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Addressing Hong Kong’s Political Crisis as a Psychotherapist

Hong Kong is about to change forever. Mental health professionals must be ready.

Key points

  • Hong Kong is undergoing an unprecedented political shift. With this shift comes anxiety, and uncertainty about the future.
  • When working with people affected by this, we must differentiate our perspectives so that it does not affect the therapist/client relationship.
  • Culture affects our perspective; Mainland Chinese therapists may approach these feelings differently.

In China, psychotherapy is a relatively new undertaking. It did not exist until therapy was introduced in the late 1980s; everything Western was off-limits until that period. Since then, China has become a modern society adept at technological development, and ever more aware of the importance of mental health (Jie Yang, 2018). This is especially true for the middle class, which enjoys more access to mental health services than the rural and urban poor, but notably the Chinese middle class is roughly equal in number to the population of all of Europe, or of either North or South America. This is no small movement.

I have taught psychotherapy in China for the past 14 years, and have presented at a number of national and international Chinese congresses. During that time, my work has been warmly embraced. I have learned about the openness and honesty of our Chinese colleagues, who are eager to learn from us and, at the same time, eager to teach us about the traditions and ways of thinking embedded in Chinese culture and history, ancient and modern. Through my experience, I have learned about the evolution—or even revolution—of culture as Chinese people have warmly embraced Western modernity.

Nowhere is this more true than in Hong Kong. A short history: since the British handover of Hong Kong back to Chinese governance in 1997, Hong Kong has been a “SAR,” or Special Administrative Region of China. It is neither a city in China nor its own sovereign country. In practice, the “one country, two systems'' policy meant that Hong Kong has operated as a democracy: free elections, permissive trade policies, and accommodating rules for expats and startup businesses. It was slated to go fully under Chinese authority in 2047, but in the interim, Hong Kong was—at least in theory—autonomous.

But the people of Hong Kong face a new reality: a system that was predominantly democratic is quickly morphing, as it has come more or less under the control of the ruling Chinese Communist Party. This affects not only the people of Hong Kong, but indirectly, mainland Chinese as well. For people born after 1997, a democratic Hong Kong as a special zone is the only situation they had ever known. But it would be hard to watch the news these days without seeing a story about the political unrest in this embattled city.

So now comes this period in which the Chinese government has become much more cautious about the loyalty and thinking of its people: a fact exemplified by its treatment of Hong Kong. Although the actions of China’s government are unpopular in the West, many Chinese see them as bolstering the well-being of China as a country; others regret the increased focus on government loyalty. Nevertheless, Chinese psychotherapists and mental health professionals must adapt to the changing attitude of their government: adaptation in a form that we in the West have never had to make.

When working with people affected by the situation in Hong Kong, we should bear the following points in mind:

  • Keep a clear boundary between work and personal life. Our job is to support personal growth and reflection within a therapeutic framework, not to enter into a country’s political conflict.
  • We change neither culture nor governmental policy. Culture will dictate perspectives on work, family, politics, and everything in between. Psychotherapy can be useful to a person living under varying governmental climates, including the very different climates of China or Russia. In our work, our values and objectives do not need to change, but at the same time, we need to keep our patients’ realities in mind.
  • Do not mix politics with psychotherapy. Always strive to apply psychotherapeutic neutrality when working with clients. Another way of saying that is that we are on the side of all patients’ health and growth. Agreeing with your clients’ politics should never be a prerequisite to working with them.
  • Avoid stereotyping. China is a country of nearly 1.4 billion people. Individuals in China may or may not agree with their government. Similarly, some Hong Kong citizens are less involved in political changes than others. People often see the world differently based on their age, occupation, or socioeconomic status.
  • Work from a place of curiosity. How has Hong Kong’s political shift affected your client there, in mainland China, or as a Chinese-American? Your client might not know the answer to this broad question, so start by asking ancillary questions. What bothers them or matters in their personal life? How are their stress levels? How are they sleeping? Do they have any family members who are affected by the changing situation? We must always strive to work respectfully to understand each patient’s perspective on the situation in which they live.

In a changing social atmosphere brought on by the increasingly cautious governmental attitude, it is nevertheless possible to work with integrity towards the betterment of our clients. As Hong Kong, mainland China, and the rest of the world explore new political territory, it still gives me great pleasure to support our Chinese colleagues in doing work that matters—perhaps now more than ever.


Jie Yang (2018) Mental Health in China. Medford, MA: Polity Press.

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