CLINICAL OBSERVATIONS OF A CANTONESE COGNITIVE– BEHAVIORAL TREATMENT PROGRAM FOR CHINESE IMMIGRANTS EDWARD K. SHEN AND LYNN E. ALDEN University of British Columbia INGRID SO ¨ CHTING AND PHOEBE TSANG The Richmond Hospital In this article, the authors describe our clinical observations about the process of delivering a Cantonese-language cognitive– behavioral therapy program to treat depression in Hong Kong immi- grants to Vancouver, Canada. Our ex- periences indicated that standard refer- ral and assessment procedures were not optimal for this population. Other fac- tors that required consideration were how to convert Cantonese terms for dysphoric affect into English equiva- lents and how to implement cognitive modification strategies when dealing with culture-syntonic beliefs about so- cial relationships. Keywords: culture, cognitive– behavioral treatment, Cantonese immi- grants, depression Asian Americans are the most rapidly expand- ing of all ethnic groups in the United States, with a growth rate of 63% between 1990 and 2000 (U.S. Census Bureau, 2006). Within the U.S. Asian immigrant population, the largest subgroup is of Chinese heritage. A similar pattern emerges in Canada. Canadian census statistics indicate that 58% of Canadian immigrants come from Asian countries, with Chinese as the largest sub- group. One third of that subgroup report speaking a Chinese dialect at home, and a substantial mi- nority describe themselves as unable to conduct a conversation in English or French, the official languages of Canada (Statistics Canada, 2003). Interestingly, although census respondents are permitted to identify themselves with multiple ethnic groups, 90% of Chinese identified them- selves only as Chinese. In contrast, only 8% of Americans living in Canada identified themselves solely as American, whereas the remainder la- beled themselves as Scottish, Irish, and so forth. Thus, not only is there a visible presence of Chinese people in North America, they are also extremely loyal to their ethnic and cultural iden- tity. These statistics point to the need to develop mental health services that are effective for, and acceptable to, Chinese North Americans. The need for culturally appropriate psychological ser- vices is particularly acute in large West-coast metropolitan areas that have sizable concentra- tions of Chinese immigrants. In this article, we describe our experiences with a Cantonese-language cognitive– behavioral therapy (CBT) program developed to treat de- pression in Chinese immigrants to Vancouver, Canada, a city with a substantial Chinese immi- grant population. We begin the article with a discussion of the rationale for program develop- ment, followed by a description of the treatment format and regimen. We then consider culture- related differences in treating our Cantonese par- ticipants relative to their Euro-North American counterparts who attended an English-language version of the program. In particular, we discuss the complexities of establishing lines of referral, conducting assessment and diagnosis, and modi- fying treatment content and process to better ac- commodate this population. We briefly discuss treatment efficacy, although readers should note that full treatment outcome data are presented Edward K. Shen and Lynn E. Alden, Department of Psy- chology, University of British Columbia; Ingrid So¨chting and Phoebe Tsang, Mental Health Outpatient Services, The Rich- mond Hospital. Correspondence concerning this article should be ad- dressed to Lynn E. Alden, Department of Psychology, Uni- versity of British Columbia, Vancouver, BC Canada V6T 1Z4. E-mail: lalden@psych.ubc.ca Psychotherapy: Theory, Research, Practice, Training Copyright 2006 by the American Psychological Association 2006, Vol. 43, No. 4, 518 –530 0033-3204/06/$12.00 DOI: 10.1037/0033-3204.43.4.518 518