Therapy Via Text: In Rural China, a New Outlet for Troubled Teens
15 Sep, 2021  |  Source:Sixth Tone  |  Hits:2032

Even by China’s standards, Hechuan is considered small: it takes just 20 minutes to drive across the town, and its population is less than 100,000. Mountains fence the town in on three sides, and its only link to the outside world is a long, narrow corridor to the north.

With no high-speed rail, or even regular trains, people here rely either on buses or their own cars — it was connected to a highway only a few years ago.

And just like most small towns across the country, it’s easy to see that education is paramount for the community. Within Hechuan’s area of just under 50 square kilometers are nine primary schools, six middle schools, and one vocational institute. But for further studies, the choice is limited.

The closest city, Ji’an, is more than 100 km away and has just one university; the best in the province, Nanchang University, is at least three times as far. This is possibly why the town’s parents rarely hesitate to impose lofty expectations on their children, firm in the belief that only education can change one’s destiny.

But when the stress takes its toll on students, desperate parents send their “bad kids” for mental health counseling. Shu Huai says parents primarily hope therapy will help their children become “good” and dutifully return to their studies, rather than caring about their psychological well-being.

The county itself was officially declared poverty-free in 2018, and Hechuan is considered its most prosperous town. But according to Shu, left-behind children — kids of migrant workers left with relatives — in the county account for around 30% of the town’s students. And among the children who come to her for counseling, the share is closer to 60%.

Shu says that due to low income levels in the county, some parents often accept contractual work in Guangdong, Jiangsu, or Zhejiang provinces to make ends meet. The moment the first child no longer needs nursing, parents leave to work in the city, only returning two years later to have a second child. Then, they go out to work again, leaving both children with elderly relatives.

“The third grade is generally when children begin to cultivate basic learning and living habits — but, in the absence of parental guidance, these children often lack confidence,” says Shu.

“When they reach middle school, their problems bubble to the surface: the boys fight, skip classes to play games in internet cafés, and form little gangs. Meanwhile, the girls are often distracted from academics, choosing to spend more time instead on their physical appearance and social relationships.”

By this time, she says, such students completely exceed the control of their grandparents. Even if the parents come back home to discipline them, it rarely helps — their methods are often limited to beating and scolding the children.

A view of the playground of a high school in Hechuan Town, Jiangxi province, 2020. From 掌上永新 on WeChat

A view of the playground of a high school in Hechuan Town, Jiangxi province, 2020. From 掌上永新 on WeChat

Ripples in the Pond

When Shu Huai obtained her certificate, mental health counseling was virtually nonexistent in Hechuan.

In-person consultation resources are still extremely scarce in the region: there are no psychiatric hospitals in the town and very few clinics offering psychological counseling in regular hospitals, let alone private psychologists.

Most residents turn pale at the mere mention of the phrase “mental health”; if someone in the family develops psychological issues, however minor, no one dares speak out about it until they absolutely have no choice. Most believe the tiniest bit of “gossip” will quickly spread across the entire county.

For those in need of therapy, the first step to finding a counselor near them is an internet search. They contact Shu Huai through the details mentioned on her website and public WeChat account, progressing to confide in her later through instant messages and phone calls.

After making contact online, patients often make appointments to meet Shu in person. Most who request such offline meetings are uneducated parents worried about their children’s progress at school. “Maybe it’s because people in small towns only feel like they can trust you if they see you in person,” says Shu.

She’s discovered that around two-thirds of her patients believe mental health counseling is a last resort. Seeking her out online and deciding to give her services a go takes great courage, she says.

Shu once received a call from a man who worked in the city as a plasterer, who said his daughter back in his rural hometown had serious psychological problems. He asked Shu when she would be free, hoping she’d help his daughter.

It was only when they met that Shu realized the man had decided to call because his daughter’s situation was so out of control that he felt he had nothing to lose.

Consultations conducted purely online are a little more complicated. Shu recalls being contacted by someone who’d been urged to see her by his father. The young man had seriously limited social skills and was paranoid about always being watched.

Visual elements from LaVika/VectorStock, reedited by Sixth Tone

Visual elements from LaVika/VectorStock, reedited by Sixth Tone

When he walked alone, he often had hallucinations that he was being chased and was terrified of being assaulted. Though he lived in Hechuan, Shu was unable to see him in person and could only communicate with him via text on WeChat. When Shu urged him to talk, he was totally uncooperative.

Despite Shu’s best efforts to earn his trust, he only sent her a total of around 15 messages, most of them monosyllabic like “oh,” “okay,” or “alright.”

About this experience, Shu says: “It’s really sad, but there’s nothing you can do.” Fortunately, since then, the young man has looked back over the messages she sent him, and has reported feeling better.

Weiwei believes that in-person consultations help counselors better evaluate a patient’s personality and problems by observing their appearance, clothing, expressions, and mental state. It’s also easier for counselors to adjust their approach when they can see the patient’s reactions to questions in real-time.

But in online consultations, Weiwei can’t be sure whether the patient really trusts her or how truthful they’re being. Through text-only conversations in particular, she can’t even accurately judge the patient’s tone or know how her own tone is received. This creates serious communication barriers, she says.

Though Weiwei has only offered her services for a short time and hasn’t taken on many cases, she still insists on answering questions visitors leave on her platform.

Though she can’t divine the psychological problems of the people around her, on the internet, Weiwei has discovered that ostensibly functional members of society may force a smile as they endure huge psychological burdens.

“Sometimes I feel that this small town is like a closed lake; unless there’s a huge disruption, you don’t see any waves on the surface,” says Weiwei.

“It’s only when people discover that someone in their family has a serious psychological problem, or when they hear a news story, for example, about a child jumping off a building, that they pay any attention to mental health. After all, people are more likely to care about things related to themselves. Even if they sometimes see one or two messages on their phones about mental health, it doesn’t leave a lasting impression unless the person is directly affected.”

But the last few years have witnessed much change. With the internet’s capacity to bring people together, Hechuan’s residents have at least one vital outlet for their hidden problems.

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