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Guide XI-004

Vietnamese traditional medicine (thuốc Nam, thuốc Bắc)

Tuệ Tĩnh, Lê Hữu Trác (Hải Thượng Lãn Ông)1300Vietnam
A 37 · L 53 · M 1014 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Vietnamese traditional medicine (y học cổ truyền, YHCT) as Vietnam's Ministry of Health (Bộ Y tế) regulates it under Thông tư 02/2024/TT-BYT (12 March 2024; consolidated text including amendments by Thông tư 49/2025/TT-BYT), with the Ministry's traditional-medicine examination and diagnosis procedures; the psychotherapist's work alongside it follows the DSM-5-TR Cultural Formulation Interview (CFI) and its Supplementary Modules.

Vietnamese traditional medicine is a codified, state-recognised medical system, not a psychotherapy. Vietnamese sources describe it as an official form of medicine in Vietnam, taught in universities and used in hospitals alongside modern medicine ("thuốc Tây") [source: Oda 2008; Hello Bacsi 2022]. It has two strands that Vietnamese usage often treats together as traditional or national medicine [source: Oda 2008]:

  • Thuốc Nam ("southern medicine"): remedies developed in Vietnam from local plants and passed down through generations [source: Hello Bacsi 2022]. It is associated with the physician-monk Tuệ Tĩnh (Nguyễn Bá Tĩnh, born 1330; death date not recorded in the source), author of Nam dược thần hiệu and Hồng nghĩa giác tư y thư, remembered for the principle "Thuốc Nam chữa người Nam" (Southern medicine for Southern people) [source: Báo Lào Cai]. The Sino-Vietnamese form "Nam dược trị Nam nhân" is widely quoted [uncertain: not verified]. One account links the emergence of thuốc Nam in the 14th century to resistance to Chinese power, while noting that in practice thuốc Nam and thuốc Bắc are very close [source: Oda 2008].
  • Thuốc Bắc ("northern medicine"): Chinese-derived medicine adapted for Vietnamese patients [source: Hello Bacsi 2022; Oda 2008]. Lê Hữu Trác, known as Hải Thượng Lãn Ông (1724–1791), honoured as "Đại y tôn Việt Nam", wrote Hải Thượng y tông tâm lĩnh, a multi-volume encyclopaedia of traditional medicine that includes medical ethics (đạo đức y học), and is described as adapting outside knowledge to Vietnamese conditions [source: Báo Lào Cai].

Core idea of how change happens, as the system holds it: illness reflects imbalance (âm–dương, the five phases or ngũ hành, organs and channels), and treatment aims to restore balance so that function, including sleep and mood, recovers [source: Hello Bacsi 2022; Long Châu 2026]. These concepts are the system's own; they are described here, not asserted as physiology.

The psychotherapist does not practise YHCT. This guide covers what the system is, who is authorised to practise it, and the psychotherapist's own culturally responsive work with clients who use it.

2. Framework

2a. The system as official sources describe it

  • Theory: âm–dương and ngũ hành as the foundation; organs (tạng phủ), channels (kinh lạc/kinh mạch) and acupoints (huyệt); treatment aims to rebalance âm and dương [source: Hello Bacsi 2022; Ministry procedures].
  • Diagnosis: the four examinations (tứ chẩn): vọng (inspection), văn (listening and smelling), vấn (questioning), thiết (palpation, including pulse). Findings are organised by the eight principles (bát cương: including hư/thực deficiency/excess and hàn/nhiệt cold/heat), organ patterns, channel patterns, cause and disease name, then "biện chứng luận trị" (pattern differentiation leading to a treatment method) [source: Ministry procedures]. A Vietnamese consumer health source recommends combining these with modern investigations [source: Hello Bacsi 2022].
  • Therapies: herbal medicines (thuốc Nam, thuốc Bắc), acupuncture (châm cứu), massage and acupressure (xoa bóp), thread embedding (cấy chỉ) for some neurological and musculoskeletal conditions in Ministry procedures, and lifestyle and mental care [source: Ministry procedures; Hello Bacsi 2022; Long Châu 2026]. Coining (cạo gió) is a widely used home and folk practice among Vietnamese, Cambodian and Laotian people [source: Lam et al. 2016]. This guide gives no formulas, doses, point locations or techniques.
  • Mental-health concepts within the system (attributed): YHCT sources describe insomnia (thất miên) as a sign of deeper imbalance among organs, qi and blood and mind, with patterns such as tâm tỳ hư (heart–spleen weakness with fatigue and overthinking), can khí uất (constrained liver qi with emotional pressure) and âm hư hỏa vượng (deficiency with internal heat) [source: Long Châu 2026]. A review of depression in Vietnam reports that distress is often described through vital energy, hot/cold and wind concepts; that the nearest everyday term to depression was uất ức (pent-up grievance linked to situations that cannot be openly challenged); that neurasthenia (suy nhược thần kinh) may serve as a less stigmatising label for depression; and that traditional medicine is used for neurasthenia and dissociative disorders but generally not for psychosis, personality disorders or suicidal thoughts [source: Niemi et al. 2013].

