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 people actually come with
Rarely one thing. The three below arrive together often enough that treating any one of them alone is the usual reason people improve for a while and then do not.
The trauma nobody moved here to treat
A significant proportion of the expatriates I work with in Thailand are carrying something from long before Thailand. A childhood. A marriage that ended badly. A bereavement that was never grieved. A career that collapsed. Something that happened once, was never spoken about, and has been quietly organising the shape of a life ever since.
They did not come here for that. They came for work, or for a fresh start, or because the previous arrangement had stopped working. And for a while the move helped, often considerably.
Leaving a country removes the reminders: the streets, the associations, the people, the routines that carried the material. That is a genuine reduction in daily load and the relief is not imaginary. But nothing has been processed. The memory is not integrated; it is simply not being triggered as often.
That works well enough, for long enough, that almost nobody connects the two. Which is why the pattern I see so often is a man who has been in Thailand for five or eight years, whose drinking has become structural, whose relationships have become short, and who has no idea that the thing underneath it all happened in 1998.
It reappears as something else, and in this population usually as one of four: drinking or using that escalates without an obvious reason; relationships that stay short, not by preference but because closeness is the condition under which the material becomes accessible; a flatness arriving after the first few good years, often called depression; or rage, a startle response, or sleep that has never been right, which people describe as simply how they are.
EMDR for single-event trauma, which it resolves faster than talking around it ever will, and which works over secure video — over a hundred sessions in this practice have been delivered that way. Depth psychotherapy for complex and childhood trauma, where EMDR is part of the work rather than the whole of it. Trauma that ran through a childhood has no single memory to reprocess; it shaped the architecture.
The midlife crisis, and why Thailand answers it so well
The phrase is used dismissively, which is a shame, because the event it describes is real and it is not vanity.
A midlife crisis is what it feels like when the arrangement you built your life around stops supplying meaning. The career still works. The marriage may still work. Nothing has necessarily gone wrong. And yet the thing that made it all worth doing has quietly gone, leaving performance without content. Jung’s observation, and it has held up, was that the second half of life has a different task from the first — and nobody is told what it is.
What Thailand offers is not primarily a lower cost of living. It is the removal of the audience. Nobody here knew you at forty. Nobody is measuring the present against the person you used to be. The identity that took thirty years to construct can be put down without anybody objecting.
That makes a second adolescence practically available for the first time since the first one. Late nights, attention from much younger women, alcohol that is cheap and socially compulsory, drugs at prices that remove the friction, and no obligation to explain any of it. The relief is real. Most of the men I work with here were, for the first year or two, genuinely happier than they had been at home. That is the part people outside never understand, and it is why advice from home is so useless.
It stops working because a second adolescence is an answer to the wrong question. The question underneath is about meaning — what this life is for, now that the thing it was organised around has stopped supplying an answer. A second adolescence does not answer that. It anaesthetises it, and the anaesthetic is excellent, and it works for about three years. Then the drinking that was social has become structural, the relationships shorter and more transactional, the money moves in one direction, old friendships have thinned, and the original emptiness is still there with a decade of consequences attached.
Jung had a name for the energy that arrives here, and it is more useful than “midlife crisis” because it describes what it feels like from the inside rather than from the outside. The puer aeternus: the eternal youth.
Men describe it almost identically. There is more energy than there has been for years. Young women look at you, and look again. Business opportunities appear everywhere, obvious and unexploited, and it is faintly astonishing that nobody else has spotted them. Everything feels like a beginning.
Some of that is real. The rest is a hall of mirrors, and it is worth being precise about who is holding the mirrors, because the usual explanation is lazy and wrong.
Thai society is socially sophisticated in a way that most Western societies are not. Enormous value is placed on grace, on hospitality, on not causing anyone to lose face. That is a genuine cultural skill, practised well, and it is not performed at you personally — it is simply how things are done.
But if you arrive from a culture that does not do this, carrying money and forty-eight years of being unremarkable, that skill lands as a verdict. It feels like being recognised at last. The mistake is not in them; it is in reading a social competence as evidence about yourself.
