Meanings of Counselling in Hong Kong

MEANINGS OF COUNSELLING IN HONG KONG:

A CONTEXTUAL PERSPECTIVE

A thesis submitted to the University of Manchester for the degree of Doctorate in Counselling Psychology (DCounsPsych) in the Faculty of Humanities

2019

TIFFANY WING-SUM LEUNG

School of Environment, Education and Development

Contents ABSTRACT ...... 6

DECLARATION ...... 7

ACKNOWLEDGEMENTS...... 9

Chapter 1. Introduction ...... 10

1.1. On counselling ...... 11 1.2. East Asia: A Theoretical Misfit ...... 13 1.3. Hong Kong counselling ...... 15 1.4. An Auto-ethnographic Account ...... 18 1.5. The Chapters/outline of the thesis ...... 19 Chapter 2. Literature Review ...... 22

2.1. Hong Kong Professional Counselling ...... 22 2.1.1. Disciplines: History and Development ...... 22 2.1.2. Education & Training...... 31 2.1.3. Culturally Appropriate Professional Practice and Research ...... 32 2.1.4. Accreditation, Ethics and Regulations ...... 36 2.2. What is Hong Kong Context? ...... 37 2.2.1. Geopolitical predispositions ...... 37 2.2.2. The ‘Chinese’ Socio-Cultural Values ...... 40 2.3. Hong Kong Counselling Situation ...... 46 2.3.1. Blurred Professional Identity ...... 46 2.3.2. Questionable Professionalism ...... 47 2.3.3. Linguistic Translation Problem ...... 48 2.3.4. Cross-Disciplinary Communication...... 49 2.3.5. Struggle with local policymaking ...... 50 2.4. The Insufficient Existing Theoretical Explanations ...... 52 2.4.1. Research Gaps ...... 52 2.4.2. Redefining Hong Kong Culture: An Indigenous Approach ...... 53 2.5. Research Rationale ...... 58 Chapter 3. Methodology ...... 60

3.1. Theoretical Positioning/Reflexive Statement ...... 60

3.2. Ontology and Epistemology ...... 61 3.3. Qualitative Mixed Methods Orientation ...... 64 3.4. Trustworthiness ...... 68 3.5. Data Collection ...... 68 3.5.1. Design ...... 68 3.5.2. Ethics ...... 70 3.5.3. Recruitment ...... 70 3.5.4. Procedure ...... 72 3.5.5. Transcription ...... 72 3.5.6. Analysis ...... 73 Chapter 4. Personal Reflexivity ...... 82

4.1. Epistemological Shift: An Insider’s Experience...... 82 4.2. Methodological Changes: A Process ...... 84 4.3. The Interview Process ...... 87 4.3.1. Underneath the Researcher’s Complex Identities...... 88 4.3.2. How to Move on from Power Struggles? An Opening Door via Communication 89 4.3.3. Can we talk about Politics? ...... 93 4.3.4. Concluding Remarks ...... 96 Chapter 5. Analysis ...... 98

Theme 1. Defining the Contextualised Counselling (Knowledge Forms) ...... 100 1.1. Humanistic and Holistic/Integrative Attendance (Phase 1) ...... 101 1.2. Between Integration and Diversification in Service...... 104 1.3. The Multi-layered/-dimensional Service Structure ...... 105 Theme 2. ‘This is Hong Kong …’ (Contextualisation) ...... 107 2.1. Resistance against Counselling is More Than Just a Culture ...... 107 2.2. ‘Hong Kongese are Chinese’ versus ‘The West is Better?!’ ...... 109 2.3. Between Improvisation and Indigenisation ...... 110 Theme 3. Practitioners’ Complex Roles ...... 116 3.1. The Middle Ground ...... 117 3.2. Dual Roles ...... 117 3.3. Specific role ...... 119 3.4. The ‘So-called’ Multi-disciplinary Collaboration ...... 121

3.5. Self-initiated Continuous Professional Development ...... 122 Theme 4. Alternative Structural/Institutional Legitimation ...... 123 4.1. Different Structural/Institutional Legitimation Forms ...... 124 4.1.1. Disciplinary-led Internal Regulatory Systems ...... 125 4.1.2. Alternative Academic Institutional Legitimisation ...... 129 4.2. Localised Power Transformations ...... 132 4.2.1. ‘Absent’ Power...... 133 4.2.1.1. (Phase 2 only) Policy Making’s ‘Outsiders’ status quo ...... 134 4.2.1.2. (Phase two only) Bottom-Up Bureaucratic regulations/官寮體制 ...... 135 4.2.1.3. ‘Resources are The Key’ ...... 136 4.2.2. Alternative Historical Legendary Informed Professional Hierarchy ...... 141 4.2.2.1. Disciplinary Prestige ...... 141 4.2.2.2. Others who are ‘In Between an Insider and Outsider’ ...... 143 4.2.2.3. (Phase 2 only) International/Social Status as a Form of Power ...... 145 4.2.2.4. (Phase 2 only) Apprenticeship-Training Hierarchy ...... 145 4.3. ‘This is dealing with human nature problems/呢啲deal with 人性嘅問題’ ...... 146 4.3.1. ‘I am the unique and only elite/唯我獨尊’ ...... 146 4.3.2. Beneficial Conflicts and Competition (phase 2 only) ...... 147 4.3.3. ‘My field has the Better Expertise.’ ...... 148 4.3.4. Securing the Existing Status quo...... 150 4.3.5. Deeper Training Developmental Disparity (phase 2 only) ...... 151 4.3.6. The Consequential Behaviour of Extending Territorial Segregation ...... 152 4.3.6.1. Identity Dissociation ...... 152 4.3.6.2. No Sharing Culture ...... 153 4.3.6.3. Re-asserting the Own Expertise ...... 155 Theme 5. Towards the Future: Remaining Discrepant Voices ...... 158 5.1. Addressing the Current Challenges ...... 160 5.1.1. Problem Externalisation ...... 161 5.1.2. Relating to Mainland China ...... 162 5.2. Towards Changes and Action ...... 164 5.2.1. Small Alterations ...... 164 5.2.2. Structural reform ...... 166 5.2.2.1. Individual Reform ...... 166

5.2.2.2. Disciplinary Reform...... 167 5.2.2.3. Academic Reform ...... 168 5.2.2.4. Accreditation and Regulation Reform ...... 168 5.2.3. The Remain Unchanged Voices ...... 169 Chapter 6. Discussion ...... 171

6.1. Methodological Considerations ...... 172 6.2. Counselling is institutionalised...... 175 6.3. What Can We Learn from Colonial Power?...... 181 6.4. What is Critical Pedagogy of Counselling? ...... 196 6.4.1. Professional Development/Education ...... 197 6.4.2. Research Areas ...... 201 6.4.3. Social Practices/Applications ...... 205 6.5. Conclusion ...... 210 Notes ...... 212

References ...... 216

Appendices ...... 279

Appendix 1. Information Sheet ...... 279 Appendix 2. Consent Form ...... 281 Research Title: The Meanings of Counseling: A Hong Kong Contextual Perspective ...... 281 Appendix 3. Email and Poster Promotion ...... 282 Appendix 4. Profile of the Participants ...... 286 Appendix 5. Interview Arrangements (also the partial interview notes/jotted points made right after each interview) ...... 289 Appendix 6. Analysis Extract ...... 293 Appendix 7. Full Translation of the Extracted Quotes ...... 295 Appendix 8. Original Interview Questions ...... 333 Appendix 9. Interview Schedule (with the improvised questions) ...... 335

Meanings of Counselling in Hong Kong: A Contextual Perspective Tiffany Wing-sum Leung Jun 2019 The University of Manchester Doctorate in Counselling Psychology ABSTRACT

This thesis undertakes a critical and qualitative inquiry into counselling in Hong Kong. It explores how counselling, a Western originated product, has been adopted by different Hong Kong healthcare professionals in the postcolonial era. The current study has a clear socio- political agenda to elucidate counselling meanings which are closely aligned with the wider context, which facilitates interrogation of domination which are in the form of structural or institutional power.

This thesis adopts indigenous methodology as the theoretical design, which comprises of an integrative framework of the pragmatic bottom-up indigenous processing, auto-ethnography and post-colonial framework. Participants with different backgrounds have been recruited, including social work, clinical psychology, counselling, counselling psychology, teaching and chaplaincy. Nineteen semi-structured interviews were conducted. The first phase interviews indicated how fourteen participants accounted for the meanings of counselling. In the second phase, five participants discussed the current socio-political status in Hong Kong. Then, mixed methods of analytical framework were adopted, including postcolonial framework/intersectionality, Interpretative phenomenological Analysis, Discourse analysis and systemic approach. Analysis was how Hong Kong counselling is conceptualised as multi- dimensional and multi-perspective, comprising five broad fields of inter-relations, including 1) Defining the Contextualised Counselling; 2) ‘This is Hong Kong…’ (Contextualisation); 3) Practitioners’ Complex Roles; 4) Alternative Structural/Institutional Legitimation; 5) Toward the Future: Remaining Discrepant Voices. The first four fields of meanings were interpreted as forming a model reflecting how the historical legacy of institutions, led by the fundamental human nature (morality), has orchestrated cross-disciplinary oppression and segregation, indicating the significance of ‘human element’ in a structural system. The discussion shows how colonial power has set the foundations of Hong Kong counselling’s ‘absence of power’, but also how local social-political collaborations have equally contributed to the territorial interplay. Implications are outlined on how change and action can take place, to enable challenge against the status quo of segregation. Actions should also happen within the structural systems and between disciplines instead of just towards the external public. This thesis suggests that communication can act as a new form of advocacy, not to combat, but instead to constructively dissolve territorial segregation with connectivity and respect. Such claims are elaborated using a three levelled conceptual framework of critical pedagogy – personal/professional development, research areas and social applications to cultivate dialogue, connection and understanding. Keywords: Hong Kong, counselling/psychology, indigenous, post-colonialism, professional identity, institutionalism/structuralism.

DECLARATION

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ACKNOWLEDGEMENTS

I would not have completed this thesis without many’s contributions and support. Mum and dad, thank you for your love and support, such that I discovered my passion in counselling and psychology. Despite missing me, you two still let me leave home to pursuit my dream.

You have sacrified a lot for me to be able to be who I am today. I love you.

A huge thanks to my sister and brother. You have been there for me when I needed someone to let the negative emotions out. Thank you for embracing and supporting me when I sometimes do not feel like being a big sister. Especially thank you to my brother who has given up some nights without complaint or questioning to practically help me out.

Thank you my aunties for your endless support. You support me by literally taking out your free time to help me quicken my work progress, especially in my last year of training. I never take this for granted.

Thank you Erica Burman for being my brilliant supervisor. You have not just given me tremendous support, but also inspired me to discover my passion in social justice and critical psychology. You have truly influenced me tremendously over my doctoral training.

Thank you Terry Hanley for your feedback and suggestions; Laura Winter and Tony Parnall for your support as my tutors and lecturers, and Liam for your administrative support. These three years of training have been a fruitful experience for me.

Thank you my work colleagues in the UK and Hong Kong, service users/clients/patients, my doctoral coursemates and my friends. You and your experiences have inspired me. I am proud to say I personally have learnt a lot from all of you.

Most importantly, I dedicate this thesis to my grandpa and grandma who have returned to

Heaven during my past three years. I hope I have made you proud.

Chapter 1. Introduction

This thesis undertakes a qualitative inquiry on counselling in the twenty-first century through a critical cultural lens. Using Hong Kong as a case example, this thesis interrogates contemporary contradictory relations between colonialism, indigenisation and globalisation.

Counselling, originally a Western product, was introduced to Hong Kong through influences of British colonisation and has since been adopted as a professional practice by different local healthcare professions (Ho, 1986; Yuen, Leung & Chan, 2014). Since then Hong Kong counselling has become multi-dimensional and multi-perspectival as it involves diverse applications and different healthcare disciplines.

By empirically investigating local narratives, this thesis explicates Hong Kong counselling’s particular multi-dimensional and multi-perspectival nature. This Introduction identifies the principal terms which comprise key concepts and themes of the current thesis: counselling,

Hong Kong and Hong Kong counselling. I borrow Derrida’s (1988) term ‘deconstruction’ to illustrate my theoretical stance, not just to understand counselling as it appears in the Hong

Kong context, but also to challenge against the traditional positivist paradigm. First, I address the need to investigate counselling’s highly contextual nature. Second, I highlight the geopolitical specificity of Hong Kong. Western theoretical hegemony has to a certain extent excluded a specific East Asian perspective. Therefore (and thirdly), there is a need for research to articulate significant implications not only of Hong Kong culture and counselling, rather to understand Hong Kong counselling as a complex conceptual apparatus which intersects with historical legacies, localised contextual factors and global patterns of domination.

I should clarify, therefore, that to define the current contemporary counselling meanings, the thesis does not seek to capture representations of either the traditional/historical or the present

11 conceptualisations, instead a combination of both. This indicates this thesis’s philosophical stance is in line with poststructuralist and affirmative postmodern paradigms (see Agger,

1991; Derrida, 1988; Foucault, 1970; Lechte, 2007). This includes challenging some representations of reality as I extend discourses on different socio-cultural-political interpretations. I will further advocate that theoretical implications can only be meaningful insofar as this leads to addressing social differences and future changes.

1.1.On counselling

I start from the position that counselling and psychology literature is historically Western influenced (Katz, 1985). Such values were not just reflected in its practice but also within structural systems. Take the US profession as an example. The rise of the US multiculturalism movement in counselling/psychology was in line with politicisation of debates on racial issues within the US public space in the late twentieth century. US research absorbed the then new socio-political agenda and actively challenged American psychology’s dominant Eurocentric, middle class and male-dominated culture (see Baldwin, 1989;

Crenshaw, 1989; 1991; Fanon, 1959; 1963; 1967; Myers, 1988; Sue & Sue, 1990). Therefore, counselling and psychology in the US were reinforced to assert their strong professional identities with the multicultural dimension as a mandatory element in counselling (Pedersen,

1988), known as the fourth movement ‘multiculturalism’. Its primary agenda claimed to prioritise challenging the white-dominated healthcare systems’ inherent marginalisation and oppression of client groups which do not belong to or share values with the white client groups (Naidoo, 1996). Movements for liberating black ethnic minority voices (Sue,

Arredondo & McDavis, 1992; White, 1984; White & Parham, 1990) would be described as a significantly localised agenda, and these appeared across the US literature, professional education and training. This phenomenon was then channelled into a global network of social justice advocacy, probably due to US’s dominant socio-political status in the globe (Pickren,

2009). For instance, UK counselling psychology’s social justice agenda was claimed to have significant influences from the US (House & Feltham, 2016).

US developments offer an exemplifying case, indicating how the professional identity of counselling is strongly built upon the socio-cultural-political contexts. From the Eastern perspective, Western practices are thus (also) regarded as a localised application (Greenfield,

2000). The proliferation of US social-political movements, especially compared with other nations is not due to the socio-political values themselves. Such development only has become successful as it intersects with national democratic culture, historical predispositions, counselling/psychology development, economic status and political agenda. As an Eastern originated researcher, I should clarify here that I am not blindly challenging Western counselling and psychological ideologies in their localised forms; rather (at this point in the thesis, anyway) I am concerned with the simplistic logical indication, that localised values and beliefs equate to universal applicability. Most criticisms at Western psychology as imposed-etic psychology (Hwang, 1999; Yang, 2012) is not at the Western knowledge itself, rather at knowledge transfer’s value-free notion as it ignores the underlying socio-political oppression across the global context. I argue that this is the culprit of Western theoretical hegemony as ideologies of individualism exclude diversity or differences. Critically speaking, colonialism occurred in parallel with Eurocentric societies’ proliferation of social- political, scientific, economic and industrial developments. In the case of Hong Kong, the city was removed from its original Chinese roots, and forcefully embraced apolitical and

Western knowledge through political colonisation (Church & Katigback, 2002). In other words, knowledge transfer of counselling and psychology from the West to Hong Kong itself is an example of geopolitics. I, therefore, cast doubt at most of the existing research which tends to overlook the complexity of knowledge transfer. In view of some internationalisation or globalisation movements in counselling and psychology (Casas et al., 2010; Gerstein,

Heppner, Egisdottir, Leung & Norsworthy, 2011; Leong & Savickas, 2007; Leung &

Hoshmand, 2007; Leung et al., 2009; Savickas, 2007), I stand in line with authors asserting the priority of preserving local specificities, particularly in the Eastern region (see indigenous psychology; section 2.4.2). In order to genuinely globalise or establish a respectful cross- cultural dialogue, historical legacies of colonial power, Western linguistic and conceptual supremacy and knowledge hegemony should be critically made aware of in any exchange. I address here the inherent asymmetrical professional status in counselling which has placed

‘The West’ as the benchmark of counselling theories and practice in comparison with ‘The

Others’ (Said, 1978). In Hong Kong, local scholars have identified historical struggles of knowledge/linguistic transfer from the West to Hong Kong in the early stages of structural establishment, including clinical psychology (Ho, 1986b) and social work (Chow, 2008; Lam

& Blyth, 2012). In this thesis, I will clarify how counselling in Hong Kong is a complex and misrepresented identity in the local region, and deviates significantly from Western traditions. What this highlights is the need to address Hong Kong specific indigenous context.

1.2.East Asia: A Theoretical Misfit

By introducing how counselling is highly contextual and incorporates local socio-cultural and political factors, this thesis marks Hong Kong’s contextual specificity as a research attempt from the East to initiate dialogue with the West. Only such communication is complicated by the deep-rooted problems of Eurocentrism. There is an increasing critical awareness of how most research originates from the Euro-North-America and West, mainly the US and the UK

(Katz, 1985; Plummer, 2013; Smith, 1981). I draw on the relevance of sociological studies which have attempted to shift the gaze away from traditional theorisations on power imbalances, predominantly East-West asymmetry and the Global North-South axis of power

(Ho, Kong & Huang, 2018; Jackson & Ho, 2018) since these became over-simplistic. For instance, Santos (2014) focused on advocating epistemologies of the south by highlighting

14 their commonly shared successes and struggles against capitalism, colonialism and patriarchy.

Local movements have occurred across different Southern regions, like Nigeria, India, Haiti,

Bangladesh, Japan and China etc., in which scholars interrogated different alternative ways of theorising social, knowledge production and epistemologies (Bhambra & Santos, 2017).

Particularly in East Asia, a few sociological scholars (Ho, Kong & Huang, 2018; Jackson &

Ho, 2018) have also pointed at East Asian layout’s misfit from traditional descriptions of the deprived South or marginalised East. Taking Hong Kong as an example, while Hong Kong is located within the Global South region, the city’s economic status was far from poor

(Birdsall, Ross & Sabot, 1995). In fact, it is one of the wealthiest in the world. Further, the city was originally an Eastern city. However, interplays between colonialism, modernisation and globalisation have blurred the traditional Western and eastern dichotomy.

Furthermore, while critical engagement has begun from outside the North and West, many are still trapped within the traditional theoretical hegemony (Bhambra & Santos, 2017;

Connell, 2015; Ho, 1998; Jackson & Ho, 2018). Historical legacy has placed Western knowledge as the ‘baseline’ or foundation, and any potential concepts tend to be regarded as the additional or alternative. For any new knowledge to be assimilated from one to another region, translation or validation was often required, which again puts the West or the north as the legitimate designation. Here I reiterate how my intention is not to absolutely oppose

Western knowledge and methods, but rather to open up alternative perspectives on Hong

Kong in the twenty-first century. The methodology chapter will illustrate the research process that follows from these epistemological commitments. Later in this thesis, I will also highlight how this thesis adds empirical value to a contemporary understanding of global power dynamics. I contend that the significance of counselling values can come from outside the Eurocentric zone via developing further constructive cross-cultural dialogue (see Jackson

& Ho, 2018). In line with a few scholars (Bhambra & Santos, 2017; Jackson & Ho, 2018) who showed their critical awareness of the rising Asian economic ascendancy, I call for more research to critically address and challenge Western theoretical hegemony, both on ethical grounds as well as the emergent political realities.

1.3.Hong Kong counselling

Counselling in Hong Kong is an intervention practice shared by different mental health and educational professionals. Social workers and clinical psychologists take the main roles in therapeutic interventions; educational psychologists and psychiatrists play the most important role in their defining expertise (Seay, 2010). Other areas in which counselling takes place include teachers who provide guidance counselling as part of holistic education; religious organisations mainly develop their counselling practices in public hospitals and private practice. Hence, despite a lack of empirical understanding, most scholars have identified

Hong Kong counselling as multidimensional and multi-perspectival. This account is to be elaborated in Chapter two as a literature review, while this section introduces the existing research gaps. First, the past literature has only investigated counselling within a single discipline, and thus arguably has overlooked key aspects of counselling which are built upon dynamics between professions/institutions. There is also a potential risk that not just the public, but also practitioners and researchers themselves prefer the simpler conceptual understanding implied from those studies. As spoken earlier, the current research intends to fill this research gap by including different counselling practices and multiple professions.

Such an approach also facilitates the researcher’s attempt to articulate inter-disciplinary dynamics in practice and other professional encounters, and this would be done by examining practitioners’ accounts.

Second, the question of whether the existing Hong Kong counselling and psychology developments are visibly lagging behind the Western or global movement needs to be

16 addressed. I do not claim Hong Kong counselling needs to meet the global standard; instead,

I would urge the field to foster dialogue from an Eastern perspective. By advocating counselling’s contribution to concurrent localised socio-political movements, Hong Kong scholars can actively join the lines of studies which interrogate the explicitly made Western knowledge claims, and more the implicit ones which tie with bigger questions of political domination in the world (Pickren, 2009). However, the ultimate purpose of challenging

Western hegemony is not to re-create polarised relationship, but rather to move beyond a geopolitically imposed segregation. Scholars outside the metropole are encouraged (see postcolonial and indigenous perspectives; sections 2.4.2.) to seek constructive ways and methods to facilitate readers’ openness to alternative perspectives or viewpoints outside the metropole. Another concern is increasing restrictions on academic freedom and socio- political advocacy (Jackson & Ho, 2018). China indeed is an exceptional case (from democratising development) with its increasing censorship alongside the growing economic/political power and global status. While international attention is cast at China, I would also remind researchers who intend to expose what is called lack of human rights and freedom of speech. There is a fine line between universality and indigeneity. Scholars and practitioners outside the East should also hold an open mind to attend to experiences under the hierarchical and suppressive Chinese social culture while attempting to cast critical interrogation.