2b. Who may practise, and how they are recognised (Vietnam)

Under Thông tư 02/2024/TT-BYT [source: Thông tư 02/2024/TT-BYT, consolidated]:

  • Lương y (traditional practitioner) certificates are issued to defined groups, including holders of earlier Central Oriental Medicine Association (Trung ương Hội Đông y) certificates, people with 30 or more years of practice at a lawful facility, and those who pass a written and case-based practical examination. Certificates for some groups are issued by the Director of the Ministry's Traditional Medicine and Pharmacy Administration (Cục Quản lý Y, Dược cổ truyền); others by the provincial health authority.
  • Người có bài thuốc gia truyền (holder of a family-inherited remedy) and người có phương pháp chữa bệnh gia truyền (holder of a family-inherited treatment method) receive certificates from the provincial health authority after review by an appraisal council; applications require acute and subacute toxicity testing of the remedy, and certificates can be revoked if the remedy or method is found unsafe or ineffective.
  • Combining traditional and modern treatment is limited to doctors and assistant doctors (bác sĩ, y sỹ) within their licensed scope, and to facilities within their licence; it must follow approved technical procedures and suit the patient's condition. Lương y are not among those named as authorised to combine methods.
  • Outside Vietnam, Vietnamese practitioners may work under local acupuncture or Chinese medicine registration where it exists, or without any regulation [uncertain: not verified]. Check the local regulator in each case.

2c. Evidence and safety status (brief)

  • A clinical-pharmacy review describes Vietnamese traditional medicine as largely not evidence-based from a clinical standpoint, with laboratory research supporting the traditional use of many herbs, and stresses that safe use requires knowledge of adverse reactions and herb–drug interactions [source: Expert Rev Clin Pharmacol abstract].
  • Vietnam's National Institute for Drug Control (Viện Kiểm nghiệm thuốc Trung ương) reported in 2016 that some herbal (đông dược) products were adulterated with undeclared modern drugs, including paracetamol, corticosteroids, glibenclamide, metformin and sildenafil, sometimes three or four in one product [source: Thanh Tra 2016].
  • Coining can leave petechiae, ecchymoses and mild burns [source: Lam et al. 2016].

2d. The psychotherapist's framework alongside YHCT [synthesis]

No manual sets phases or session counts for this work. A workable sequence, built on the CFI's structure:

  1. Engagement and cultural assessment (sessions 1–2): CFI core interview, with the Explanatory Model and Coping and Help-Seeking modules. Move on when you can state the client's own name for the problem, their causal model and every source of help they use.
  2. Coordination and safety (from session 1–3, ongoing): with consent, record all traditional products and treatments and route them to the prescriber or pharmacist; with consent, contact the traditional practitioner if the client wishes. Move on when no unaddressed safety issue remains (interaction questions handed to the prescriber, no urgent condition left untreated).
  3. Integrated therapy (main phase, length set by the psychotherapy model you use): treatment goals phrased in the client's terms; traditional care treated as part of the client's coping, not a rival.
  4. Review and ending: revisit the explanatory model; agree how the client will use each kind of help afterwards.

