benw

Hi,

Does anyone know if it's possible to get an Afghan visa here in Bangkok, and if so, where? I've looked on the web at some lists of Afghan embassies and consulates and they don't include a Bangkok location.

Thanks

[This sounds like excellent information and a real possibility thankyou.

Completely as an aside and not relating it to this case I would be interested to know your take on the fact that studies showed even reading the top rated "Feeling Good", so called bibliotherapy, had equivalent results to actual person to person therapy. A control group who had the book withheld for a month responded with like results a month later.

This is a really interesting area. I'm not completely up to date on it, although I recently went to an ACT workshop where they reviewed research on various delivery modalities (ACT is a third-generation cognitive-behavioral therapy). My recollection is not that bibliotherapy is equivalent to individual psychotherapy. My recollection is that bibliotherapy by itself is effective for some folks, but not as effective as therapy on average (not referring to just 1 or 2 studies, which have shown equivalence between books and 1-1 for a specific sample with the specific problem studied, but to reviews of studies, called meta-analyses). The effectiveness of bibliotherapy makes sense to me in that there are plenty of ways people can help and heal themselves. Especially when problems are less severe or less chronic, many people are able to find their own path to healing, using their own natural resiliency. Psychotherapy is just one method, one modality that helps people; there are plenty others. Also, my recollection is probably wrong, or at best, biased. The fact that it may not be as helpful for some people as individual psychotherapy also makes sense to me. It seems to me that every single one of us has blind spots- you, me, everybody. The thing is that we all have different blind spots. When someone sits in a room with a book, they still don't necessarily learn about their blind spots- blind spots are learned about experientially- in the same way a person can learn sitting with another person. Sometimes that person can be a friend, and sometimes not (one reason that psychotherapy exists is that we all share certain blind spots, for example around emotion or culture, which therapists are systematically trained to be aware of).

I have seen clients who tried bibliotherapy (in some cases, given a book after one session with a UK NHS provider) and whom it didn't help. Usually, by the time someone comes to see me, they have already tried a bunch of different things. They come to see me because those other things have not produced the results the person wanted/hoped for. So my view of life is biased- I don't see the people for whom something else- some other form of healing- worked. In my work, I frequently combine bibliotherapy with individual psychotherapy- the only challenge is finding books that I think are worth asking people to read.

These are my thoughts. I'm probably wrong. I just don't know how I'm wrong yet!

Here is another idea for your friend: [new info since resource list compiled] I just completed facilitating a 13-month CBT training program for Thai psychologists, psychiatric nurses at the Somdej Chao Phraya Psychiatric Institute. I learned an amazing amount while doing this, esp about doing psychotherapy with Thai clients. There are important and relevant differences, so for cognitive therapy, it's really better not to send your friend to a western therapist, IMHO (unless your friend lived abroad for a significant period and is very very sympatico with western ideas and principles).

There are some working at Somdej Chao Phraya Psych Inst I think are really good therapists for Thais, if the Thai person in question can overcome stigma and contact them. Have your friend call the institute and ask for the psychology department. I recommend s/he contact Ajarn Nakorn or Khun Sujitra or Khun Supan- these folks have extensive training in CBT, and are good therapists as well (the two don't always go together ;-)). I've been especially impressed with Nakorn and Sujitra, and Supan has a lot of CBT training (she's also a research therapist in a major outcome study of CBT here in Thailand). Once s/he has reached the department, they can ask to speak with one of those three and ask for an appointment. Recall that this is a public facility, so there may be a wait and appointments will not be available outside regular working hours. Hope this helps

Sorry to hear about your difficulties, I have also suffered from depression (well controlled now on medication) and understand what it is like. People who have not personally experienced clinical depression or had a close relative with it really do not undderstand what it is and one often gets well meant but useless or even harmful advice.

SNIP

Good luck and let me know if there is anything I can do to help

I think that the feedback and suggestions from mdeland and Sheryl are right on and I agree with them completely (full disclosure: yet another mental health professional speaking).

There are many ways to free oneself from depression; meds are one available tool with proven effectiveness (as well as variable side effects). The mistake I see most commonly is for people to go see a psychiatrist, start on meds, and not continue seeing the psychiatrist. As people already said, it's important to use psych meds while seeing a psychiatrist, so they can help you monitor the situation, deal with side effects, change meds if/when necessary, provide an effective combination of meds when things are more complex (for example, addiction and depression), make small adjustments, etc etc.

There are many steps to take: seeking professional help, finding social supoort, using your current social system, increasing your activity level (recent research is beginning to suggest that this alone may be as effective as meds for unipolar Major Depression, if interested, google behavioral activation and depression), and others -- what's important is somehow finding something inside to take some step.

