International practitioners – What does it take to practice psychology abroad?
Cultural competence is always in demand; educational requirements vary widely.
While American-trained psychologists tend to be in high demand for overseas academic jobs, finding work as a clinician can prove more challenging, even for natives who get their degree in the United States and want to return home to practice.
Not only do training and licensing requirements differ considerably around the world, but working in another culture or language can raise ethical challenges, says Merry Bullock, PhD, director of APA’s Office of International Affairs.
“APA’s multicultural guidelines, along with international guidelines, suggest that psychologists’ roles in cultures or languages that they don’t thoroughly know should be more training or consultation rather than direct intervention with clients,” she says.
Nonetheless, because many countries lack a sufficient number of well-trained clinicians, they’re recruiting psychologists, expecting that they will obtain the cultural or language training they need within a year, says Judy Hall, PhD, CEO of the National Register of Health Service Providers in Psychology and co-editor of “Global Promise, Quality Assurance and Accountability in Professional Psychology” (Oxford, 2008).
The key, she adds, is to thoroughly research the licensing and registration requirements in the countries you’re interested in. “You can’t assume that your U.S. doctorate will be sufficient,” she says. “The U.S. and Canada are the only countries that require a doctoral degree to be a licensed psychologist. The rest of the world may want additional information.”
Getting started
Although a doctorate is coveted in the United States, many other countries—including most in Europe—emphasize an undergraduate degree in psychology, says Hall. This can be a problem for U.S.-trained doctoral students who seek work overseas, because approximately half have undergraduate degrees in subjects other than psychology.
“My biggest piece of advice to students looking for overseas jobs is to document the equivalent of an undergraduate degree in psychology,” says Hall.
But such documentation isn’t a problem in countries such as New Zealand and Australia, which have a shortage of well-trained clinical psychologists. Indeed, New Zealand offers automatic licensing to job applicants with doctorates from accredited programs in the United States, says Larry Beck, a New Zealand job recruiter. And many developing countries, including India, Singapore and the United Arab Emirates, have no licensing or regulation of clinical psychology.
“Anyone can [provide] counseling and psychological services, even those who had some workshops or [minimal] training in related areas,” says Fatima Al-Darmaki, PhD, professor of counseling psychology at United Arab Emirates University. The profession is poorly regulated and only beginning to become established as a respected field of study, she notes.
Hall thinks that lack of regulation will quickly change, mostly because psychologists in those countries are asking for tighter restrictions to ensure quality control.
Because licensing laws, if they exist, vary so dramatically from country to country, job seekers should check guidelines through a country’s psychological association. APA’s Office of International Affairs maintains a list of international psychological associations at www.apa.org/international/natlorgs.html. And plans are under way to build an APA Web site that will house “The Psychologist’s Map of the World,” which will include information on licensing and registration requirements for a host of nations, says Bullock.
Cultural adjustments
Even if a country doesn’t require a license to practice, psychologists have an ethical obligation to have the training and skills needed to provide proficient care, says Bullock. That includes being knowledgeable and sensitive to the local culture and may include speaking the local language. Although English may be the academic language in some countries, clients generally feel most comfortable discussing problems in their native tongue, says Al-Darmaki.
Psychologists can sometimes get around language barriers by finding supervisory positions at community mental health centers and hospitals, says Jui Shankar, PhD, who received her doctorate at Ball State University before returning to her native India and taking a job as a mental health coordinator for Doctors Without Borders in a remote area of northeast India. She grew up in Pune, on the west coast of India, where the culture and languages couldn’t be more different. As such, she was hired to train locals to counsel people about HIV/AIDS rather than do the hands-on work herself. She’s now learning the local languages and customs so she can better evaluate her staff and, eventually, do some of the counseling herself.
As with Shankar’s job, there are many overseas opportunities with nongovernmental organizations, says Shankar.
“These kinds of places can absorb a lot of people with PhDs and master’s degrees in psychology,” says Shankar. “They work on everything from basic health care to women’s issues to mental health advocacy.”
The work is often in poor, underserved and sometimes dangerous areas, but it can provide excellent experience, she says. She was quickly promoted from a trainer to a mental health officer, and she now supervises counselors, conducts community-based assessments of mental health needs, oversees a program to publicize the center’s services and even sees a few clients.
“It’s a dream job,” she says. And she’s found that her training at Ball State prepared her well for the work.
That’s not always the case, even for psychologists returning to their native countries. Counseling psychologist Li-Fei Wang, PhD, for example, returned to Taiwan from the University of Missouri confident in her counseling skills. “I was so naive,” she admits, noting that the Taiwanese clients she saw in schools and at the National Taiwan Normal University where she is a professor, wouldn’t open up as easily as their American counterparts. “They expected me to be the expert and ask all the right questions, but, culturally, they were not used to talking about their problems,” she says.
She also found it critical to include parents and teachers when working with children and even young adults because of the enormous influence these authority figures have in Chinese culture. When working on career decisions with college students, for example, she not only explores their personal interests, but also their parents’ expectations and how students feel about them. It took her several years to develop methods to account for the complexity of traditional Chinese interpersonal-relationship dynamics. But once she did, she found her counseling to be much more effective.
Along with adjusting to a new culture, psychologists who move from the United States to other countries need to learn to work with the health-care and insurance systems. Pay for psychologists tends to be lower outside the United States, so those who choose to work abroad often do it for the experience rather than the compensation, says Nancy Pachana, PhD, who was born and educated in the United States and is now an associate professor in psychology and the director of the university’s clinical psychology training program at the University of Queensland, Australia.
Because much of the world has state-run health-care and health insurance systems that regulate salaries and services, psychologists hoping to tap into these public insurance programs need to find work in clinics, hospitals and other settings that receive compensation through them.
“In many of these countries without a licensure law, you can work in private practice even without a license, but you’ll find it difficult to get paid without some form of recognition, such as chartering by the British Psychological Service,” says Hall.
By Beth Azar