In fact, some local scholarly voices across different academic disciplines have actively contributed to these debates in Hong Kong. To name a few: in Journalism and communications (Fung, 2007; Fung & Lee, 1994; Liu, 2015), in education (Jackson, 2014;

Koh, 2018; Lee, 2008), in Politics and public administration (Chan & Chan, 2017; Cheung,

2017; Ma, 2017; Ortmann, 2012; 2015; 2017; Scott, 2017a) and in cultural studies (Fung,

2001; 2002a; 2004; 2007; Law, 2009; Shin, 2017), etc. Most studies critically reflect on

17 different Hong Kong identities and attend to a contrast of the post-colonial political dynamics between the local region and national context. The proliferation of such research can arguably be associated with Hong Kong’s transfer of sovereignty to Mainland China from Britain on

July 1, 1997. By contrast, recent Hong Kong counselling and psychology’s literature shows its engagement with socio-political advocacy remains uncommon. Most local contributions focus narrowly on psychotherapy or clinical/mental health level of well-being, addressing such topics as such as gaming, online, mobile, smoking and gambling, and specific target groups such as adolescents, adults (e.g. Jiang et al., 2016; Jiang et al., 2017; Leung, 2008;

Shek, Tang & Lo, 2009; Tse, Yu, Rossen & Wang, 2010; Tse et al., 2013; Wang, Ho, Chan

& Tse, 2015; Wang, Ho, Leung & Lam, 2015). Currently, there is little engagement with the professional issues or structural level of counselling and psychology professions. Some limited relevant contribution could be seen in Leung’s (2002; 2003a; 2003b) studies as he articulated some academic attention at formation of counselling psychology discipline and the professional issues of the overall Hong Kong counselling status (Leung & Chen, 2009;

Leung, Chan & Leahy, 2007; Yuen, Leung & Chan, 2014). Other more active academic activities have been made by counselling psychology scholars who discuss counselling psychology’s professional status in the overall healthcare professions (Seay, 2010). Such limited involvement perhaps reflects cultural struggles of gaining accreditation or governmental statutory registration (Lam & Yeung, 2017). As yet, there is no empirical study which examines structural/institutional dimensions of counselling in the Hong Kong context, which I argue as a significant indication of counselling’s pro-politicisation stance.

Furthermore, findings are mainly applied in the localised context, and there is little work that engages global perspectives. The few rare vocal voices are found in the discipline of social work, in particular, Petula Sik-Ying, Ho who has been dedicating to challenging traditional treatments of gender and sexuality and using cross-cultural comparative research paradigms

(see Jackson & Ho, 2018). I remain hopeful that Hong Kong counselling can also stand outside the positivist, or so-called apolitical regime to challenge the existing meanings of counselling in Hong Kong: What does it mean to be political, or even socially vocal in counselling? The current thesis was developed to address such questions.

1.4.An Auto-ethnographic Account

The researcher’s (that is, my) cultural and professional backgrounds are an example of a hybrid UK-Hong Kong researcher and practitioner narrative. First, my knowledge and clinical experiences (as a practitioner) as a trainee counselling psychologist are mainly attributed to the UK contextualised foundation. Before the doctoral training, I was qualified as a humanistic counsellor (from UK training), and I undertook three years of work experience in my home city, Hong Kong (China). At the time, my attempts at knowledge and practical application were restricted or minimalised. Most of the negative appraisals implied that “counselling, a Western thing, cannot be applied (to the work context)”, or “there is no room for this (counselling/Fu-Do)”. I was inspired to take a step back and reflect on the fundamental concepts of Hong Kong and counselling. Across the literature, professional struggles were rarely reflected on. Notwithstanding the muddling structural dimension of counselling (as a deep-rooted problem) was a common knowledge shared by most of the local practitioners, I was surprised by the indifferent attitude at individual struggles, segregation and marginalisation. ‘An internal cold war’ best describes the relationship between different healthcare disciplines. However, I was more concerned about how much of those issues are rendered out of the picture in the literature as well as the local community. My situation echoed that of many overseas practitioners or scholars who struggle to engage with the local territory. I also wonder how much of such struggles may also apply to local practitioners who are technically the insiders yet feel like outsiders of the system. Therefore, this thesis serves

19 as an empirical account to explicate local dynamics, as well as to articulate dialogue on the generally unspoken.

Through being transparent about my hybrid identities as a UK trainee and Chinese practitioner, I note that this thesis automatically becomes a critical cross-cultural dialogue between Hong Kong and the UK. In the post-colonial era, the two places still share overlapping similarities on the different infrastructures ranging from socio-political systems

(Chan & Cheng, 2002; Chan & Lee, 1995) to healthcare services (Ungvari & Chiu, 2004). In the thesis, my research journey was also made transparent in the form of an auto- ethnographic approach (Anderson, 2006; Etherington, 2004; McIlveen, 2008; Richardson &

St Pierre, 2008; Roth, 2005; also see chapter four), as I navigated between the shared and different features or experiences. In other words, my research approach itself involved a somewhat comparative analysis between the UK and Hong Kong literature and practice.

Furthermore, my strong ties with social justice and advocacy have oriented my purposeful thesis orientation to engaging with social actions and change. Therefore, implications directly address but are not limited to Hong Kong dynamics and the macro-level of social impacts in the UK and across the globe which challenge structural power relations and oppression.

There is a need for different regional/national policies to critically revisit the fitness of their models in the own contexts.

1.5.The Chapters/outline of the thesis

In this introductory chapter, I have defined the key terms and concepts of the current researched topic. This clarifies the particular theoretical angle of this thesis. This chapter has identified research gaps and shortcomings, which justify the thesis’s socio-political focus on the spectrum of Hong Kong counselling/related professions. My concluding remarks are summarised as follows,

a) This thesis has a clear socio-political agenda to address regional (Hong Kong) and

global socio-political inequalities. Particular attention was paid to Western theoretical

hegemony and political domination brought by historical legacies. Despite Hong

Kong literature’s active engagement in the socio-political agenda, disengagement was

shown in counselling and psychology literature and activities. This thesis reiterates

the call for more indigenous input and politicisation process to cultivate more non-

Western initiated dialogue with the West.

b) The central focus here is to articulate the localised meanings of counselling. Hong

Kong counselling’s lack of professional identity is attributed to its interdisciplinary

and multi-perspectival nature. To capture counselling’s diverse picture, narratives

from different disciplines should all be included.

c) Past analyses have until now only captured a descriptive level of the current Hong

Kong dynamics, for instance, theoretical critiques, or empirical implications focusing

on a specific client population. The current thesis provides a broader and more a

critical empirical enquiry via examining practitioner perspectives.

In chapter two, a literature review is provided to give a comprehensive picture of the Hong

Kong context and different disciplinary developments. The literature consists of five sections.

First, an overview of the broad six counselling and the related professions is provided, including social work, clinical psychology, chaplaincy, guidance and teaching, counselling and counselling psychology disciplines. The overview offers an encapsulating picture of

Hong Kong counselling professions and the underlying socio-cultural-political contexts which influence its local development. Third, current challenges confronting Hong Kong counselling situation are introduced, and then evaluated (fourthly) via drawing on the existing theoretical frameworks (East-West binary, postcolonial theory and indigenous approach).

Their implications explain the theoretical rationale of the current thesis. Chapter three

21 methodologically documents and outlines the development of this thesis. This thesis is a qualitative study aiming to articulate the socio-political agendas informing Hong Kong counselling from indigenous perspectives. Different local practitioners' narratives were collected ranging across six disciplines including social work, clinical psychology, counselling, counselling psychology, ‘guidance and teaching’, and chaplaincy. This chapter outlines my indigenous epistemological and ontological foundations, elaborates the rationale for adopting an eclectic theoretical framework, and describes the data collection procedures and processes. Furthermore, ethical considerations were addressed, as well as the mixed methods analytical framework.

Chapter four includes personal reflexivity of my research process. Here my personal and professional backgrounds are made transparent. Other records reflected upon include significant incidents or encounters which directly and indirectly changed my research process. This includes the shift of theoretical rationale, from only focusing on articulating theoretical and epistemological grounds of Hong Kong counselling, to using a critical socio- political lens to look at the localised institutional collaborations. Analyses are then presented and interpreted in chapter five. The collected data comprises comments and reflections made by different counselling practitioners across different professions. The conceptual model was built upon the intertwined layers of inter-relations. I also note that the numbering system in this chapter is separate from the other chapters, as it directly represents the sequencing of the findings. In the sixth and final chapter, I discuss research implications with a particular focus on structural dissonance/segregation, which I argue as the key to Hong Kong counselling’s overall diversifying/disoriented status. I provide an alternative critical evaluation of different local inter-relations to suggest that colonial power is not the only responsible culprit, but its historical legacies have also reinforced particular local actors’ contribution to the current structural problems.

Chapter 2. Literature Review

Currently, there is no consensual definition of counselling in Hong Kong. Looking at counselling from an indigenous perspective requires some understanding of the systemic context. Such systemic knowledge refers to the multi-disciplinary, multi-dimensional and multi-perspectival Hong Kong counselling. That is, counselling conceptualisation does not comprise a unified layout, rather different theoretical and epistemological paradigms, services and structural systems. This chapter extends understanding from the introductory chapter with a preliminary overview of counselling in Hong Kong. Section 2.1 introduces different institutional developments which all contribute to meanings of counselling, including social work, clinical psychology, Christian chaplainry, guidance and teaching, counselling and counselling psychology. The review suggests how meanings of counselling are driven by structural dynamics and how they fit within the broader socio-political context. Section 2.2 elaborates local specificity of Hong Kong. I show the intricate relationship between counselling and its context, and thus indigenous perspective of Hong Kong counselling requires more attention. Section 2.3 introduces the professional issues of Hong Kong counselling. Then (in section 2.4), postcolonial and indigenous knowledge bases are drawn on to challenge against Hong Kong counselling’s supposed apolitical status. Thus they are set as the theoretical foundation of the current thesis.

2.1. Hong Kong Professional Counselling

2.1.1. Disciplines: History and Development Social Work

Social work is the first established social welfare profession in Hong Kong with historical traces as early as the 1950s. The rise of the profession was a humanitarian response to the rapidly rising need after the Second World War. At the time, the sufficient international relief interventions or sacrificial services reinforced social work’s development into a culturally

23 hybrid product with twin roots of Christian ideology and Chinese family values (Lai & Chan,

2009; Lam and Blyth, 2012). In the early stage, social work services were dominated by foreign religious groups and few local groups (Sinn, 1989; Webb, 1977). The discipline went through several revolutionary developments until today, as the profession has become the largest social service provider and the only statutory body among other counselling/related service providers (Social Workers Registration Board, 2016). The discipline covers all social welfare services, and is the only designated profession to support or form the partnership with other sectors such as education (see guidance/counselling), mental health and medical care

(clinical/psychiatric/hospital settings). To name an example, I note the continued increasing collaborations between the government sector and social work can be seen by the new funding allocated by the government to implement a three years pilot scheme for one school one social worker to become available in kindergarten and childcare in academic year

2018/19 (Lau & Ho, 2018). Furthermore, Hong Kong social work has established its professional status to ‘lead and assist’ the Mainland social work development1.

Social work’s strong socio-political advocate image was not just due to its pre-determined professional commitment, but also a historical product of the local development2 (Chow,

2004). The profession has long been challenging against bureaucratic regulations during colonialism, directly at the Colonial government’s primary interests shared with the British private companies, and local voices not being heard (Tsang, 2004). Another reason was due to social work’s parallel development with the unstable local politics, in particular in the

1980s as Hong Kong‘s political system became opened up regarding Hong Kong’s future

1 China’s social work did not rise until the 1980s, and Hong Kong social work’s more or less established professional status reinforced its dominant training, educational, consultant, mentor and even politically influential role in the Mainland China (Gray, 2008; Tsang, Sin, Jia & Yan., 2008; Meng, Gray, Bradt & Roets, 2019). Hong Kong social work’s superiority could be reflected in the social norm as Hong Kong educators organise special seminars and workshops for the Mainland counterparts, or they travel cross the border to provide assistance in supervision, professional association formation and academic purposes (Leung, 2012; Meng, Gray, Bradt & Roets, 2018), including a supervision purchase scheme funded by the Shenzhen municipal government to coach Shenzhen social workers in the city (Hooper, 2013; Hung, Ng & Fung., 2010). 2 See Note no. 2 (pp. 206)

24 after 1997. Social work discipline which had already established some advocacy work could claim to be in a mature status to assert itself into the political system. Until now, the profession has produced the most substantial academic contributions and social practices concerning social justice and political agenda3. On the other hand, a few scholars criticised social workers’ retreated political engagement since the postcolonial era, due to governmental suppression on diminishing job opportunities, and the insufficient political structure (Chiu &

Wong, 1997; Chui & Gray, 2004; Lam & Blyth, 2012; Lam & Chan, 2003). Some scholars suggested de-politicisation of social workers is illustrated by their increasing focus on the micro-level psychotherapeutic intervention (Chu, 2003; Lam & Blyth, 2012; Lam & Chan,

2003). Since the 1990s, counselling has been regarded as a service expansion, as social work discipline extended its work agenda to clinical models, therapies and casework to establish a full-spectrum of services in the local community.

What can be learnt here is that the Social Work discipline’s legitimisation has not been an accessible path. It mirrors to Hong Kong counselling’s current shortcomings (see section

2.3). The discipline of social work has overcome prolonged struggles before it asserts its professional identity and is registered as a governmental statutory body. Through its own multi-dimensional and multi-perspectival development, social work overlaps with counselling in practice in which practitioners provide individual treatments and group work.

Counselling has become a part of a range of social services which are flexibly applied, in order for social workers to form partnerships and supportive relationships. On the other hand,

Lam and Blyth (2012) critically addressed how counselling has become an apolitical path for social workers to distance themselves from the macro-level policy practice. Although there is

3 There is a lack of systematic review/analysis of Hong Kong social work’s literature on socio-political agenda, and thus a few exemplifying studies are named. This includes socio-political advocacy and movements (Lam & Blyth, 2012; Chu, Tsui & Yan, 2009; Chui & Gray, 2004; Kam, 2014; Hooper, 2013), gender and sexuality (Hu & Ho, 2016; Jackson & Ho, 2018; Jackson, Ho & Na, 2013), and indigenisation of research and practice (Law & Lee, 2016; Sim et al. 2018; Yip, 2005; 2006; Lam, 1996; Lam & Chan, 2004), etc. Recently there has also been an increase of research on multicultural practice, cultural competency, ethnic minority groups and migration (Kwok, Lee & Law, 2018; Arat, Hoang, Jordan & Wong., 2016; Arat & Kerelian, 2017; Law & Lee, 2016).

25 no indication to associate between social workers’ views and the overall counselling’s apolitical status, I would like to point out social work’s dominant representation of counselling identity in Hong Kong4. There is a need that a diversity of practitioner accounts is reflected. Furthermore, I take note of Hong Kong’s unstable political status and its close ties with professionals’ personal views and involvement. In the face of the most recent rapid increase of politicisation movement since the Umbrella Revolution (2014), I suggest there is a need that professionals’ narratives are collected not just for us to phenomenologically capture the current phenomenon, but also actively inform how practitioners can constructively engage with changes and actions.

Clinical Psychology

In the beginning, psychology in Hong Kong was predominantly a knowledge transfer from the West to the East (Ho, 1986a). Clinical psychology had its first establishment academically and professionally in the year 1968, known as the first formal psychological discipline and service in Hong Kong and Asia. By the late 1980s, Hong Kong clinical and educational psychology disciplines claimed to have made sustainable development in research and practice in Hong Kong and Asia. In academia, clinical psychology grew as higher learning in Hong Kong institutions expanded. By 1986, clinical psychology led regional development of psychology, while educational psychology made a moderate level of presence (Ho, 1986a). Until now, such hierarchical phenomenon has remained unchanged; even counselling psychology rose as the third largest distinctive member. Professional teaching or training was traditionally a cultural conceptual and organisational adaptation of

Western models. While there has been an increasing number of local scholars and trainers in the institutes, many are Western educated, and teaching materials are exclusively in English.

Ho (1980; 1987) also raised socio-linguistic adaptation concerns as students or practitioners

4 The profession is the biggest service provider in public and charitable sectors with more than 23,000 registered members (Social Workers Registration Board, 2018).

26 were caught between English learning and Chinese everyday contexts. Until now, there is still a research gap in this area.

A paradoxical picture is presented in clinical psychology’s employment status. Currently, there is no legislation or any licensing for psychology professions/professionals. Professional competency, ethics, and other standards are purely reliant on clinical psychology’s internal regulations or individual work conduct as it appears in the work setting. On the other hand, the marketplace shows inadequate workforce and a great demand for psychological services

(Social Welfare Department, 2015). In Cantonese-Chinese language, psychologists are called

"psycho-doctors/心理醫生” which reflects their highly regarded professional status.

Furthermore, clinical psychologists mostly adopt the terminology ‘psychotherapy’ instead of counselling despite the overlapping service nature (Fong & Wong, 2016). Clinical psychologists work in public and private hospitals, the government sector and non- government organisations. The discipline has developed a reputation arising from its claims to exclusive specialty in psychological assessments, formulation of treatment plans and psychotherapy provision (Fong & Wong, 2016), but practitioners’ roles vary depending on work settings, for instance, forensic settings require mainly assessment roles, whereas roles in hospital settings are more diverse, in which clinical psychologists can choose between providing psychological assessments, psychotherapy and outpatient treatment support. In general, clinical psychologists prioritise maintaining clinical expertise by adhering to evidence-based practice and research. That is, clinical psychologists highly regard statistical/objective analysis as the performance index of incremental clinical practice instead of the mere delivery of conventional treatment.

To conclude, there is limited literature on clinical psychology’s institutional development or professional status. The above summary is based on a limited and dated account (e.g. Ho,

1985; 1986b). Arguably little is known about Hong Kong clinical psychologists. An

27 unverified example is a claim that clinical psychologists can give diagnosis for individuals in community settings for some specific mental health criteria. Despite a lack of empirical indication, there is a common consensus in the public that clinical psychology holds the highest professional status in providing psychological services amongst all psychological specifications and the overall healthcare professions such as psychiatrists and social workers

(Wu, 2013).

School Guidance/Counselling

Counselling shares the same Chinese terminology (Fu-do/輔導) with guidance, but guidance and counselling are fundamentally different concepts both originated from the West (Luk-

Fong, 2013). Guidance supports an individual’s important decision making, whereas counselling focuses on changes. In the Hong Kong educational curriculum, the two’s relationship was blurred by Hong Kong counselling’s lack of consensual definition, as well as the two’s complementary application in the school setting, formally known as ‘whole-school based curriculum’ (Education Commission, 1990; Hui, 2000). Across the localised development, guidance and counselling have conceptually and linguistically become cultural hybridity between the Western therapeutic intervention and Chinese traditions and moral philosophies (Luk-Fong, 2013). Such hybridisation process was not just a cultural product, but more importantly the historical policy influences5.

The whole-school curriculum focuses on ‘whole-person’ growth, meaning students’ holistic development (Education Commission, 1990; Education Department, 1995; Hui, 1994; Miller et al., 1978). Main roles of a ‘school counsellor’ involve developing and managing the school’s guidance programme to support students’ whole-person growth (Hong Kong

Education Department, 1995; Yuen, 2002). The curriculum signifies the governmental policy’s shifting focus from only remedial and reactive, to whole school approach (remedial,

5 See Note no. 5 (pp. 209)

28 preventive and developmental interventions; Education & Manpower Bureau, 2003; Gysbers,

2000; Hong Kong Education Commission, 1990; Hui & Lo, 1997; Yu, 1995; Yuen, 2008;

Yuen et al., 2012). While counselling from the traditional perspective belongs to the remedial intervention, arguably it has been integrated with guidance into both personalised services and programmes in the Hong Kong school settings. Cross-disciplinary collaboration is an essential element in guidance/counselling. Other teachers have also become part of the curriculum. A counselling team is a mandatory support formed by a few in-school teachers

(Hui, 2000) who collaboratively work with the school counsellor or social worker. Instead of just passively making referrals when problems occur, the team actively implements guidance programmes through classroom teaching and activities under the school counsellor/guidance teacher’s support (Hui, 2000). Furthermore, the whole-person curriculum implies guidance’s multi-levelled and comprehensive conceptualisation. The initial refers to guidance’s individual, group and whole school interventions, not just individual casework approach

(Education Commission, 1990). The latter refers to the curriculum’s comprehensive coverage of four domains of learning6 (Education & Manpower Bureau, 2003), and five Chinese culturally informed learning experiences (moral and civic education, intellectual development, community service, physical and aesthetic development and career-related experiences).

6 The four domains of guidance & counselling include Management and Organisation, Supportive Service, Personal Growth Education and Responsive Service. In order to deliver four domains of the comprehensive student guidance service, strategies of management and organisation in school are suggested as follows (Lee & Wong, 2008),

a) cultivate a positive and caring school culture, b) establish a school guidance team which comprises teachers and the student guidance personnel or school social worker to formulate school guidance policy, plans and coordinates the guidance service. c) set up the internal and external referral system whereby students with learning and behavioural problems are identified and provided with the appropriate services. d) build a mechanism for school self-evaluation to ensure the effective implementation of the student guidance service.

Due to the policy and curriculum’s successful development and implementation, other policy interventions have taken place in response to the rising service needs. For instance, policy

‘one school social worker for each secondary school’ became a mandatory requirement in all public secondary schools in 2000-2001 school year. The government outsourced funding to non-governmental organisations (social work driven) to send their social workers to their designated schools (The Hong Kong Council of Social Workers, 2000). This indicates that there is a compulsory supportive counselling role in each school. By 2011, public funding for social work workforce per secondary school had been increased by 20% (Social Welfare

Department, 2011). Furthermore, guidance teachers, social workers and counsellors hold the equivalent roles in primary schools starting in 2006/07 school year (Education & Manpower

Bureau, 2006). In 2018/19 year, the government formally introduced ‘one school social worker for each school’ in public sector primary schools (Education Bureau, 2018) to ensure sufficient guidance/counselling support.