3. Guiding principles

  • YHCT is a legitimate, regulated system in Vietnam [source: Oda 2008; Thông tư 02/2024/TT-BYT]. Practical meaning: speak of it as medicine the client has every right to use, never as superstition.
  • You work alongside, not within, the system [synthesis]. Practical meaning: never diagnose YHCT patterns, recommend herbs, acupuncture or coining, or interpret pulse or tongue findings.
  • Authority sits with recognised practitioners and regulators [source: Thông tư 02/2024/TT-BYT]. Practical meaning: when coordinating, ask what qualification the practitioner holds (bác sĩ YHCT, y sỹ, lương y, certified family-remedy holder, or local registration abroad).
  • Body and mind are not sharply separated in the client's frame [source: Niemi et al. 2013]. Practical meaning: accept somatic language (headache, dizziness, insomnia, weakness, "nerves") as the doorway to emotional work rather than pushing for psychological vocabulary.
  • Labels carry stigma differently [source: Niemi et al. 2013]. Practical meaning: use the client's preferred term (e.g. suy nhược thần kinh) in conversation while documenting your own diagnosis accurately.
  • Family is central [source: Niemi et al. 2013]. Practical meaning: ask early whom the client wants involved; individual-only therapy may feel strange.
  • Medicines decisions belong to the prescriber [synthesis]. Practical meaning: never advise starting, stopping or changing any herbal or modern medicine; pass interaction and adulteration questions to the prescriber or pharmacist.
  • Safety overrides preference [synthesis]. Practical meaning: psychosis, suicidality, mania or serious physical illness need urgent conventional assessment even if the client prefers traditional care; one review notes that traditional medicine is generally not used for psychosis or suicidal thoughts [source: Niemi et al. 2013].
  • Cultural marks are not automatically abuse, and abuse is not excused by culture [source: Lam et al. 2016; synthesis]. Practical meaning: take a careful history of any marks; apply the usual red flags.
  • Consent and confidentiality govern every contact with healers [synthesis]. Practical meaning: written consent naming the practitioner and what will be shared, before any contact.
  • Humility about your own frame [source: CFI Patient–Clinician Relationship module]. Practical meaning: notice when you are ranking explanations and ask how the client experiences the difference between you.

4. Intervention inventory

All interventions below are the psychotherapist's own. None involves performing, prescribing or recommending a YHCT treatment. Example language is illustrative unless quoted. The CFI may be reproduced by clinicians for use with their own patients; it may not be modified without American Psychiatric Association permission, and translations need an APA request [source: APA CFI]. Its items are paraphrased, not reproduced, here.

4.1 Cultural self-examination before and during the work

  • Purpose / when: before the first session with a client who uses thuốc Nam, thuốc Bắc or other traditional care, and whenever you notice irritation, fascination or dismissiveness [source: CFI Patient–Clinician Relationship module; synthesis].
  • Steps: (1) Write down what you assume about herbal medicine, acupuncture and coining, and where those assumptions came from. (2) Note any reflex to rank modern medicine above the client's frame. (3) Note your knowledge gaps (e.g. thuốc Nam vs thuốc Bắc, practitioner titles). (4) After sessions, review moments when you corrected or redirected the client's explanation. (5) Take recurring reactions to supervision [synthesis].
  • Example language (to yourself or in supervision, illustrative): "When she said the herbs were cooling her liver, I changed the subject. What was I protecting?"
  • Watch for: curiosity that turns the client into a cultural informant for your benefit; over-identifying with the tradition and losing your clinical role. It is working when you can hold the client's model and your formulation side by side without pushing either.

4.2 CFI core interview

  • Purpose / when: at intake or when cultural factors seem to shape the problem or the help sought. Sixteen core questions in four parts: cultural definition of the problem; perceptions of cause, context and support (including the role of cultural identity); self-coping and past help seeking; current help seeking, including the clinician–patient relationship [source: APA CFI]. It informs, but is not the sole basis for, diagnosis [source: APA CFI].
  • Steps: (1) Introduce it as a way to understand the client's own view. (2) Ask, in your own words, how the client and family name the problem and what troubles them most. (3) Ask what they think caused it and what others around them think. (4) Ask what makes it better or worse and how their background helps or hinders. (5) Ask what they have done themselves and every kind of help tried, explicitly including folk, traditional, religious and alternative healing, and which helped. (6) Ask about barriers (cost, stigma, language). (7) Ask what help they want now and any worries about you or the service [source: APA CFI].
  • Example language (illustrative): "People in your family may have their own name for this. What do you call it?" "Many people see a lương y, use thuốc Nam or thuốc Bắc, have acupuncture, or go to the pagoda. Have you tried any of these? What did they tell you?"
  • Watch for: brief, guarded answers about traditional care (fear of disapproval); answers that change once family are present. It is working when the client volunteers names, causes and remedies in their own terms.

