Building the China American Psychoanalytic Alliance
Chinese psychoanalysis emerges through training and scholarship
By Karyne Messina, Robert Gordon, and David Scharff
Photo by Boris Ulzibat. Creative Commons license.
Introduction
By Karyne Messina
The first stories I read from Chinese practitioners upended my assumptions about psychoanalysis in China. I expected to read about the logistics—the time zones, the technology, the translation hurdles. Instead, I read how defense mechanisms like projection take unique forms in Chinese society, how individual and collective experience interweave in ways Western theory hadn't imagined. These insights forced me to reimagine psychoanalytic concepts I thought I understood.
For more than two decades, the work of the China American Psychoanalytic Alliance (CAPA) in China has challenged many of our assumptions about psychoanalysis. As a board member, I saw the difficulties and rewards of introducing Western concepts to Chinese practitioners. My own experience teaching infant observation, an enriching aspect of psychoanalytic training, has opened unexpected windows into Chinese culture. Drawing from my work at the Washington School of Psychiatry’s Observational Studies Program (now part of the Washington Baltimore Center for Psychoanalysis), I’ve helped Chinese practitioners learn this essential technique. I’ve helped Chinese practitioners learn this essential technique. What they notice and what catches their attention often differs from Western perspectives, teaching us all new ways to think about parents and children.
My coauthors, Robert Gordon and David Scharff, have been essential partners in this journey. Robert’s research has proved what many of us sensed: that distance learning really works. His studies of CAPA’s teachers and students show that the longer people train with us, the more effective they become as therapists. David’s pioneering work as founding editor of Psychoanalysis and Psychotherapy in China opened new doors for dialogue between Western and Chinese practitioners.
As editor of the CAPA Newsletter, I’ve heard stories from practitioners working in China. Their accounts capture the challenges and successes in bringing psychoanalytic practice to a new cultural setting. Reading these experiences reveals patterns about what works and what may need to be revamped when studying Western therapeutic approaches.
My research on projection and projective identification takes on new meaning in China’s rapidly changing society. These defense mechanisms emerge in different ways in Chinese family dynamics and social relationships than they do in Western contexts. Studying these differences reveals how core psychoanalytic concepts can speak to universal human experiences while adapting to specific cultural settings.
As I prepare to become coeditor of Psychoanalysis and Psychotherapy in China, under the leadership of David Scharff, I’m grateful to be drawing on decades of shared experience. David’s guidance since the 1990s has shaped my understanding of how psychoanalytic concepts translate across cultures. The journal will continue exploring one of the questions that matter most to our readers: how effective learning can be, how cultural differences enrich our work, and how research can guide our path forward.
Rebirth: The Development of Psychoanalysis in Modern China
By Karyne Messina
The story of psychoanalysis in China is one of rebirth. For decades, the practice was banned and dismissed as bourgeois thinking. Though a small community of analysts had emerged before Communist rule, their work disappeared from public view until the late 1980s. Only in the last 25 years has psychoanalysis gained real acceptance in China, allowing for a new generation of practitioners to help their fellow citizens.
A key moment came in 2001, when Dr. Elise Snyder spoke at a literary conference in Beijing. Her visit included meetings with academics and clinicians in Chengdu who wanted to learn more about psychoanalytic theory. These connections helped restart serious discussions about psychoanalysis in China.
The sweeping transformation of Chinese society reshaped mental health needs. As extended families gave way to nuclear households and millions moved to cities, traditional support systems weakened. These changes, coupled with intense urban pressures, led to a critical need for mental health services.
In response, training programs emerged through partnerships with the United States, Norway, and Germany. These initiatives had to connect different therapeutic traditions while working across time zones. Through online learning, we made international expertise accessible to Chinese practitioners who could maintain their clinical work while training. This early embrace of remote learning proved prescient: When COVID-19 struck, CAPA-trained practitioners adapted seamlessly to teletherapy, outpacing their US counterparts who were new to remote work.
These social transformations have only intensified China's need for psychological support. Our work there has confirmed a core principle: that good therapy crosses cultural boundaries when practitioners listen and learn from each other. These lessons from China could open doors for mental health care in other underserved regions worldwide.