In short, counselling and guidance have become intertwined as they complement one another to promote students’ holistic well-being, which more or less reinforced counselling’s repositioning into a holistic service in schools. The service also involves cross-disciplinary collaborations, including teachers, social workers, and other professionals as external support.

Again the continuous governmental policy and financial support signified the government’s preference for the prolonged if not strengthened partnership between schools and social work discipline. On the other hand, there is little research which has investigated implications and social impact or outcomes of services overlap and collaborations, such as professional identities and cross-disciplinary dynamics.

Hong Kong Counselling Psychology

Hong Kong Counselling Psychology (HKCP) is a younger and fast-growing psychological specialisation, mainly developed in Hong Kong Shue Yan University (formally known as

Hong Kong Shue Yan College until 2006). Alongside the increasing recognition of counselling training, counselling psychology training programme was first established in the

1990s (Leung, 1999; 2003), and the first Hong Kong and Asian doctorate training was established in the year 2015. Parallel with the increasing training development, the profession has been the centre of discussion regarding its professional identity, mostly due to its newly developing stage and the consequential doubt at its professional status (e.g. Leung, 1999;

2003; 2007; 2009; Seay, 2010). In public, the profession is perceived as a linguistic and conceptual synonym as Fu-do (Yu et al., 2010), which reflects counselling psychologists’ similar social status as counsellors (Seay, 2010). So far, most studies which have explored counselling psychology discipline are based on scholarly observations (by professor Leung, educational psychology, the Chinese University of Hong Kong). In practice, counselling psychologists have mainly established their services in the University Counselling and

Research Centre, outreach school interventions and private practice. There is little record contributed from within the discipline regarding its structural development and activities, which implies a great research need on documenting the discipline’s status.

Christian Chaplaincy

There is a lack of independent research on Chaplaincy in Hong Kong. The profession’s work is mostly found in studies conducted by other disciplines, and thus the current thesis may not have captured the fullest account of chaplaincy’s professional activities. Another concern is the absent official definition of hospital chaplaincy. In Chan, Tin & Wong (2015; 2017)’s studies on exploring death work among healthcare professionals, participant criteria of chaplains included Catholic and Protestant chaplains, which suggested Hong Kong chaplains are mainly formed by these two Christian groups. Chaplaincy work has been mostly reported in the hospital setting, e.g. Palliative care (Mok et al., 2010; Tsao, 1991), death or bereavement work (Chan & Tin, 2012; Chan, Tin & Wong, 2017; Tsui, Chan & Tin, 2016)

31 and spiritual care (Chung, Wong & Chan, 2007; Lam, 2014), emergent care (Chan, Wong,

Chan, Wan & Mo, 2009). First of all, In Tsao (1991)’s study, chaplains were part of the psychological support team aside social workers, clinical psychologists, psychiatrists, nurses, experienced volunteers and oncologists. Chung, Wong & Chan’s (2007) study reported some nurses’ referral of clients to hospital chaplains. In Mok et al. (2010)’s study on healthcare professionals’ perceptions of existential distress in patients with advanced cancer, the recruitment was done in a palliative care unit in a local Christian hospital, and the functionality of religious support was clearly acknowledged and described as three-fold7. Lo

(2006) also reported chaplains providing support in the palliative care unit regardless of patients’ religious backgrounds. In short, despite some evidence which has shown traces of chaplaincy activities in hospital counselling/psychological support, findings were scattered, and there was a lack of independent voice to make clear the chaplaincy’s distinctive contribution.

2.1.2. Education & Training Counselling is regarded as a higher education in most of the Hong Kong training curriculum.

In the 1990s, some accredited courses were established to meet the rising service demands

(Leung, 1999; 2003). Currently, there is only one institute which provides specific undergraduate training (Bachelors of Sciences in Counselling and Psychology; Department of

Counselling and Psychology, Shue Yan University of Hong Kong). Social work discipline makes an exceptional case as its undergraduate teaching claims to include counselling learning. Strictly speaking, counselling (Western informed meanings) only occupies a limited part of the overall curriculum. Most of the other equivalent trainings are mostly defined as specialised counselling and psychotherapy training on the postgraduate level. They are under

7 “Since our study was carried out in a Christian hospital, religious support referred to the preaching of Christianity by chaplains. The functions of religious support were three-fold, according to our participants: before death, patients could rely on God to live, rather than solely on themselves; life would continue after death through eternal life in heaven, and patients were able to maintain a connection with their loved ones through eternal life.” (Mok et al., 2010; pp. 1518).

32 different counselling, psychology and other non-counselling disciplines, including clinical psychology, counselling psychology, school guidance and counselling, Christian based training institutes and social work8. Before the government considered social work as the main counselling support in schools, teachers were also encouraged to provide guidance and counselling support (Yuen, 2002) and were offered formal curriculum counselling training and other short courses or seminars by Hong Kong Department of Education (now known as

Educational Bureau; 2000). However, the training was limited in trainee number and was dismantled.

Aside from the traditional academic institutional route, practitioners also obtain professional training in a few privately owned settings. Examples include Satir counselling led by Hong

Kong Satir Centre and a few other institutions (see Leung, Lau & Chung, 2018); Emotion-

Focused Therapy (e.g. The Hong Kong Catholic Marriage Advisory Council, 2018). These trainings are model specific learning and are accredited by the US or UK counselling accreditation systems. Due to Hong Kong’s absent legislative accreditation system, such training programmes do not provide cross-national certification transfer.

2.1.3. Culturally Appropriate Professional Practice and Research Backgrounds of Hong Kong counselling practitioners are diverse in nature, including their different biographical (race, ethnicity, culture, etc.) and training backgrounds (Leung, 2003), as well as their theoretical orientations ranging from eclectic, cognitive-behavioural therapy, person-centred theory to psychodynamic therapy (Chan & Lee, 1995; Pelling, 2013). In a government release (Labour and Welfare Bureau, 2016), public counselling and psychological services stream mainly comprises of contributions from social workers and clinical psychologists. When an individual wishes to seek help from the public services, social workers are the first contact point as they conduct a preliminary assessment, before

8 See Note no. 8 for a brief list of counselling/Fu-do or psychotherapy course/training in Hong Kong, pp. 209

33 clinical psychologists follow up with the concerned cases. However, the government release only addresses public services, and many voluntary or private services which involve other counselling practitioners or professions appear to be cut out of the picture.

This thesis aims to redefine counselling based on a comprehensive overview of its services.

First, counselling in Hong Kong is multi-perspectival, as it is an integral part of, and involves partnerships or collaborative interventions between multiple public sectors/governmental departments9. Furthermore, it is recognised that counselling consists of various levels of interventions, ranging from preventive (psychoeducation/mental health education programmes and public promotion), developmental (schooling and educational support) to remedial approaches (casework counselling, outreaching services, therapeutic and supportive groups). Furthermore, other studies have also defined counselling services into two broad categories: a) mild to severely mentally ill clients; b) non-diagnosed populations who experience distress/difficulties in life (Fong & Wong, 2016; Seay, 2010; Yuen, Leung &

Chan, 2014). Despite of a lack of empirical resource, scholars have generally formed some categorisation between different services. Clinical psychologists and clinical social workers mainly serve the severe mentally ill populations, whereas other professionals are mainly referred to as ‘counsellor-levelled practitioners’, and they are mostly found in career, school and community settings.

Counselling’s local specificity is an essential issue in Hong Kong practice. There are two broad themes of research interests. First, scholars devote to develop culturally appropriate therapeutic interventions for a specific disorder/issue. There is an extensive amount of research on modifying the existing therapeutic/psychological models. While some focus has aimed at the general Chinese population (Guo & Henley, 2015; Lin, 2002; Wong, 2013),

9 Public sectors which involve mental health/well-being support include the Education Bureau, Labour Department and the Occupational Safety and Health Council, Department of Health, Social Welfare Department, etc.

34 more local studies have been produced since the millennium, specifically for Hong Kong individuals10. Moreover, in line with other Asian regions (Korea, India & Philippines), local activities have claimed their indigenous research and practice developments (Lagmay, 1984;

Leung, 1999; Lau, 2000; Sinha, 1986). Psychology professions in Hong Kong are the leading producer of evidence-based indigenous mind-body-spirit psychotherapeutic models, including Body-Mind-Spirit psychosocial intervention model by the Centre on Behavioural

Health, the University of Hong Kong (Chan, Ng, Chan, Ho & Chow, 2006)11, Chinese Chan- based mind-body intervention12 (successful first trial in 2015) by Chanwyui Research Centre for Neuropsychological Well-being, Chinese University of Hong Kong (Yu et al., 2014), and

Bodhisattva-Spirit-Oriented Counselling framework13 by Cheng (Cheng, 2014a; Cheng &

Tse, 2014), a Buddhist-informed intervention (Cheng, 2015a; 2015d). Despite Hong Kong’s transfer of sovereignty to China, local scholars appear to have retained their commitment to reflecting Hong Kong regional specificity. This leads to a pondering question that Hong

Kong’s prolonged distinction from the rest of the different Chinese ethnic groups and geographical regions is not merely a historical outcome, but also the concurrent contributions and views which continue to shape the future.

10 The most extensive Hong Kong research development has been on cognitive behavioural therapy (e.g. Chan, Li & Leung, 2016; Pan, Ng, Young & Caroline, 2017; Wong, 2008; 2009; Wong, Chau, Kwok & Kwan, 2007; Wong, Ng, Ip & Chung & Choi, 2018), whereas other studies cover diverse therapeutic approaches, including psychoanalysis (Busiol, 2015; 2016; 2018), Experience Transformed Model (Chong & Liu, 2002), Satir model (Cheung & Chan, 2002; Leung, Lau & Chung, 2018; Wong, 2013); or various specific issues/target groups, such as family intervention (Fabrizio et al., 2015; Shen et al., 2017; Wong & Ma, 2013), sexuality (Chan, Cheung, Gray, Ip & Lee, 2004; Chow & Cheng, 2010) and school counselling (Hue, 2016)(also see introduction for other examples). 11 Body-Mind-Spirit psychosocial intervention model was developed by Centre on Behavioural Health, the University of Hong Kong (Chan, Ng, Chan, Ho & Chan, 2006; Chan, Chan, Ng, Ng & Ho, 2005). This model is an eastern-based body-mind-spirit group intervention for infertile women undergoing in vitro fertilisation. The model has a strong intertwined mind-body-spirit foundation, as well as Chinese philosophies and concepts of health.

12 Chinese Chan-based mind-body intervention (successful first trial in 2015) by Chanwyui Research Centre for Neuropsychological Well-being, Chinese University of Hong Kong (Yu et al., 2014) 13 See Note 13 (pp. 211)

The second theme of research interests is addressing the specific socio-cultural elements in counselling and psychology as a whole. According to Leung & Lee (1996), culture is a crucial part in the therapeutic process, in which one constructs meanings with the practitioner as they identify problems, shape therapeutic processes and develop the choices of solutions.

Such construction requires an individual’s conscious re-conceptualisation of Western theories into the local context. While early literature had interests in adopting a cross-cultural approach, and tended to describe Hong Kong as a dichotomous East meets West cultural product (e.g. group based fairness in Yang & Hui, 1986; equity principles in Leung & Bond,

1984), more recently studies (after the Millennium period) appear to have shifted the lens at

Hong Kong local development (Cheung et al., 1996; Ho, 1986a; Lam & Blyth, 2012; Lau,

2000; Leung & Chen, 2009). Exampling models include model of traditionality and modernity (Yang, 1996; 2003) and attitudinal and belief orientated framework (Lau, 2000), both derived from the US multicultural framework (Leung, 2003; Sue & Sue, 1990). These studies paid attention at individual struggles in between the conflicting cultural values of

Hong Kong’s collectivistic/traditional values and modern Western influences and attempted to reinforce integration. Personality structures and psychological functioning were another research interest as Cheung et al. (1996) developed a cross-cultural Chinese personality inventory which incorporated the relevant Chinese indigenous values and personality constructs (also see Cheung & Leung, 1998). Furthermore, Hong Kong guidance and counselling service itself is a hybrid cultural product between traditional Chinese

Confucianism and modern values (Lee, 1996; Luk-Fong, 2006; Yuen, 2008). Its research has received extensive attention as scholars attempted to overcome cultural conflicts to adopt

Western guidance or counselling into the local context.

2.1.4. Accreditation, Ethics and Regulations There is currently no statutory registration system for counselling practitioners in Hong

Kong. In the Western counselling credentialism, a sufficient process consists of certification, registration and licensure (Lam & Yeung, 2017; Sweeney, 1995). In contrast, Hong Kong counselling’s professional identity continues to be established on non-legitimised certification or registration. I summarise a few general guidelines as follows: 1) graduates hold a recognised academic or training certification, including non-counselling disciplines such as teachers or social work; 2) a postgraduate counselling or psychological training in a recognisable University or other institutional settings; and 3) (non-mandatory) registration in a professional counselling association or professional body14. However, the non-legitimised regulations are complicated by some job roles’ exclusive set of criteria, for instance, most of the non-governmental organisations only accept qualified social workers for their counsellor posts due to funding constraints. In public, the government has no official information about registration and practice. Therefore, most people rely on personal sources or access when seeking help. These resources would be obtained via local voluntary or private organisational contributions (e.g. Cheung, 2016; South China Morning Post, 2018). However, incomprehensive information (resources from both individual and organisational knowledge)

14 The locally run professional counselling associations include The Hong Kong Professional Counselling Association, The Hong Kong Professional Counselling Association, and the Hong Kong Society of Counselling and Psychology. Professional counsellors were mostly associated with these groups. The groups are mainly open to qualified professionals with all titles (e.g. social workers) and independent practitioners. However, Pelling (2003) found that psychologists do not associate themselves with counsellor levelled professional groups, and there were nearly no registered members with psychologist title.

Psychological professional membership and services are specifically under the Hong Kong Psychological Society, in which clinical, education and counselling psychology disciplines form their own divisions. Division of Clinical Psychology was formed in 1982. Ho (1986) argued that HKPS had reciprocal membership rights with the British Psychology Society, yet HKPS’s legal or social impact was far behind with the membership’s lack of licensing rights. Clinical psychology also operates a separate organisation, Hong Kong Clinical Psychologists Association which has unofficial linkage (but not statutory) with the governmental bodies of Hospital Authority (Medical department) and Department of Health and Social Welfare Department. Clinical psychologists with doctoral qualification form a more narrowly specific professional group, called The Hong Kong Association of Doctors in Clinical Psychology. Counselling psychology profession situates itself between psychology and counselling, while it remains as a member in the Hong Kong Psychological Society.

37 can hinder service access or cause bias of public awareness. Regarding professional code of ethics, there are some localised ethical guidelines which have been developed within the respective professional groups15 (Leung, Leung & Chan, 2003). Regulation of ethical practice often is reliant on self-obligation or based on practitioners belonging to a professional association.

To sum up, there is no mandatory requirement for a practitioner to obtain a license or registration with a governmental agency or professional board before practice. Although systems for registration or certification are in place for the respective disciplines, their impact falls short due to the absence of a licensure system. In other words, there is no legal entitlement for counsellor or psychologist posts in Hong Kong. Exceptional cases are social workers and teachers who have their respective non-counselling statutory registry systems.

However, their license does not guarantee a clear standard of counselling practice.

2.2.What is Hong Kong Context?

The thesis is in line with some studies which have attempted to situate psychology and counselling knowledge base outside Western or American domination. Elaboration of such accounts would be useful to challenge the existing Hong Kong counselling’s current apolitical status. This section implies that indigenisation movement would sufficiently reflect the broader socio-economic and political processes in Hong Kong.

2.2.1. Geopolitical predispositions Colonialism has remained impactful upon the formal establishment of the Hong Kong Special

Administrative Region (HKSAR)16. Transfer of sovereignty mirrors to the regional economic

15 Hong Kong ethical guidelines include the Code of Professional Conduct (Hong Kong Psychological Society [HKPS], 1998), the Code of Conduct (The Hong Kong Professional Counselling Association [HKPCA], 1996), and the Code of Practice for Registered Social Workers (Social Workers Registration Board, 1998) (Leung, Leung & Chan, 2003). 16 Situated at the south-eastern end of China, Hong Kong is a modern Chinese city with a dense population. The history of the city could be traced back to 200 years ago when Hong Kong was a harbour village which mainly functioned as an export trade location. The first significant historical transformation In Hong Kong occurred when the city faced the then British Imperial Empire’s political/military invasion. Different parts of

38 recession at the time. To many, the HKSAR government assumed responsibility for the turbulent socio-cultural and political challenges when global epidemics occurred, including the Asian financial crisis in 1997, the severe acute respiratory syndrome (SARS) epidemic in

2003, and the 2008 financial tsunami. For instance, Hong Kong’s strong commitment to a free-market economic approach has fostered the city’s liberal and consumer-oriented culture.

Materialism and consumerism has become a commonly shared lifestyle. However, while enjoying an internationally competitive economy17 and good living standard, people also face the city’s high cost of living, high inflation rates, and the widening gap between the rich and the poor (J. Y-S. Cheng, 2014; Ma, Wong & Lau, 2009). Furthermore, several regional practices have become new social norms. The government promoted the newly formed ‘Hong

Kong’ citizenship and national identity. Moral and civic education curriculum and policies have been implemented (HKCDC, 2001; HKEC, 2000). Another example is Hong Kong’s freely religious status. Under the practice of Basic Law (Hong Kong Government, 2017),

Hong Kong remains as a city with multiple religions aside its secular doctrine. This can be seen in Hong Kong education, in which 56.6 per cent of Hong Kong schools are religious schools (88.1 per cent are Christian; other religions or beliefs include Buddhist, Taoist,

Confucian and Muslim; Cheng, 2004).

the city were consecutively fallen into British colonisation. First, Hong Kong Island and the other outlying islands were unconditionally given to Britain after the Opium war; the Kowloon Peninsula was subsequently taken in 1869. Finally, the New Territories region was claimed to be borrowed on a 99-year lease (till the year 1997). In other words, the local society collapsed and was forcefully immersed with another culture. Followed by the Second World War and Chinese Cultural Revolution, China made the first negotiation with Britain in 1984, known as Sino-Anglo Declaration regarding the 1997 lease (the New Territories) (Wong, 2004). This then led to the transfer of sovereignty to China on July 1, 1997, and Hong Kong transformed again from a British colony to a newly formed Hong Kong Special Administrative Region (HKSAR). Due to the different stages of developments between Hong Kong and Mainland China, Hong Kong has since been operating under the ‘one country, two systems’ principle for the following 50 years. In most of the governmental administrations, Hong Kong enjoys autonomous status as those infrastructures are independently operated. On the other hand, Mainland China remains the ultimate sovereignty, including administrations of foreign relations and military defence. 17 In the year 2018, the International Institute for Management Development has ranked the city as the world’s second most competitive economy (news.gov.hk, 2018).

The city is not democratic. Hong Kong’s continued unstable political status is marked by its consistent and fluctuating democratic development before and after colonisation (Ortmann,

2017). While Hong Kong has encountered a series of unstable democratisation developments since the 1950s, individuals’ attention was on the rapidly increasing pro-democratic movement right before the transfer of sovereignty (1990s). Under the regime of the last

Governor Chris Patten, Hong Kong was implemented with many pro-democratic measures and policies. However, most of those last-stage political implementations were then dismantled by the Mainland Government under the replaced ‘One Country, Two Systems’ principle. This has triggered public fear regarding rights, democracy, autonomy and the rule of law (Ku, 2004). The Mainland Government has been blamed for not making progress on universal suffrage, and thus this has led to a series of protests, notably the Umbrella

Revolution turned ‘Umbrella Movements’ in 2014 (Leung, 2016). Other human rights practices were also under debate, including the Mainland Government’s attempted legitimisation of Article 23 of the Basic Law18 in the year 2003, which was widely considered as a political indication to prohibit freedom of speech and other human rights (Wong, 2004), and led to the historical ‘July 01, 2003’ protest participated by 500,000 people. Furthermore,

Hong Kong’s deteriorating relationship with Mainland China was accentuated under China’s tourism wave (Colomb & Novy, 2016; Lowe & Tsang, 2017). The social discontent has reinforced the younger generation’s political participation (Lee & Chiu, 2017).

Until now, there is limited counselling or psychology literature which has engaged with the corresponding discourse. Social work has been a robust socio-political advocate, but the recent critics pointed at counselling as having been used as a tool of de-politicisation (section

18 Article 23 of the Basic Law states that Hong Kong should ‘enact laws on its own to prohibit any act of treason, secession, sedition, subversion against the Central People’s Government, or theft of state secrets, to prohibit foreign political organisations or bodies from conducting political activities in the Region, and to prohibit political organisations or bodies of the Region from establishing ties with foreign political organisations or bodies.’ (Hong Kong government, 2017)

2.1.1). I challenge the apolitical counselling meanings, and cast doubt at counselling and psychology’s linkage with the socio-political realities. According to Smith (1999),

“We have often allowed our histories to be told and have then become outsiders as we

heard them being retold.” (p.33)

How can counselling professionals deliver social impact without understanding and intervening with the existing socio-political concerns? This thesis, therefore, intends to interrogate the various intertwined meanings of counselling.

2.2.2. The ‘Chinese’ Socio-Cultural Values Situated in the historical intersections between colonialism and Chinese sovereignty, Hong

Kong is described as a city of contradictions between collectivism and individualism; phenomenological and future-oriented approaches; and between modernity and traditionalism

(Ho & Chiu, 1994; Hofstede, 1980; Lin, 2001; Voronov & Singer, 2002). Hong Kong individuals’ complex identity conceptualisation is arguably built upon such opposition

(Cheng, Lee & Lo, 2004; Lowe & Tsang, 2018; Xia, 2016). This section introduces such different identity forms by giving each a respective exampling socio-cultural trait. A specific focus in this section is to reconstruct the relationship between Hong Kong culture and counselling stigmatisation – is Hong Kong culture the primary cause of stigma against counselling?