4.3 Explanatory Model module, tuned to YHCT concepts

  • Purpose / when: when the client frames distress in YHCT terms (imbalance, heat/cold, wind, weak nerves, organ weakness) [source: CFI Supplementary Modules; Niemi et al. 2013]. The module clarifies the client's understanding of cause, mechanism and the experiences that shaped it [source: CFI Supplementary Modules]. Kleinman's explanatory-model questions come from Kleinman, Eisenberg and Good (1978) [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]; that the approach builds on them is [uncertain].
  • Steps: (1) Ask what the client calls the problem (e.g. suy nhược thần kinh, uất ức, mất ngủ, "nerves"). (2) Ask what they understand is happening in the body (e.g. what a practitioner said about heat, weakness or qi). (3) Ask why now, and what they fear it could lead to. (4) Ask what treatment they expect and from whom. (5) Reflect the model back in the client's words. (6) Offer your own understanding as an additional view, and ask how the two fit [source: CFI Supplementary Modules; synthesis for steps 5–6].
  • Example language (illustrative): "You said the thầy thuốc told you your body is too hot inside and that is why you can't sleep. What does that feel like for you? … I also notice the sleeplessness started after the move. Could both be part of the picture?"
  • Watch for: do not translate the client's concept into a psychiatric label and treat the matter as settled; do not "correct" it either. It is working when the client can hold the bodily account and the emotional or social account together and agree a goal that respects both.

4.4 Inventory of traditional treatments and routing to the prescriber

  • Purpose / when: at intake and at every medication change. A clinical-pharmacy review stresses herb–drug interactions and adverse reactions [source: Expert Rev Clin Pharmacol abstract]; some đông dược products have contained undeclared corticosteroids, glibenclamide, metformin, paracetamol or sildenafil [source: Thanh Tra 2016]; a Vietnamese consumer source advises asking a doctor before combining traditional and Western medicine [source: Hello Bacsi 2022].
  • Steps: (1) Ask, without judgement, about every herbal product (thuốc Nam, thuốc Bắc, packaged đông dược, products sent from Vietnam, family remedies), acupuncture, massage, coining and other treatments. (2) Record names as the client gives them, the source (licensed facility, market, relative, online) and who recommended them. (3) Ask whether the prescriber knows. (4) With consent, inform the prescriber or pharmacist and ask the client to take the products or packaging to them. (5) Do not comment on whether to continue, stop or change anything; say that is the prescriber's decision. (6) Revisit at each review [synthesis].
  • Example language (illustrative): "I'm not the person to advise on medicines, herbal or otherwise, but your doctor needs the full picture so everything is safe together. Would you be willing to bring the packets to your next appointment, or let me tell Dr … what you're taking?"
  • Watch for: unexplained new symptoms after starting a product (e.g. weight gain, facial swelling, low blood sugar, sedation) and products of unknown origin; refer for medical review rather than interpreting yourself [synthesis]. Working when the prescriber has an accurate list and the client feels no need to hide products.

4.5 Working with somatic idioms and the neurasthenia label

  • Purpose / when: when the client presents with headache, dizziness, insomnia, epigastric discomfort, aches or "weak nerves" rather than emotional complaints [source: Niemi et al. 2013].
  • Steps: (1) Take somatic symptoms seriously and check that medical assessment has been done. (2) Ask about the life context of each symptom (when it started, what was happening in the family, at work). (3) Ask whether the client or family uses a term such as suy nhược thần kinh, and what it means to them. (4) Use their term in conversation; screen for depression and anxiety using somatic as well as mood questions. (5) Introduce emotional vocabulary gradually, linked to the bodily experience. (6) Document your diagnosis accurately while explaining it in terms the client accepts [source: Niemi et al. 2013 for steps 1–4 context; synthesis for the sequence].
  • Example language (illustrative): "Your family calls this weak nerves. When the nerves are worst, what else is going on in your life?" "Sometimes heavy feelings that can't be said out loud show up in the body. Does that fit for you at all?"
  • Watch for: missing depression because the client denies sadness; pushing a psychiatric label that triggers shame. The review notes lower validated screening cut-offs in Vietnam than in many settings, and that the Vietnamese Depression Scale had not been validated there [source: Niemi et al. 2013]; interpret scores cautiously. Working when the client starts naming feelings or social stressors alongside symptoms.

