Dear Douglas,


I am a Vietnamese woman, aged 31, who has lived for three years in Germany and returned to Vietnam one year ago. I have a lot of questions for you. Do you only work with expats or with Vietnamese patients as well? I have some problems that have been bothering me and I don’t know who to talk to. I called a local medical practice that is for foreigners in Ho Chi Minh City. They told me the fee for seeing a psychologist for one hour, but it is too much for me. Is it always expensive to see a psychologist? Also, in Vietnam seeing a psychologist is not normal and I wonder if working with Vietnamese patients is the same as working with foreign patients. Are people the same?


— Wondering about psychotherapy and needing some help


Dear Wondering,


I am happy to answer your questions. About 90% of the clients (another word for patients) I see are English-speaking foreigners. The number of Vietnamese clients I see has increased a lot since I started six years ago. I am limited to English speakers because I have not yet learnt to speak Vietnamese well.


One of the challenges for me is to find a balance in a country that has two or three different economies. I charge fees that are more in line with what would be paid in western countries, which makes it unaffordable for many people in Vietnam, not only Vietnamese. Many foreigners have insurance that will pay a percentage of the cost. For that reason I have a sliding fee for about 25% of my clients. A fee that is affordable for them. After one session, together we assess their need for therapy and a realistic fee that will allow them to continue to come.


Another challenge is that many people from countries where therapy is less common, like Vietnam, are not sure what to expect from therapy. Often they are looking for expert advice or they come to consult about the problems they are having for one or two sessions, not realising that it usually takes several sessions to understand the problem and to work on changes that are long lasting.


Because the cost is high they may hope to get “fixed” as quickly as possible. These assumptions are not totally false. Psychotherapists and psychologists know a lot about anxiety, depression, relationship problems and other mental health issues, but the therapeutic process is not only about exchanging information. Often, change happens when we pull back the layers to gain a deeper understanding of who we are and how to affect change in our lives.


Research says that the “therapeutic alliance” is a key to the therapeutic process. I think it means that the trust and connection that forms with the therapist allows a person to look at and understand themselves more deeply. A client will feel that the therapist is supportive of them, without judgment or criticism. In the beginning the goals are to fully understand the problems and to clarify what changes the client would like to have.


Often we think not only of the short-term outcome but how these changes can be permanent and affect the trajectory of a person’s life. We expect that to take time. It is most common for clients to expect to meet for six to eight weekly sessions and often much longer. Some clients will stay in therapy for a year or more. For some it is looking back at their life to understand how they have become the person they are. If there are traumas or negative messages that have impacted them it is important they revisit those experiences to understand what the impact has been. For others it is about the stress of their current life, work, relationships or moods that make life difficult.


Psychotherapy is a practice that is more common in cultures where individualism is the norm, but people from collectivist and traditional cultures also have personal problems and difficult challenges, emotionally and in their relationships. Having a confidential and supportive place to sort out issues is important for all people… everywhere. Often, friends and family are enough — but not always.


Wondering… I hope I have answered your questions and I hope you can find a qualified psychotherapist who can help you sort out your problems.


Wishing you wellness,




Do you have a question you would like Douglas’s help with? You can email him at This email address is being protected from spambots. You need JavaScript enabled to view it.. Personal details will not be printed

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