When United Psychological Service was established in downtown Taipei in 2005, it became one of Taiwan’s first clinics to offer mental health care provided by licensed counseling psychologists. Chen Shu-yi (陳舒儀), United’s head psychologist, helped found the service after years of working in university counseling centers and community health care facilities run by local governments. “In the past, when most people felt disturbed, they tended to talk to their family members or friends—if they chose to talk to anyone at all. Or they might’ve sought comfort in religion or pursued alternative healing options like energy therapy or hypnotherapy,” Chen says. “But now people have the option to talk to counseling psychologists. We like to think we’re just as effective—if not more effective—at helping people than those other options.”
Chen is one of more than 2,300 Taiwanese counseling psychologists who are licensed under the Psychologist Act, which was promulgated in 2001. United, meanwhile, is one of more than 40 local clinics that employ counseling psychologists, but are not attached to larger medical institutions or nonprofit organizations.
Shyu Shi-sen (徐西森) is a counseling psychologist in the Student Guidance Center at National Kaohsiung Normal University in southern Taiwan, a professor in the school’s Graduate Institute of Counseling Psychology and Rehabilitation Counseling and president of the Taiwan Counseling Psychologist Union (TCPU). Clinical psychologists can perform evaluations and treat disorders such as impaired mental function, he explains, while counseling psychologists help otherwise healthy individuals cope with behavioral, cognitive, emotional and social adaptation difficulties in settings including businesses, communities, schools and universities.
Counseling and clinical psychologists are also able to treat neurosis under the direction of psychiatrists, or medical doctors who diagnose and treat mental disorders. Only psychiatrists have the ability to prescribe medication, but Chen does not see that as a problem. “Insomnia, for example, can be caused by physical disorders or by psychological issues, and we can help with the latter,” she says. “And some physical problems such as upset stomach, nausea, chest tightness and palpitations are psychological in origin.” In cases where medication should be avoided, such as during pregnancy, psychological care is usually recommended as the best option, the psychologist adds.
Chen uses the example of depression to point out the preventative nature of the work performed by counseling psychologists. “We try to help those who suffer sadness before it develops into a depressive disorder,” she says. “We try to build up an individual’s positive feelings or sense of happiness before sadness crosses that critical line.”
Demand for the services provided by counseling psychologists is increasing in Taiwan. One factor behind that rise is simply an increased focus on mental health in both the public and private sectors. An obvious example of that shift can be seen in the July 2013 establishment of the Department of Mental and Oral Health under the Ministry of Health and Welfare (MOHW). Other factors behind the growing demand for counseling psychologists include the lingering effects of the 2008 global financial crisis, political strife and unemployment, all of which have caused anxiety levels to rise, Chen says, adding that “the decline in the supportive function of families has also intensified mental instability.”
Guidance counselors and counseling psychologists participate in a training program organized by the Taiwan Guidance and Counseling Association. (Photo courtesy of Taiwan Counseling Psychologist Union)
Shyu believes that alienation and an unhealthy focus on individuality have given rise to an increasingly widespread sense of uncertainty. “Many people tend to waver between excessive egoism and a keen sense of helplessness, and that can lead to suicidal inclinations,” the professor says.
The TCPU was established in Taipei in 2010 and currently comprises 11 regional associations that serve more than 1,500 practicing counseling psychologists across the country. As more than 65 percent of such psychologists work in elementary schools, secondary schools and universities, Shyu also heads the Taiwan Guidance and Counseling Association (TGCA), the forerunner of which was established in 1958 in Taipei. Most of the TGCA’s members are academics and guidance counselors at schools of various levels.
A master’s degree in psychology is required to become a licensed clinical or counseling psychologist. Primary and secondary schools also employ guidance counselors, who must have an undergraduate degree, complete a required number of education courses and hold a teaching certificate issued by the Ministry of Education. A 2011 revision to the Primary and Junior High School Act calls for every elementary school with 24 or more classes to have one guidance counselor, while a second is required for larger elementary schools that have 45 classes or more. All junior high schools must employ at least one guidance counselor. “This means elementary and junior high schools will eventually have a total of more than 2,000 full-time guidance counselors,” Shyu notes.