The Impact of Traditionalism Remains: Collectivism/Confucianism

China’s collectivistic features are rooted in Confucianism. Despite the strong Western influences, Hong Kong individuals have retained certain parts of the Chinese culture, including strong allegiance to family life and the commonly shared belief in learning and education. Some scholars argued that a Chinese individual’s agent is not just based on the individual self (individualism), but the self within the family circle: ‘It is this great self that an individual is obligated to protect (family) against any threat from the outside…’ (Bedford

& Hwang, 2003; p. 130) Interpersonal relations are regarded as part of and an informing agent of an individual’s self (Hamaguchi, 1982). Therefore, an individual's psychological mechanism and status (self-esteem, beliefs and value etc.) are fundamentally dependent of group dynamics or relationships, and so a person's identity is relational by nature (Hofstede,

1980). Examples include the face (Ho, 1976; Hwang, 2006), Yuan (predestined relational affinity) (Goodwin & Findlay, 1997; Yang & Ho, 1988), altruism and conformity (Bond,

1994; Leung, 2003b). In counselling, collectivism is shown in an individual’s help-seeking attitude/behaviour. Individuals rely on helping within a group context in which help-seeking could be based on a reciprocal dynamics as well as the in-group environment. Sacrifice is justified and even righteous for a Chinese when the situation relates to maintaining family harmony. Such action is noted to be different from the Western definition of low self- awareness or individuality. Therefore, individualistic based counselling context is regarded as a misfit. Other collectivistic based traits include filial piety, family or social hierarchy

(Hwang, 1999; Kwan, 2000a; Lau, 2000; Leung, 2003), Guanxi (Xin & Pearce, 1996); and wisdom19. A person’s identity formation and perceptions in established on the collectivistic family and social hierarchy, and thus the own behaviour and attitudes are regulated according to the own positioning within the hierarchical structure.

A Newly Built Identity: Pragmatism

Situated between the East and the West, Hong Kong people have gradually adopted a localised pragmatic practice, which refers to an emphasis on solution tackling by action

19 Wisdom is a longstanding cultural philosophy or value base. It has been developed and valued by many non- white cultures, including Buddhist (e.g. Sri Lanka, India, China), African American (Asante, 1987) and Native American (Lame Deer & Erdoes, 1992) cultures. Western research first addressed its significance in therapy in the 1980s (e.g. Hanna, Bemak & Chung, 1999; Robinson, 1990), as many practitioners were reported to demonstrate problematic effectiveness and competence in practice after they complete training (Hattie, Sharpley & Rogers, 1984; Stein & Lambert, 1995). Hanna, Bemak & Chung (1999) attempted to link cases of such problematic practice/competence with Western counselling and psychology’s neglect of wisdom in education. They conceptualised wisdom as a particular set of cognitive and affective traits on influencing individual management of well-being, effective coping, attendance to the self and the related others/surrounding, etc. Some few scholars also advocated wisdom as a necessary personal quality/life skill of a counselling practitioner regardless of any form of adopted therapy/model (Baltes & Smith; 1990).

42 instead of speaking (Busiol, 2015). The city practically utilises material resources from the

Mainland China, while it also maintains as an open and free market to the globe. Pragmatism is also illustrated in an individual’s lifestyle or way of living (Cheng, 2004), for instance, some citizens distance themselves from attending to or involving with Mainland Chinese politics and turn towards Western cultures. When addressing the potential socio-cultural conflicts, people use pragmatism as an avoidant coping mechanism. Furthermore, levels of

Western or modern assimilation vary. Some may hold traditional Chinese values; some move away or give up such values (Farth, Leong & Law, 1998). It appears that many Hong Kong people may have pragmatically prioritised money and career over emotions and feelings.

Their environmental lifestyle and principles significantly impact on their time management, life priorities and needs; thus they become distant or do not see counselling as a priority.

Morality/Moral Education - An Integrating Product

Traditional moral education has remained as a strong influence on Hong Kong people’s strong emphasis on values clarification and moral reasoning. Hong Kong people are surrounded by modern culturally hybrid moral sources of Confucian-parental, Christian- religious and liberal-civic sources20 (Cheng, 2003; Cheng, 2004). Some of these successful changes are not driven by intrinsic traditional cultural values, but by an effective legislative/policy intervention. One successful example is probity culture (Li, 2004). The rise of such culture was led by an instrumental anti-corruption practice when The Independent

Commission Against Corruption (ICAC) was established in 197421 (Lee, 1999). ICAC devotes to fight against corruption through effective law enforcement, prevention and

20 The modern moral sources are under the threefold framework, including 1) Hong Kong individuals’ family orientation under Confucian values, such as diligence, self-reliance, role modelling, verbal instruction, self- determination or perseverance, benevolence and dutifulness; 2) religious beliefs in particular Christian source; and 3) civic or liberal influences in relation to the community contexts, in particular positive values of integrity, justice, law-abiding and etc. Moral education has influenced Hong Kong social norms (Cheng, 2003; Cheng, 2004). 21 The rise of ICAC was a response to the rampant corruption status in the colonial stage, notably the malpractice among field officers and clerks, including the police force (de Speville, 1997). The public protests led to the then British governor MacLehose’s order to set up ICAC.

43 education. Public awareness is promoted with various methods and channels, such as the department’s clear independent practice and system separated from the government, dissemination of multimedia messages (Cheng, 2004; GovHK, 2018), the specific business ethics promotion among corporate and companies, and implementation of the mandatory educational curriculum in public schools22 etc.

Anti-corruption practice in Hong Kong is regarded as a thriving local derived culture in a short period, and it marks its distinction from the Mainland Chinese practice (Li, 2004). By

2001, public perceptions of ICAC’s performance were as high as 99.2 per cent and were positively correlated to their strong opposition to corruption (ICAC, 2002). Hong Kong probity culture is a positive example of the then governor rule’s strong integration with the local political phenomenon, and the practice could be maintained after the transfer of sovereignty. Furthermore, such practice was a governmental implementation and required the governor’s strong combat against institutional corruption (the entire police force), including its ability to withhold strong opposition from such corrupted institutions or systems (de

Speville, 1997) clearly indicates that a successful derived local practice relies on a well- regulated practice or support, and such support has to be on the governmental or related level.

I turn to some other models of moral development such as modelling and autonomy (Lee,

1993; Lee, Ng & Lam, 1995), and integrating between moral and religious education (Lee,

1993b). Despite their sufficient guidelines or system in place, these examples have fallen short of their impractical practice and social applications (Lam, 1991). This suggests the importance of a good governmental and structural intervention, and that culture in the modern twenty-first century is not just a culture, but more importantly a socio-political product.

What is Exactly Stigma against Counselling?

22 The mandatory moral education was formally implemented in the public educational curriculum since 1981 (General guidelines on moral education, 1981). According to a nation-wide survey (Hong Kong Federation of Education Workers Limited, 1997), moral education in Hong Kong consists of diverse teaching methods, ranging from counselling, talks, classroom teaching, whole-school programme, religious education and special projects).

I attempt to draw on implications from public awareness and receptiveness of counselling.

Traditional explanation has associated stigma against counselling with the specific Chinese socio-cultural superstition, as individuals avoided counselling as much as they avoid

“madness/craziness” (Mo & Mak, 2009). However, such theoretical explanation was not empirically explored until Yu et al. (2010) collected public understanding and perceptions of counselling and counsellors through a survey. It was reported that half of the participants showed interest in counselling, in which a majority were willing to pay less than HKD 199 per session. Yu et al. (2010) concluded that the public perceived counselling as a lowly ranked service. Other studies (Busiol, 2015; Ip et al., 2016; Yuen, Leung & Chan, 2014) advocated that resistance against counselling was not just a specific socio-cultural stigma.

Busiol (2015)’s grounded theory research explored college student populations’ help-seeking behaviour and attitudes. Busiol argued that students’ negative attitude was a result of their lack of interest and knowledge in counselling, and low access to counselling services. Ip et al.

(2016) also investigated similar college population group and showed similar findings. The research further explicated participants’ counselling preference was related to practitioners’ prestigious training qualifications (institutional reputation), age and work experience; qualified practitioners with little experience were less favoured. Furthermore, Lee et al.’s study (2014) investigated the conjoint measurement of therapist preferences. Therapists’ professional background and training institutions were also found as two essential contextual factors. This somewhat implies the public (at least in the young adult/student population) highly valued what would be ‘professional’ as they considered accessing counselling. A more recent study by Tse, Fung, Tsoi, Chan & Lo (2017) targeted at the wider public perception

(941 participants), and showed their similar expectations, such as older age and having experiences of receiving counselling, are positively associated to the positive attitude of help- seeking. Different from Yu et al. (2010)’s findings, a higher 88.1 per cent of the participants

45 would pay to see a counsellor; 46.7 per cent were willing to afford between HKD 100-49 for a counselling session. A large number of participants reported they would consider seeking or refer someone to counselling in the future when they have a mental breakdown, emotional crisis, or when they become upset and worried for a long time. This provides a preliminary conclusion that the public more or less has shaped some clear expectation that counselling is a specialised service for emotional support. However, Tse, Fung, Tsoi, Chan & Lo’s results are prone to participant selection biases. Over half of the participants come from middle- and upper-class background (income 20,000 and above) and have a bachelor degree and above. It can be argued that the research’s online interview design may also have limited certain types of participation, and thus the sample size does not represent the actual Hong Kong demographics, at least those from the lower or root class.

I highlight that the concept of stigma against counselling reflects the more prominant socio- cultural processes than merely a fixated concept. Findings showed that public awareness and receptiveness are consistently correlated with practitioners’ professional qualifications, older age and experiences. These factors are arguably in line with Chinese socio-cultural construction of individual competence (Ip et al., 2016; Tse, Fung, Tsoi, Chan & Lo, 2017; Yu et al., 2010). Such concept is informed by social hierarchy, in which maturity was an indicator of higher position. Nonetheless, different socio-cultural-economic factors and their intersections were yet to be fully incorporated in the interpretive findings. Furthermore, previous research designs reflect an apolitical assumption that an individual’s access to counselling services is largely dependent on self-choices, whereas public awareness often only reflects the larger macro-level picture which shows socio-cultural-economic and political inequalities. A more in-depth methodological approach is needed to confront the close ties between individuals’ socio-cultural positioning and their perception, awareness and access to counselling. More studies are needed to investigate how intersections of social

46 factors push individuals to social marginalisation and vulnerability (Cole, 2009; Crenshaw,

1991; Syed, 2010). Furthermore, the literature has yet to incorporate multiple levels of counselling needs and types of services, for instance, mental health/counselling issues or level of severity, or differences between public, charitable/private sectors. This again reflects stigmatisation’s complex contextual foundation, and it involves macro-levelled systemic understanding (Imber-Black, 1990). Therefore, the thesis argues that first, an alternative perspective (other than the public) needs to be collected, in case of the current thesis, practitioner roles. Furthermore, the thesis adopts a macro systemic approach. This will be elaborated in Chapter three: Methodology.

2.3.Hong Kong Counselling Situation

Hong Kong counselling is formed by multiple disciplines and involves multi-dimensional services. The earlier sections have shown counselling’s diverse nature is intertwined with institutional developments and public policy decisions. Counselling’s institutional nature is not localised within the field but also mirrors the larger Hong Kong historical and political processes. Examples of local cultures illustrate how political influences have shaped the new

Hong Kong identities and cultures. Therefore, counselling and Hong Kong context are by nature institutional and political. I now continue to summarise the confronting socio-political challenges against Hong Kong counselling field.

2.3.1. Blurred Professional Identity There is currently no official consensus on counselling’s definition or professional identity.

Counselling’s lack of independence is a historical outcome as it has been shared by multiple professional disciplines. Therefore, counselling identity is further blurred by the lack of consensus on the linguistic and conceptual definitions of counselling. One common perception is that Hong Kong counselling does not have a clear speciality or strength. The sharing culture also implies counselling can be often muddled with other tasks and focuses of

47 non-counselling healthcare professions (Leung, Chan & Leahy, 2007), hence its inability to develop an independent identity. Another perception is that Hong Kong counselling is often described as a general profession. The word ‘general’ refers to counselling’s lacking speciality and uniqueness. Counselling professionals are found in diverse settings ranging from school, university, healthcare, social services and business settings, yet client groups are mostly limited to psychologically healthy populations with daily life difficulties (Seay, 2010;

Yuen, Leung & Chan, 2014). Correspondingly counselling professionals struggle to demonstrate professionalism in the specialised mental health services. Counselling-levelled practitioners cannot infiltrate clinical level of services not just due to training boundaries, but also disciplinary boundaries and restrain from the policy. There is an unspoken consensus that counselling practitioners lack clinical expertise. They are lower or lacking professional identity, as well as lower in professional status of counselling as a whole. In some empirical studies, professionals self-reported being perceived by other professionals and regarded themselves as non-professional counsellors (Leung, Leung & Chan, 2003). Johnston et al.

(2005) explored social workers’ attitudes and self-perceived competence in smoking cessation services. In self-report, social worker participants did not see themselves in counselling provider roles, though they were more confident in their competency than nurses.

Other studies also identified counselling practitioners’ lack of professional identity by reporting counselling training graduates’ remained non-counselling professional titles, in particular to those with multiple or dual work roles (Mok, 2003; University of Hong Kong,

2016).

2.3.2. Questionable Professionalism Leung (2003) critically addressed the problematic professional qualification of Hong Kong counselling training programmes. Despite an abundant number of master-level training programmes, there is no official or related indication how the programmes qualify a person to

48 call himself/herself a counselling professional. Furthermore, there is no transparent or independent monitoring system which ensures ethical and professional practice. Some studies evaluated practitioners’ inadequate training or supervision in guidance counselling (Chan,

Shea, Lau & Yuen, 2005; Yuen, Chan, Lau, Gysbers & Shea, 2007) and social work disciplines23 (Chui, 2014; Wong, Wan & Ng, 2016). Furthermore, the multi-dimensional and multi-perspectival nature of counselling exposes counselling’s lacking uniform training curriculum (Leung, 2003). Questions remain whether a specific training standard is required, in other words, some unification is required to clarify counselling’s professional identity and application when a diversity of training maintains as a key characteristic of Hong Kong counselling (Leung, 2003). While a unified training standard is not the only choice, problematic implications brought by the diverse nature of counselling should not be ignored.

2.3.3. Linguistic Translation Problem I name some examples to show the confusing Cantonese-Chinese terminologies of

Counselling and Psychology (Fu-Do & Sum Lei Hok) in research and practice. For instance,

Sum Lei Fu Do and Fu-Do (counselling psychology and counselling) are interpreted as synonymous spoken and written terms of professional counselling. The overlapping terminologies do not necessarily link with the respective professional practice or theoretical paradigms. The public misunderstands that counselling psychologists are no different from counsellors (Yu et al., 2010). The local counselling psychologists are reported to struggle in advocating their professional identities and distinctiveness from those who hold multiple/dual professional identities (counselling and the original disciplinary role; Mok, 2003; Seay,

2010). Another example is the inconsistent terminologies used in guidance and counselling,

23 Family intervention studies identified the existing training gap for social work practitioners between their in- training and highly experienced professional status. While family counselling/intervention is a specialised counselling support commonly shared by only experienced social workers in public sectors (Chui, 2014), there is no equivalent foundational learning in social work curriculum (Wong, Wan & Ng, 2016), hence the possible inconsistent service quality or professional competence.

49 in which job titles have been inconsistently named as a guidance teacher, counselling teacher, teacher-counsellor or school counsellor across the literature (Leung, Leung & Chan, 2003;

Luk-Fong, 2013; Ng & Yuen, 2016; Yuen, 2002). There is little regarding the relationship between linguistic and conceptual translations. One explanation is that the job role is shared by different disciplines (teaching, social work and professional counselling), and involved the respectively adopted terminologies. However, little is recorded regarding cross-disciplinary communication in research and practice, which is, in fact, a common practice in Hong Kong.

For instance, there is a large number of social workers practising in guidance and counselling

(section 2.1.1). Although there is specific training available to practitioners (e.g. Master of

Arts in School Guidance and Counselling, Hong Kong Polytechnic University; Leung, Leung

& Chan, 2003), there are no mandatory regulations or requirements that social workers must hold the equivalent qualifications to work in the specific school context. One can argue that such sharing nature itself is a localised conceptual translation. More research is needed to fill in such research gap. This thesis addresses this matter by highlighting the lacking cross- disciplinary communication.

2.3.4. Cross-Disciplinary Communication There has rarely been a report or record of cross-disciplinary dialogue or activity. Most of the studies were conducted within the discipline despite the growing overlapping theoretical literature and methods of interventions, for instance, between counselling and counselling psychology (the former seldom refers to the latter; Yu et al., 2010). Another unspoken socio- political reality is the cross-disciplinary hierarchy and the related dynamics. Some studies have addressed Hong Kong counselling psychology’s struggling professional identity compared with the other existing healthcare disciplines (Seay, 2010; Yu et al., 2010).

Another critical observation is the missing voices from student guidance’s teachers, hospital chaplains and other independent counsellors. From a critical perspective, what is not found in

50 the literature review may reflect the marginalised groups which are not being heard about or attended to. The current thesis has the political agenda to advocate for these particular groups.

There is also an unrecorded social phenomenon, which is that academic reputation appears as one of the main criteria of counselling professionalism. It is commonly known (by practitioners, scholars and the public) that disciplines in the higher position of the cross- disciplinary hierarchy are linked with training programmes from more prestigious

Universities and institutes. For instance, clinical psychology programmes are currently only developed in University of Hong Kong and the Chinese University of Hong Kong, the only two Universities with longstanding historical and world-class reputation. In contrast, clinical psychology training programme by the City University of Hong Kong was under criticism, including from the clinical psychology profession itself. Recently the government has released its intention not to be involved in internal conflicts within the psychology profession

(SCMP, 2018). This more or less has exposed discontent between different academic institutions even they are from the same discipline. One should critically look at the literature gap related to the socio-political dynamics, or the intentionality of the unspoken, instead of making a superficial conclusion of the lack of evidence.

2.3.5. Struggle with local policymaking Lump-Sum Grant

Lump Sum Grant (LSG) system was a social welfare reconstruction by the Hong Kong government in the year 2001. The government replaced its funding allocation from the subvention system to LSG (one-off funding) as a claimed attempt to meet the public needs. In other words, the subvention system covered most of NGOs’ eligible costs, expenditure ceilings and staffing standards in service provision. However, after a review commissioned by Coopers & Lybrand (1996), the government concluded that the existing arrangements are insufficient to meet the rising social demand, and thus LSG policy would take place instead.

By 2009, all NGOs were reported to have adopted LSG (Social Welfare Department, 2010).

Several implications were listed from the policy decision. First, scholars and practitioners criticised that such policy decision equals budget constraints and has significantly impacted on the overall social welfare development (Chow, 2008; 2004; Lam & Blyth, 2012). Second, counselling is limited to develop as a partial conceptualisation among the overall services due to budget restraints. Instead of being allocated separate funding, counselling budget is a partial element of the centralised yet smaller expenditure planning. Another concern was organisations’ increasing struggle to provide a full spectrum of services after such funding cut. There has been limited collected empirical evidence to testify the funding impact on practitioners’ decreased work morale.

Self-Funded Model in Postgraduate Training

According to Leung (2003), most of the governmental funding for postgraduate training has shrunk. Many programme organisers had to admit a sizable number of students to maintain their financial feasibility. Since then, it was suggested that many Hong Kong programmes had increased the number of students, and counselling training quality is severely affected by quantity. However, this critic is limited by a lack of empirical support.

Non-Legitimisation = Lack of Power

Counselling professionalism in Hong Kong is significantly discrepant given that practitioners do not require licence/accreditation from any legislative power or governing body.

Counselling is not included in the Hong Kong governmental credentialing system, civil service recruitment policy or practice (Ip et al., 2016). Some research has reported some healthcare professionals’ relatively stable professional status, including clinical psychologists, clinical social workers and psychiatrists who have securely held most of the governmental funding and career opportunities in the public sectors (Seay & Seay, 2006; Yu et al., 2010; Yuen, Leung & Chan, 2014). Again such a problematic social phenomenon is yet

52 to be illustrated by any empirical study. Few studies may show a partial picture, for instance,

University students’ positive attitude or behavioural choice of counselling was largely dependent on practitioners’ prestigious counselling qualification (Ip et al., 2016). This indirectly suggests individuals, at least those from the younger generation, regard institutional reputation as a determining factor of professionalism.

2.4.The Insufficient Existing Theoretical Explanations

2.4.1. Research Gaps There has been no empirical study or intervention to examine the professional status and comprehensive development of Hong Kong counselling disciplines as a whole. Most studies

(Leung, 2002; 2003a; 2003b; Yuen, Leung & Chan, 2014) are theoretical critics or scholarly observations. Diverse perspectives and methods of research were lacking, and discourses have remained the focus on developing counselling’s professional expertise (Yuen, Leung &

Chan, 2014). A more recent empirical study was conducted by Lam & Yeung (2017) who examined cultural reasons of Hong Kong counselling’s lack of professional accreditation.

Furthermore, Wong (2013) revealed the segregating relationship between different Hong

Kong family therapy branches in Hong Kong. So far, no study has attempted to understand or engage with counselling practitioners on their attitudes towards counselling in Hong Kong, a matter which is especially important as they are the main engine of services. In the current content analysis, Hong Kong counselling’s structural characteristics are prevalent, that: 1) counselling is considered as a partial element of the overall public services; 2) historically counselling was a West turned local product via the British sovereignty; 3) counselling is a structural product under socio-political movements and governmental policies, more than the pure theoretical or philosophical underpinnings.

Counselling and psychology in Hong Kong have also drawn some international attention. For instance, Australian scholar Pelling (2013) attempted to empirically explore the professional

53 status and activities of psychologists and counsellors in Hong Kong and Singapore. She reported on the demographics of Hong Kong practitioners that they were on average female, about 46 years of age, in a marital or partnered relationship, heterosexual, have children, bilingual, Chinese and hold Christian beliefs. However, the study failed to fully incorporate

Hong Kong counselling’s multi-perspectival nature, as social workers, teachers and pastors were left outside the picture. Therefore, Pelling’s (2013) findings could not have reflected

Hong Kong counselling’s highly contextual nature. Another question is, how much has Hong

Kong counselling been shown to the public and the international audience? The thesis deviates from merely criticising Pelling’s (2013) methodological shortcoming. I put the pondering thought on the limited picture revealed by the Hong Kong local professions. I challenge that the existing literature or at least what has been made to the public only narrowly reflects scholars and even the overall field’s apolitical status. Hong Kong counselling’s status and structure is a miniature of the socio-political constitution of Hong

Kong itself. Critical awareness without action only prolongs different healthcare domains’ segregated status from the concurrent political movements in Hong Kong (J Y-S. Cheng,

2014; Leung, 2016). I reiterate the importance of empirical research to address this research gap.

