The startlingly tall, thin young Vietnamese man was standing naked in the middle of a busy city street talking to himself as motorcycles and bicycles whizzed by him. Perhaps even more peculiar was the reaction from others — there was none.

Libby Zinman-Schwartz was watching the man out the window of the old French villa in Vietnam’s Ho Chi Minh City where she was staying during one of her several visits to better understand the country’s traditional healing techniques. The experienced American therapist and counselor was surprised by the reaction from the other people on the busy street. And when she called the authorities, she got a similar response.

“The police and the local hospital just told me, ‘He is not harming anyone. Leave him alone.’ No one felt they should be involved. That incident became part of my mission to bring psychotherapy to this country.”

What Zinman-Schwartz found in that event was the culture’s avoidance of certain serious mental illnesses. It spurred an effort by her that was contrary to — and conveniently connected with — her first mission, which had been to learn and put to use Vietnamese methods of helping people with emotional pain. Now she was beginning to realize that this culture, which had for so long treated emotional distress with its mixture of Confucianism and Buddhism, was being turned upside down by the influence of Western culture. Ironically, perhaps, the treatments she revered and came to study were not enough.

“Traditional methods for the health of the mind and the body that stress things like rest and diet and herbal remedies — and even just principled ways of behaving with kindness and compassion to others — are what I wanted to learn,” she said. “They are secrets that have been passed along through generations, and they work so beautifully. However, for emotional disorders and for treatment of things like schizophrenia or depression, there is no Vietnamese frame of reference. There is no treatment in this country that really addresses these problems.”

So Zinman-Schwartz moved permanently to this Southeast Asian nation that shares a strained and sad history with the United States and began the process of introducing certain Western therapeutic techniques that she thought would help. She spoke to the health community and opened a free clinic where the first therapy of this type could be practiced in Vietnam. Gradually, her voice began to penetrate deeper into the culture.

Where it began

In contrast to the subdued people of Vietnam whom she so warmly describes, Zinman-Schwartz is intense and excitable. She is passionate about the things she holds dear — most notably her work and the people of this “amazing” culture. She rattles out sentences vigorously in rapid fire, skipping from topic to topic and hardly catching her breath. There is little doubt that her advocacy would benefit her chosen cause.

Zinman-Schwartz received her undergraduate degree and master’s in literature in the early 1960s. She earned her doctorate in education and her master’s in psychology in 1982. She was also interested in traditional forms of healing and how they might be used to deal with emotional distress. She visited other nations to learn more about their use, spending time in several Central American countries and in Mexico. In 1996 she went to Vietnam and immediately was drawn to the people.

“I fell in love with them,” she said. “This is the most supportive, warm and caring culture I’ve seen in all my travels. They are artistically gifted and have a high level of emotional intelligence. There is so much that is so interesting and attractive about these people.”

While on that first visit she found that there was much to learn, and as she spent more time in Vietnam, she began to sense the nation’s need for other therapeutic techniques. She also discovered that the Vietnamese culture was perhaps not ready for her message or for the guidance she wanted to offer.

In one situation, she asked a group she thought was well-versed in modern therapy techniques who Freud was — but she got no response. In other cases, segments of the mental health industry were combative. “No one was really ready to hear what I had to say. But there was beginning to be an interest,” she said. “Some people saw the value in new ways of doing things.”

That interest in her ideas grew as she continued to visit Vietnam. In 2001, when she finally moved to Vietnam, she was gaining attention both there and in the West. American Counseling Association member Patricia Stevens, then chair of the Counseling Department at Eastern Kentucky University, was one of several experts who heard Zinman-Schwartz’s message, saw her clinic in travels to Vietnam,or learned about her through press coverage and the books and articles she was writing. “When we visited Vietnam for an International Counseling Conference in Ho Chi Minh City,” Stevens said, “she asked us to come see her clinic. I was incredibly impressed with what she was trying to do. We then asked her to come to the conference to talk about counseling in Vietnam.”

Stevens knew that other cultures faced similar pressures, but Vietnam — rocked by the war and the ensuing U.S. economic embargo — was now rapidly being thrust into a new age. “They are so quickly faced with all the issues we have dealt with for 50 to 60 years,” Stevens said. “We’ve sort of come full circle in how we handle things — looking toward traditional techniques. They understand those techniques but probably need more. Libby is trying to take what works in an Eastern culture and combine it with what might work from the West.”

