I work with expatriates in Bangkok and across Thailand online, by secure video, in English or French.
The curry
People come to Thailand for the reason anyone orders the local curry rather than the safe thing on the menu. You want a bit of adventure. Something with heat in it. Something that is not the meal you have been eating for twenty years.
And it is good. That is the part that gets left out of every warning anyone ever gives.
But a curry can be too hot, and the trouble with too hot is that you rarely notice at the first mouthful. You notice several minutes in, when it is already burning and there is nothing to be done except get through it. Nobody sets out to be burned. They set out for something with a bit of flavour in it, and the heat crept up while they were enjoying themselves.
That is most of the men I work with here. Not people who made a reckless decision. People who made a reasonable one, and stayed at the table a few years longer than the dish allowed.
The arrangement, and why it works so well
A great many men arrive in Thailand having decided, consciously or not, to start again.
What Thailand offers is not simply a lower cost of living. It is the removal of the audience. Nobody here knew you before. Nobody is keeping score against the person you were at forty in London, Sydney or Frankfurt. The professional identity that took thirty years to build can be set down, and with it the obligations that came attached.
So a second adolescence becomes available, and it is genuinely enjoyable. Late nights are possible again. Attention from much younger women is available in a way it was not at home. Alcohol is cheap, constant and entirely normal. Drugs are cheap. Nothing has to be explained to anyone.
This is usually described as a midlife crisis and then dismissed. That is a mistake. It is a real psychological event, and dismissing it is precisely why it goes untreated for years.
What is actually happening
A second adolescence is an attempt to answer a question that was never answered the first time.
The question is not about women, or drink, or the freedom to stay out. It is about meaning. Somewhere in the previous life the sense of purpose came out of the arrangement, and what was left was performance without content. Thailand does not create that emptiness. It offers a very effective anaesthetic for it, and the anaesthetic works well enough and long enough that the question stops being asked.
For a while this looks like happiness. Most people who eventually contact me were, for the first year or two, genuinely happier than they had been at home.
Then the arithmetic begins. The drinking that was social becomes daily. The relationships get shorter. The money moves in one direction. Old friendships thin out because there is less and less that can be said honestly. And underneath, usually, is something much older: a history that was never dealt with and that the whole arrangement has been organised around not feeling.
The trauma nobody came here to treat
A significant proportion of the expatriates I work with are carrying trauma from long before Thailand. Childhood, a marriage, a bereavement, a career that ended badly, something that happened once and was never spoken about.
Leaving the country does not process it. It removes the reminders, which is a different thing and works surprisingly well for a time.
That is why so much of this work is not really about the drinking. The drinking is the presenting problem. Underneath there is usually an untreated trauma and a lost sense of meaning, and treating the alcohol while leaving those alone is why people stop for six months and start again.
The absence of limits
The word men use for it is fluidity. Everything moves. Nothing meets resistance. Whatever you want is arrangeable, and nobody appears to mind.
It is worth being exact about where that comes from, because the usual explanations are either sentimental or contemptuous and neither is accurate.
Part of it is cultural. Thai social life places real value on grace and on not causing anyone to lose face, and that is a genuine skill practised well.
The larger part is purchased. A great deal of what is experienced as acceptance is a transaction, conducted politely, and conditional on the money continuing. That is not a criticism of anybody: it is an ordinary economic arrangement, and it is only dangerous when one party has misidentified it as something else.
And here is the part that matters clinically. Most people’s limits are not internal. They are supplied by other people — a colleague who would notice, a partner who would ask, a mother, an employer, a bank, the cost of things, the fear of being seen. That structure does its work invisibly, and almost nobody knows how much of their behaviour it was holding.
Remove all of it at once, which is what this move does, and you find out what you actually had. A number of men discover there was less than they assumed. There is no shame in that discovery. Those structures had simply never been tested, and testing them was never the plan.
What “losing yourself” actually means
It is the phrase everyone uses, and it is more precise than it sounds.