Courtesy Karnac Books
My Psychoanalytic Journey in China
By David Scharff
My involvement in psychanalysis in China began in 2007, when my wife Jill and I presented at a national psychotherapy congress in Shanghai at the invitation of Professor Shi Qijia. Through Dr. Shi’s introduction to Fang Xin at Peking University, we organized training in couple and family psychoanalytic therapy beginning in 2010, which is now under the auspices of Beijing Zhi-Dao-Zhong-He Medical Institute. The program has grown to include many Western analytic therapists as coteachers, including Janine Wanlass and Jill Scharff.
In 2019, through the International Psychotherapy Institute (which Jill and I founded in 1994), we partnered with Li Zhen and her online mental health platform Jiandanxinli to offer adult psychotherapy and child therapy trainings.
My experiences teaching in China have led to numerous publications, including two books—Psychoanalysis in China (edited with Sverre Varvin, 2014), and Marriage and Family in Modern China (2021a)—along with several scholarly articles supporting the development of psychoanalysis in China.
In 2014, I founded Psychoanalysis and Psychotherapy in China to foster scholarly exchange by featuring articles from this field and others, like art and literature. While we cannot yet circulate the journal in Mandarin (we hope to someday), half the articles are authored by Chinese colleagues. Our partnership with Tongji University, led by Professor Ju Fei, reflects the growing integration of psychoanalytic thinking with Chinese academic psychology and philosophy programs.
Our work exists within a broader framework of psychoanalytic training in China. The China American Psychoanalytic Alliance, along with the Sino-German, Sino-Norwegian and Sino-British programs, has created a robust network of Western-Chinese exchange. While the International Psychoanalytic Association (IPA) maintains traditional requirements for in-person analysis at its centers in Shanghai, Beijing, and Wuhan, programs like CAPA have adapted to China’s unique circumstances. After graduating from our training programs, many of our graduates now pursue formal psychoanalysis through the American Psychoanalytic Association institutes that recognize the necessity and effectiveness of remote analysis for Chinese trainees and practitioners.
The enthusiasm of our Chinese colleagues extends beyond clinical practice into broader academic and cultural domains. Yes, they are endlessly eager to learn from Western teachers, but they are equally passionate about sharing their cultural perspectives on individual and family development with us. They carry the flame for analysis, and this exchange will influence how psychoanalytic concepts translate across cultures.
As an example, this exchange has revealed differences in how maturity is understood. Western psychoanalysis, articulated in its American form, views psychological maturity as the achievement of individual autonomy and moral independence. Chinese culture defines maturity through group relationships and collective identify. A mature person in Chinese society derives their sense of worth and moral structure from their connection to family, colleagues, and broader social groups, rather than from individual independence.
These two approaches to maturity reveal complimentary systems of moral regulation. In Western autonomous morality, guilt serves as the primary emotional regulator, a private dialogue between the individual and his or her conscience. In Chinese group morality, shame and “loss of face” regulate behavior through an internalized sense of how one’s actions affect and are perceived by the group. Both systems involve internal monitoring, but the locus of judgment varies from the self’s own judgment through guilt to the judgment by internal objects in shame.
Other differences extend to ways of describing psychological experience. Chinese thinking leans toward more metaphorical expression, particularly in describing emotional states. In our recent work on “Empty Heart Disease” (Scharff and Scharff, 2024), we explored how Chinese clinicians use richly metaphorical, body-based language to describe a form of existential distress first observed in college students. This approach stands in contrast to Western psychiatry’s more concretize terms like “depression” or “bipolar disorder,” revealing how cultural differences shape how we conceptualize psychological experience.
In the future, the collaboration between Western and Chinese practitioners will only grow. I hope that many of you will enjoy all that we may learn together as we continue to explore psychoanalytic theory and techniques.
CAPA’s Research Findings on Distance Training and Treatment
By Robert Gordon
An obvious fact about China and the United States is that they are distant. This distance can be surmounted in psychoanalytic training, however. In 2013, while I was in Beijing, CAPA founder Elise Snyder asked me to conduct a study to test the effectiveness of CAPA's distance training. With my background in research methods, I knew that laboratory studies isolating variables would lack ecological validity for such complex work. Just as Freud’s case studies gave us psychology’s richest theoretical framework, we needed a method that could capture the full complexity of psychoanalytic training. There is no ideal research design, only the best designs for the task.