Stevens said it is both fascinating and challenging work, noting that Zinman-Schwartz faces the same opposition to new therapy techniques or approaches in this culture as counselors in Western cultures have faced for ages. Along with that, she faces a culture steeped in a very different tradition.

But Zinman-Schwartz has made inroads, and her ideas have taken root and gained ground. She has been the only board-certified Western counselor operating privately in Vietnam and has served as a consultant for Western clinics and hospitals. For the first time in the country’s history, she offered training in Western psychotherapy at a local university. She has also gathered research on the relationship between Vietnamese culture and psychological disorders.

In addition, Zinman-Schwartz has become a popular speaker at universities and hospitals and was recently asked to head the Department of Psychotherapy in a new building at the Ho Chi Minh University of Medicine and Pharmacology, one of the nation’s most prestigious schools. Her free clinic, which she operates from her home, has also expanded, with facilities at a military hospital and a pediatric clinic. And more than 200 people attended a two-part conference she sponsored last June.

The approach

Zinman-Schwartz came to understand that the Vietnamese culture might benefit from a new, unique way of counseling. “There was not a psychological approach here,” she said. “They had never seen psychotherapy practices. Some were fascinated by the field, but no one had seen it. There was no infrastructure for it.”

But she also understood that the culture had traditions that were strong and potent. “The family is at the center of Vietnamese life, and they all live together,” she said. “In that environment, children are nurtured in this incredible way. There is nothing better for a child than that sort of nurturing.” She found some aspects of the culture that she didn’t like — a tradition of physical violence against women and children, for instance — but Zinman-Schwartz said the culture’s mix of Buddhism and Confucianism generally creates happy, emotionally healthy people.

However, she also discovered that more difficult issues needed additional attention — for instance, serious mental illnesses such as schizophrenia and depression, as well as issues resulting from the influence of Western culture, including divorce and, among adolescents, drug abuse and suicide. Those problems got Zinman-Schwartz’s attention, but she was determined to treat them with respect for Vietnamese society’s traditions.

“My Vietnamese student counselors and I have learned how to promote Western ideas with a deep and mindful respect for Eastern values,” she said, noting that she often uses and trains her staff in a few simple techniques. Thus far she has trained five student counselors, and three more are in the process of being trained. “There are hundreds waiting,” Zinman-Schwartz said, “but I still do not have the large room I need to train with a one-way mirror and an audio hookup.”

She said clients are often receptive to new approaches to their problems and constructive suggestions because their culture treats authority and education so respectfully. “Vietnamese culture has a level of politeness and generosity I’ve never seen anywhere else,” she said. “When they learn about our approach, without exception, every client agrees.”

That counseling approach is something Zinman-Schwartz stumbled upon, but she now believes it works particularly well in Vietnamese society. She sits in on sessions held by her new counselors, along with other students and interpreters. She often offers comments or seeks information during the sessions so that the new counselors can receive direction and observing students can learn about the counseling process. They can also interject.

“While the translators were excellent and I felt that I was well aware of the client-therapist communication process taking place in front of me, eventually I became more impatient and wanted to check what the client had said before the counselor responded,” Zinman-Schwartz said. She began intervening with questions and encouraged other students to do likewise, especially when clients proved comfortable with the practice.

“The (counseling) model fused with the Vietnamese family and cultural life,” she said. “The extended family and trust it engenders is a foundation of Vietnamese life and social security. We simply fit ourselves into that existing cultural construct of tolerance for inclusion of others. The shifting from one counselor to another and the different personality of each prompts clients to react and reveal to us behavior we might not have otherwise noted. What evolved is a process related to ‘team theory’ and other techniques that have been successful in group therapy. It was well suited in Vietnam because of the critical link by individuals to their families.”

Because of those strong ties to family, counselors often must introduce concepts such as countertransference, internalizing and interjecting parental figures and attitudes, Zinman-Schwartz said. Additionally, parents in Vietnamese culture frequently are excessively dependent on their children and overly involved in their development, which can cause distress to both parties.

In addition, Zinman-Schwartz said, the counselors must try to combat one significant cultural problem — an unwillingness to express themselves. The counselors often simply attempt to get clients to be more open with their feelings.

“It is a process of seeing what works from both cultures and putting it to use,” she said. “And our clients are very comfortable with that approach. It works.”