It describes the point at which the person you are here has drifted so far from the person you were that the two can no longer be held in the same room. Old friendships thin, not from neglect but because there is progressively less that can be said honestly. Visits home become harder. The account you give of your life becomes edited, then vague, then avoided.
Somewhere in that process, sexual life often changes in ways the person has no framework for. Some men encounter desire here that did not have room to exist at home — including men who find themselves drawn to trans women, who are a visible and ordinary part of Thai life rather than a curiosity or a symptom.
The desire is not the problem, and treating it as one is how a great deal of harm gets done. The problem is that it arrives with nobody to talk to about it, usually mediated by money, and set against whatever a man was taught about himself thirty years earlier. That combination — an ordinary desire, complete isolation, and inherited shame — is what turns something unremarkable into something secret, then compulsive, then organising.
By the time someone reaches me, the presenting complaint is rarely the sex. It is the secrecy, and what the secrecy has cost.
The container you cannot see
There is an error underneath all of this, and it is worth stating precisely, because nearly everybody makes it and it is the one that does the damage.
The freedom is not there. What the expatriate experiences as an absence of structure is in fact one of the most structured societies he has ever stood in. He simply cannot read it.
Thailand is a traditional culture with a strong and confident identity. Hierarchy is observed carefully and seniority is real. Obligation to family is not optional. A Buddhist framework organises the moral world. There is an elaborate everyday practice around face and around not imposing on other people. Almost none of this is legible to a newcomer, because none of it is announced. It is simply how things are run.
What he sees instead is warmth, ease, and an absence of objection — and he reads all three as informality. They are not informality. They are competence, exercised inside a system he has not begun to understand.
That produces a peculiar inversion. He believes he has stepped out of a structure into open space. What he has actually done is step out of his own structure — the one he could read, argue with, complain about and be held by — and into somebody else’s, which he cannot read at all. He is not uncontained. He is contained by rules he cannot see, which is a considerably worse position, because there is no negotiating with a structure you have not noticed.
The people around him, meanwhile, are in most cases markedly less free than he is. Obligation to parents in particular is a serious matter here. A great deal of the money the expatriate believes is being spent on his pleasure is travelling to a family in the northeast, discharging a duty that is neither cynical nor optional. The transaction is real. It is simply not the one he thinks he is having.
The client and the product
Which brings the sharpest part of it.
He arrives believing he is the client. He is. There is a substantial economy arranged to serve him, and it serves him well.
He is also the product.
Not in the crude sense. Most of these arrangements involve no fraud at all, and treating every Thai person in an expatriate’s life as a confidence trickster is both wrong and a convenient way of avoiding the actual problem. In the accurate sense: he is a resource. His arrival was anticipated. His preferences are understood rather better than he understands them himself. And there is a well-developed, entirely legitimate apparatus for converting his presence into income. Being served extremely well and being worked are not alternatives — in most of what he enjoys here, they are the same activity.
There is a last turn, and it is the one men take hardest.
He came here to put an identity down. What he has done is exchange it for one he did not choose and cannot resign from. Farang: a category with its own assumptions, its own pricing and its own ceiling, applied to him permanently, regardless of how long he stays or how well he learns the language. He has not escaped being seen in a fixed way. He has swapped a description he spent thirty years earning for one issued to him on arrival.
This is why the ending is so often described as a collapse rather than a decision. He was never free. He was unmoored — which feels identical for about three years, and is the opposite thing. Durkheim’s word for the condition was anomie, normlessness, and he regarded it as one of the more dangerous states a person can be in.
The work, when someone finally arrives at it, is not usually about going home. It is about building a structure that belongs to him, in a place that was never going to supply one.
Thailand and the residential question
Thailand is one of the largest destinations in the world for residential addiction treatment. People fly in from everywhere for it, and some of it is excellent.
Which produces a particular irony for the expatriate already living here: world-class residential treatment is on his doorstep, and he will not go into it. Not because it is far, but because walking through that door is the public admission he moved eight thousand miles to avoid making.
So the choice is not really residential or therapy. It is therapy or nothing, for years.