4.6 Supporting the client's own YHCT self-care within therapy goals

  • Purpose / when: when the client already follows lifestyle advice from a YHCT practitioner (e.g. regular sleep times, less stimulation before bed, emotional relaxation, which YHCT sources describe for insomnia) [source: Long Châu 2026].
  • Steps: (1) Ask what the practitioner advised beyond medicines. (2) Identify overlaps with your own plan (sleep routines, relaxation, reducing rumination). (3) Frame your techniques as compatible where they genuinely are. (4) Leave herbal, acupuncture or massage decisions to the practitioner and prescriber [synthesis].
  • Example language (illustrative): "Your lương y suggested going to bed at the same time and calming the mind before sleep. That fits well with what we were planning. Shall we build on it?"
  • Watch for: do not borrow YHCT concepts to explain your own techniques (e.g. claiming a breathing exercise "balances âm and dương"); that misrepresents both. Working when the plans reinforce each other and the client reports no conflicting instructions.

4.7 Coordinating with a YHCT practitioner

  • Purpose / when: when the client wants their therapist and traditional practitioner to share information, or when safety requires it [synthesis].
  • Steps: (1) Ask the client whether they want contact, and what they want shared and withheld. (2) Ask the practitioner's title and qualification (in Vietnam: bác sĩ YHCT, y sỹ, lương y with certificate, certified family-remedy or method holder, or a hospital YHCT department [source: Thông tư 02/2024/TT-BYT]; abroad: check the local regulator). (3) Obtain written consent naming the practitioner. (4) Introduce yourself as the psychotherapist, share only agreed information, and ask how they understand the client's condition. (5) Agree who watches for what (e.g. you for mood and risk; the prescriber for drug safety). (6) Feed back to the client [synthesis].
  • Example language (to the practitioner, illustrative): "I'm seeing Mr … for low mood and sleep problems, with his consent. He values your treatment. I'd like us to know what each of us is doing so his care fits together."
  • Watch for: practitioners claiming to treat psychosis, suicidality or serious physical disease without medical input; requests to stop prescribed medication. Respond by involving the prescriber and, where needed, regulators. Working when the client experiences one coherent plan.

4.8 Coining and other marks: assessment without misreading

  • Purpose / when: when you see linear petechial or bruise-like streaks on the back, neck or chest, or the client mentions cạo gió for a cold, nausea or "wind" [source: Lam et al. 2016].
  • Steps: (1) Ask neutrally what the marks are and who did them. (2) If the explanation fits (coining in a fishbone pattern along spine and ribs, used for cough, nausea or viral illness [source: Lam et al. 2016]), note it without alarm. (3) For a child, apply the standard red flags: explanation that does not fit the injuries, a history that changes, injuries in multiple areas or at different stages of healing, delay in seeking care [source: Lam et al. 2016]. (4) If any red flag is present, follow your safeguarding procedure as for any other injury. (5) Check whether a medical condition behind the coining (e.g. fever, persistent vomiting) has been assessed [synthesis].
  • Example language (illustrative): "I noticed some marks on your son's neck. Many families use cạo gió when a child is unwell. Is that what happened? How has he been since?"
  • Watch for: either error: filing a report on a typical coining pattern alone, or accepting "tradition" as an explanation for injuries that do not fit. Burns are a reported complication [source: Lam et al. 2016]. Never name minors in notes beyond what your record-keeping rules require.

4.9 Family involvement

  • Purpose / when: when family members guide treatment choices, supply remedies, or are part of the stress (e.g. in-law conflict, a spouse's drinking or affairs, coercive control, which the review links to depression risk) [source: Niemi et al. 2013].
  • Steps: (1) Ask early whom the client wants involved (CFI Social Network and Caregivers modules) [source: CFI Supplementary Modules]. (2) Meet family with the client's consent, and ask their explanatory model and what they have tried. (3) Acknowledge family care (rest, special foods were linked with reduced distress) [source: Niemi et al. 2013]. (4) Keep some individual time to ask about coercion, violence or pressure [synthesis]. (5) Agree roles in supporting the plan.
  • Example language (illustrative): "Your mother has been preparing thuốc for you. It's clear she cares a lot. Would you like her to join a session so we can all understand what's happening?"
  • Watch for: family pressure to keep problems hidden, or traditional remedies used to override the client's wishes; domestic abuse disclosed only in individual time. Working when family understanding aligns with the plan and the client still has a private voice.

