Culturally Informed Marriage and Family Therapy with the Chinese Population


In light of the growing recognition of the importance for marriage and family therapists (MFTs) to be sensitive to their clients’ cultural backgrounds and memberships, this article is intended to provide several culturally-informed clinical suggestions for therapists applying Western-based MFT theories, models, and concepts to the Chinese population. When the authors use the term “Chinese population,” we are including both those physically living in China and those culturally immersed in the Chinese culture but currently residing elsewhere. We discuss these two populations collectively because we believe both groups are influenced by traditional Chinese culture and modernized Western culture, which is often reflected in this population’s families and intimate relationships.

Culturally informed family therapy with adolescents 

When working with Chinese families, therapists may prioritize considering the cultural ideal of collectivism (Epstein et al., 2014). However, more and more teenagers and younger generations have a tendency to embrace individualism. Thus, it is not uncommon for local Chinese therapists to find that the problem bringing families into therapy centers around the conflict between collectivism and individualism, or traditional and modern values. This cultural phenomenon is due to historical changes or shifts happening in China, including the power shift from the elder to the younger generation (Epstein et al., 2014; Quek & Chen, 2017). To address this issue, systemic and family-based perspectives can be extremely valuable as the conflict is embedded in the family context. Therefore, for problems between parents and adolescents in a Chinese family, adolescents may appreciate more the respect for and acceptance of their worldview by therapists. A non-judgmental attitude can initiate stronger connections between therapists and adolescents in the room (Liu et al., 2020; Quek & Chen, 2017). Meanwhile, the older generations also need their perspectives to be heard to balance the therapeutic alliance with the whole family.

When working with Chinese families, stories and item-comparison metaphors can be useful in many situations. Engaging in metaphor practice is important for three reasons. First, therapists can use this technique to establish a more approachable and understandable representation for Chinese families attending therapy. Second, many families seek therapy with the expectation that the therapist is the authority or the leading figure for the solution of their problems. Metaphors can then be used as a form of psychoeducaion to fulfill the potential expectation. Third, metaphors promote therapeutic efficiency. As the families are not generally familiar with therapeutic concepts, related metaphors can promote the learning of these concepts in an efficient way (Liu et al., 2014; Liu et al., 2020).

To help illustrate the use of metaphors with Chinese families, we provide a list of several examples. Therapists may talk about how a previous family they dealt with had a similar problem like this current family has, without disclosing confidential details. More importantly, therapists may also illustrate how they successfully solved that previous family’s problems as an assurance or demonstration of professionalism or therapy efficacy. Therapists may also use stories from Chinese and international classics, such as stories of historical figures, Greek fables, or even “The Adventure of Tom Sawyer” (Liu et al., 2014).

For the example of item comparison, the therapist may use the metaphor of parents raising a child and launching the child out of the home to elder birds raising a bird from its newly born state and letting it fly away. This metaphor is useful for discussing adolescent independence and identity issues, or similar subjects (Liu et al., 2014).

Research findings from the literature on this population can be transformed into applicable therapy practices for the Chinese population. The first applicable result centers on the dynamic of control and trust between parents and adolescents. Specifically, parental control is also strongly related to the quality of parent-adolescent trust. Parent-adolescent trust is further connected with the development of the parent-adolescent relationship (Liu et al., 2020). For repairing or fostering trust and relationship, research shows that attachment-based family therapy seems to be working with Chinese families as well (Liu et al., 2020; Ngai et al., 2021).

One potential reason for this difference is the relatively lesser amount of communication between the father and the child in Chinese families compared to other cultures…

Nevertheless, there are certainly some cultural factors to be considered when therapists conduct this type of therapy with Chinese families (Liu et al., 2020; Ngai et al., 2021). Parental control greatly predicts mother-adolescent trust in Chinese families, which is contradictory to the global finding of control predicting father-adolescent trust. One potential reason for this difference is the relatively lesser amount of communication between the father and the child in Chinese families compared to other cultures (Liu et al., 2020). This is especially useful for therapists to be aware of during initial rapport building. For Chinese families coming to therapy, there can be discrepancies in the adolescent’s allegiance with parents. Under this circumstance, the therapeutic alliance can be tricky to maintain, as the situation can devolve into two family members against another one. In addition, as mentioned above, the conflict between adolescents and older generations can center around highly conflicting cultural values. Thus, the monitoring of the alliance and fair acknowledgment of perspectives will be extremely important for therapists in these situations.

As discussed above, many local Chinese families attend therapy, expecting therapists to be the leading role or figure. Thus, in addition to normal therapeutic alliance components, therapists’ professional competence and ability to give relatable theoretical explanations for all family members can be more appreciated by Chinese families. Even similar demographic factors like age, worldviews, and cultural and SES backgrounds can also build the therapeutic relationship relatively quicker for many Chinese families (Liu et al., 2020). It is important to emphasize again that for Chinese immigrant families in the United States, this specific undertone may or may not apply due to the relatively wide-spread societal knowledge of psychotherapies.

It is important to always maintain an open mind. Different families have different kinds of struggles, and some methods or interventions work for them while others do not. Therapists need to be aware of this heterogeneity, such as educational background and the degree of the conflicts, while considering the cultural background of Chinese families as well as the individual characteristics of each family member.