That is the person this practice is for. One to one, weekly, confidential, without an admission, without an absence, and without anyone at home needing to be told.
Why online, and why from outside
Bangkok has good clinicians, and there are English-speaking therapists here. But expatriate communities are small and they talk. The person you would be seeing may well drink at the same bars, know your employer, or know the woman you are living with.
I do not know your GP, your employer, or anyone who drinks in your local. Nobody I know will be in the room when your name comes up. For a good number of people that is the entire reason they made contact.
What I work with
Addiction, including the combinations that are specific to this part of the world.
Alcohol, particularly the functioning drinker whose consumption looks unremarkable against everyone around him.
Trauma, including complex and childhood trauma, using EMDR delivered online.
Chemsex and sexual compulsivity, where drug use and sex have become a single behaviour.
The midlife crisis, which is the frame that makes sense of most of the above.
Online psychotherapy, how it is delivered and why it works.
Some figures, for context
Thailand consumes about 7.99 litres of pure alcohol per person a year among those aged fifteen and over, on World Bank and WHO figures. That is not extreme by European standards. What is different is not the national average but the expatriate environment: alcohol is inexpensive, permanently available, socially compulsory, and nobody is counting.
On drugs, there are two separate markets and they rarely get described separately.
The Thai drug is methamphetamine, in tablet form as yaba and crystal as ice. Prices have collapsed over two decades, from around 200 baht a tablet to roughly 20 in the provinces and 50 to 60 in Bangkok, and use rose by about thirty per cent in a single recent year. Thailand records the largest methamphetamine seizures in East and Southeast Asia, including one seizure of a billion yaba tablets.
The expatriate drug is cocaine. It is expensive here, considerably more so than in Europe, and that is part of its function: it signals that you are not using what the locals use. It travels with the drinking rather than separately from it, and in this practice the two almost always arrive together.
The two markets meet in one place, which is chemsex, where crystal methamphetamine crosses over into the expatriate scene through sex rather than through the street.
That combination, cheap stimulants and unlimited alcohol in an environment with no witnesses, is not a moral problem. It is a clinical one, and it accelerates things that would otherwise have taken a decade.
Practicalities
Sessions are fifty minutes, weekly, by secure video, from Bangkok, Chiang Mai, Phuket, Pattaya or anywhere else in Thailand. In English or French.
Clients may work with me directly or, where appropriate, with an Associate under my clinical supervision.
If in-person or residential treatment is what you actually need, I will say so at the assessment rather than six months in.
Specialist services for Thailand
- Addiction and Alcohol Therapy for Thailand
- Eating Disorder Treatment for Thailand
- Trauma Therapy and EMDR for Thailand
- English-Speaking Therapist in Bangkok
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: the Samaritans of Thailand English line is 02 113 6789, press 2. It is anonymous and staffed around the clock; leave a message and someone calls back. The Department of Mental Health hotline is 1323, free and 24 hours, in Thai. In an emergency, go to the emergency department of an international hospital and ask for the psychiatrist on duty.
Alcoholics Anonymous runs English-language meetings in Bangkok, Chiang Mai, Pattaya, Phuket and Udon Thani, as well as online.
Statistics: World Bank and World Health Organization alcohol consumption estimates; United Nations Office on Drugs and Crime regional synthetic drug reporting. This page is for information and does not replace assessment or treatment.
All international work is delivered by secure video. How the online work is done.
How the work is delivered from here
All international sessions are by secure video, in English or French. Online therapy is not a reduced version of consulting room work: it is the format that lets weekly work survive living abroad, travelling, or relocating. Sessions run in United Kingdom hours, which suits most regions, and if your time zone makes none of it workable, say so when you enquire rather than assuming it rules you out.
For clinicians and treatment services
Dr Jacquet supervises clinical teams in private residential addiction treatment and in a private psychiatric hospital. For treatment centres, psychiatric units and group practices looking for external clinical supervision, including in places where no supervisor of this seniority is available locally, team supervision is also delivered by video. For individual practitioners, see clinical supervision.
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