Also- check out the list of mental health resources available in Bangkok pinned at the top of the health forum. If you're German, please be aware that the German Embassy is developing a resource/response team for their nationals with mental health problems- give them a call. In another nationality, you can PM me and I can tell which therapists/counselors in Bangkok speak your native language, if any.

Maybe someone should start a website (hosted outside Thailand), where farang can rate Thai doctors and hospitals departments and share their experiences with each other. If run responsibly and with discretion, it could be very useful for the expat community.

re: Chris' comment about their "no repeats" policy.

Is that correct about the Wat T. program? That you're only allowed one chance, and that's it? I hadn't heard that before.

Yes, you are only allowed to go once.

This is due to the seriousness in which the satja (Vow) is taken. You are not allowed to take a vow, break it, then make it again. At Wat Tamkrabok when you make this solemn vow you need to be prepared to keep it for the rest of your life (if you decide to quit for the rest of your life).

Many Thais believe that if they break the vow terrible things will happen to them but if they keep it fantastic things will happen.

As mdeland states, there are plenty of places that have a revolving door policy when you can go for a break from alcohol.

Thanks.

I can see the spiritual basis for their policy. Unfortunately, addiction is a relapsing and remitting disorder. The overwhelming majority of people of who ultimately quit and stay sober, clean, or change whatever behavior for the rest of their lives go through more than one attempt before they are successful (and a simple majority appear to go through multiple attempts). So, for some people who go to Wat T., this time isn't going to be >the< time. Not because they're bad people, but because beating addiction is hard and requires determination and persistence.

Unlike California, Thailand doesn't have dozens of residential treatment programs for farang who want to beat their addiction (In the US, the "three tries" rule makes sense- I worked in a residential program with the same policy).

Aside from Wat T., does anyone of any residential, substance abuse treatment programs here in Thailand that foreigners can benefit from? (I'm already familiar with a number of the Thai programs, such as BMA's past Onnut, and I wouldn't recommend them for foreigners)

re: Chris' comment about their "no repeats" policy.

Is that correct about the Wat T. program? That you're only allowed one chance, and that's it? I hadn't heard that before.

One comment to make:

My wife said to me before she left for Udon that the only reason why she wanted to 'recover' was because she finally realised that if she did not, then I would certainly leave her.

Now, that suggests to me right now that her reason to recover is not because she herself wishes this, but rather that she realises that her 'good life' would be over if I left. (I'm putting aside the fact that she would still have control of the hotel assets, so would hardly be poor!).

I presume that therapy must try to persuade her that recovery is for her own benefit, and not just to stop her husband leaving her.

Simon

Hi Simon,

I also hope that therapy will increase her self awareness/insight and increase her motivation to adhere to the treatment regimen for whatever diagnoses are finally decided on.

At the same time, don't underestimate the value of negative consequences to help create and sustain motivation to change. In the long-term, motivation to change must come from inside. But, sometimes, in the short-term, and at the beginning of a difficult and demanding change process, motivation comes from an awareness of potential negative consequences (for example, the loss of something deeply valued such as a relationship, freedom, money, etc). In this case, that would be her losing you.

In fact, my personal belief is that a person who has never experienced significant negative consequences of their behavior (addictive, manic, controlling, rude, whatever), and has no expectation of future negative consequences for that behavior will not be motivated to change that behavior. This means that one of the most important things that people can do for someone they love who has a serious behavioral problem, like addiction, is to allow that person to suffer the negative consequences of their own behavior, rather than shield them from those consequences.

We sometimes call this tendency to shield people from the consequences of their own behavior- enabling. In some, but not all, situations, it means that we protect people we love from having to suffer life's (and our own) full fury brought about by their choices. It is done from love, and it is mistaken. Negative consequences help create the impetus for change. The opposite of enabling is usually referred to as "tough love" which has, unfortunately, become a fad label, and in some cases, an excuse to abuse people (personally, I don't like either of these terms, but the ideas they're meant to communicate are very imporant in situations like this)

Of course, there are plenty of people who experiences loads, literally tons, of negative consequences without changing. But people who do change can tell you why they did- and they will usually describe their suffering and negative experiences and losses as the original motivator.

Striking this balance between supporting someone you love, and setting limits, and seeing them suffer losses because of their choices is extremely difficult. I'm American and I've seen families/wives/husbands/parents/children struggle with this enormously. It is really difficult to do. No simple platitudes will help you do it. I suspect that it will be even harder in a Thai family (since giving money is regarded as a direct expression of love and devotion). It's a day-to-day thing, like slogging through the trenches. It's delicate and it's obvious, it's tiring and frustrating, and and it's no fun.

Based on what I have read, I believe that you have the determination and dedication necessary to give it a fair shake and make it work, if that's possible, given all the stuff that is not under your control. I also see that you have the support of many people, and know how to access more support when you need it. Your wife and her family are lucky to have a persistent, determined, dedicated and resourceful guy like you around when something like this happens.

