Why expatriates here work with someone outside Thailand
Bangkok is not short of clinicians, and there are good English-speaking therapists in the city. For some people, seeing somebody locally is exactly right.
The difficulty is not competence. It is arithmetic.
Expatriate communities are small and they overlap heavily. The therapist you are considering may drink in the same bars, know your employer, share friends with your partner, or sit on the same committee. That is nobody’s fault, and no amount of professionalism removes it.
It matters very little if the subject is stress at work. It matters a great deal if the subject is your drinking, what you have been doing at weekends, or something that happened twenty years ago that you have never told anyone.
I do not know your employer. I do not know your friends. Nobody I know will be in the room when your name comes up.
What the evidence says about working by video
The argument about whether online therapy works is settled.
Randomised trials comparing video-delivered psychotherapy with in-person treatment have repeatedly found no statistically significant difference in symptom reduction. A twelve month service evaluation at Cardiff and Vale University Health Board found that patients who received EMDR online finished treatment with lower PTSD scores than those seen in the room.
The consistent caveat is fidelity. It works when the therapist adapts the protocol properly, and fails when the same session is simply pointed at a webcam. That is a difference in practitioner rather than in medium.
What is treated
Addiction, including cocaine, alcohol, gambling and sexual compulsivity.
Alcohol specifically, and particularly the functioning drinker.
Trauma, including complex and childhood trauma, with EMDR delivered by video.
The midlife crisis, and the loss of meaning underneath it.
Chemsex and sexual compulsivity.
Eating disorders, low self-esteem, bereavement, and Jungian analysis with dream work.
Practicalities
Fifty minutes, usually weekly, by secure video. Some work, particularly analysis and complex trauma, is better served twice weekly, and that is discussed rather than assumed.
London time is six hours behind Bangkok, which in practice means a London early evening is a Thailand late evening, and a London morning is a Thailand afternoon. A regular slot is agreed at the start rather than rearranged each week.
In English or French.
Clients may work with me directly or, where appropriate, with an Associate under my clinical supervision. The choice is yours and fees differ accordingly.
If what you actually need is a clinician in the room, or medical treatment, or residential care, you will be told that at the assessment rather than six months in.
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Doctorate of Professional Practice at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.
In crisis in Thailand: Samaritans of Thailand English line 02 113 6789, press 2, anonymous and staffed around the clock. Department of Mental Health hotline 1323. In an emergency, go to the emergency department of an international hospital.
Common questions
Is there a good English speaking therapist in Bangkok?
There are capable English-speaking clinicians in Bangkok, and for some people seeing someone locally is the right answer. The difficulty is not competence, it is proximity: expatriate circles in Bangkok are small and heavily overlapping, and a local therapist may know your employer, your friends or the places you drink. Working with someone outside the country removes that entirely, which for a substantial number of people here is the deciding factor.
Does online therapy actually work?
Randomised trials comparing video-delivered psychotherapy with in-person treatment have repeatedly found no statistically significant difference in symptom reduction, and a twelve month service evaluation at Cardiff and Vale University Health Board found patients treated online finished with lower PTSD scores than those seen in the room. The consistent caveat is fidelity: it works when the protocol is properly adapted, not automatically because it is on a screen.
What time zone do you work in?
London, which is six hours behind Bangkok in winter and six in summer. In practice that means early evening in London is late evening in Thailand, and morning appointments in London fall in the afternoon there. Regular slots are agreed rather than negotiated weekly.
Can EMDR be done online?
Yes. Bilateral stimulation can be delivered remotely and the protocol holds. Over a hundred EMDR sessions in this practice have been conducted by video, including some of its best outcomes.
What do I need for a session?
A reliable connection, a device with a camera, headphones, and a room where you will not be interrupted for fifty minutes. The last matters more than the technology, and in shared accommodation it is worth solving properly before the first session rather than working around for months.
Do you work in French as well as English?
Yes. I am French and work fluently in both, and there is a francophone expatriate population in Bangkok that is very poorly served for French-speaking therapy.