The Challenge of Cross-Cultural Training in China

王倩主任授权刊登 | 本文为第51届国际精神分析协会(IPA)大会王倩主任所作专题报告，由IJP编辑形成专题报告，登载在国际精神分析杂志(The International Journal of Psychoanalysis, 100: 5, 1012-1014)。

本文为同济“精神分析与人文”系列研讨会—11月7日“精神分析的临床循证实践”主题研讨补充资料（主讲：王倩主任）

王倩 -《 中国转型期的个体化进程》

（THE PROCESS OF INDIVIDUALIZATION AND‘WE-RELATION-BASED EGOCENTRISM’IN TRANSFORMATION PERIOD IN CHINA）

个体化进程

• 去传统化趋势：中国背景下的个体化受到全球现代化进程中去传统化趋势的影响，意味着个体从社会关系和限制中脱离，变得更孤立。去传统化指后现代主义对传统和社会的侵蚀（世俗化，不可知论，宗教派别林立） 。

• 当代生活中个体化的两个特点：从社会生活中区分和脱嵌；强迫性、强制性的主动和自决。

  脱嵌：人们越来越脱离社会纽带（诸如血缘、地理、学术和商业纽带等）的约束，变得孤立和分散。

• 随着去传统化和脱嵌的趋势发展，社会呈现更加差别化多元化的态势，中国青年群体在私人生活层面通过消费实现个体主义，而在更广的社会层面表现为理性的实用主义者。

• “关系”与个体化：

  中国式“关系”（Guanxi），不仅指其本意（实体间的“关联”relationship），而且包括它们所构成的社交网络，以及在此基础上进行的社会实践。

  中国式个体化发展进程无法脱离“关系”网络（Guanxi），因此在本体论上无法实现真正的独立进程。不同于保持个体独立，与他人共同创造生活经历，处在关系（Guanxi）中的个体是先赋的、预先而在的、以情境中心的。

• 中西跨文化差异：

  个人主义本身并无中西的差异，区别在于两者的群体形成过程，因此不能把中西差异片面化为集体主义与个人主义的二分对立。

• 中国式“关系”（Guanxi）具有连续性和差序性特点，由自我的内核向外发散，反映为自我中心主义，而非西方的个人主义。

• “以我们的关系为基础的自我中心主义”（We-Relation-Based Egocentrism）：体现为“关系”（Guanxi），而非“关联”（Relationship）。

• 中国现代化进程为个体化发展提供了可能性与条件，而“以我们的关系为基础的自我中心主义”描绘出从自我中心主义到个体化的范式变迁，经由转化性亲密与个性化过程,  与对存在的深在而繁复的渴望交织在一起。

• 如果将差序格局视为外显的社会模式（或习性），“以我们的关系为基础的自我中心主义”则是隐藏的中式处事思维，并通过中国式“关系”（Guanxi）表达出来。

• 互观人类学：

  互观人类学由法国人类学家阿兰·乐比雄（Alain Le Pichon）发展，是一种用于文化间相互理解的方法学，提倡建立跨主体的跨文化交流，不仅理解（Understanding）彼此的思维方式、实现对话，而且彼此辨识（Recognition）、共同建立新文化。

• 悬置主体性与交互主体性:

  观察者同时互为被观察者，探索是相互的。

  推翻认识论的权威性，强调悬置主体性，交互主体性。

  悬置主体性：阿兰反向使用胡塞尔的方法将主体性转变为需要被悬置的对象，即保留并忽略其主观知识结构，将其去授权化和初始化。

• 原初经验 （Ur-Experience）：

  这个冒险意味着一下子回到原初的心理状态，那里尚未受到各种知识的限制，无论真假,  所有人都是初学者，迷失在互相辨识的陌生感中,  并开启重新探索。

  这是一次回到存在之初的机会，如同海德格尔所想、歌德所言、阿兰所建议的那样，回到“原初经验”。

• 文化重构（Re-culturing）：
  跨文化不是简单地在表面上理解别人的经历，而是“也许不情愿地透过别人的手来改造自己”的过程。
  跨文化指的是在实践中接受他人，而非仅对他人展开科学观察。 
  因此，跨文化的重点是彼此辨识，而非单纯理解。
• 语言包容性（Language Accommodation）：
  语言包容性是跨文化交流成功的必要条件。某种语言如果不能为其他语言内的概念留出空间，跨文化实践的努力很可能会付诸东流。
  阿兰·乐比雄（Alain Le Pichon）认为，语言在保持自身完整性的同时，具有与其他语言相区别的能力。异质性的消失不可避免地伴随着他性消失，如此一来，跨文化建立的前提将不再存在。

