(5 minute read)
If you’ve decided to look for a counsellor (or psychotherapist, or psychologist…the terms are pretty much interchangeable as I explain below), you’re probably thinking “What kind of counsellor do I look for?” as well as “How do I find a good one?” Most people just close their eyes and pick someone, hoping that they’ll get lucky.
But picking a therapist is not like picking a doctor. It’s not just a matter of how much knowledge they have: it’s much more about their personality and how they work with you. You may not care much if your doctor is brusque and unfriendly, but I can pretty much guarantee your therapy will fail if your counsellor has those characteristics.
There are three areas you should pay attention to: First, how to find a good counsellor. Second, once you’ve met them, figuring out if your counsellor is right for you. (A good counsellor for someone else isn't necessarily good for you.) Finally, how much this will cost you. And there’s one area you don’t need to pay attention to — the type of degree your counsellor holds (more on that later).
How Do I Find A Good Counsellor?
The most reliable way is to ask around. The fact that your friend worships their counsellor is no guarantee you’ll feel the same, but it’s better than picking someone at random. But it's not enough to just ask for a name: Ask what they like about their counsellor. Do they feel they can really open up without being judged? Do they get good suggestions and different ways of thinking about their problems? Do they feel good about the way the counsellor works with them? Have they gotten happier, and in what way? What could their counsellor do better? Remember that a lukewarm recommendation is probably worthless.
If you don’t get any recommendations that work for you, the internet is the next step. AsiaXpat.com, geoexpat.com, angloinfo.com, psychologymatters.asia and the US Consulate website have listings of counsellors, with links to their websites. You can ask your GP if they would recommend the counsellors in their practice, if they have any. And you can do a Google search to see what comes up. You won't lack for names -- but how do you choose?
First, see if the website appeals to you. Does the counsellor sound like someone you could get along with? Read their blog postings to get a feel of what they sound like (or if they’re reposting other people’s work, what do they consider important enough to post?) Email them to see if they respond quickly and whether they sound empathic and warm in their emails.
Second, arrange to see three different counsellors for an initial consultation. That can be expensive, so explain what you’re doing and ask if the counsellor will see you at a reduced rate, or even for free if you choose not to come back. You will triple the chances of finding a counsellor you really like, and you’ll also be able to screen out counsellors who aren’t particularly caring. After all, you’re about to invest a lot of your time and money in seeing them over many weeks, months or possibly years: if they’re not willing to meet you halfway that says something about them.
Third, if you’re looking for regular, long term counselling, ask about the counsellor’s holiday and repatriation plans. Many counsellors are trailing spouses or not the primary breadwinner, which means they may be in Hong Kong for a limited time. In addition, if they’re not the primary breadwinner, counselling can be something they fit into the rest of their life, rather than their core activity. Which means they may take long holidays. Some will continue to do Skype sessions while on holiday, so you should ask about this too. You don’t want to be at a critical juncture in your therapy and have your counsellor go on a two month holiday and refuse to see you by Skype.
When I Meet A Counsellor, How Can I Tell If They’re Good?
Most people have little or no experience being in counselling so they’re very unsure of what is right or wrong, good or bad. Generally, they close their eyes, assume that the counsellor is a professional and knows best, and do what they’re told. Only if they feel really uncomfortable do they not come back for a second session. (And that happens far more than the profession would like to admit: The most common number of sessions is one, which means an awful lot of people don’t like their counsellor and don’t return for a second session.)
Fortunately, it’s a lot easier to pick a good counsellor than it is to pick a good doctor or lawyer. It’s impossible for a layman to judge the knowledge and ability of a doctor or lawyer, and it’s primarily that knowledge and ability which makes them a good or bad professional. But with a counsellor, the fundamental key to success is their ability to establish a good relationship with you, to make you feel accepted, not judged, and to give you the sense that you can trust what they say. Which is why it’s important to see more than one counsellor at the initial stage — you need some comparisons. You can’t trust your gut with a doctor or lawyer, but you can when you’re picking a counsellor.
After you finish meeting your counsellor, ask yourself the following questions:
Am I looking forward to seeing this person again? If the answer is no, don’t force yourself. They obviously weren’t able to establish that critical relationship.
Do I feel more hopeful? The research shows that the ability to inspire hope that things can get better is critical.
