 1990s from East China Normal University in Shanghai, one of the first schools with a psychology department. Qiu said that clinical psychology was rarely taught in college at the time, and most in the field relied on internships and on-the-job training.  

Public awareness of counseling grew following the Wenchuan Earthquake that devastated parts of Sichuan Province in 2008, when professionals and volunteers poured into the region to treat traumatized survivors. Although more universities started psychology departments since then, there are not enough instructors to go around.  

Most psychology graduates pursue careers in academic research, according to Qiao Zhihong, Party secretary of the psychology department at Beijing Normal University. He said while there are more than 100 universities and institutions offering master’s degrees in applied psychology, only half provide courses in counseling, producing under 500 counselors a year.  

Adult education programs are a major pathway to certification in counseling. Off-campus training for counselors began in 1988 when German therapist and former Peking University student Margarete Haass‐Wiesegart in cooperation with Professor Wan Wenpeng of the Yunnan Province Psychiatric Hospital in Kunming brought a team of German psychotherapists to China. The team held three workshops covering major schools of psychotherapy. In 1996, Haass‐Wiesegart founded the German-Chinese Academy of Psychotherapy (GCAP). A year later, she started its psychotherapy training program that still runs today. The program, which focuses on psychoanalysis, cognitive behavior and family therapy, provided a rare opportunity for standardized training in the Chinese mainland.  

The program is considered the cradle of psychotherapy in China. Qiu, a former student in the program who now heads GCAP’s China operations, said the program is directly responsible for the development of clinical psychotherapy in China. Subsequently, China started similar training programs with Norway, the US and France.  

In 2001, counseling became a formally recognized career in China, and the Ministry of Human Resources and Social Security held counseling certification exams from 2002 to 2017. During this period, numerous training programs emerged and about 1.5 million people were accredited. However, the quality of training varied, and the certificate, though still officially valid, is not universally recognized by professional psychology organizations.  

As mental health treatment entered the public consciousness, demand for therapy grew. Over 100 million people aged 15 and older (about 10 percent of the overall population) suffer from mental disorders, while 16 million are diagnosed with severe mental disorders, according to the People’s Daily, citing an epidemiological survey on mental disorders in many regions in 2016. According to the Chinese Association for Mental Health (CAMH), there were less than 30,000 professionally trained counselors in China in 2018, a far cry from the World Health Organization’s recommended ratio of one counselor per 1,000 people.  

A counseling hotline in Shenyang, Liaoning Province offers 24/7 services

Questions about Quackery 
Qiu Jianyin said that unlike China’s first batch of foreign instructors, most today are seeking to tap the country’s giant market and launch programs in cooperation with domestic teaching platforms. However, the quality of teachers is inconsistent, Qiu said. 

For example, Australian therapist Steve Vinay Gunther regularly charges 18,000 yuan (US$2,741) for six-day courses held in Shanghai in Gestalt psychology, a major school in modern psychology. He is touted in ads as a “top-level Gestalt psychology expert.” But Lin Fang, a formally trained counselor, told NewsChina that Gunther is not among the best experts of the Gestalt school. “In China these experts are hyped up to the skies,” Lin said.  

Qiao Zhihong said training programs in China focus on different schools of psychology, which training platforms then advertise like commercial products. “Driven by profit, the platforms exaggerate the benefits of their own school of thought and their trainers,” Qiao said.  

An expert from CAMH who spoke with NewsChina on condition of anonymity said there are over 2,000 different schools of therapy worldwide, the majority of which have taken root to different degrees in China. Some have localized by mixing in cultural elements, but most treatments use similar methods. In the late 1990s, Zhu Jianjun, a professor at Beijing Forestry University, developed a treatment called imagery communication, which mixes Western psychotherapy methods with elements of Confucianism, Buddhism and Taoism.  

“This discipline [psychology] appears to have boomed in recent years, but there is a dire shortage of instructors. As many psychologists are often busy lecturing [at training institutions], they rarely take on patients and do research,” said the expert.  

As psychology becomes an increasingly popular career choice, particularly due to online courses, more institutions are entering the fray.  

“Some psychologists manage to make a decent living because of the growing interest in psychology and people seeking to become counselors. Institutions, instructors and professors say their courses will help people earn lots of money,” said the expert from CAMH. “But for most, counseling will not be a lucrative career.”  

Lin Chun, an official at the Chinese Psychological Society, a nonprofit, said that job opportunities for counselors are not as abundant as advertised by training platforms because limited market capacity hinders growth. Many people do not seek treatment out of concern for prevailing stigmas associated with psychology and mental issues in China.  

What’s more, after the national certification exam ended in 2017, many institutions began issuing their own certificates because of a dearth of regulation and oversight. Some platforms masquerade as research institutions to attract students or sell certificates to people with no background in psychology.  

Patients Lose Out 
Training new counselors will rely on formal schooling and adult education for a time, Lin Chun told NewsChina, but eventually formal education will become the main channel.  

Patients are bearing the brunt of the chaos. Normally, counseling is charged per session. But Lin said that according to interviewed patients, counselors charge for up to 30 sessions in advance. If clients are dissatisfied, they say counselors make it difficult to get refunds.  

Qiu said that counselors should refer clients with severe psychological issues to psychiatrists for diagnosis and treatment, or carry out treatment in cooperation with psychiatrists. However, Qiu said many counselors are not properly trained to identify symptoms, while others delay referrals so they can charge patients for more sessions. This can sometimes lead to irreparable consequences, including suicide.  

In the US and some countries in Europe, psychotherapy and counseling are covered by healthcare programs, which helps regulate cost and frequency of treatment. In some regions in the Chinese mainland, psychotherapy and counseling are included in the country’s social insurance program. But due to limited medical resources, hospitals usually opt for shorter-term solutions. If the patients require further treatment, they must turn to private counseling institutions or platforms, Qiu said. Private institutions usually charge 400-800 yuan (US$61-122) per session.  

Most patients cannot judge what kind of therapy they need or how long the treatment should last. “Many counselors do not have a treatment plan or regularly check for efficacy. The patient just keeps showing up. If there is some disagreement about the treatment, the counselor might say, ‘Let’s give it one more try,’” Lin Fang said, adding that a treatment such as cognitive behavior therapy – a method that targets negative thinking habits – usually takes more than 10 sessions, while others can last five to six.  

According to a survey by Jiandanxinli, an online psychotherapy platform, 29 percent of its users responded they had between 5 and 20 sessions with a therapist, while 23 percent had over 20 sessions.  

Xiao Li, an intern at Jiandanxinli, said that many counselors do not address the underlying issues during sessions with patients in the first years of therapy, but rather build a dependent relationship where the counselor is a patient’s sole confidant.  

“Sometimes it’s not the therapy taking effect but the relationship with the therapist that keeps patients coming to sessions,” Xiao said.  

While there have been calls for tightened regulation over the industry, improvements are on the horizon. Directed by the Ministry of Human Resources and Social Security, four leading organizations – IPCAS, Chinese Psychological Society (CPS), CMHA and the Chinese Association of Social Psychology – embarked on setting assessment standards for professional counselors in September 2020. The standards are slated to launch this summer.  

As part of the regulations, the four organizations are considering an exam to evaluate counselors and setting up certification systems to regulate market access. The CPS is also working on a registration system to further evaluate China’s 1.5 million accredited counselors. 
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