Angela Joyce introduced the panel and observed the great challenges inherent in adapting and transplanting descriptions of theory, method, and practice from Western culture to another setting.

Viviane Green introduced her paper “The Challenge of Cross-Cultural Teaching” by noting the huge socio-economic changes in China over the last 30 years.  As a country with an ethnically uniform (91% Han) population of 1.37 billion, there are only 20,000 psychiatrists.  She reports a sense of dislocation, anxiety and anomie.  These difficulties flourish in a population with large scale internal migration, the breakdown of the traditional family structures, an increase in individuality, and the prevalence of only children as a result of the one child policy from 1976-2016.

There are aspects of Chinese culture that may appear to be unsuitable for the development of psychotherapy.  For instance, people may not be use to talking of their problems in such a family-oriented culture, especially when shame is so prevalent, and boundaries between self and other seem less structured than in the West.  Moreover, the place in society of a professional offering certain defined services was not established in Chinese society, and not well understood. Nonetheless, there is a great need for psychological programs.  The Sino-British program grew from 60-80 students to 200, by the third cohort.

The Sino-British program is a 3-year training, centered on teaching how to work in the transference/countertransference, to develop competencies in working with children and adolescents.  It involves 2 annual 5-day training sessions, as well as the option of weekly mother-infant seminars over the internet with experienced child psychotherapists/analysts. There are also weekly clinical groups. The training is recognized by the IPA Chinese Committee and several significant Chinese mental health associations.  Training is conducted in English, with translators, which is challenging but workable.  The difficulty is trusting the accuracy of what the translator is conveying and how the students are replying.

Generally, a major driver of parents seeking help with their youngsters concerns educational difficulties.  Educational success is highly prized, with enormous pressure on the child.  Therapeutic outcomes tend to be judged by educational result.  

A second feature is a mercantile attitude toward the treatment.  Observed families want to be paid for their efforts.  The value of having a family observed and interacting with therapists had to be explained and experienced. Consent often had to be obtained from multiple generations within a family. Also, certain issues of access to the therapist were expected if money was involved. The notion of a professional offering defined services had to be conveyed. 

The teaching of psychotherapy is often done via online seminars, with participants in different cities and unknown to each other.  Green insists on seeing the full face of each participant, stressing confidentiality, and discouraging participation while traveling.  Establishing boundaries with the prevalent use of social media becomes important.  Another challenge is that many therapies are conducted online and the therapist never or rarely sees the client.  This may skew receptivity to unconscious material, and transference/countertransference.

A common problem in learning is the culturally determined deferential attitude of the Chinese students.  Deferential rule following had to be questioned, a “chalk and talk” expectation had to be countered, and curiosity had to be modeled.  It took time and effort to establish a process of the group thinking and talking together.  In group supervision the teacher would often feel pressure to give advice and guidance.  This was best understood as parallel process, allowing access to what the therapist feels.  It was helpful to demonstrate this to the students to teach and to avoid disappointment.  While many of the students have an intellectual understanding of transference and countertransference, a frequent difficulty arises in teaching how to metabolize countertransference feelings as an understanding reflecting the therapeutic communication.  This was more difficult and required careful attention.

A challenge is adapting the developmental model applicable in the West to fit Chinese culture.  The Western model posits a pathway toward separation and individuation from family of origin.  In the Chinese context, self-experience may need to encompass a “we go”, i.e. a self inextricably bound to the family.  Most families are 3 generational, and the family structure is often seen as an inverted triangle with the child at the bottom, with many adults watching over.  At best, this provides a rich environment with many attachment experiences; more often in our population the child grows up lonely in a pressurized environment. A challenge for the Chinese student involves who to identify with.  It appears it is often easier for the students to identify with the parents rather than the child.