And underneath all of it, the arithmetic has not changed. You are not getting younger. The puer’s characteristic quality — von Franz called it the provisional life — is the conviction that the real thing has not started yet, that the present arrangement is temporary, and that the moment of arrival is somewhere just ahead. It is a very pleasant belief. It also has the effect of postponing a life indefinitely while the years go through anyway.
None of this is an argument that feeling good is a problem. It is good, and men who have not felt it in twenty years are entitled to enjoy it.
The difficulty is what gets decided while it lasts. Jung called this state inflation: the point at which a person stops experiencing an archetypal energy and starts identifying with it. The reliable feature of inflation is not the height. It is the deflation that follows, and the wreckage that was signed for on the way up.
In practice that means capital put into ventures that only looked obvious from inside the state. A marriage ended on the strength of a feeling that will not survive its third year. Relationships built on a misreading of what was being offered. Friendships at home allowed to thin, because there is progressively less that can be said honestly to people who knew the earlier version. And a slow narrowing of the people around you to those who benefit from your staying exactly as you are.
Then it goes, because it always goes. What is left is a man in his mid-fifties, considerably poorer, in a country he chose while inflated, with a drinking pattern that is now structural and a question about meaning that has not been touched.
Jungian analysis is particularly suited to this. It is the one approach explicitly organised around the second half of life rather than the repair of the first.
Addiction
Alcohol, cocaine, gambling, sexual compulsivity, and behavioural compulsions including overwork. In this environment every external brake is removed at once, and consequences arrive late. That has its own page: addiction counselling for Bangkok and Thailand.
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. More on how the online work is done.
When this is not the right place to start
If you are drinking or using daily, processing trauma is not where to begin. It tends to destabilise rather than resolve, and the sequencing is part of what the assessment is for. The same applies where there is an acute medical situation; Bangkok has excellent international hospitals for it.
When medical treatment comes first
This is psychotherapy, not medical treatment. Withdrawal from alcohol or benzodiazepines can be dangerous and occasionally life threatening, and needs to be managed by a GP, an addiction psychiatrist or a medically supervised detox rather than attempted alone. Where that is what is needed, it is said at the assessment and the referral is made.
The same applies where a psychiatric assessment should come first or run alongside the work, and where the right answer is residential treatment rather than weekly sessions. Therapy does the work that follows stabilisation, and it does that work better once stabilisation is in place.
Practicalities
Fifty minutes, usually weekly, by secure video, from Bangkok, Chiang Mai, Phuket or anywhere else in Thailand. 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.
What do you treat?
Addiction, including alcohol, cocaine, gambling and sexual compulsivity. Complex and childhood trauma, with EMDR by video. The midlife crisis and the loss of meaning underneath it. Eating disorders, with a particular specialism in men. Low self-esteem, bereavement, and Jungian analysis with dream work. In this population they very often arrive together rather than separately.
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 practice that means early evening in London is late evening in Thailand, and morning appointments in London fall in the afternoon there. A regular slot is agreed at the start rather than rearranged each week.
I moved abroad and felt better. Was that the trauma resolving?
Almost certainly not, though the improvement is real and worth taking seriously. Leaving removes the reminders, the associations and the people involved, which lowers the daily load considerably. It does not process the material. That is why the relief tends to have a shelf life, and why symptoms often reappear some years later in a form that seems unconnected.
Why do so many midlife crises end up in Thailand?
Because Thailand answers the question extremely well in the short term. It removes the audience that knew who you were, it makes a second adolescence practically available, and it is inexpensive enough that the decision feels reversible. The relief is genuine, which is precisely why it takes several years for most people to notice that the original question has not been answered, only postponed.
Should trauma be treated before or after the drinking?
Sequencing matters and it is decided at the assessment rather than assumed. Processing trauma while a substance is doing the regulating tends to destabilise rather than resolve. Where daily drinking or using is present, stabilisation comes first, and where withdrawal needs medical supervision that comes first of all.
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.