Seeking Psychological Help Abroad

by Dr. Cathy Tsang-Feign

Expatriate psychologist


Looking for psychological help in a foreign country can be an aggravating and intimidating search. How do you find out who is providing such services out there? Are these people qualified or even trained? How can you tell the difference?

When living in a foreign country where you speak the language, you will obviously find many choices of mental health professionals. The question however, is how to locate and choose someone who can understand your problems as a foreigner, and whose training, methods and cultural understanding are all suitable for helping you.

If you live in a country where you are not fluent in the language, or if you prefer treatment in your native language, clearly your choices are much more limited. Among larger expatriate communities you are likely to find a few people offering psychological services in English, and to a lesser extent, in other languages.

The question obviously is: Where do you begin to find the right help?

Before going further, it helps to understand exactly what the different types of mental health practitioners are and what they can and cannot do.

“I'm having problems with my wife. I think I need a psychiatrist,” a middle-aged man said. He imagines himself in a Woody Allen movie, lying on the couch and talking about his past, while a man with a pointed beard and spectacles sits poised with a notepad, nodding and saying, “Ja, ja,” with a German accent.

In fact, a psychiatrist is not necessarily the answer for personal problems, especially those involving emotional, family, personal growth or relationship issues.

There are various mental health professionals who provide different forms of treatment. These include Psychiatrists, Psychologists, Family Therapists and Clinical Social Workers. Unfortunately, there are some misconceptions about who does what.

Let's take an overview of different types of mental health practitioners. It is not easy to neatly distinguish their roles from one another because many have overlapping functions and expertise. They can be broadly placed into two groups: psychiatrists and psychotherapists.

  • A medical doctor whose specialty is treatment of mental illness. Examples of mental illnesses include schizophrenia, personality disorders, psychosis and chemical imbalance in the brain. A psychiatrist's initial role is to diagnose mentally ill patients and determine what form of treatment is necessary. Psychiatric treatment usually includes short or long-term medication. Though the traditional picture of a psychiatrist from Freud's time was a person who provided psychoanalysis, this is not commonly practiced in a modern psychiatric setting. Some psychiatrists do offer counseling, though in actual practice this is rarely their specialty.

  • A broad term for therapists who provide treatment for mental and emotional problems—as opposed to mental illnesses—by applying various psychotherapeutic techniques. This category includes Psychologists, Family Therapists and Clinical Social Workers.

  • Psychologists work in various specialties, including Educational, Industrial and Clinical Psychologists. Generally, Educational and Industrial Psychologists do research, testing and education. Clinical Psychologists are the ones who do psychological counseling. The latters' role is to treat psychological, mental and emotional disorders for individual patients.

  • MFTs similarly treat psychological and emotional problems. They generally look at a patient's family background and dynamics to gain insight into individual problems and behavior. This field was developed in the USA, and is widely recognized and practiced in North America, Australia and Europe.

  • LCSWs generally deal with crisis intervention and short-term therapy, though increasingly they also provide long-term therapy to individuals, families or groups.

    How do you choose among all these practitioners when you have a problem? There is no unequivocal answer. The above three types of therapists (excluding psychiatrists) have similar roles, their main differences being in educational background and title. In a private practice setting, all provide nearly identical services. You should feel confident in consulting either a Psychologist, Family Therapist or Clinical Social Worker for most problems. A genuine professional will tell you up-front whether they can help you with your problem.

    It is important to distinguish between mental illness and other emotional problems. If you suspect that mental illness is the issue, a psychiatrist is the most likely first source to consult. For family and personal emotional problems, any of the three categories of psychotherapist will be able to assess the problem and help you to proceed.

    Psychotherapists are not medical doctors and may not prescribe medication. When a qualified psychotherapist feels an individual may require medication he or she will refer the person to a psychiatrist for evaluation. Likewise, if a psychiatrist thinks counseling is recommended, he or she will usually refer the patient to a trusted psychotherapist.

  • How do I know if they're qualified?
  • Unfortunately, in many countries the field of psychological services is unregulated. Many places lack even a professional governing body (equivalent to a medical association for doctors) to monitor those who provide psychological treatment. The quality of psychological services can be quite varied, ranging from the genuinely qualified to the inadequately trained, and even to outright charlatans out to steal your money.

    This is especially so among the small expatriate communities, where resources are limited. There are often many enterprising but minimally trained individuals offering “counseling”, using catchy advertisements or offering false promises of instant fixes to psychological problems. Unfortunately, expat communities are a breeding ground for amateur and unprofessional practice, which can lead to serious harm.

    Psychological training requires far more than just “being good with people”, reading a book or attending a training seminar. To practice legally in most developed countries, Psychologists, Family Therapists, and Clinical Social Workers all require a minimum Masters level university training plus at least two years of internship. Usually a license or other professional registration is required to practice.

    To protect your mental welfare, and eliminate some of the pitfalls in the search for a qualified and professional mental health therapist, you should start by checking their credentials.

Dr. Cathy Tsang Feign, Hong Kong Psychologist

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