4.10 Spirituality, Religion and Moral Traditions module

  • Purpose / when: Vietnamese clients' understanding of distress is shaped by Confucian, Buddhist and Taoist traditions; help seeking can include spiritual blessing, sorcery and Buddhist practice at pagodas, where Pure Land Buddhism emphasises prayer and almsgiving more than meditation [source: Niemi et al. 2013]. Use the module when these appear in the client's account [source: CFI Supplementary Modules].
  • Steps: (1) Ask how faith and moral traditions shape daily life and coping. (2) Ask whether they have caused conflict or distress (e.g. shame, karma-related guilt as the client frames it [uncertain: not verified as a common theme]). (3) Ask which religious or spiritual helpers the client uses and what they advised. (4) Describe spiritual concepts as the client holds them, neither confirming nor dismissing them. (5) Note practices that support coping and include them in the plan if the client wishes [source: CFI Supplementary Modules; synthesis for steps 4–5].
  • Example language (illustrative): "Some people find going to the pagoda or praying helps them through hard times. Is that part of your life? Has it helped with this, or made anything harder?"
  • Watch for: spiritual explanations used to block urgent care, or advice from a spiritual helper that conflicts with safety. Working when the client's spiritual resources are named and used and conflicts are discussed openly.

4.11 Distinguishing culturally framed distress from conditions needing urgent care

  • Purpose / when: throughout, and especially when symptoms suggest psychosis, mania, severe depression, suicidality, dissociation or serious physical illness. Traditional medicine in Vietnam is reported to be used for neurasthenia and dissociative disorders but generally not for psychosis, personality disorders or suicidal thoughts [source: Niemi et al. 2013].
  • Steps: (1) Separate the idiom (e.g. heat, wind, weak nerves) from the severity of the underlying state. (2) Assess risk using standard practice, asking directly about suicidal thoughts in language the client accepts. (3) Where meaning is unclear, consult a cultural broker or the client's family, with consent. (4) If urgent care is needed, explain it in terms compatible with the client's model and arrange it; do not wait for traditional treatment to "work first". (5) Document the reasoning [synthesis].
  • Example language (illustrative): "I respect the treatment you're having with the lương y. What you're telling me about wanting to die worries me, and that needs a doctor's help today as well. Can we arrange that together?"
  • Watch for: both pathologising culturally normal idioms and missing illness behind them; physical symptoms (fever, weight loss, chest pain) treated only by traditional remedies. Working when risk is assessed, urgent needs are met, and the client keeps their traditional care if they wish.

4.12 Migration, ageing and life-stage context

  • Purpose / when: for migrants and refugees, older adults and young people in Vietnamese families, using the Immigrants and Refugees, Older Adults and School-Age Children and Adolescents modules [source: CFI Supplementary Modules].
  • Steps: (1) Take a migration history: losses, separation, resettlement problems, and how they link to the current problem and access to help. (2) For older adults, explore views of ageing, co-occurring illness and multiple medicines (traditional and modern), and the support available. (3) For young people, explore mismatches between home, school and peer expectations, including differing views of traditional medicine across generations. (4) Note where traditional remedies are a link to home and family [source: CFI Supplementary Modules for 1–3; synthesis for 4].
  • Example language (illustrative): "Do you still get thuốc sent from Việt Nam? What does it mean to you to have it?"
  • Watch for: products imported informally with no labelling (route to the prescriber, see 4.4); intergenerational conflict over treatment; trauma histories surfacing. Working when the migration story is part of the formulation and practical barriers are addressed.

4.13 Interpreters and cultural brokers

  • Purpose / when: when the client's preferred language is Vietnamese or another language, or when YHCT terms need careful rendering; lack of culturally or linguistically appropriate services is a barrier the CFI asks about [source: APA CFI].
  • Steps: (1) Use a trained interpreter, not a family member, for clinical content. (2) Brief the interpreter on terms that may come up (e.g. thuốc Nam, thuốc Bắc, lương y, suy nhược thần kinh, cạo gió) and ask them to render, not explain away. (3) Ask about the interpreter's own community ties and confidentiality concerns. (4) Debrief after sessions. (5) Use a cultural broker (with consent) for context, keeping their role separate from interpreting [synthesis].
  • Example language (to interpreter, illustrative): "If she uses a traditional medicine term, please give me the Vietnamese word and her meaning, and I'll ask her about it."
  • Watch for: the interpreter softening reports of distress or of traditional treatment; the client fearing gossip in a small community. Working when the client speaks freely and terms are preserved.