2.4.2. Redefining Hong Kong Culture: An Indigenous Approach ‘Culture is something that Western societies have not clearly understood, so that the

challenges they have to face in an increasingly multicultural world are particularly

difficult to manage. Understanding culture is certainly not only a Western problem,

but a universal problem as well.’ (Mantovani, 2000; p. 1)

In this section, I elaborate sections 1.1 to 1.3 of the introductory chapter by drawing a linkage between Hong Kong counselling and theories of East-West cultural axis, postcolonial theory and indigenous psychology. First, I show that meanings of Hong Kong culture are beyond

East-West Binary. I use Asian Americans (Okazaki & Saw, 2011) as a distinctive cultural example from the mainstream American or Asian cultures. Literature has shown that formation of values and behaviour of Asian Americans are tied with historical and socio- political discourses (e.g. immigration, war), and thus traditional cultural research design24 would have overlooked the macro-social environmental influences (Maton, 2000; Okazaki &

Saw, 2011). In contrast, the more recent studies have turned to relook at culture in pattern forms (Adams & Markus, 2001). This more or less has reinforced some American cultural research’s transcendence from only reflecting social constructionist homogenous views to postmodern environmental variability. I draw parallels from Asian American cultural studies to Hong Kong culture which has been claimed to reflect neither the pure Western nor Chinese culture. Hong Kong culture has undergone a process of hybridisation as it reflects Chinese culture (Confucianism and collectivism), as well as modern Western influences (Christianity, capitalism, social welfare). Therefore, the contemporary Hong Kong culture presents as a challenge against the clear-cut proximate explanations (of individualism and egalitarianism versus collectivism and hierarchy; Schwartz, 1999; Voronov & Singer, 2002) which would have overlooked complications of local specificity in Hong Kong. Instead, a culture consists of various societal constructs and ecological dimensions (Crenshaw, 1989; Hays, 2008; Said,

1978) which are interwoven or intersectional in nature, including age or generational influences, ethnicity, race, class, religion, disabilities, socioeconomic status, education, sexual orientation, and gender, etc. An individual is naturally a product of these multiple constructs as they indicate the own social position. This implies that individuals in the society are interconnected on the hierarchical scale, and an individual’s social power between privilege and vulnerability/marginalisation is determined by such imbalanced comparative

24 Traditionally cultural psychological research has tended to specify and isolate the operative components of culture into simplistic interpretations of race and ethnicity groups (Okazaki et al., 2008; Seeley, 2003). The emphasis of scientific measures thus reinforced a knowledge base of culture which is context-free and history- free, and culture has often been analysed as one of the many individual levels of variables.

55 scale. Therefore, the mental health state of a person is informed by impacts of intersecting cultural conditions and hierarchical relationships. Mental health is somewhat dyadic on the societal level, between mainstream and ‘the other’, privileged and oppressed, dominant and marginalised. The thesis stands in line with studies (Maton, 2000) which advocate counselling/psychology research to be more than an academic discipline or clinical service, but also vehicles of social transformation. Mahalingam (2007) argued that cultural essentialism (using ethnicity and race groups to apply social differences) had been used by scholars from the dominant groups (white, male, non-lower class). There is a danger that scholars maintain and even orchestrate power and privilege by adopting such biased research methods (Western hegemony). Scholars should not just claim their serious account taken at the problematic social-political realities in the community systems, but also examine their research design, process and delivery. That is, the critics are not merely at the methodological shortcomings but also the fundamental social value of a counselling/psychology profession.

Moving beyond the West-East binaural understanding, I explain the relevance of postcolonial theory for the socio-political foundation of the current thesis. Hong Kong culture is built upon the more substantial geopolitical and historical dispositions, in which colonial history is arguably the leading ecological dimension (Gjerde & Onishi, 2000). Postcolonial studies (e.g.

Fanon, 1965; Foucault, 1970; 1977b; Matsumoto, 2007; Said, 1978) have critically challenged the over-simplistic East-West cultural axis theory to reflect power imbalance between metropole or the colonised. The theory advocated that the previously colonised cultures show a social reality which has been historically constituted, produced and reproduced. Even after colonialism, these cultures have remained as ‘the others’

(sociocultural identities and values) as they appear in the global context. Identity reconstruction, to them, would be a resistance against the dominant once-colonised or the

West (named as decolonising; Matsumoto, 2007; Okazaki, David & Abelmann, 2008; Wang,

1997). However, such understanding (of dynamics of power and sovereignty) is further complicated by Hong Kong’s unique socio-political state. Different from most of the colonised nations in the postcolonial studies (India, African countries, Brazil, etc.), Hong

Kong was never a nation, but a city of Mainland China. While it has cut its ties with the formal coloniser, the city still carries the British legacies (structural systems, language, lifestyle, etc.), and at the same time under Chinese sovereignty. Despite having some level of autonomy, the city is directly under the Chinese regime, in which the consistent liberation and other resistance movements (see section 2.2.1) reflect Hong Kong people’s dissatisfaction of the political situation. This muddling triangular relationship gives rise to the question, what is exactly ‘the other’? What are liberation and independence movements?

What is Hong Kong culture? 'Hong Kong Chinese' and the general Chinese notions have become distinctive ideologies and practices throughout the colonialism era, and continue the diverging path under political discontent. Most postcolonial studies have discussed the concept of hybridity as the integration of cultural signs and practices from the colonising and the colonised cultures. However, again Hong Kong appears as a misfit in postcolonial theory due to not the dyadic, but the triangular relationship with Britain and the Mainland China. To address this complex relationship, I stress that psychology and colonialism are closely linked, and psychological research can shed light on psychosocial processes on the individual and disciplinary levels, as well as the practice of psychology as a whole. I reiterate Hong Kong counselling and psychology literature’s apolitical status only further extend the discipline’s disconnect from direct societal concerns (see Chapter 2). Unless counselling and psychology put socio-political agenda (globalisation, indigenisation, poverty, cross-cultural encounters, etc.) at the centre of knowledge and practices, there is a danger counselling/psychology would become irrelevant in the society.

Here I suggest using an indigenous approach to investigate Hong Kong counselling in this thesis. In fact, postcolonial studies are informed by indigenous philosophies on explicating legitimacy of colonial power. Indigenous psychology puts psychological agenda on challenging against Western hegemony25 (Danziger, 2006; Hwang, 2005b). The approach also commits to developing social justice education, social changes and actions even they do not necessarily refer to decolonisation (Tuck & Yang, 2018). In research, indigenous scholars advocate regenerating non-Western based epistemological and methodological paradigms to adequately reflect local social, language and cultural issues, as well as local people’s worldviews, identities and behaviour (Danziger, 1985; 1994; 2009; Hwang, 1999; 2009;

Yang, 1999; 2000). Psychological understanding needs to be built upon the local context, and thus different definitions (e.g. Hwang, 2005a; Kwan, 2009; Kim, Yan & Hwang, 2006a;

Yang, 2000) and methods (e.g. indigenous cross-cultural psychology, Yang, 1997; 1999; the derived etic approach; Kim & Berry, 1993) have been developed in different socio-cultural regions. In the Chinese context, most of the research interests have been centralised around developing the scientific study of human behaviour and psychological processes within the particular context26. The existing limited account in Hong Kong has engaged in discourses of indigenisation movement, in which a majority of researchers were overseas returning scholars

25 Danziger (2006), a historian of psychology, proposed the concept of intellectual geography of centre and periphery. The theory emphasised power/knowledge relations of scientific disciplines in diverse geographic locales across the world. Before WW2, some regions have become the central locations in producing psychological knowledge and practice, dependent on the particular intellectual, institutional and economic resources. Such knowledge production/practices inevitably reflected the particular characteristics of that region, which was described as schools of thought. On the other hand, the proliferation of research and practice in the US has led to the extreme disproportion of resources across the world. The word psychology has also become rapidly used by international scholars who travelled to the US for training and education. This fostered a one-way communication between central (US) and peripheral locations (outside the US), notably there was little interest from the central location. 26 Advocacy of collectivism appeared in popular cross-cultural theory. An eastern educated individual tends to (but not limited to) seek group harmony in favour of the stronger interpersonal relationships, whereas a Western educated individual seeks individual freedom due to the pursuit of own rights. Indigenous psychology deconstructed indigeneity into different psychological constructs of Chinese people, including native language comprehension (Yang, 2012) instead of a foreign one (including English even as the official international language); others include cultural characteristics of guilt and shame (Bedford, 2004; Bedford & Hwang, 2003), Filial Piety (Ho, 1996; Hwang, 1999; Kwan, 2000a).

(Kim, Yang & Hwang, 2006b). Furthermore, colonialism/post-colonialism in Hong Kong has received tremendous attention and interests across diverse professions, only outside the counselling and psychology disciplinary boundaries. I summarise that there is still a lack of existing empirical input on indigenisation or post-colonialism of Hong Kong culture, especially from Hong Kong counselling/psychology scholars. The current thesis aims to fill in the research gap. One point to note is the existing development remained in tension between indigenising and globalising counselling and psychology (Ho et al., 2001; Leung &

Lee, 1996; Moir-Bussy & Sun, 2008). Despite the abundant theoretical research (see globalisation movement of counselling and psychology in section 1.1), scholars have yet to link theorisation to the actual structural and political situations of Hong Kong counselling and psychology professions. I suggest that indigenous approach and postcolonial theory provide a complementary theoretical foundation for the thesis to reposition Hong Kong counselling towards re-politicisation.

2.5. Research Rationale

The current thesis has two purposes. One is to empirically explore Hong Kong counselling meanings. To do this, I looked at local practitioners’ narratives on the indigenous meanings of Hong Kong Chinese counselling. Local practitioners across different counselling/related disciplines were invited to share on their professional experiences. The second aim was an expansion from the original one-phase research design, as the researcher intended to articulate participants’ reflections specifically on future changes and actions.

The current study is one of the few empirical studies to construct an East Asian layout of counselling which differs from the existing Western mainstream development. Furthermore, it is the first empirical study in Hong Kong to explicate the structural dynamics of counselling. Given the thesis’s focus on drawing out local content and dynamics of Hong

Kong, it is expected that implications from the current study would also facilitate socio-

59 cultural discourses on defining Hong Kong culture, including the complex geopolitical and historical development. While the present research directly contributes to the indigenous literature, such empirical findings aim to bridge with the Western development, particularly in response to the ongoing globalising demand for a unified knowledge base. Hong Kong study especially adds value to cultural diversity and multiculturalism. Furthermore, as I am a

Hong Kong born and raised individual and Western educated counselling practitioner and researcher, the study acts as a cross-cultural exchange between Hong Kong China and the

UK.

Chapter 3. Methodology

3.1.Theoretical Positioning/Reflexive Statement

This section is written in the first person perspective, as I highly regard subjectivity in research in relation to ‘co-construction’ of meaning and interpretation of the data (Charmaz,

2006). This includes my roles as a psychologist trainee, bi-cultural individual and an overseas resident and how they impact on data construction. For instance, I am a Hong Kong Chinese born and raised individual who received tertiary education (counselling/counselling psychology) in England. I consider myself a bilingual with multi-cultural experiences. This research was conducted for the Professional Doctorate in Counselling Psychology, but also out of my personal interest alongside my prior accumulative work experiences both in Hong

Kong, China (three years) and England (four years). I developed a passion for underpinning the complex dynamics in the local region. Furthermore, I conceptualised my professional identities in my clinical training under the UK counselling psychology integrative model guidelines and my theoretical positioning in line with social justice values. My mixed cultural and professional identities will be elaborated in Chapter four.

I recognise my inherent Hong Kong Chinese cultural upbringing in my knowledge base, while Western education has also been a dominant knowledge resource, including epistemological and ontological theories which are originated outside my home cultural context. Therefore my mixed/fluid non-Western and Western personal/professional experiences naturally explicate the diverse standpoints (see Chapter Four). I highlight knowledge construction from the perspective of patterns of fluidity rather than an accurate description. That is, this research’s theoretical stance is outside a fixated adherence to a particular paradigm, which to me is only a label or a rigid set of beliefs. Instead I acknowledge multiple subjective realities and beliefs constituted on the intra- and interpersonal levels. I identify interaction, connection and dialogue between different realities

61 themselves can also be a set of knowledge. Therefore, I positioned myself in the research as the interacting point with different local counselling practitioners, and I pay more attention at understanding individuals’ intentionality of their sense-making of their experiences, and the outer contextual factors’ impact on them.

I selected a methodological design which allowed me to fulfil my obligations as a researcher.

I am transparent about my strong ties with social justice values which I will elaborate in

Chapter Four (Chung & Bemak, 2012; Goodman et al., 2004; Kagan et al., 2011; Miller,

1999). My epistemological commitments expand from just reflecting a descriptive level of knowledge forms. My critical position of enquiry is in line with my worldview that societies are inherently unjust. That is, the context of such knowledge forms more or less is itself a major orchestration of injustice and inequality. In the case of Hong Kong, colonial influences have constructed the unstable socio-cultural and political foundation (see Law, 2009). I suggest that the status quo of mental health/counselling professions is an exemplary feature of colonialism in Hong Kong. Beyond simply underpinning or revealing social morals and obligations within the diversity of worldviews, I also focus on how shift/change and actions can occur via contact or interactions or exchange (in case of the current study, via interviews as a form of exchange). To do this, my mindset has gradually become oriented towards conceptualising local specificity and developing a pro-political encounter. This thesis has two clear focuses: 1) articulating indigeneity of counselling in Hong Kong, and 2) repositioning counselling towards re-politicisation.

3.2.Ontology and Epistemology

This thesis mobilises an indigenous framework (e.g. Drawson, Toombs & Mushquash, 2017;

Hwang, 2005; Kuo, Hsu & Lai, 2011; Leung & Chen, 2009). According to Wilson (2001), indigenous paradigm acknowledges there is more than one reality, and knowledge is relational. That is, knowledge is not just interpersonal relationships or research subjects, but a

62 relationship with all of creation. Its research represents a unique set of ideas and values of the context, as the researcher builds a relationship with the interrogated context. Furthermore, the word ‘indigenous’ is political, because its terminology stems from the society’s separation from the Western approaches or influences as the ‘mainstream’ or ‘original tradition’ (Ho,

1998). In theory, indigenous psychology (Chilisa, 2011; Kovach, 2009; Smith, 1999; Smith,

Tuck & Yang, 2018; Tuck & Yang, 2012; Wilson, 2008; Yang, 2000) is a scientific knowledge base which is in line with the political stance of nationalism and anti-colonialism.

I believe that one should pay more attention to the impact of institutional representation. In other words, counselling conceptualisation and formation is inherently political. I have a particular interest in articulating the complex intertwined subjective and institutional experiences of identity construction and shaping. Aside from adhering to the indigenous paradigm, I make clear of how my understanding is transferable to the international context instead of being restricted in the localised Chinese region. That is, I show how the other

Western methodologies relate to the indigenous paradigm below (see Drawson, Toombs &

Mushquash, 2017). I clarify I do not adopt these methodologies but they have acted as a resource to inform my indigenous epistemological understanding. a) Post-constructivism (Jackson, 2014; Rorty, 1989; Roth, 2006; 2012; 2013; 2014; 2015;

Wehling, 2006; Wittgenstein, 1997) has the methodological strength to unpack long-

standing or ‘stuck’ social phenomenoa or situations. It derives from the mainstream

constructivist approach which emphasises social constructionist learning. The approach

highlights human being’s mode of learning is oriented towards becoming aware of the

‘unknown’ (James, 1948; Peirce, 1955; Shank, 1993) – meaning what is not aware of or

yet to be known or learnt. Post-constructivism is built on postmodernism (Lyotard, 1979),

as there is no more a single vision for a culture.

The indigenous framework is in line with post-constructivism, as I am open about the

limits of my capacities to make full sense of the situation and to explore the complexity of

multiple narratives and visions. Therefore, I could immerse myself in the actual data

collection experience, in which I developed the language as I became skilful of doing it

(Rorty, 1989; Roth, 2015). Therefore, keeping a record of my research process is essential

as I reflect on the fluid changes of what I know and not (e.g. Chapter four). Accordingly,

this thesis is an ‘a posteriori account’ of the discovery and language by emphasising I

become aware of what I was previously ‘unaware’ of. It requires the researcher to

develop a proactive, curious and open mind-set/attitude, as well as the underlying base for

the own preparedness towards critical counters. b) My indigenous stance is in line with the post-modernist stance, whih means I am against

the mainstream social science research’s apolitical and neutral stance (Derrida, 1988;

Foucault, 1970; 1977a; 1977b; Fraser, 1989; Kuhn, 1970; Rosenau, 1992). By situating

closely with the socially unjust, postmodernists strongly reject universal knowledge; they

rather advocate the de-privileged and oppressed by de-privileging the mainstream

positivist voice. Although postmodernism, as a movement, developed over nearly half a

century ago; it can be argued that positivist research has remained the existing dominant

paradigm, especially in psychological research. This thesis continues to highlight its

ongoing challenge against the positivist status quo. I regard postmodernism as an eclectic

approach to exemplify social justice. c) A critical realist paradigm (Bhaskar, 1975; 1986; Sayer, 1992; 2000) purposefully unfolds

the pervading realism by showing the parallel tensions between realism and relativism.

This is similar to the indigenous framework which attempts to articulate the current

‘stuck’ Hong Kong socio-political agenda on counselling development, but also navigate

between the current ‘reality’ and the possible future changes/actions in the research

process (see Fleetwood, 2013).

3.3.Qualitative Mixed Methods Orientation

Indigenous research paradigms typically mobilise qualitative methodologies. Qualitative philosophy stems from the constructivist view (Henwood & Pidgeon, 1994) to capture the in- depth complexity and fluidity of human experiences, particularly developing cross-cultural research (Liamputtong, 2010). For instance, idiographic and inductive approaches highlight individual experiences on an in-depth level. There is no absolute truth but multiple realities given by participants’ interpretative subjective experiences. Therefore the researcher would tentatively and flexibly explore concerns around the existing or pre-determined truth or reality (Smith, 2004). I also referred to the phenomenological approach, which is closely aligned with pre-conceptions and assumptions. Phenomenology allows one to focus on interconnectedness between the past, present and future. It also seeks moment-to-moment changes or ‘the new’ in the spontaneous contact/interaction (McLeod, 2011).

Indigenous methodology has extended from the above traditional constructivist view. Its research paradigm prioritises on reflecting inter-relations between individuals and macro- institutional influences, and thus indigenous methodology has clear attention at ‘relational validity/relational accountability’ (Wilson, 2001; 2008), instead of just validity or reliability.

In other words, a researcher attempts to answer all the own relationships when conducting research, hence in this way fulfilling the own relationships with the world around the self.

Accordingly, explication of my indigenous conceptual development has also naturally become part of the thesis aims, as it serves as an example of indigenous methodology.

Indigenous methodology commonly consists of a mixed methods adoption, often modified by the researcher to tailor the own critical attention to a particular context. In this thesis, the indigenous methodology comprises of an integrative framework of a pragmatic bottom-up

65 indigenous processing, autho-ethnography and post-colonial framework. First, the methodological construction graduated from pragmatic engagement to theorisation, to integration of theoretical or philosophical learning. Such methodological development can be understood as a bottom-up processing or process-oriented conceptualisation (Kim, 2000). The word ‘bottom-up’ comes from critical discursive psychology’s ‘top-down’ and ‘bottom-up’ analyses (Potter & Wetherell, 1987). Such an approach is in line with indigenous psychology which explicates unequal subject positions via illustrative social representations, practices and discourses. In the research process, I first began by attending to the practical issues, for instance, sampling diversity and size control, rather than pinpointing at the full philosophical grounding at once. This was necessary for me to fit with the fluid research process, such that

I can deeply engage with the context. I define a few indigenous principles as follows,

i. Methodological process in this thesis is a fluid process and has been led by my auto-

ethnographic experience. That is, the methodological framework has been initially

designed, modified and improvised throughout the data collection period, which

allows space for my rich capturing of dynamics and changes of the socio-cultural and

political phenomenon.

ii. In the interview process, I was explicit about my positioning. This has reinforced my

opened engagement and articulation of different narratives in particular on the

sensitive political levels. Critical awareness of the political status in the local region is

particularly important, as the collected data can reflect participants’ revealed

narratives as well as the unspoken. One would decide whether to be explicit of the

own preference on discussing the own positioning which is towards change and

action. I utilised conversation techniques and critical awareness to encourage the

participants to engage and re-engage with the discussing subject in different levels

and perspectives. In this way, the collected narratives can reflect constructed

meanings which stretch across time, space and relationships. This indicates that

knowledge construction can be dynamic and fluid, and open to change, shift or

reconstruction. iii. In the analysis process, a mix-methods analytical framework benefited my flexible

engagement with the indigenous material, particularly the complex relationships and

dynamics between individuals as well as institutional settings. First, the bottom-up

approach (Kim, 2000) has reinforced my analytic formulation which could be (at least

in my most effort) shaped to be free from the pre-existing knowledge; rather I freely

associated with the data’s multi-perspective illustrations. Second, my critical

awareness of mix-methods of analysis helps me explore different perspectives,

including psychological process, linguistic terminology, interpersonal dynamics,

systemic interpretations, and institutionalisation etc. In this way, a situated,

comprehensive and contextualised understanding of counselling in Hong Kong can be

illustrated.

Second, indigenous methodology in this thesis combines with auto-ethnography (Anderson,

2006; Ellis & Bochner, 2000; 2006; Etherington, 2004; McIlveen, 2008; Richardson & St

Pierre, 2008; Roth, 2005). Such a combined approach (McIvor, 2010; Smithers-Graeme,

2013) is suggested also to set trustworthiness for this thesis (section 3.4) and the bottom-up processing of indigenous methodology. Auto-ethnography justifies my subjective interrogation of the research subject (Sparkes, 2000). This method is grounded in postmodern philosophy and proves to be useful for researchers as insiders to explore, interpret, question and reflect on their experiences and learning. This is particularly useful as the researcher can take part in the discussion instead of merely facilitating the conversation on the minimum descriptive level. That is, I could engage both cognitively and emotionally with intra- and interpersonal experiences. In this thesis, I combined auto-ethnography with personal

67 reflexivity or the reflexive practitioner model (Chapter four; Fossey et al., 2002; Morrow,

2005) to make transparent my epistemological grounding, experience as a practitioner, and personal engagement with Hong Kong’s socio-cultural-political context. Personal Reflexivity is one of the recognised theoretical models adopted by the UK counselling psychology practitioners. This approach allows the flexibility of a researcher's transparent personal/subjective influences, particularly the impact of the own mixed cultural identity on analysis, hence a balanced output of the phenomenological research. In the study, I was clear about my positioning of political stance about the socio-political context of the studied geographical region (Hong Kong).

