‘Rethink the Couch’: A New Perspective on Therapy in Asia

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Allison Heiliczer and her book 'Rethink the Coouch.'

Balancing the demands of parenting, a full-time job as a therapist, and a recent move to Singapore meant that Allison Heiliczer found solace in the early morning hours.

“Sitting in front of the computer, sipping on a large cup of green tea, the darkness outside mirrored the depths I delved into while exploring the intricacies of Asia’s mental health landscape,” she described, recalling the countless mornings, some as early as 3 am, spent writing “Rethink the Couch.”

In a region where mental health struggles often remain unspoken, Heiliczer’s book offers a new culturally appropriate perspective on therapy through narratives and the untold stories of courage, hope, and the desperate search for oneself.

Allison Heiliczer. (Photo supplied)

Heiliczer is an American therapist who made the move to Asia over 15 years ago. After more than a decade in Hong Kong, she now calls Singapore home. Her path as a therapist in this region is unique. Mental health has historically been a sensitive topic here, especially a decade and a half ago. Local communities often harbor feelings of apprehension, mistrust, and caution towards mental health treatment. This hesitancy is rooted not just in a lack of cultural understanding but also in pervasive societal stigma.

She worked extensively throughout Southeast Asia and beyond, taking on patients from Laos, Thailand, Vietnam, Myanmar, and Cambodia, in addition to her in-person sessions in Singapore and Hong Kong. Particularly during the COVID-19 pandemic, patients from across the region reached out to her, requesting online therapy sessions.

Reflecting on her experiences, Heiliczer said, “Some people’s stories just go untold for many, many years, for various reasons. For political reasons, for economic reasons, for all these sorts of reasons.” This realization served as an inspiration for her exploration of the Asian therapeutic environment, where stories of resilience and healing often remain hidden from view.

“Most of my online patients didn’t want to turn their cameras on for fear of societal repercussions,” she recalled.

At the heart of “Rethink the Couch” lies a turning point for Heiliczer, as she remembered proposing the idea of reading a book about a former boy soldier from Sierra Leone to a group of men she was working with in Hong Kong. The choice was deliberate, driven by the desire to shed light on untold stories and offer glimpses of hope amidst major life challenges.

“We were just going to meet every week. So it became clear that of the two things, the one thing that they really wanted was to start to feel like they were going to learn a skill that would be helpful for them eventually in their future,” Heiliczer reflected on her first steps into this journey.

“The goal is not to just copy and paste from what Americans, you know, and others in Europe are doing,” Heiliczer explained. She meant to work with locals and adapt to their own needs rather than using traditional western methods of therapy, which, according to her, would simply be a failure in an Asian context.

Writing “Rethink the Couch” took Allison Heiliczer into tough places, facing the darker sides of human experiences with deep care and resolve. Her writing journey reveals the emotional depth and tough choices involved, especially in chapters dealing with sensitive issues like human trafficking and exploitation.

Heiliczer’s involvement with pro bono work for organizations like the Mekong Club, dedicated to ending modern slavery, added another layer of complexity to her writing process. The connection to real-life stories of exploitation and suffering weighed heavily on her conscience, forcing her to confront the darkest facets of Southeast Asia.

“I love Asia, and I love so many things about this region, and yet that was very difficult because it put me back into really the shadow side of sex trafficking and exploitation,” she said.

Describing the process, Heiliczer shared, “The second chapter is about this guy who has an affair with this trafficked woman who’s inside a cage. That was very difficult to write because it’s like you have to kind of put yourself psychically back in that space and live the narrative in your mind.”

As Heiliczer delved deeper into the world of therapy in the Asian context, she also confronted the stark reality of underrepresentation.

“Sixty percent of the world’s population had never been represented in the therapy room,” she observed. Inspired by this revelation, she set out to write about the diversity of human experiences, challenging conventional narratives, and amplifying voices that have long been silenced.

“Therapy is not always the answer for people. Sometimes it is part of the support, but sometimes it’s not.”

Her approach emphasizes accessibility and inclusivity, recognizing the diverse needs of individuals and communities across Southeast Asia.

“I don’t think the answer to mental health challenges is to just train more therapists,” she carried on, specifically referring to rural contexts such as remote areas in Laos.

In her quest to bridge gaps in mental health care, Heiliczer explored innovative solutions and community-driven approaches. “People in certain villages in Laos don’t have access to Wi-Fi and they can’t afford to pay for therapy,” she acknowledged. Yet, amidst these challenges, she remained steadfast in her commitment to holistic healthcare, blurring the lines between mental and physical well-being.

As Heiliczer eloquently articulated, “Mental health is really also physical health. It’s a false dichotomy.” Through her work, she invites readers to reconsider conventional notions of therapy, inviting them on a journey of introspection, connection, and transformation.