Did we talk only about my problems, or did the counsellor notice my strengths? Again, the research shows that counsellors who talk only about problems and weaknesses have poorer outcomes than those who remind their clients of their strengths.
Do I agree with whatever theory my counsellor has for my problems? If you don’t buy what they’re selling, the therapy isn’t going to work.
Has the counsellor told me how we will work together to solve the problems, and does it all make sense to me? If you can’t see how the counselling you’ll get will lead to solutions then it’s not going to work.
How Much Will This Cost?
At the high end, about HK$2,500 for a 50 minute session. But don’t worry — you can also get therapy for as little as HK$300 a session, or perhaps even a bit less if you truly are strapped for cash. Insurance isn’t going to be of much help: most plans in Hong Kong don’t offer much, if any coverage for mental health, but you should still check.
There are two organizations (and a couple of individuals, myself included) in Hong Kong that offer sliding scales based on the income of their client: St. John's Counselling and Resource The Counselling Center. They’re able to offer inexpensive therapy partly because they get external financial support, and partly because they tend to use relatively inexperienced counsellors. That’s not to say everyone is inexperienced: some of their counsellors have been in the field for many years. Even if you get an inexperienced counsellor, that’s not necessarily a bad thing: the research shows that, on average, inexperienced counsellors get slightly better client outcomes than very experienced counsellors. (While this certainly seems counter-intuitive, a relatively new counsellor is less likely to be burned out, more likely to be willing to adapt to you, and less wedded to a rigid theory that may not fit your situation.)
St. John’s tends to be more flexible with the experience of their counsellors — they’ll even take on Masters degree students doing their internship — so they are able to offer lower fees than Resource. But that means you have no choice over who you get — they don’t even have the names or backgrounds of their counsellors on their website. At Resource, you’ll have more input into your choice, depending on availability of the counsellors.
In the mid-range of fees you’ll find counsellors in a range of settings: Sole practitioners, practices of a couple of counsellors and medical practices that offer counselling services as part of their ‘supermarket’ of services. As a general rule, medical practices have more rent to cover and owners to pay, so their prices might be somewhat higher, yet the counsellors themselves getting less income. Their counsellors tend to work as little as a day a week in the practice, so unless your schedule can accommodate their limited hours, you might want to look elsewhere. They also charge more for counsellors with PhD’s versus Masters degrees, although there’s no evidence that PhD’s get better outcomes with their clients.
At the high end you’ll usually find therapists with the most advanced degrees: PhD’s and MD’s. Psychiatrists (who by definition have an MD) will likely be the most expensive as they’ve invested many years and a good deal of money in their degree. They will focus on dispensing medication, so using them for talk therapy is not a good idea.
There’s no harm in asking for a break in the fee. Of course, if you’ve got lots of money you’re not going to get very far, but if you’re struggling to make ends meet, many counsellor will shave something off their stated fee to help you out.
What Doesn’t Matter?
With one exception, the degree your counsellor holds is irrelevant. The research shows that whether the counsellor has a PhD or a Masters in Clinical Psychology, Clinical Social Work, Marriage and Family Therapy, or Counselling or a variety of other mental health disciplines has no impact on client outcomes. (By the way, the word “clinical” means that the degree qualifies the person to perform psychotherapy or counselling, as opposed to a psychologist who does research, or a social worker who just does social work.)
You definitely want your counsellor to have a graduate level degree in something psychological: Hong Kong has no licensing system so anyone can hang out a shingle and call themselves a counsellor or psychotherapist.
The terms psychologist, therapist, psychotherapist and counsellor all mean essentially the same thing — a person who does talk therapy. Some countries, however, reserve the term psychologist for people with PhD’s.
The one degree that does make a difference is an MD. A medical doctor who specializes in emotional and psychological problems is called a psychiatrist. These are the only people in Hong Kong who can prescribe medication to treat things like anxiety, depression, ADHD, OCD and psychosis. The financial incentives drive psychiatrists to focus on prescribing medication rather than talk therapy. If all you want is drugs (much as I would recommend against this) your best bet would be to just go see a psychiatrist.
Interestingly, as I've said above, there’s a good deal of evidence to show that years of experience has virtually no relationship to outcomes. So don't be afraid to see someone who is relatively new to the field.
If you’ve made the decision to seek counselling, well done. It takes courage to examine yourself, and the process is sometimes painful. But it’s worth it in the end. And I very much hope this article helps you find the perfect counsellor!