Mrs. Chang, a middle-aged Chinese-American woman, tells her American physician that she thinks she has heart disease. Her symptoms include breathlessness, fatigue, and trembling. After a complete physical, Mrs. Chang's doctor tells her that her heart is fine but that he thinks she may be suffering from feelings of anxiety and depression, and he refers her to a psychologist. One barrier that Mrs. Chang may face in Western-style psychotherapy is that she may:

Question

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The description of Mrs. Chang's symptoms suggests that she may be experiencing somatic symptoms of anxiety and depression rather than actual heart disease. Furthermore, her cultural background and beliefs may lead her to view negative emotions and thoughts as something that should be suppressed or hidden rather than explored and discussed openly in therapy. This may create a barrier to effective treatment if Mrs. Chang is resistant to discussing intimate feelings with a therapist who is a stranger.

Mrs Chang, a Middle-Aged Chinese-American Woman, Tells Her American Physician