4.14 Reviewing the clinician–client relationship and ending

  • Purpose / when: periodically and before ending; the CFI asks about concerns with the clinician and cultural differences, and the Patient–Clinician Relationship module prompts the clinician to reflect on how culture shapes the relationship and assessment [source: APA CFI; CFI Supplementary Modules].
  • Steps: (1) Ask whether the client has felt able to talk about traditional care. (2) Ask whether anything you said felt dismissive. (3) Revisit the explanatory model: what has changed, what stayed. (4) Agree how the client will use each source of help after ending, including when to return to conventional care [synthesis].
  • Example language (illustrative): "We've talked about the herbs, the acupuncture and our sessions. Has there been anything I said about your traditional treatment that didn't sit right?"
  • Watch for: polite agreement that hides disagreement (deference to authority); late disclosure of treatments not mentioned before. Working when the client can disagree with you and leaves with a plan in their own terms.

5. Handling problems

The sources do not address psychotherapy problems directly; the responses below are [synthesis] unless a source is given.

  • Client conceals traditional treatment. Likely fear of disapproval. Normalise use (it is mainstream and official in Vietnam [source: Oda 2008]), ask again in a later session, and explain that full information protects them. Do not interrogate.
  • Client asks you whether to keep taking herbs, or whether to stop antidepressants and use thuốc Bắc instead. Do not advise. Say the decision belongs with the prescriber, offer to help prepare questions, and, with consent, alert the prescriber.
  • Client experiences you and the YHCT practitioner as rivals. Name the dilemma, emphasise different roles, and offer coordination (4.7). Avoid statements that imply one system is superior.
  • Practitioner advises stopping prescribed medication or claims to cure serious mental or physical illness. Inform the prescriber with consent; check the practitioner's qualification and, if they act outside their recognised scope, the relevant regulator. In Vietnam, combining traditional and modern treatment is reserved to doctors and assistant doctors within their licence [source: Thông tư 02/2024/TT-BYT]. Abroad, check local rules [uncertain: not verified].
  • Suspected adulterated or unknown product, or new physical symptoms. Refer promptly for medical review; mention that undeclared modern drugs have been found in some herbal products [source: Thanh Tra 2016]. Do not interpret symptoms yourself.
  • Somatic presentation persists; client rejects any emotional framing ("stuck"). Stay with the body: track symptoms against life events, use the client's term (e.g. suy nhược thần kinh), and work on concrete problems (sleep, work, family conflict) where the review places the causes of distress [source: Niemi et al. 2013]. Revisit the explanatory model rather than arguing.
  • Low engagement, missed sessions, or "non-adherence" to homework. Check practical barriers (cost, work, transport, language) that the CFI asks about [source: APA CFI]; check whether therapy feels foreign to a sociocentric family [source: Niemi et al. 2013] and consider family sessions; shorten and make tasks concrete.
  • Rupture after the client feels judged (e.g. you looked sceptical about coining or herbs). Name it, apologise for the impact, ask what it meant to them, and restate your respect for their choices. Review in the next session (4.14).
  • Overwhelm when trauma or migration losses surface. Slow down, ground in the present, and return to stabilising tasks before further exploration; check support from family and faith community.
  • Family pressure to keep the problem secret, or to use only traditional care. Explore the family's fears (stigma, shame); find areas of agreement (rest, food, sleep routines); keep individual time for risk and coercion questions (4.9).
  • Marks on a child. Use 4.8: neither assume abuse from a typical coining pattern nor accept "tradition" for injuries that do not fit [source: Lam et al. 2016]. Follow local safeguarding procedures where red flags appear.
  • Delay of urgent care (psychosis, suicidality, serious physical illness) while waiting for traditional treatment. Act on risk as usual (4.11), explaining urgency in the client's terms; traditional care can continue alongside if the medical team agrees.
  • You disagree with a YHCT concept. Your disagreement is not clinically relevant unless it bears on safety. Describe the concept as the client and system hold it and keep the focus on the client's goals.
  • Uncertainty about practitioner titles abroad. "Lương y" is a Vietnamese certificate under Ministry rules [source: Thông tư 02/2024/TT-BYT]; a practitioner using the title elsewhere may or may not hold local registration [uncertain: not verified]. Ask, and check the local register.

Sources

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