Difficulties emerge when child abuse is an issue.  It is uncertain who can be called upon in China to investigate.  It often seems difficult for the student to maintain empathy for the child, rather than focusing on confronting the parents.  Another problem is the cultural perception of abuse.    What is culturally acceptable discipline?  How do we help students who may have been abused themselves recognize this abuse and the shame of acknowledging it, in order to recognize the abuse of their patients?

Green concluded with the observation that areas of Chinese culture are hard to perceive in their “difference.”  Often these differences are discovered as a surprise, as when in teaching Freud’s notion of the flow of psychic energy, a student easily related this to Chinese notions of “chi”, the idea of energy in Chinese medicine.  The teacher must operate accepting her blind spots, and recognize that just as students are encountering something new, so is she. 

Wang presented a paper on “The Process of Individualization and ‘We-Relation-Based Egocentrism’ in Transformation Period in China.”  She noted the incongruity of trying to apply psychoanalysis to a fundamentally family-centered unconscious “differential mode of association” (DMA) and the prevalence of Guanxi.

Guanxi is considered a specifically Chinese pattern of social networks, using personal relationships to get through life and work.  It combines a Chinese individualism with embedded relationships.  The DMA (differential mode of association), conceptualized as concentric circles with the innermost ego, then familial ties, familiar ties, and weak ties as the outermost band.  The boundaries between circles are ambiguous.

There is a growing individualization in China, understood as a detradionalization.”  This involves a shift, very incomplete, from traditional Confucian values of self restraint to more Western values of personal interest.  As a result, a growing proportion of the population is developing a bicultural self.  For instance, traditional collectivistic Chinese culture views psychological difficulties as challenges in daily life and relationships, while the Western model sees psychiatric illness.  Urban and educated Chinese will now see illness.  Detraditionalization involves the increasing separation of the individual from social ties and constraints such as blood ties, geographic ties, etc., so individuals become more isolated and atomized.  Individuals may become more detached from traditional social constraints. 

Another feature of individualization, Wang asserts, is that social structures compel people to become proactive and self-determining, developing a reflective self. Wang believes individualism leads Chinese youth to be lonely and self-centered, cynical and immune to spiritual inspirations, with little idealism.  In the public sphere Chinese youth tend to be rational pragmatists, skillfully moving toward goals and handling interpersonal relations, with a distaste for idealism.

Wang cites Fei Xiatong’s view that Individualism/collectivism may not define the West/East as much as the notion of distinct patterns of group formation, with DMA more characteristic of China.  The “ego” or “I” in “we-relation-based egocentrism is always related to family, clan, relatives, friends, etc.  The ego only exists within this social web.  This is what distinguishes the DMA “group mode of association” from Western “individualism.”  DMA may be regarded as an implicit organizing feature of Chinese thought, and is expressed as Guanxi.  “We-relation-based egocentrism” may represent a paradigm shift from egocentrism to individualization through transformative intimacy.

Wang concludes with a consideration of the idea of “reciprocal anthropology” developed by Alain Le Pichon.  When there is a cross-cultural “cross-subjectivity,” a new culture is created.  Reciprocal anthropology involves both cultures observing and being observed, all the while examining what lies below the surface patterns of each.  It is a true transcultural dialogue, and involves a suspension of judgment.  It is the start of true conversations between Chinese and Western scholars.  

There were a number of questions and comments from the floor.  One woman who teaches in China, Britain, and Sri Lanka said she was struck by the similarities in the psychological relatedness between children and parents in these countries.  Another comment from a woman from Singapore noted a lag between cultural change and economic change, and downplayed the growth of “individualism” in China.  She wondered whether Western concepts rooted in individualism really could be applied to China. Another person teaching in China remarked how all her stereotypes turn out wrong, and suggested Westerners teaching and treating Chinese should be prepared for surprise and open to learning new perspectives.

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