In the past, guidance counseling was typically taken on as an additional task by qualified teachers at primary and secondary schools. Today, while there are still more counseling psychologists in universities than primary and secondary schools, the number of those who provide services for younger students is increasing. Hsieh Iou-zen (謝曜任), for example, is a full-time counseling psychologist at Taipei Municipal Dongmen Elementary School and also serves as secretary-general of the Taiwan Counseling Psychology Association. “School guidance counselors aren’t required to have a psychologist’s license, but licensed counseling psychologists who do guidance work have an enhanced professional image,” Hsieh says. “There’s also an ongoing push to integrate the expertise of guidance counselors, counseling psychologists and social workers in the primary and secondary education system, which means that counseling psychologists who perform guidance work are ahead of the curve.”
A Bit of Help
Counseling psychologists who work in schools typically do not treat students as patients, but rather as individuals who need a bit of help. “We look at them from the angle of enhancing their mental health, rather than from the viewpoint of curing a disease,” Shyu says. One group of young people that could use such help these days, Chen says, is those who tend to overindulge in using the Internet. “They’re online so much that they lack confidence when they have to face the frustrations of the real world,” she says.
Hsieh points out that counseling psychologists have a range of tools for helping students overcome behavioral, emotional and interpersonal problems. “Some kids can’t express themselves clearly,” Hsieh says. “In such cases, we can employ other ways of expression like drawing or playing games.”
Counseling psychologists believe that incorporating their services into the National Health Insurance system will provide better mental health care for an increasing number of elderly people. (Photo by Huang Chung-hsin)
Hsieh serves as a mentor for interns studying in university counseling departments. Auyong Yin-yin (歐陽瑩瑩), a student in the fourth year of her undergraduate studies in the Department of Educational Psychology and Counseling at National Hsinchu University of Education in northern Taiwan, for example, is an intern at Dongmen who wants to specialize in using play therapy with very young students. Another of Hsieh’s interns is Yen Jui-yi (顏睿怡), a student in the fourth year of undergraduate studies in the Department of Psychology and Counseling at the University of Taipei who is considering a counseling career in the school system.
While most counseling psychologists work in schools, there is a growing need for their services in a range of other fields. Taiwan’s rapidly aging population, for example, means that such psychologists are providing more mental health services for elderly people. “For instance, when a senior’s old friends pass away, he or she needs to be soothed and diverted from indulging in sadness,” Hsieh says.
Chen says enterprises frequently ask United’s counseling psychologists to give employee seminars on topics such as coping with workplace pressure. “Some companies also pay for individual staff members who want to talk to us,” she says.
Counseling psychologists are also playing a more visible role in Taiwan’s larger health care system. The 2012 revision of the Medical Institution Establishment Standards, for example, requires that at least one clinical or counseling psychologist be employed in every general hospital that has 30 or more beds for acute psychiatric patients, while at least one is required for every hospital that has 300 or more beds for patients suffering from other acute illnesses. Hospitals that have 1,000 or more beds for patients with acute illnesses are required to employ a second psychologist.
Counseling Health Workers
Given the stressful nature of working in hospitals, the revision also requires that every general hospital with 300 or more employees employ one clinical or counseling psychologist to provide services for staff members. An additional psychologist is required for hospitals that have 1,000 or more employees. Currently, only a few dozen counseling psychologists work in Taiwan’s medical institutions, which means that the revised standards will create hundreds of openings for such professionals.
“The next focus of our efforts will be incorporating counseling psychologists into the National Health Insurance (NHI) system,” Shyu says. “At present, the system covers treatment by clinical psychologists, but not by counseling psychologists.” The professor notes that groups like the Taiwanese Society of Psychiatry have agreed that the services provided by counseling psychologists should be covered under the NHI scheme. The issue is currently being considered by the NHI Administration under the MOHW.
Chen says that she is concerned about the numerous people she has met who have “chosen to be numb” about their lives, adding that such individuals can learn how to tune in to their emotions and thus help themselves. The capacity to understand and manage one’s emotions might be one of the greatest blessings in modern society, she says, and Taiwan’s counseling psychologists are determined to help more people do just that.
Write to Pat Gao at cjkao@mofa.gov.tw