I explained to Elise that using a large purposive sample of experts would give us the best external validity. Following that conversation, in 2014, at her request, I embarked on the first research project on psychodynamic distance training and treatment. The survey sample was of 176 CAPA teachers, supervisors and treaters who were mostly new to internet technology and distance work. Nevertheless, our experts felt that distance teaching, supervising, and treating were only “slightly less effective” than local work. The highest-rated indications for distance treatment were “to offer high-quality treatment to underserved or remote patients” and “when the patient is housebound, or travel would be impractical.” The highest rated contraindication for distance treatment was “patient needs close observation due to crisis or decompensation.” At this time, about 60 percent of the therapists rated distance treatment to CAPA students as similar to local work. This would change drastically after COVID, when 89 percent of treaters found it as effective as in-office treatment.
The next logical step was to survey CAPA’s consumers of distance training and treatment. Our consumers were not ordinary patients but highly insightful psychodynamic therapists in either the two-year or four-year CAPA program, all in psychoanalytic treatment themselves. Among the 90 CAPA graduates surveyed, we found that
the more years of CAPA training and treatment, the more our graduates used psychoanalytic formulations in their work;
distance treatment proved valuable both personally and professionally; and
therapist variables (warmth, wisdom, empathy, and skillfulness) were rated as being significantly more important than treatment modality or cultural differences.
Overall, our Chinese therapist-consumers were more positive about distance training and treatment than were CAPA trainers and treaters.
When the COVID-19 pandemic began, most practitioners worldwide had to turn to teletherapy out of necessity. In 2020, we compared our survey results from 164 CAPA practitioners with 165 US practitioners (matched for age) who had treated patients remotely. CAPA practitioners reported more positive experiences with teletherapy and showed greater preparedness for remote work during the pandemic than their US counterparts who had no involvement with CAPA.
Our 2021 international study surveyed 1,490 practitioners from 56 countries who had shifted to teletherapy. We asked them to rank six factors in psychodynamic treatment: use of couch, session modality, cultural similarity, session frequency, patient factors (motivation, insightfulness, and high functioning) and therapist factors (empathy, warmth, wisdom, and skillfulness). As predicted, therapist and patient variables tied as most important, outranking all other factors including whether the therapy was in person or by remote methods.
A small group (17 percent) reported negative experiences, citing concerns about therapeutic effectiveness. They also expressed discomfort with both the technology and the absence of in-person contact.
These studies reveal a clear trajectory about the acceptance of distance treatment. What began as a necessary innovation for reaching Chinese practitioners has evolved into a validated psychoanalytic training and treatment method. CAPA's early adoption of distance work served its original mission in China and positioned its practitioners to lead others during a global shift to remote practice.
Learning Across Boundaries
The evolution of psychoanalysis in China reveals the significant adaptability of mental health care across cultures. Through research-backed innovation and technical solutions, CAPA has shown how geographic and political distances can strengthen therapeutic work. This model of collaborative learning, where practitioners share knowledge while honoring local traditions, offers hope for expanding mental health care around the globe. Such cross-cultural exchanges will no doubt continue to shape the future of psychoanalysis.
Karyne E. Messina, EdD, FABP, is a supervising and training analyst at the Washington Baltimore Center for Psychoanalysis, CAPA board member, and editor of the CAPA Newsletter. She serves on APsA’s Council on Artificial Intelligence and chairs its scholarship and writing section.
David E. Scharff, MD, FABP, is cofounder of the International Psychotherapy Institute, clinical professor of psychiatry at Georgetown University, and founder/editor of Psychoanalysis and Psychotherapy in China. He chairs the IPA's Committee on Couple and Family Psychoanalysis.
Robert M. Gordon, PhD, ABPP, is a diplomate in clinical psychology and psychoanalysis, honorary member of the American Psychoanalytic Association, and Psychodynamic Diagnostic Manual 2 (PDM-2) editor. He has published extensively on psychodynamic assessment, diagnosis, and distance training effectiveness.
Published June 2025