Simon,

One thing you should be aware of is if they just medicate her it does nothing to treat the cause. Medication was never meant to be a long term fix but only a tool to stabilize if necessary. Simply someone needs to get inside her head to help her sort this out. Depending on what approach is used that can be a short or long road to recovery. If the drugs she was taking are highly addictive like crack cocaine then you are in it for the long haul. Don’t be afraid to ask for therapy other than a pill, if you love her then you owe it to her to give her the very best available. She does not need to understand the therapy and what it does, only that it will help her get better.

What you're saying John, is true some of the time, but not all of the time. There are people, with serious psychiatric illness, who benefit from taking medication for the rest of their lives. This would include folks suffering from schizophrenia and bipolar disorder. It is clear that the decision to use and stay on medication is an individual one, made by the person in collaboration with their family, friends and professional helpers. No adult can or should be compelled to take any medication against their will. At the same time, for severe psychiatric illness, medication is intended as an essential component of long term treatment alongside various therapies and case management. Making statements like the above has the potential to reinforce stigma and keep people away from medication who might benefit.

Simon's situation is heart wrenching and his devotion is impressive. If the diagnosis is bipolar disorder, then Simon's wife would probably benefit from being on medication for a long time, even when she is symptom free (which is when many folks suffering from severe psychiatric illness stop taking their meds and relapse). Simon and his wife (and her family) need to be open to considering this possibility and supporting her in making healthy choices.

I've noticed some comments in the topics here addressing peoples' ideas about moderate drinking versus complete abstinence. There is controversy because of the strong feelings that many people have about this, on both sides.

Well designed, peer-reviewed research on controlled drinking suggests that the approach is effective for some people, although not everyone. I thought someone might value reading this summary of research on the topic by Bob Westermeyer. It's not the definitive word on the topic, since it was written in the late 1990's. It is a good summary of how professionals who work with alcohol abuse/dependence think about this issue.

http://www.habitsmart.com/cntrldnk.html

It's no coincidence that Thai authorities are 'reversing' years of of unoffocial policy, during which Hmong refugees were able to find shelter here (the current round of deportations started in 2005), at the same time that the Lao and Thai governments have announced a plan to increase bilateral trade to $4.5 billion by 2010 (triple the current level, I guess, according to official figures).

Thai Health Insurance. Wide variety of coverage at reasonable prices.

http://www.thaihealth.co.th/index_e.php

-O

My wife and I have Thai Health major medical/emergency coverage through a group policy. We're thinking of getting the outpatient coverage as well. Does anyone have experience using Thai Health's outpatient coverage for hospital visits, lab tests, etc?

Anyway- if anyone has experience with Thai Health's outpatient coverage, please share your insights!

One other question to Benqw -- aere you able to comment at all on inmpatient pysch facilities in Thailand for persons either suicidal or psychotic and in need of hospitalization? From what I hear Bangkok General and Samitivej seem the best bets but I'd be interested in any observations you may have...

It's difficult to make a generalization about this. This is a sensitive and difficult area where each case requires separate examination and judgment, based on individual circumstances. While I'm somewhat familiar with inpatient psychiatric facilities available for Thais, my experience with inpatient psych facilities that would be acceptable for foreigners is quite limited (I provide some training for Bangkok's largest inpatient psych facility, the Somdej Chaophraya Psychiatric Institute which provides good local care for the seriously mentally ill).

I think that some of the private hospitals can provide psychiatric care for people ready to be voluntarily hospitalized. That would be situations where someone has enough insight to realize that they need help that warrants hospitalization (for example, severe depression with suicidal tendencies, bipolar mania, detox from substance abuse). I don't have enough information or experience to point out a specific facility for their inpatient psychiatric care. There was apparently going to be a new, private psychiatric hospital for wealthy Thais and foreigners called Manoram Hospital, but I haven't hear much about it recently. While this could be a welcome addition to mental health resources in Bangkok, I currently have no information about their policies, procedures, etc.

It's not clear to me, however, that there are facilities for involuntary psychiatric hospitalization of foreigners (for acutely suicidal or psychotic behavior). I mean, what we sometimes call a "locked unit," where a psychiatrist/psychologist has the power to detain a person, against their will if necessary, because they may harm themselves (or others). Whatever you think of that, there are [highly infrequent] cases where it is called for (and even in the US, many people discharge themselves from such units AMA- against medical advice). My understanding, which may be mistaken, is that no private psychiatric unit exists in Thailand where a foreigner can be detained against their will (the public institutions like SCP have rarely admitted foreign patients but they have to be floridly psychotic).

