Psychotherapy

Take my advice

PUBLISHED : Monday, 09 May, 1994, 12:00am
UPDATED : Monday, 09 May, 1994, 12:00am

HONG Kong is a stressful city for families. It is also a magnet for English-speaking counsellors - psychologists, social workers and therapists providing a sympathetic ear and advice on anything from drug and alcohol abuse, to marital problems, adjustment, stress and trauma.


From just a handful three years ago, the number of private counsellors have increased four or five times making counselling, particularly family counselling, one of the fastest growing industries in Hong Kong.


While counselling can do much good, some professionals believe bewildered and vulnerable clients are at a greater risk than ever of being exploited by articulate, self-confident peddlers of comfort and advice, dressed up in psychological jargon.


Complaints of ''over-counselling'' are increasing. After a help-line was set up by the Hong Kong Psychology Society following the Lan Kwai Fong disaster in 1993, some English-speaking families complained of being ''pursued'' by counsellors ''falling over each other'' to help them.


More recently at a seminar organised by the YWCA on family stress, counsellors almost outnumbered members of the public in the audience, and that did not include members of the professional panel.


Local doctors who often recommend counsellors to their patients say they are bewildered by the proliferation of new counsellors with no known track record.


''Anyone can print a card and set up shop in Hong Kong. You can't do this in many other parts of the world,'' says Karol Misso, director of St John's Counselling Service, an established church-run service.


Jayne Surrey who specialises in drug and alcohol abuse counselling at the Adventist Hospital says the potential for unscrupulous counsellors to make money out of clients is huge. In one example she has come across, a counsellor wanted to see an adolescent addict five times a week and the family three times a week. ''This is outrageous over-counselling and clearly unethical. You can see that such clients are cash cows.'' From just one family and charging $750 an hour the counsellor was earning $6,000 a week. ''All you need is two to three families who are willing to participate and you are set up,'' Ms Surrey says.


Such exploitation is particularly distressing in the drug counselling field where the clean-up rate for addiction is low, averaging out at two to five per cent only. It is easy for families to spend a fortune without results. ''It disturbs me that families do not get good information and have to learn the hard way that what is being offered does not work,'' Ms Surrey says.


There is also a growing number of people coming in for short periods to set up special courses on ''enlightenment'', repressed memory and other practices that have been questioned in the West.


''These things are increasing in Hong Kong because of the lack of controls,'' says Mr Misso. ''People go there, they are vulnerable, they fall apart, there is no one to pick up the pieces.'' The booklet A Guide to Mental Health Services in Hong Kong edited by Carol Betson and Nia Pryde notes under its entry on counsellors: ''No standardised or legal definition was found and there are no laws regulating the use of the title.'' The Hong Kong Psychological Society has set up a register of psychologists, psychotherapists and clinical psychologists and will issue its first certificates this month. Its conditions are stringent but it is not mandatory, and it does not prevent unqualified people from setting up.


A counsellor need not be a psychologist, and a psychologist is not necessarily a counsellor although some do offer counselling. ''Counsellors are trained to work one to one,'' says Mr Misso.


Meera Chandran of the Marriage and Personal Counselling Service notes: ''Some psychologists may offer counselling after attending two or three workshops. It's not illegal here.'' Carol Cornell, who is registered with the British Association of Counsellors which uses a stringent procedure to accredit just 600 of Britain's 30,000 counsellors, arrived in Hong Kong a few months ago and was surprised to find there was no accreditation procedure.


''Although I am qualified, I might not have been,'' she says.


Some private counsellors say the free market checks abuse. Rumours about bad practice can spread swiftly leading to a loss of business.


But now counsellors are more likely to be here for a short stay and less committed to the community.


Abuses appear to be far more common among the transient English-speaking community than among the Chinese. Partly this is because local psychologists and counsellors tend to go into the hospital system where there are more checks and balances. By contrast, government-funded mental health facilities are limited for English speakers leaving them with little alternative but the unregulated private sector.


In the past the lack of services in English has led to a proliferation of self-help support groups on anything from bereavement, infertility, child abuse and other family problems. They may include professionals, or may just be a loosely-knit group of people who have been in the same situation.


These groups have their value. ''There is something very reassuring about talking to someone who has been through the same experience,'' says Ms Chandran. ''We often refer people to support groups, and referrals from them.'' But support groups do not claim to offer counselling. Some such as the Samaritans which runs a hotline for those feeling suicidal is adamant that its volunteers, mostly unqualified, should not offer advice on the phone, or in any way counsel callers.


''Giving unqualified advice is potentially dangerous,'' said a Samaritans spokeswoman. Many private counsellors are not so scrupulous.


Support groups also differ significantly from private counsellors because they are often registered charities and charge nominal or no fees.


Some counsellors do say clients spend an hour interviewing them about their qualifications and methods before agreeing to their services.


But ''in a crisis people are clutching at straws, they do not wait to do research'', says Ms Surrey.


Qualifications may be diverse and difficult to check out, particularly if they are from the United States where registration requirements are stringent but vary widely from state to state.


Because most abuses, such as sexual approaches, occur when counsellors work alone, counselling agencies and private counsellors say supervision is important. This is where they undertake to meet with a colleague to discuss cases under strict confidentiality. Newly-qualified counsellors may submit to supervision once a week, and even the most experienced counsellors require it to retain some objectivity.


Overseas, professional bodies normally require a report from a counselling supervisor. In the private sector, counsellors often organise supervision among themselves. It provides a degree of accountability within the profession and it is an additional safeguard for the client. A register also helps. But all these attempts at self-regulation do nothing to stop those who are not within their bounds from practising. ''Some can be quite unashamed and blatant in the way they go about their business,'' says Ms Pryde.