Culturally informed couples therapy 

Similar to what was described before regarding Chinese teenagers and parents, the dual influence of individualism and collectivism can be impactful on couple relationships, as well. How partners identify with the two cultural systems could be reflected somewhere in a spectrum with the extremes of two types of marital harmony (Quek et al. 2010). Those identified more with traditional social norms tend to fall on the side of structural harmony. Some characteristics of this identification are that they regulate their behaviors based on culturally shared rules and divide family tasks based on traditional gender roles. They also assume husbands to be the authority figures when making decisions and voicing for the whole family. In contrast, couples who fall elsewhere on the spectrum tend to pursue relational harmony which is influenced more by individualism. They tend to share the decision-making process and prioritize couple relationships over other relationships in the family. They also have a more flexible distribution of roles based on individual choices and family needs.

Another way to understand how traditional values influence heterosexual Chinese couples is by looking at the female partner’s roles. When traditional values teach females to be submissive and dependent on their husbands, Chinese women are also encouraged to utilize their power in making decisions and speaking up for their families. An old Chinese saying during its revolutionary period was “Women can hold up half of the sky.” Nowadays, China has one of the highest female employment rates in the world which allows women to be more demanding in the family by expecting their partner to share some roles in child rearing and household chores. As a result, the common presenting difficulty in therapy is how duties and obligations should be split among couples. Guilt and depression could be present among individuals when they fail to take care of their parents, support their siblings, and nurture their children. It is important for therapists to help individuals in couple relationships find a balance between the duties they were assigned and pursuits they individually value (Shi & Wang 2009).

Certain constraints when working with this population are unavoidable. When working on emotions in couple therapy, some discomforts and resistance are identifiable. The cause of the resistance is that Chinese people tend to perceive overt expressions of affection as embarrassing and disrespectful to others witnessing. We suggest therapists observe the context rather than solely the content of therapy, like nonverbal and inferred messages hiding behind the couple’s communications. When trying to read the implicit messages from what they are saying, Western therapists could invite couples to use metaphors and concrete real-life examples to help them access their emotions.

>>SFBT with Asian and Asian-American Clients

Another constraint is the difficulty in disclosing negativities which is caused by the cultural stigma around pursuing external help and disclosing family negatives to outsiders (Shi & Wang, 2009). The fear of being judged by the therapist and betraying the entire family could restrain couples from disclosing during the beginning assessment phase. We suggest therapists provide more validation on those potential barriers and be patient when they sense the hesitation to share.

To best treat Chinese couples, it is important to understand the responsibilities that are assumed of each partner in Chinese couples. When adopting Sternberg’s theory on the triangle of love, passion is less prominent than commitment (Chen & Li, 2007). Chinese couples believe that commitment is not just the desire to stay together, but how they fulfill the responsibilities and obligations as a couple.

In Chinese marriage, the primary goal is to maintain loyalty and harmony in the extended family, and a practical goal is to raise children (Shi & Wang 2009). Couples fulfill their responsibilities by receiving parental approval of the marriage, and also sacrifice individual needs or careers to nurture children and take care of the extended family. It is not surprising that when children are born, the emphasis on marital satisfaction shifts to maintain the overall well-being of the family.

We suggest that couple therapists be more cautious when introducing Western-based concepts such as “boundary” and “privacy” to evaluate marriage satisfaction. It is important to help couples recognize that prioritizing couple relationships does not contradict the task of fulfilling their familial obligations. Instead, marital relationship is the foundation, therefore strengthening couple relationship does not equate to being selfish and could, in fact, be beneficial for extended families as well.

An old Chinese saying during its revolutionary period was “Women can hold up half of the sky.”

Yinan Li and Huan Liu, Student members of AAMFT, are therapists-in-training in the master’s program of Marriage and Family Therapy at The Family Institute of Northwestern University. /

Chen, F.-M., & Li, T.-S. (2007). Marital enqing: An examination of its relationship to spousal contributions, sacrifices, and family stress in Chinese marriages. The Journal of Social Psychology, 147(4), 393-412.

Epstein, N. B., Curtis, D. S., Edwards, E., Young, J. L., & Zheng, L. (2014). Therapy with families in China: Cultural factors influencing the therapeutic alliance and therapy goals. Contemporary Family Therapy, 36, 201-212.

Liu, L., Wu, J., Wang, J., Wang, Y., Tong, Y., Ge, C., & Wang, Y. (2020). What do Chinese families with depressed adolescents find helpful in family therapy? A qualitative study. Frontiers in Psychology, 11, 1318.

Liu, L., Zhao, X., & Miller, J. K. (2014). Use of metaphors in Chinese family therapy: a qualitative study. Journal of Family Therapy, 36, 65-85.

Ngai, S., Au-Yeung, H., Tsui, W. C., & Zhu, S. (2021). The effectiveness of an attachment-based parenting programme for parents in Hong Kong. China Journal of Social Work, 14(1), 4-16.

Quek, K. M. T., & Chen, H. M. (2017). Family therapy in Chinese culture and context: Lessons from supervising therapists-in-training in China. Contemporary Family Therapy, 39, 12-20.

Quek, K. M. T., Knudson-Martin, C., Rue, D., & Alabiso, C. (2010). Relational harmony: A new model of collectivism and gender equality among Chinese American couples. Journal of Family Issues, 31(3), 358-380. doi: 10.1177/0192513X09351162

Shi, L., & Wang, L. (2009). A multilevel contextual model for couples from mainland China.

In M. Rastogi & V. Thomas (Eds.), Multicultural Couple Therapy (pp. 297-316). Sage Publications, Inc.

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