Thus, presented with a situation where the client represents a threat to themselves (I have yet to see a therapy client here where the person represents threat to others), I have sometimes recommended medical evacuation from Thailand (bearing in mind that this is a sensitive and difficult area where each case requires separate examination and judgment, based on individual circumstances). And of course, people are free to reject my opinion, as they should be.

If anyone has a friend who they feel is imminently suicidal, my recommendation is that same as what you have heard before: take action and don't wait. Frankly what's most common here is serious substance abuse, usually alcohol abuse. And alcohol use is the most serious risk factor for suicide (since alcohol turns all the red lights green). Feel free to contact any of the professionals on the list above for a consultation.

Some Credentialed Foreign Mental Health Professionals in Bangkok

There are [limited] resources available here for people in distress and suffering from difficulties that come up in life. As a clinician, I'm aware of a number of qualified professionals people can turn to.

This is not meant to be a definitive 'List.' Nor is it meant to promote individual clinicians. It is intended to help increase people's awareness about well trained professionals available here in Bangkok (for people like op, who may benefit from being able to consult with a professional therapist). I believe that people are able to find help and help themselves in an amazing variety of ways- this list is meant to represent a sampling of one method to obtain help: therapy/counseling.

Many foreigners live outside Bangkok and may find this list not very helpful. Some of the organizations on this list will offer phone consultation. Other people choose to travel to Bangkok to receive treatment weekly, biweekly, or monthly. There are also useful self help resources on the internet (along with much that is not helpful)- for people interested in that, please get a copy of the Authoritative Guide to Self-Help Resources in Mental Health, edited by John Norcross (among others). It's an outstanding, peer- and consumer-reviewed guide to self help resources (book, video, internet) in a really broad range of areas.

How did I assemble this list? These are people who I am personally familair with who are able to provide mental health services (counseling/therapy, assessments) at a European/North American/Commonwealth standard of care. There are other credentialed mental health professionals I do not personally know (I don't recommend people I have never met). There are a very large number of uncredentialed people claiming to have credentials. Never be afraid to ask a provider about their training, experience, credentials, etc.

And adults are free, thank goodness, to spend their money on whatever treatment they prefer; I'm providing this incomplete and subjective list in order to help people who are interested in a professional consultation. I invite you to share any feedback about your experiences with these providers directly with me.

For more information, please contact each organization directly

NCS New Community Services

61/1 Soi Intamara 3

Sutisan Road

Phaya Thai (Sapan Kwai Area)

Tel.: 0-2279 8503

Fax: 0-2279 8502

[email protected]

Languages Spoken: Dutch, Thai, German & English (They may have added some other languages, including Japanese, but I'm not sure)

Opinion: The only clinic in Thailand I know if where well trained Thai counselors work side by side with well trained and credentialed foreign meantal health professionals. This is place to refer your Thai friends to for western style counseling.

Bangkok Psych Associates

Library Plaza 1000/200

Sukhumvit 55, Thonglor

Bangkok 10110

Languages Spoken: English

(02-712-7255)

Opinion: Credentialed professionals working with kids, teens and families

[email protected]

Psychological Services International

9/2 Sukhumvit Soi 43 (near Phrom Pong/Emporium)

Bangkok 10110,

Tel: 02-2591467

Fax: 02-2620505

www.psiadmin.com

Languages Spoken: English and French

Opinion: 3 licensed clinical psychologists (2 American, 1 Belgian); 1 licensed educational psychologist (Australian); 1 clinical social worker (American); 2 professional counselors. Working with teens, adults and couples. Educational assessment available

[full disclosure: I work at PSI]

Saisilp: The Centre for Creative Growth andProfessional Training

BB Building, 54 Soi 21 Sukhumvit

Tel: 02-2587562 press 0-Office

press 1-Khun Piyachat

Languages Spoken: Thai and English

Opinion: Piyachat R. Finney, ATR, CP. is one a new generation of Thai clinicians. Trained and credentialed in the US, she provides her expertise here.

Village Education Centre and Reed Institute have credentialed professionals providing educational assessment and interventions for children and teens who have learning and behavioral problems. Also- Reed Institute has at least one American licensed clinical psychologist and therefore able to provide therapy/counseling. She also specializes in eating disorders.

Bangkok also has two credentialed hypnotherapists I have met: John Kurkowski (many of you have seen his posts) and Karen Braddock. Bumrungrad is the only Thai hospital with a credentialed foreign counselor. Many private hospitals are now scrambling to hire Thai counselors, whose standard of training is not the same as other countries where counseling is an long-established profession.

I hope that people find this useful. In general, I prefer to read rather than post but in this situation, this information may be useful so I want to provide it. I just found about this thread (someone mentioned it to me). And thanks to the person who called my website amateurish. That was spot on and has motivated me to get back to working on it!