Third, postcolonial framework is a dominant theoretical resource which informs Hong Kong city’s local specificity. Due to Hong Kong’s past colonisation history, postcolonial theory

(Fanon, 1965; Foucault, 1970; 1977b; Matsumoto, 2007; Said, 1978; see Chapter two: 2.4.2) is suggested as a primary mode of critical enquiry to explicate how individuals have come to inhabit ‘Westernisation’ from the past, today and to the future. Postcolonial framework allows the research’s rehearsal of the basic problems of colonial power. Traditionally there is an aim to reconcile the locally oppressed with the external intrusion. However, I also show my critical awareness of Hong Kong city’s local specificity and its misfit in the traditional colonial studies (see Chapter one). In many ways, Hong Kong situation differs from the traditional description about the colonised as the oppressed. Its triangular relationship with

Britain and Mainland China, since it is a city and not a nation, also reflects the complexity of colonialism meanings. Therefore, postcolonial framework serves only as a part of the analytical lens to look at the interplay of power and injustice, for instance, colonial power’s impact on the institutional notion of counselling as to how it appears in the localised socio- political collaborations.

3.4.Trustworthiness

To ensure this thesis’s fitness with indigenous and auto-ethnographic frameworks, I clarify my evaluation of a few adhered principles. First, adherence to auto-ethnographic approach

(Anderson, 2006; Etherington, 2004; Ellis & Bochner, 2000; 2006; McIlveen, 2008;

Richardson & St Pierre, 2008; Roth, 2005) is a natural decision since I am a member of the investigated society and home city. Therefore, my reflective journal could naturally serve as an auto-ethnographic material (Atkinson, 2006). Second, aside from the physical geographical visit, my lived cultural experiences in Hong Kong as an individual and working professional (section 4.1) fulfil the criteria that the data is to be observed for a prolonged time frame, and I have had rich interactions with members of the culture. Third, the current section recognises auto-ethnography’s methodological limitation regarding the generalisability issue

(McIlveen, 2008). Thus it only serves as a part of the theoretical and analytical framework

(alongside the main empirical findings; Chapter five). Furthermore, I draw from heuristics principles (Moustakas, 1990; 1994; West, 2011), which are found to mirror principles of auto-ethnography (six questions by Wilson, 2008). I specify my prolonged deep engagement with the lived experiences based on felt sense or embodied countertransference (West, 2011;

Gendlin, 1982).

3.5.Data Collection

3.5.1. Design The study consisted of two consecutive phases. The first phase aimed to collect Hong Kong practitioners’ narrative accounts about the indigenous Hong Kong Chinese meanings of counselling. The second phase acted as an extension from the first, to focus on articulating

Hong Kong counselling teaching fellows or leadership roles’ reflexivity regarding the current socio-political status, and on the action and change levels.

Each interview was conducted under the in-depth, semi-structured format (Smith, 1996;

Smith & Osborn, 2007), to tap into the complexity of processes about the controversy or personal experiences (McLeod, 2011; Smith, 1996). Participants were also encouraged to discuss their thoughts, feelings and other reflections. I drew upon the equivalent clinical/interview skills to help the participants articulate and maintain reflexivity. In particular, I ensured my equipped enhanced skills and awareness of facilitating an effective communication on the sensitive socio-political subject matters. Several rehearsals for the interviews were also done in English and Cantonese languages respectively prior to the interview period. Furthermore, to facilitate the analytic process, I made recording and observational notes during the interviews. Reflexive notes after each interview were also made, included general reflections, body language, emotional processes, etc.

There were several developments from the original data collection design. The initial interview purpose was to collect participants’ narratives on Hong Kong counselling meaning specifically about theories and philosophy, and the questions in the interview arrangements and schedule (Appendix 5 and 9) correspondingly focused on participants’ adopted therapeutic models, training, and cultural adaptation at work. However, through the interview process, I gradually changed my epistemological focus, so that the interviews came to focus more on socio-political agendas. Although some questions remained the same in content, my orientation shifted from exploring individual questions to the macro-structural levels of the meanings and modes of counselling. The second data collection phase was, therefore, a major addition to the original plan, as my research focus became more oriented towards social change and action by documenting leadership roles’ critical engagement with the current status quo.

3.5.2. Ethics The research obtained ethics approval from the University of Manchester's Research Ethics

Committee before any recruitment or data collection was conducted. All consent was gained following the required procedure and rules. Furthermore, the researcher was a trainee counselling psychologist under Health and Care Professions Council (HCPC) and British

Psychology Society (BPS) standard. The research thus also strictly adheres to the Code of

Human Research Ethics (BPS, 2014) and the data is expected to be handled under Code of

Ethics and Conduct (BPS, 2018) and Data Protection Act (1998).

The primary ethical concern at play in this thesis is confidentiality which was maintained via taking a number of actions. First, participants were ensured of confidentiality and anonymity, as they were given clear information before the actual interview, including an information sheet and discussion confirming informed consent (Appendices 1.1 & 1.2). Second, verbal briefings, hard copies of the information sheet and consent forms were given to the participants at the beginning of the interviews. Third, participants were sent the transcribed material (Cantonese Chinese) for checking after the data collection phase, to ensure the accuracy of the transcribed material. This also allowed them to confirm consent for the researcher’s usage of data and anonymised quotes. Participants’ right to withdraw from the research was ensured until the completion point of the data analysis. No participant showed a negative response or requested withdrawal, and all data was used for the analysis. Other measures made to ensure confidentiality include encryption and secure storage of the audio recordings and transcripts, and removal of any identifying information from the transcripts.

3.5.3. Recruitment Participants were recruited via purposive snowball or chain sampling (Bieranacki & Waldorf,

1981; Goodman, 1961) which has traditionally been adopted by sociological scholars, and more recently feminist research (Atkinson & Flint, 2001; Noy, 2008) who have tied snowball

71 sampling with hermeneutics and feminist sensibilities. Some participants were recruited via formal invitations, and they supported further recruitment by giving referrals. Due to my limited length of stay in Hong Kong, part of my recruitment process overlapped with my two interview phases. The considered invitees are the local senior counselling practitioners based in Hong Kong with any related qualified counselling or related professional accreditation.

Due to the high level of variance of participants’ professional backgrounds, a heterogeneous sample was included. Maximum variation sampling was required to critically correspond to

Hong Kong counselling’s disperse and multi-perspective institutional nature (see Chapter

Two: Literature Review). This study follows the multi-perspectival design which allows examination of the different professional perspectives. Despite participants' varying professional identities, the research maintains a certain level of homogeneity of participants

(Smith, Flowers & Larkin, 2009) by setting inclusion criteria as follows,

The first phase – a) The participant was a qualified counselling provider with relevant accredited training, e.g. clinical psychologist, social worker, counsellor, counselling psychologist, pastor, teacher or any related professions; b) The participant was currently a counselling practitioner in practice and has accumulative relevant experiences for no fewer than five years.

The second phase – a) The participant was an accredited counselling psychologist or counselling/counselling psychology teaching fellow; b) The participant was a current counselling practitioner in practice, and has accumulative relevant experiences for no fewer than two years.

The two stages of participant recruitment were conducted via personal connection or online

(email and Linkedin invitations). First, I sent the recommendation emails/texts to establish

72 the contact, with written content and poster included (Appendix 3). Verbal invitations were also given to those who showed interest or could pass the electronic invitations to the other relevant practitioners. Out of 40 invited individuals, nineteen agreed to take part, and their profile was elaborated in Appendix 5 (First phase: Thirteen Hong Kong local practitioners; second phase: Four Hong Kong counselling and counselling psychology programme lecturer/professors/trainers). Furthermore, I was invited by one of the participants to travel to

Guangdong province, China, and hence the additional two interviews with a local practitioner and a director of a local non-governmental/charitable organisation.

3.5.4. Procedure The semi-structured interviews were in one-to-one and face-to-face formats, and their lengths ranged between 30 – 75 minutes, often depending on the participant’s available time for the interviews. The interviews were conducted in participants’ native languages: sixteen interviews in Cantonese Chinese, two in Mandarin Chinese, and one in English. I asked two main questions to generate a spontaneous and dynamic conversation (Appendix 9, the derived version of the list of questions; also see the original version as the original list of questions, see Appendix 8):

After the interviews, participants were reminded of their right to withdraw from the research before confirming the final data analysis. After transcription, all identifiable information was removed, and participants were given pseudonyms to preserve anonymity.

3.5.5. Transcription The interviews were audio-recorded and transcribed. Of the eighteen transcripts, fifteen were in Cantonese Chinese; two in Mandarin Chinese and one in English. Due to the complexity of language translation, transcription was mainly conducted by an external professional to fulfil the pragmatic translation needs (the difficult translation ability required), while confidentiality was applied with his agreement ensured in the contract. I also highlight the

73 limitations of loss of tone or body language when transcription and translation is merely on the linguistic level. Seventeen Chinese interviews were transcribed by an external professional transcriber to written Chinese language, while I did one English transcription.

My bilingual background enables me to engage with the material in both languages deeply.

To remain close ties with participants’ interpretative narratives, I have remained engaged with the original linguistic material until all analysis was done. In other words, any analytical writing before a formal draft was in mixed Chinese and English languages. Then, I translated the extracted quotes from Chinese to English languages (Appendix 7).

3.5.6. Analysis The main method of analysis is thematic (Braun & Clarke, 2006; Nowell, Norris, White &

Moules, 2017), while such approach is informed by other methods (interpretative phenomenological analysis (IPA), discourse analysis, intersectionality and systematic approach, to which I will elaborate below). I argue that due to this research as the first of its kind to interrogate socio-political perspectives of counselling and psychology in Hong Kong, there is a need that one recognises the beginning stage of the research to interrogate the widely unspoken concept of power. Therefore, at this point one should sensitively develop a narrative on unfolding such existing phenomenon; even it means describing and naming it.

This study uses thematic analysis to serve this purpose. I will further explain below the reason this study is informed by other analytical approaches but for the reason I stated above, they may not be fit to be the major analytical framework.

The analysis began with a complete set of the collected data in the form of text, which included the transcribed interviews, and field notes (reflective journal) from the ethnographic study. In the initial stage, original transcripts (in Cantonese Chinese language) were read once to stimulate my thinking. Due to the complex transcription requirement, the actual analysis period overlapped with transcription. The coding stage is based on a derived coding

74 method developed by myself as I made reference to the different analytical frameworks. To do this, I first carefully and multiply read each transcript. Open coding was made, together with comments and thoughts noted (in English) aside from the transcript (appendix 6). Such coding was done with careful consideration of how the findings could be generalised to the international context. Patterns of social practice or individual processes were conceptualised which could relate to the mainstream literature to avoid issues of knowledge translation. I put a mark on any phrase or quote which appeared to indicate the main keywords of each theoretical framework which informed my analysis, particularly in the fourth theme (see

Chapter five; postcolonial framework/intersectionality: power, hierarchy; IPA: psychological, process, emotional, identity; and discourse analysis: narrative, intentionality, identity).

Followed by that, the focused coding was conducted, as codes across the different transcripts were re-read, compared and re-organised (Appendix 6). I elaborate other informed analytical frameworks as follows,

 Interpretative phenomenological analysis (IPA) was initially considered as the main

methodological paradigm for its phenomenological inquiry of participants’ subjective

experiences and worldviews (Eatough & Smith, 2008; Smith, Flowers & Larkin,

2009). Its coherence with indigenous psychology was acknowledged, in particular,

recognition and utilisation of its explicit interpretative nature. Furthermore, IPA’s

idiographic and inductive approaches (Fade, 2004) are found to be useful to

understand narratives’ interpretations of the current socio-cultural-political post-

colonial state. One interest was to look at interviewees’ linguistic interpretations and

how they indicated or even reinforced (along the interview dialogue) the multi-levels

of identity construction/utilisation. On the other hand, the study’s larger sample size

made this problematic. IPA highlights the strength of a small number of sampling in

order to richly articulate inner subjective orientations, whereas this thesis focuses on

explicating a macro-structural level of interpretation instead of the detailed individual

linguistic patterns. However, I eclectically used its coding principles so as to highlight

how I sensitively dealt with the collaborative exchange between the interviewees and

me in a way which respects interviewees’ individuality, as well as retains their

multiple identities as they appear in the current professional hierarchy and power.

Also once as an insider (ex-Hong Kong counselling practitioner), I emphasised how I

attempted to ‘put myself into practitioner participants’ shoes’, such that their voices

can be advocated. Therefore, I have included many quotations to indicate their

narratives are already part the ‘interpretations and meanings’ derived from the

interviews. I put my analytical interpretations aside the quotes, which shows my

attempt to construct a collaborative picture with the interviewees.

 Discourse analysis (Billig, 1982; 1987; 1989; Billig et al., 1988; Burman, 1991; 1992;

2004/5; Burman et al., 2006; Burman & Parker, 1993; Parker, 1990; Simons & Billig,

1994; Van Dijk, 1998) highlights the interest of using linguistic methods and devices

to construct reality, and often the powerful institutional status quo. It is in line with

post-structuralism (Davies, 1989; 1991; 1993; 1994; Fuery, 1995; Gannon & Davies,

2007), another example of an epistemology which intends to move away from the

descriptive level of interpretation, to the creation of meanings and experiences by

using language. Language is emphasised in this analysis due to several reasons. First,

the current thesis crosses different languages (Cantonese or Mandarin Chinese and

English), and I am myself a bilingual speaker. Interpretation of participants’

narratives was more than linguistic translation, as I also had to interpret terminologies

or meanings which cannot be directly transferred to another language. Therefore, I

paid careful attention to accurately reflect narratives’ understanding as it appears in

Hong Kong and its counselling situation, and naturally such relation to the context fits

76 with discourse analysis’ principles. Second, I was aware of translation which underpins the underlying post-colonial structural and political nature of language formation (Foucault, 1977b; 1982; Gannon, 2001; 2004; 2005; Gannon & Davies,

2007; Richardson & Pierre, 2008; Spivak, 1976; 2000; 2001). The interplay between forms of languages and narratives conveyed was particularly attended to, such that my understanding of their identity association, creation and utilisation would be in close ties with the sociocultural and political context. I also highlight that interpretation of language was not just about the spoken and written languages, but also the rules which determine how languages and knowledge are conveyed. Rules indicate power and system of control. I have been an insider as a working professional in Hong

Kong, and note the complexity of the institutional dynamics and different practitioners’ drastically different accounts/worldviews. Therefore, obtaining a singular truth of the reality would be meaningless in this analysis. Discourse analysis captures how I attempted to co-construct understanding with the participants in the interviews, and how I tried to link such narratives with knowledge which is institutionally imprinted. However, discourse analysis would be a misfit due to the beginning stage of this study to unpack the socio-political dynamics. I prioritised political concerns, instead of being led by the analytical approach itself. Description and naming of different topics, such as institutionalisation, fluctuating identities, and cultural stigma, etc. are necessary. Therefore, I agree that my approach of interpreting the data will inevitably be regarded as under-analysis (Antaki, Billig, Edwards &

Potter, 2003; Burman, 2004/05), particularly as there is yet to be a discourse being explicitly formed. Discourse analysis was then not considered as the main analytical framework, rather a critical inform on deconstructing different narratives on dynamics of institutionalisation and power particularly in theme four.

 Intersectionality (Chow, Segal & Tan, 2011; Cole, 2009; Collins & Bilge, 2017;

Cooper, 2016; Crenshaw, 1989; 1991; Kwan, 2000b; Lim & Skinner, 2012; Burman,

2003) was used as another pair of critical lens, particularly regarding the macro

levelled institutional tensions. Intersectionality has a strong emphasis on social justice

by elucidating relationships between socio-cultural agenda and institutional power or

privilege orchestration. Oppression and marginalisation of an individual or a group

are established on the influences of not just one but the multiple intersecting social

group membership or categories (e.g. gender, ethnicity, race, sexuality, class, socio-

economic status, etc.; Cole, 2009; Syed, 2010). Intersectionality helps inform the

postcolonial framework which unveils and challenges different interlocked identities

under power and privilege (e.g. Collins & Pilge, 2016). This thesis has a particular

interest in how identities have become related to the structural level of oppression in

counselling (Hong Kong): power imbalance, hierarchy and segregation. In other

words, intersectionality is manifested not just within the level of individual

characteristics but also at how oppression is structured at the level of structural and

social processes.

Due to different approaches being used as a method of data analysis, conflicts and tensions between those approaches were acknowledged, for instance, between IPA and discourse analysis. I firstly attempted to address this by looking at both approaches (separately) on the level of different relationships and interrelations as they appear in the various systems. I retained most of the selected codings, and pragmatically dealt with those which are marked with both with IPA and discourse analysis labels. While recognising both approaches’ inevitable conflicts and tensions, I put the upmost priority at the pragmatic concerns. Due to participants’ diverse backgrounds, their different narratives represent their separate worldviews as well as their belonging institutional structures. I emphisised a researcher ought

78 to be socio-politically aware and also sensitive if a critical analysis is to be carried out. This means that I would evaluate the codes not based on their representative level among the participants, but be critical if they are the ‘socially hidden or ignored’. I was also mindful how my analysis should be developed, such that it can be respectually communicated to the readers, and they can constructively respond to the ‘politically sensitive’. Therefore, I attribute the tensions between IPA and discourse analysis to the tensions between those different narratives in the reality (institutional tensions, oppression and inequality). In order to resolve the tensions, I highlight the need to approach such diverse narratives by firstly acknowledging and capturing their presence (all narratives), which was the initial open coding procedure. IPA seems to reflect some narratives’ emphasis of counselling/psychology on individual processes, whereas some narratives advocated principles of discourse analysis as their attention was on institutionoal interplay and social practices. This drew my effort to maintain a balance between institutional picture and individuality. I demonstrated the different macro-systemtic structures and their influences (if not control) on participants’ different narratives, and I also advocated different individualities’ existence and contributions to counselling meanings in Hong Kong.

Furthermore, I also advocate my pragmatic approach (also as a response to addressing tensions between IPA and discourse analysis) means that I sensitively communicarte my criticality. This indicates my analytical interpretations are under my consideration how such understanding transforms as a constructive and engaging communication with the readers who may include the local practitioners, local Hong Kong public and the global audience. As spoken this thesis serves the re-politication purpose. While I hold a clear agenda that Hong

Kong counselling needs to be viewed in regards to its situatedness in the wider socio-political contexts, I am also aware, particularly informed by the existing literature, my insider experience (see Chapter 4 on engaging with politics) and the wider socio-political

79 movements, that politics and institutional dynamics of healthcare professions remain as a less if not rarely addressed discussion. The interviews thus have become a form of social action project which attempts to invite participants to engage and articulate voices in this area.

Therefore, in the analysis, while I retain the critical lens on participants’ narratives, which would involve my subjective judgment and interpretations of how participants’ differences correspond to the existing societal picture of Hong Kong counselling, such judgments and interpretations have to be embedded within humanistic principles that my writing respects differences and diversity of viewpoints, political positions and institutional hierarchy. This means I pay respect to participants’ current political stance despite my individual strong political viewpoint. In the analysis writing, I consider the written content has to be selective as I prioritise on delivering constructive messages which strive to articulate reflections and opening dialogue, and not necessarily criticisms which cause spontaneous distancing and defence.

I also highlight that criticality is clearly shown as I generated and categorised different broad and sub- themes, which inform a critical macro-levelled understanding of counselling in

Hong Kong. Though I have analysed individual participants’ messages, my presentation in the analysis does not intend to illustrate how I analysed them ‘word by word’ to inform ‘the right/wrong’, as the narratives do can speak for themselves (as they come from the collaborative discussions in the interviews). Rather, I emphasise how such initial mixed- methods of analysis is further transformed into the broader systematic understanding. My macro-institutional level of analytical focus was informed by systemic approach (Imber-

Black, 1990; Scott, 2017b). This is a main analytic lens (and intersectionality) on how I grouped different codings and placed them into different categorical status. The notion of

‘systemic’ refers to both the concrete entities of mental health and governmental systems and the abstract mental construct of an individual, as I interpret macro-socio levels of the world as

80 inter-relations of connections. By holistically attending to and engaging with the systemic enquiry of the complex problems, different forms and levels of relationships of Hong Kong counselling (at different healthcare systems or disciplines) can be contextually understood and illustrated. This implies that a ‘culture’ reflects not just racial/ethnic meanings, but also complex socio-cultural-political inter-relations between knowledge, context and institutionalisation. Accordingly, my interpretation of intersectionality was also on the broader organisational forms instead of the individual characteristics. Intersectionality has critically shed light on how I conceptualised these different narratives as how they appear in the wider socio-political context, for instance, which factor (theme) places as the orchestrating power of counselling meanings. After all codings are read and re-read, I grouped the codings based on their similarities with each other. The codings fall into five broad fields: 1) Defining the Contextualised Counselling; 2) ‘This is Hong Kong…’

(Contextualisation); 3) Practitioners’ Complex Roles; 4) Alternative Structural/Institutional

Legitimation; 5) Toward the Future: Remaining Discrepant Voices. The first four broad fields form a conceptualised model (see figure 1; Chapter five) which show their relationships are dynamic and interchangeable as they appear in the present socio-political circumstances (see

Chapter five for full explanation). For instance, the fourth broad theme has been placed as the largest and most influential theme of counselling, and thus it is placed at the bottom; the first theme is one of the spoken topics in the interviews, but it was placed at the top due to its less presence and smaller social impact made compared with the other themes. The fifth broad field consists of participants’ linkage from the existing thoughts (based on the four fields of understanding) to future changes and actions.

In the further stage of analysis (categorisation), the coded content in each broad field (theme) was read repeatedly to enable grouping together according to similar principles, and then accorded higher/lower categorical status. Alongside this, I drew on reflexivity to make clear

81 of the interplay of the sub-categories and how they worked within the whole picture

(principles of intersectionality; see appendix 6). There was particular attention paid at any form of discrimination or inequality via interpreting intersections of different socio-cultural- political factors and Hong Kong counselling. Marginalisation and oppression can also occur on the structural scale (within or between institutions), even healthcare disciplines are representatives to support alleviating social inequality. Therefore, the analysis was directed towards the bigger intersecting power relations between capitalism and democracy. I highlighted that hierarchy between different mental health disciplines was not a natural product of marketing competition, but the unequal outcomes of marketplace relations.

Furthermore, the analysis involved some re-coding and several codes were truncated, mainly due to redundancy or that they lay outside the primary analytic focus. I note that translation of quotes from Cantonese Chinese to English was done after all analysis was completed, so that translation was merely on the linguistic level. This indicated my bilingual identity as I navigated between two languages instantly and I ensured my in-depth and spontaneous reflections via engaging with my home language (Cantonese Chinese).

Chapter 4. Personal Reflexivity

To serve the ethnographic rationale of the current thesis, this chapter (personal reflexivity;

Shaw, 2010) was written in the form of a single-case narrative analysis of my research process. I critically reviewed my life episodes by flexibly utilising my researcher and practitioner identities. Another point to note is that my first person writing facilitates my disclosure of reflections, examination and re-evaluation.

4.1.Epistemological Shift: An Insider’s Experience

Reflexivity began much before the data collection phase, at the point of my relocation back to

Hong Kong from the UK. As a UK trained counsellor and with postgraduate qualifications, I struggled to have opportunities to deliver individual counselling service in Hong Kong.

Eventually, those experiences have equipped my criticality of the staggered counselling functionality in Hong Kong.

In the job seeking process, my applications were affected both in quantity (number of applications) and quality (much lower job positioning). Any positions with pure counselling orientation required applicants’ mandatory social work or clinical psychology qualifications.

Therefore, whether qualified or not, counsellors are not accepted to conduct counselling, or even any relevant bachelors’ level of job post. Gradually I conformed to the popular claim that ‘no one can get a job without any social work qualification’. I was disheartened by the lack of response to my applications. Since then, I have made a much smaller number of job applications than my capacity, and have focused on only the ‘counsellors’ posts. My limited granted interviews were mainly from the local primary educational settings which included

‘counsellors’ in the advertised posts. However, the job function was no different from the social work roles, and yet its offered salary was much lower than the standardised social worker salary grading. Eventually, I obtained a job in a large NGO setting which required

83 secondary (high-school) qualifications, and my second job (in a local college) was obtained via word of mouth referral. Both job positions were under social work structure and leadership and did not consider counselling as an independent service.

My views towards my work experiences were mixed. As an overseas returner, I struggled to accept my newly gained ‘outsider’ identity, especially I always considered myself as a Hong-

Konger. On one hand, I was overly grateful for being accepted into the ‘mainstream’ system.

I strived to establish excellent work relationships; especially I perceived them as the higher ones who pulled me out from the rejected and isolated professional status. My dissatisfaction was subconsciously suppressed, as I conformed to the social rejection of counsellors’ professional status. On the other hand, I became gradually more dissatisfied when my struggle to maintain the ‘social worker’ level of work performance prolonged. The struggle was not just due to my acceptance of some of the genuine mistakes caused by inexperience. I was also frustrated for not being recognised nor acknowledged of who I truly was. I was left with two choices, which was either to conform to the mainstream ‘game rules’: obtain another local mainstream training (social work or clinical psychology), or to pursue further overseas training. The third private practice option was an unlikely consideration due to me relatively new to the field and the lacking accumulative client group. Eventually, I decided that I did not want to conform to the ‘unfair’ system. Returning to the UK would be a way of

‘breaking free’.

Looking back, my insight was lacking due to my restricted therapeutically based counselling perspective and limited personal experiences. Although I held the first-person knowledge of my research topic, I now acknowledge that at the time, I appeared to be containing the different puzzles, but I did not know how to put them together, nor was I even aware they would form a picture. I lacked a rich understanding or sense-making of structural/institutional counselling’s impact on a practitioner. My limited insight was also evident in my early thesis

84 design. I initially decided on my thesis focus on the restricted theoretical and philosophical grounding. I presumed that the muddling situation in Hong Kong was mainly attributed to the lacking consensus of a unified paradigm. Furthermore, I restricted participant recruitment to practitioners only from two mental health professions. At the time, I assumed they would represent the overall healthcare professions objectively by quantity and quality.

On the other hand, my Hong Kong experiences still have set as a pruning seed for my latter research development, in particular to the gradual epistemological shift. First, alongside my counselling psychology training, I became motivated to learn from social justice theories and other relevant learning (see Chapter Three for philosophical and methodological theories).

Furthermore, I gained the confidence in my inner-changes via thinking as well as actions. I gradually incorporated my interests in diversity and equality issues into my academic, professional and volunteering work in the doctoral training, which became the stepping stones to my later methodological modification. Overall, such change was significant particularly considering my previous declared politically neutral stance, and the intentional avoidance from involving in the most political agenda (before I started the doctoral training).

Second, I also recognised my prior humanistic counselling training’s misinform on my apolitical status, as I believed that being apolitical was the only condition that I could fully act out humanistic values. At present, I recognised that I could be both political and therapeutic as a psychologist.

4.2.Methodological Changes: A Process

My second return to Hong Kong was an emotional experience. As a researcher, my training was UK based, and I felt disconnected from the Hong Kong context. Conducting ethnographic research then appeared as a natural progression for me to re-connect with a more critical lens. Personally, I was also a warrior with a political hat. I proudly declared my social justice supporter status, and was confident with my well-equipped capability to

85 incorporate socio-political agenda actively. One could say that my thesis was a fulfilling task, as I desired to seek some reconciliation with the past identity loss and struggles in my local work experiences.

The first methodological modification occurred at my interviews preparation stage. I recognised that my participant criterion was also a mirroring act of social exclusion. In other words, my so-called ‘statistically objective criterion’, on the socio-political level, was biased towards the dominant groups which own the most social power, and neglected voices and contributions from professions which are perceived as the ‘minority’. Therefore, the inclusion of all professional groups in the participant criteria was not just an act of my heightened awareness, but also a social obligation and equality. Furthermore, there was an alternative radical approach, which was to only recruit participants outside the social work and clinical psychology groups to fully vocalise social justice values. Considered the primitive status of the research area, and the sensitive nature of the social-political agenda, I assert the current thesis focuses on firstly generating a comprehensive picture of counselling by involving all groups (to find out the What?), before the future research proceeds to underpin the specific discourses (to articulate the Why?).

Furthermore, thinking or belief does not necessarily equate to action in reality. Only in the interview experiences then I realised my thinking did not match with my execution of actions. Most of my methodological modifications occurred during my data collection period as I continuously learned from experiences. For instance, in the first few interviews, a large percentage of the discussed topics were centred on theorisation, and my main concern was not being able to cover participants’ in-depth philosophical underpinnings. While it could be argued that the generated data was mainly attributed to participants’ subjectivity, I also addressed my reciprocal passive role as I only waited for participants’ relevant disclosure, that ‘I should not obtrude my agenda’. Concurrently, only via the actual interview

86 experiences again that I addressed the inevitable imbalanced relationship between the participants and me. As a researcher, I have substantially immersed myself into the relevant literature, and my personal and professional growth has particularly centred at the growing critical awareness of the socio-political agenda. Therefore, despite most research’s claim of the researcher’s facilitator or gentle pointer role for participants’ free navigation, I instead admit my superior position with my well-equipped theoretical/philosophical clarity and a clear mind of sense-making. Therefore the research direction was inevitably led to where I pre-anticipated.

To minimise my imposing superiority, I had to come to terms with myself about participants’ different experiences and their respective levels of awareness and views from mine. Only then was I capable of creating an opened and transparent space before participants could comfortably inject themselves into the experiential process of the interviews, in which they gradually navigate their different dots (experiences). Another key point was not to pinpoint what was right or wrong about being in the superior position; instead, there was a need that I had to return to myself to clarify my research focuses within the overly broad counselling category: What was the core thing in counselling that I truly wanted to lead the interview direction to? Such clarification had to penetrate not just my cognitive as well as emotional levels.

The second change of my research direction occurred after an interview in the initial data collection stage, in which a participant elaborated extensively on the socio-political dynamics of Hong Kong counselling. While I attempted to remain emotionally steady in the interview, my inner-self clicked. I realised that the political and institutional dynamics were the content that I was keen to unfold. That interview was like a bridging channel between my British based learning and my professional understanding of Hong Kong. I was further inspired to refine my research focuses on the specific socio-cultural-political levels of Hong Kong

87 counselling, while my thesis title still reflected the broader/general counselling notion to avoid the potential sensitive communication problems. Furthermore, my changing approach in the interview also indicated my action levels of changes. I took a more active role to encourage participants’ connection with their socio-political interpretative meanings, for instance, picking up and acknowledging participants’ underlying revealed institutional dynamics, tentatively opening the dialogue on cross-disciplinary differences and the created hierarchy, etc. In other words, I remained my belief in participants’ active roles of joining the dots in our collaborative work, before a new understanding or insight is formed. However, their direction and momentum of joining the dots are not always dependent on their subjectivity. Due to the nature of some particular topics, in case of the current study, the socio-political agenda, my critical awareness informed my necessary active role.

Moreover, I obtained a consultation opportunity with a local social work professor from the

Chinese University of Hong Kong. She critically enquired on the implications of my research, by highlighting that the research topic was a well-known prolonged social phenomenon in Hong Kong. No one would research the area because, in her words,

‘everyone knows it already’. Researching in this area does not give much value’. Despite my opposing standpoint, I was stimulated to relook at my methodology for new insight. She suggested that I interviewed the local counselling psychologists to collect views on the necessary changes and actions. This suggestion, after modification, became the second data collection phase, as well as an additional integral part of the study. This change signified as an illustrating example of my incorporation of social morals and obligations into the thesis.

4.3.The Interview Process

The interview process is a product which has captured my gradual engagement with structural counselling. I highlight the impact of my trainee and early researcher status on my portrayal of subjectivity, as some of the shortcomings would be linked with my limited

88 practice, experiences and insight. Therefore this thesis, in particularly this chapter, is prudent to make clear of my possible biased or inconclusive observations, evaluations and outcomes, and how they were then ensured not to deviate from the main research process.

4.3.1. Underneath the Researcher’s Complex Identities One necessary clarification is my complex insider and outsider lens/positioning about my cultural and professional situatedness, and their interplay in the interview process. First, my

Hong Kong upbringing and the prior local work experiences allowed my ‘insider’ engagement with not just the superficially descriptive levels, but also the overt or subtle underlying socio-cultural-political dynamics. For instance, I conducted the interviews in my home language which was a strong indication of me as a ‘local’; I also realised the need to be transparent of my prior local work experiences to clarify my current understanding of the

Hong Kong situation. My insider experiences and my clarity of my insider identity to the participants did influence my tone in the interviews and analysis. To avoid overly imposing my identity, I carefully separated myself from the insider constrain by being mindful of my communication style, for instance not to overly respond to participants’ positive feedback of my background.

My discovery shed light on the two-folded nature of my multiple identities. Not only the complex identities were internalised by me, but they were also reciprocally perceived by the participants. This was shown as they subtly associated with the particular cultural or professional identity, depending on the different instances of the interview. Throughout the interview process, it did show that such ‘insider’ positioning facilitated practitioners’ enhanced disclosure. This was illustrated via their explicit remarks like ‘I’m sure you know this Hong Kong situation…’, and ‘You must already understand…’ Implicit examples were also shown, as participants naturally addressed the localised social policies and the symbolic slangs (of the localised notable names and terminologies) without feeling needed to clarify

89 their definitions or meaning. On the other hand, phrases like ‘I am not sure if the UK system was like that,’ and ‘Hong Kong is different…’ reflected participants’ alienation from me, or their positioning of me as a foreigner. This was a result of our different professional backgrounds, as well as a projection of their sole isolation and struggles on me. A double- edged sword cuts both sides. The advantage of my ‘outsider’ identity was simultaneously evident, in particular when the sensitive political agenda was raised in the room. To them, I was a representation of the ‘West’, and an outsider of the local practice. Therefore, I believe that some participants’ more opened disclosure, including their revelation of their stereotypes and criticisms, was a natural result that ‘you are not part of our conflict.’ Meanwhile, I note that my portrayal of these encounters deviates from expounding the complex patterns and their interpretive explanations, rather signify its fluid nature and the significant implications.

4.3.2. How to Move on from Power Struggles? An Opening Door via Communication Furthermore, despite my claimed in-depth understanding and the flexible adoption of my multi-layered identities, surprises still occurred. One example is the impact of my counselling psychologist trainee identity on my effortful portrayal of the ‘neutral professional stance’. My encounters with the counselling psychologists were emotionally evoking. When attending to their described numerous oppression experiences by clinical psychology, surprisingly I appeared less empathic, and was aware of my positioning in line with the ‘described bully’. I realised I also looked down on the counselling psychologists, as my mind held the same doubt that their oppressed state was due to their boast of what they were incapable of. This was an unusual experience considered my shared counselling psychologist identity. Initially,

I reckoned that such emotive and cognitive distancing from Hong Kong counselling psychology was only temporary emotive arousal. My loyalty to counselling psychology would remain in most other times. When I relooked at my reflexive journal after several days,

I almost still relied on my ‘logical mind’ as the main information to re-cultivate my empathic

90 attitude towards Hong Kong counselling psychology. I was forced to address my prolonged emotional distancing, and my remained ‘outsider’ state. I automatically assigned myself with the differently ‘overseas label’, particularly I was privileged to have established some level of clinical expertise compared with the local trainees. Therefore, not only did I not connect with the local counselling psychology field, I noticed my friendliness with clinical psychology.

This experience shows that differences do occur within counselling psychology, especially in a cross-cultural setting.

I further unfolded power as the core drive of interpersonal segregation. For fear of relating to counselling psychology’s inferior states, I felt competitive to put on my overseas identity to re-assert my power presence. Accordingly, a hierarchy was asserted which serves as a regulating function to reinstate my superiority. Competitiveness was the emotional projection

I cast at the participant, “I had to overpower you by being the better and different one”. At this point, I reinforced using narrative data as a beneficial observational report of hierarchical segregation. It entails how one’s emotive processing is incoherent, and can even override the cognitive semantic resource, as I sub-consciously associated with the profession which was

‘by public definition’ my enemy; and alienation was aroused against a profession I professionally belong to. In other words, one’s identity association is not merely restricted to the static pre-determined semantic information. In case of the current study, the complex intra-/inter-personal process of power was found to also act as the prmiary influence. I suggest that this finding, together with the empirical data, can be generated into a form of psychological understanding and research interest in socio-political processes. This would be elaborated further in Chapter six: Discussion.

Another observation was my varied emotional arousal towards the different counselling psychology participants with varying levels of experiences and social status. I noticed that I more favourably perceived those with a higher level of expertise and age were more

91 favourably perceived by me; whereas the younger and more newly qualified participants were less favourable, despite our common grounds of the similar age and professional development. As I looked back at the recordings, I noticed the younger and more newly accredited participant’s more emotional and casual communicative styles, and thus I was repelled to associate him with labels ‘not professional’ and ‘less mature’. However, the older and comparatively more experienced participant appeared more posed, calmer and organised, and hence my association of him with positive qualities of maturity and confidence. I admit that my selective perception was a form of my socio-cultural bias and stereotypes. I clarify my intention not to underpin the complex strctures of the Chinese socio-cultural hierarchy; instead, I grew the attention to the interpersonal communicative styles. In addition to the next postulated interview encounter, I put forward my pondering thoughts on communication as the primary key to some political resolution.

Another essential interview encounter also led to my extensive self-reflection. In the interview, I invited a teaching fellow participant to shed light on social changes and actions, in response to her addressed existing institutional problems. Suddenly she noted ‘I have already answered you...’ Apparently I had repeatedly asked her the same question at different times. I got carried away with my individual agenda and assumed that the participant could not be critical enough to give me any constructive information on changes and actions.

Therefore I became over-confident that it was the right thing for me to stimulate the participant’s political awareness to ‘the way I envisioned’. I was startled by the participant’s polite yet annoyed tone. Participant appeared bewildered by my ‘unnecessary re-questioning’.

Correspondingly, I quickly altered my interview tone to fit with the participant’s flow. My change without any further clarification was perhaps wrapped with my fear of upsetting the participant. However, that led to my concluding remark that the participant was one of the privileged ones who could not leave the comfort zone. It was until I entered another

92 interview, then I reconciled with my stereotype. The participant was another teaching fellow who showed a similar attitude. I was by then more emotionally prepared and receptive towards the participant’s different view. I also recognised the research process’s situatedness in the latter data collection stage. Therefore my interview tone was inevitably affected by my strengthened social justice mind, and I may have obtruded my beliefs upon the participants.

Subsequently, my attitude changed as reflected in the personal journal,

‘Somehow a realisation hit me, that I more or less should hold respect to the different

beliefs and thinking of counselling practice. At the end of the day, it is always about

people. The world is diverse and consists of different individuals. If we only follow

and impose on a singular belief, we gradually get fixated at creating a world as a

homogeneous place, and that’s so wrong. Counselling is such a complex and multi-

layered system which does involve different means and levels of contributions. Some

are bound to be more radical and do not conform to counselling’s current status quo;

some are content with their conservative positioning to suit their job nature or beliefs.

Perhaps their conservative presence indeed does somehow serve the function of

stability maintenance. There is always Yin and Yang in everything, and so are the

different voices. However, it does not mean I have to stop doing what I believe in. It

is about critically addressing inequality and seeking balance and regaining equality. It

is about finding the appropriate communication between differences and diversity.

There should be more understanding and respect between one and other.’ (Reflexive

Journal, dated on Aug 21, 2018)

I gradually turned to deal with and resolving my intra-process, to humbly acknowledge and allow concurrence of such differences and even contradictory beliefs. Could practices of humility and respect overcome cross-disciplinary indifference? My new insight has reinforced my growing attention to exploring the appropriative political communication

93 means and styles as a constructive key to resolution, and creation of new understanding. This would be elaborated in Chapter six: Discussion.

4.3.3. Can we talk about Politics? In the interviews, I particularly put tentative effort to facilitate participants’ disclosure, as it was found that other participants’ sharing was mostly on the ‘common knowledge’ level, which refers to the local professor’s critic that ‘everyone commonly shares Hong Kong social/mental health professions’ problems’. I became aware of my ‘stuck’ feeling, as I struggled to go across participants’ common knowledge level of narrative, to the individual interpretation and emotional experiences. Initially, I expected an hour of an interview as a sufficient period for the in-depth data collection. However, in the actual interviews, I recognised the much longer stage required for the participants and me to break the ice to the personal level,

‘I was asking her/him about the issue. We were talking. Yet somehow everything

he/she said was commonly known. Yes, I know it (the problem). You know it. He

knows it. Well if there is indeed any opinion or comment, then I have to go through

that whole ‘what we do’ boundary. How our team/our agency is doing. What the

profession is involved with... But then what is it that you really think about? How do

you feel? There was no indication of “I”. I feel I did not get that subjectivity account

out. But then my instinct told me that our relationship was not well enough to go

deeper. I felt so stuck…’ (Reflexive Journal; dated on July 24, 2018)

Was it really just because of the insufficient interview length? Or was it about the sensitive nature of the discussed political agenda? I became fixated at the ‘how’ question of ‘getting through the closed door’. From initially doubting whether I actually could achieve the research aims of eliciting participants’ narratives, I drew attention to the Hong Kong context’s significant collectivistic influences. The possibility of participants’ elicited

94 individualistic and collectivistic subjectivities and other contextual influences would be put forward to the further discourse in the discussion section.

Lastly, I included my interview experiences across the Hong Kong border, because the nature of the visited geographical location and encounters with people is political. On the way to the interview venue, I became aware of my strong sensation of unfamiliarity. While I could vaguely visualise the interviews in Hong Kong, for instance, the tone of voice, illustrating attitude, the interviewed work setting, etc., I did not know what to expect in the Mainland settings, and I told myself to experience with an opening new mind. However, a few subsequent unexpected circumstances occurred, as I ‘wimped out’ of a few things because of the sense of unfamiliarity. One of the most significant deviations was my decision not to record a participant’s interview. As I met the interviewer, I was amused by her friendliness with Hong Kong as she highlighted her previous Hong Kong studies and association with many Hong Kong friends. She also emphasised her openness to any procedure I would bring up, as she said ‘Do whatever you like, I am ok with it.’ That gave me the impression that she attempted to demonstrate she was ‘Hong-Kongised’ and she was different from the most

Chinese in the Mainland. However, when I put forward the audio-recording requirement, I immediately noticed the participant’s uncomfortable timid gesture. Although she quickly noted she did not mind, her hesitant tone and turned away eye contact informed me she did not want to take part. Attending to her unspoken signs, I decided not to proceed to the recording. At the moment I admit my inexperience and lack of calmness, and thus I went along with my so-called instinct that my recording would profoundly affect significantly on the interview quality.

On the other hand, I would question the intentionality of my actions and thinking. My decision making at the time was much more than a reductionist procedure. At the time, I arrived at the Mainland border with the impression that ‘China suppresses political acts’.

With the generalised impression that China blocks freedom of speech, public disclosure of politics, I thought that my interview recordings would be a marginal case of invading the political territory. Therefore, even the participant gave me verbal reassurance that she did not mind, my presumptive judgment was also an important and influential factor. My obliviousness of the context caused my anxiety to rely on my presumptions, and fear drove me to play the ‘safe’ game rather than taking a bold act. Another factor which influenced my decision was interpersonal driven. The interviews were arranged due to a prior Hong Kong participant’s supportive referral, in Chinese guanxi (network and relationships making). It refers to ‘I do you this favour, and you would recognise what I have done and reciprocated in a later date.’ (Xin and Pearce, 1996; Pfeffer, 1992) Guanxi is one of the most vital Chinese cultural influences in almost everything from personal matters to official tasks or collaboration. In my case, the participant’s support was guanxi, and I became guarded of owing favour. As a result, I was overly concerned about sabotaging the relationship with the participant by ruining the relationship with the referred interviewee. My priority to make a good relationship overrode my goal orientation to conduct a good interview. I am left with contemplation that my inexperience perhaps had caused my inability to make thought- through actions. However, I was more certain that my unfamiliarity in a new context deeply affected my rational decisions, as well as personal qualities of confidence, courage, and social sensitivity. We are from the same country, but we are different. Or I perceive them as the different others which promoted my behaviour and attitude to exercise the ‘imagined difference’. Or perhaps the defined difference is indeed a combined product of presumptions and reality. In any case, my conceptual understanding is already determined by my presumptions. Would things change if I were to re-encounter the participant and deliver a more mature and constructive communication? I put forward the idea that my Mainland

China experience was an example of a cross-cultural encounter, as well as a case study which reflects the macro socio-political dynamics between Hong Kong and China.

Although the interview record was affected, I reinforce the attention at the political value of communication. I argue that research implications should not remain at the traditional descriptive phenomenological level (Langridge, 2007; West, 2013), instead, to creating innovative actions. The interview interactions clearly showed my communicative style’s influences by my pre-determined assumptions, stereotypes and individuality. Through personal reflexivity, I articulate potential growth and changes regarding my mindset and my future interpersonal communication. In the empirical findings (Chapter five), Hong Kong counselling practitioners are aware of the future central governmental movement in mental health care, and their political implications brought to Hong Kong. Therefore, this chapter’s implication value has transcended from the interview methodological suggestions to the broader topics of communication and political affiliations, which again is elaborated in the discussion section.

4.3.4. Concluding Remarks I would like to end by sharing a reflexive note from my journal,

‘Institutions are formed by people. Services are run by individuals. Practitioners are

human beings too.’ (Reflexive Journal; Aug 27, 2018)

When I first started my psychologist training, I was still unsure what the exactly in counselling I was passionate about. I believed that my early researcher and psychologist trainee states would not allow me to give contributions that are mature enough. I did not see myself making a difference. Therefore, I was initially hesitant to orient my thesis towards

‘boldly address the socio-political critics and suggestions’. Across the research process, answer to the unsolved puzzle gradually unfolded. The key to the core question of the thesis,

‘What are the changes and actions for Hong Kong counselling?’ is not just an absolute answer. It was not an intervention which only begins when a comprehensive picture is prepared, nor when we have the sufficient social-political contextual prepositions. Taking my thesis development as personal growth, I have come to realise that change does not necessarily begin with the perfect input from the mature or well-experienced people. It is a process of social movement which occurs in society as well as within the self. It is radical learning for everyone to re-look at the society with critical consciousness (Freire, 1974), and build readiness for changes and actions. My research journey began from my standpoint, to towards the macro-institutional levels of counselling, until I return to the people’s fundamental values of growth. Indeed it is about human beings.

Chapter 5. Analysis

(The numbering system in this chapter is separate from the other chapters as it directly represents the sequencing of the findings.) This section presents how practitioners conceptualised counselling in Hong Kong, offering a multi-levelled analysis. Phase one of data collection focused on local practitioner narratives of counselling in Hong Kong. Phase two was an extension of phase one. It attempted to directly engage with the socio-political structure in which counselling takes place in Hong Kong, in particular regarding change and action. Analyses of two phases were undertaken separately. Their findings were found to correspond to each other. Therefore, I present their results together, but also specify their differences. Phase one findings show a comprehensive layout of counselling meanings. Phase two has a more specific emphasis on institutional dynamics. In addition to the limited thesis length, the reported results of phase two are highly selective as findings of the fourth broad field (alternative structural and institutional legitimisation) were only included in this

Chapter. Results from the analysis present five broad fields, including 1) Defining the

Contextualised Counselling; 2) ‘This is Hong Kong…’ (Contextualisation); 3) Practitioners’

Complex Roles; 4) Alternative Structural/Institutional Legitimation; 5) Toward the Future:

Remaining Discrepant Voices. I conceptualised the first four broad fields into a conceptualised model (see figure 1), as the nature of these fields’ relationships are dynamic and interchangeable according to the current socio-political circumstances. Such analytical findings explicate indigeneity of Hong Kong counselling in the form which graduates across four levels of inter-relations (see figure 1). For the case of Hong Kong counselling, the fourth broad field of counselling meanings has been defined as the largest and most influential theme of counselling, and thus it is placed at the bottom; the first theme is one of the raised topics in the interviews, but it was placed at the top due to its less presence and smaller social impact made compared with the other themes. The fifth broad field consists of participants’

99 linkage from the existing thoughts (based on the four fields of understanding) to future changes and actions.

I first explicate the conceptual framework. This framework reflects the macro-levelled and systemic understanding of counselling in four interrelated levels. I rank them according to the level of social impact and power influences in the wider society. The four broad fields represent counselling meanings of 1) knowledge forms, 2) contextualisation, 3) practitioners’ complex roles, and 4) structural/institutional legitimisation (full explanation in the below chapter). Counselling meanings are found to graduate across three macro-levels (the first, second and fourth). Practitioners’ complex roles (the third level) represent how practitioners act as a mediating figure in between the three levels (see Figure 1). I will explain in the later section (4.3) how practitioners’ fluid presence in the conceptualised model reflect their flexible and adaptive figures as they link between knowledge and practice, their relation to the wider socio-political context, and the complex institutions and their power influences, but they, as practitioners who appear to represent professional organisations, are not within the institutions (they have no control of institutional legitimisation)

I use quotations from the eighteen transcripts to present the participants’ meanings (one without transcript; see Chapter four; full original transcripts in appendix 7). Of these

100 transcripts, seventeen were in Cantonese, and one was in English. Most of the Cantonese interviewees used a mixture of Cantonese and English languages. I bolded words in the quotations to indicate their spoken English words; the unbolded words were translations from

Cantonese to English. Each quotation is identified at the end with information of the participant who said the quotation and the quote number, e.g. (1, Q1). Furthermore, while I attempted to minimise my interpretations or translation biases, translation gaps could still occur due to the different Chinese and English linguistic structures. Chinese linguistic system, from the English linguistic standard, would be regarded as a grammar-free (and possibly confusing) structure. Therefore, some improvisations were necessary, and the changes were made clear by using square brackets [] to indicate my changes made. Brackets

() refer to comments which the participants have further added. Another method used was to put the original Chinese term aside the English translation using the solidus (/), as to complete the translation. The bracketed and underlined phrases then indicate my clarifications and explanations.

Theme 1. Defining the Contextualised Counselling (Knowledge Forms) This level serves as a brief overview of counselling meanings in Hong Kong. Participants drew to their learnt academic theories, philosophies and practices in order to make sense how their individual experiences define counselling in Hong Kong. This level is regarded as a descriptive picture of counselling meanings, as I intend to state counselling meanings in

Hong Kong can be in different knowledge forms. Aside adhereing to the theoretical learning, participants gave an impression that counselling in Hong Kong is highly contextual and

‘unique’ due to its multi-dimensional and multi-perspectival nature. In other words, counselling is more than a theory, but a socio-economic-political product which requires fitting in within the Hong Kong context.

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1.1. Humanistic and Holistic/Integrative Attendance (Phase 1) Participants 3, 4, 9, and 10 used theory (mainly the common humanistic principles) to define counselling, such as active listening, self-awareness, the therapist’s accompanying role, the client’s motivation, the co-establishment of goals and a safe environment. Therapeutic alliance was highlighted, as participants claimed they attended to the clients’ deeper meanings for the struggles they faced, their motivation to change before a decision for therapeutic change is made. In practice, participants highlighted the integrative and holistic approach is necessary to attend to Hong Kong individuals’ needs, in which flexibility was an essential quality of a practitioner (see Q1).

A common integrative approach (highlighted by counsellor-levelled practitioners; participants 2, 9, 10) is holistic therapy (body, mind and spirit/身心靈). The emphasis on the physical symptoms (including shortness of breath or tense muscles) is from a locally developed holistic counselling training (the body-mind-spirit model, University of Hong

Kong). Participant 10 gave an example which shows how the connection between clients’ physical and emotional perspectives helped their articulation of distress or needs:

[I attend to] their psychological, emotional status, to understand why they often feel

the physical discomfort […] Chinese people, especially the elderly say, ‘I often feel

lo-lo/囉囉 (complex anxious emotion) […] actually I initially did not really

understand [what it meant], as I am also young […] I then went to ask and understand,

listen to the elderly’s explanation of Lo-lo-lun/囉囉攣(complex anxious emotion).

They could not say it themselves […] like an ant bite on them. Sometimes it hurts,

sometimes it doesn’t […] when I listened to them more patiently, [I found that]

actually they talked and talked, and no longer talked about that illness. They often

then brought up [issues] like their faced sad things, bad relationship with the family or

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no one [was there] to take care of them. Lo-lo-lun/囉囉攣 reflects their much inner

concerns. (10; Q3)

Furthermore, most practitioners recognised spirituality/靈 in Hong Kong counselling (see

Quote 5). It is the intertwined form of the local religious and secular traditional cultural beliefs. Regardless of their backgrounds, practitioners (participants 2, 9, 10) in general held to both secular and religious perspectives in therapy. This also explains why chaplains have a counselling role in Hong Kong services. An example of such alternative religious-spiritual interpretation was the acknowledgement of ghosts/撈撈 instead of a clinical diagnosis of paranormal beliefs:

They feel that some patients’ psychiatric conditions do not make sense. They may

speak ‘paranormal-spiritual’ stuff. Actually it can be psychosis, but as the patients

speak about seeing things non-stop, as we come from a religious belief perspective,

then this has become our difference from clinical psychology. (10, Q6)

On the other hand, a number of participants associate their theory learning with the idealistic counselling condition, which can indicate that theory equals to unrealistic practice. In the real work setting, counselling meanings are infused with practicality issues, such as non- counselling work schedule (section 3.2, also see Q7) which limits provision of full-scale counselling. Participant 4’s narrative showed counselling as a pre-determined health concept or a theory is impossible, rather it exists as an affordable luxury product defined by the capitalist, utilitarian socio-economic state of Hong Kong.

Psychological health is actually an expensive concept. Everyone hears mostly about

surviving, not living. You talk about self-actualisation in counselling…that is

actually a luxury. I [have to] complete summer assignments first, I do examinations

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well first. What are my interests? What should I do? I am not off work till 10 p.m.,

how can I talk about parenting time? How can I talk about inspiration? This fact is

(a) tricky (topic) in Hong Kong. [My company does not grant holiday] even I see a

clinical psychologist, as two days of sick leave is used already, one day for psychiatric

consultation, one day for diabetics follow-up. I used up two days, so I do not have

sick leave anymore. You still tell me to go for counselling? I reckon everyone knows

psychological health is good […] everyone understands [that]. However, the

underlying issue is how respectful the society is towards people, how much

allowance is given to a person. In the ideal stage, [I would foresee] more going for

counselling, fewer go to see psychologists, meaning fewer people with a clinical

illness. However, the system is collapsed. There are too many people unwell. If your

condition is not too severe then you go queuing (for assessment), children queue for

ten months, one year and a half if not urgent. If suicidal then you jump in the queue

and come in first […] for you to talk about counselling in this context, it is actually

quite luxurious to me. (4, Q9)

Furthermore, interpretation of counselling meanings can be affected by the practitioner’s more favourable work conditions. If a practitioner’s job role allows the person to establish and egange in counselling work, the individual would be able to articulate a better or richer meaning of practitioner-client relationships. This reflects that counselling quality intersects with various external factors, including permanent (secure) job position, qualification, having a specialty. For instance, participant 1 revealed her confidence in delivering counselling.

Along her narrative (see Q8), one could link her competence with her advantageous work conditions. She was a former teacher which then allowed her ability to acquire a permanent job position; her permanent position allowed her long term experience built in the same institute, thus her successful built therapeutic alliance with her clients.

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1.2. Between Integration and Diversification in Service Participants in general focused on the nature of the services provided as they explored the meanings of counselling. The services tend to move towards two directions, one as to be more integrative, and another kind as to be more specialised or to create a particular specialty. In Hong Kong, integrative counselling refers to the therapeutic modality as well as the localised service structure. In social services, counselling is not an independent but rather a part of the overall well-being services ranging from groups, programme to resources allocation (administrative based work). From practitioners’ experiences, the nature of such integrative services is beneficial to Hong Kong individuals who may not yet fully understand the meaning of counselling, nor regard emotional problems as a need for support. Therefore, integrative services can be directly targeted at clients who can then associate counselling with the familiar tangible or material needs (see Quote 10).

On the other hand, the phenomenon that there is an increase in counselling specialities in

Hong Kong is more likely to be a result of the separate disciplinary-led developments. In other words, different client groups are served by the respective professions not only due to clinical competence, but also dependent on the particular disciplinary power. For instance, clinical psychologists exclusively conduct cognitive behavioural assessments with the profession’s qualified ‘clinical’ status. Participant 4 (clinical psychologist)’s narrative also gives another example, as he attempted to differentiate between psychotherapy (as a more in- depth intervention) and counselling. Such suggestion does not appear to stem from theoretical understanding, rather subjective interpretation which links with disciplinary power, as participant 4 stated clinical psychologists tended to provide psychotherapy and not counselling.

It is just my division, as (it) reaches somewhat in-depth things, reaching flesh level of

emotional process, and in the process there is an adoption of some terms, changing

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or core schema […] or emotional schema, that we would generally regard as beyond

counselling level. (4, Q12)

However, participant 4 also admitted the challenge to differentiate between psychotherapy and counselling in real practice, in particular in the non-DSM diagnostic cases. By admitting there were more overlapping fundamental features in between (see Q15), participant 4 provided an alternative narrative as he further reflected on his actual practice.

In private practice, the diverging speciality was presented as necessary, as a practitioner is limited in individual power to provide a full range of issues/specialties (see Q11). However, some practitioners (participants 5 & 9) were aware of malpractice’s infusion with the speciality branding, and neglect in holistic attendance (see Q14).

1.3.The Multi-layered/-dimensional Service Structure Alongside the contrasting integrating and diversifying counselling development, I suggest that this is how counselling in Hong Kong has evolved into a multi-layered intervention. For instance, amongst most public social services and educational settings (participant 1, 2, 3, 5), counselling is diversified into individual/case, group, and organisational/community levels of intervention within the same organisation. Participant 1 defined organisational-levelled intervention as a superficial but necessary guiding support/輔助同引度 on students’ developmental growth in life and developmental skills building.

Another example is public social services’ inclusion of a broad range of services, and the staff’s differential work focuses. For instance, participant 2 defined counselling in her work setting (integrative family service centre) which includes emotional support, skillful and techniques education, crisis intervention to career and outreach counselling. Her focus suggested a greater focus on counselling (60%) than others due to her personal interests; whereas participant 5 from the same agency preferred not to prioritise counselling.

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Furthermore, different modes of intervention involve multiple public engagement levels, for instance, a chaplain’s ward and community home visits in the hospital setting was a strategy used by those lacking access from some vulnerable groups,

What it meant by incapability to find resources: first the individual cannot reach it;

second no one understands him/her, so gradually the person should become what we

often call ‘invisible elderly’, those who stay at home alone all day, never go out nor

see anyone […] this condition is not just applied to the elderly. There is an increasing

number of people in similar situations in Hong Kong […] the youth, middle-age

groups. (10, Q16)

A few participants (3, 4, 5, 11) commonly defined counselling interventions into two levels of severity (the easy/non-mental and severe/clinical counselling support). There are currently no official guidelines or training manual on defining different services, and participants noted their interpretations are based on their personal understanding. I suggest participants’ perspectives are a glimpse of the underlying legitimisation of local powers which claim speciality ownership (section 4.2). Social workers mainly handle easy/non-clinical work, whereas the severe cases are covered by clinical psychologists or specialist counsellor.

Participant 11 also shared how such differentiation also caused uneven resources allocated between non-clinical and clinical levelled practitioners. Positioned in the general family integrative service, participant 11 does not have the relevant clinical training to assess individuals with more significant issues due to the fact that her job role is not specialised for the crisis level of abuse. However, I point out here the potential service gap as participant 11 is responsible for the initial screening assessments.

At the point of assessment, based on my capacity and knowledge, I determined my

incapability to handle kleptomania/有偷野癖好 […] there is no actual

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guidelines/manual, we relied on ourselves [to do the job…] actually this requires long

term or intensive sessions of support, but we (family integrative service) handle non-

crisis level of family cases. If dealing with abuse, we have a specialised department

to handle cases with different levels of abuse. Perhaps those staff members have more

time and more specialised training to handle these (cases). (11, Q17)

Theme 2. ‘This is Hong Kong …’ (Contextualisation)

Theme 1 clearly showed that counselling meanings are closely linked with the Hong Kong context. Theme 2 explicates such socio-cultural-economic-political characteristics. For instance, the capitalist and utilitarian socio-economic states were suggested to have led to the distant interpersonal relationships or connectedness (participant 9). From looking at participants’ reported individual and service levels of adaptation of counselling practice into the context, I note the historical colonial or post-colonial impact, and show how participants’ narratiaves reflected their fluid identities which shifted within the Chinese – West cultural/national spectrum. This indicates that this theme has a direct influence on participants’ understanding of counselling knowledge forms (theme 1), and thus theme 2 is placed below theme 1.

2.1. Resistance against Counselling is More Than Just a Culture At first glance, many participants commonly identified cultural based mental health stigma and exclusion to public disclosure as the main underlying factors of Hong Kong Individuals’ resistance against counselling. However, alongside the interview dialogues, they then dived into the meanings of public’s resistance which were more than a culture or a fixated belief of stigma. They linked stigma with the multiple socio-economic influences, and such intersectionality relationship orchestrated individuals’ varied levels of mental health awareness and counselling engagement. This may show participants’ somewhat understanding is in line with principles of intersectionality. For instance, participant 5 noted

108 that the few self-referrals made in his workplace are by clients with better educational- economic state or middle class, or are ‘more capable’, whereas those entering the service system at the last point are mostly linked with more devalued conditions (such as being working class, having a learning disability, being of older age, etc.). Participant 3 also described his gradual shift to attend to different intersecting social categories (religions, age, traditions) among individuals instead of putting them under the same cultural category (see

Q19).

Participant 1 gave an example of school counselling with an elder client (student’s grandparent) regarding smoking problem. The quotation shows the clients’ mental health stigma could be conveyed through their defensive tone and lacking cooperation with participant 1. This indicates stigma appears to intersect with other external factors (older age, generational gap, lower class, etc.). Furthermore, public receptiveness of counselling is a dynamic process between the macro socio-cultural-economic levels and individual internal beliefs.

They [grandparents] said, “You don’t know how much (we) suffered in the past”.

(They) talked much about the old days [as they experienced] poverty […] meaning

that “we are the old, (we) eat salt more than your rice intake. You in return teach me

not to smoke? […]” You sometimes cannot communicate [with them] like in this

case. Their hierarchy is strong and clear, meaning “you are so young you teach me

how to take care of the sons/daughter/grandchildren” […] they think, “why do you

need to teach me? I don’t need your teaching, I think [it’s your problem that] you tell

me not to smoke. (1, Q18)

Few participants (17) highlighted a lack of awareness amongst vulnerable groups which are prone to be misinformed or misled, even during their participation of the service. Therefore,

109 all professions are obligated to enhance public clarity on different counselling service types/genres, the varied levels of counselling goals/expectations, and the respective corresponding charge/fee. However, this obligation is hindered by localised power legitimisation which will be elaborated in section 4.2.

2.2. ‘Hong Kongese are Chinese’ versus ‘The West is Better?!’ While outlining the adaptive practice in Hong Kong, participants’ narratives reflect their fluctuation between identifying themselves and Hong Kong people with ‘Chinese/中國人’ and projecting fantasies of ‘the West’/alienating from ‘Chinese’. On the one hand, participants acknowledged the interwoven ‘Chinese’ traditional morality, values and perceptions when addressing psychological distress. This was shown in the interviews as many linguistically naturally named as well as particularly highlighted Hong Kong individuals (and themselves) as ‘Chinese’ instead of ‘Hong Kongese’. A common shared example by them was psychological distress after patients’ terminal illness diagnosis.

Participant 4 named guilt-/shame-based depression was wrapped around morality, a distinct

Chinese based cultural value, and commented it was less articulated in the Western literature

(see Q20). Furthermore, the intersected traditional-cultural beliefs in ghosts and clinical diagnosis were holistically attended to (section 1.1), for instance by chaplains (participant 10, see Q21), due to the common recognition of such particular cultural belief in Hong Kong. It is also noted that the character of ghost/“guai-chai” also equals to ‘foreign-Western people’.

On the other hand, despite different disciplines, participants’ narratives commonly revealed their fantasisation that ‘the overseas/外國’ is better. For instance, the Chinese terminology they used, ‘foreign countries’ linguistically refer to non-Hong Kong regions, but the meanings which participants indicated were clearly referring to the white-dominated Western regions only. Some statements were direct assumptions made that ‘foreign countries’ could do better than Hong Kong, ranging from personal perceptions of the West being more

110 committed to equality (age and gender; see Q22 and Q23), to the West having a more developed and institutionalised establishment. It was seen that often fantasisation would then lead to more criticism heaped upon Hong Kong. However, those assumptions (shown below) were found to be mostly without evidence.

So I heard […], but Hong Kong is not like this. In overseas perhaps a psychologist

follows up the whole child case, then it turns out that the resources provided are well

used […] (Hong Kong) psychologists provide assessment for our children, and attend

the meetings [with us], “hey this child has this problem”, but [then] we have to take it

(the case) back […] We do not have their (clinical psychology) expertise to support

these children, and we really just do superficial things […] I think there aren’t many

resources in Hong Kong, really too few resources … (1, Q24)

[It’s] different from the overseas. The overseas has a clear indication of a chaplain’s

positioning in the hospital, the own professionalism [and] functionality. However,

Hong Kong is not at that stage yet. It is still [in the] preliminary [stage…]. We are a

religious organisation. They do not see any linkage between this and medicine, so it

turns out that we do not have an independent professional job positioning in the

hospital. Therefore we say we are a big volunteer in the hospital! It is an honorary

job that the hospital gives […] not like the overseas. The overseas chaplains are

medical staff equal to the medical doctor. Their position can be even higher than a

doctor […] However Hong Kong is not yet at that stage. Hong Kong is still far (from

it), because “they” do not have the insight that this is important. (10, Q25)

2.3. Between Improvisation and Indigenisation This section elaborates on how participants adapted counselling practice into the Hong Kong context. Summarising participants’ accounts, I identified the two levels (linguistic and cultural) of adaptive practice. Linguistic level can be seen as a more brief adaptive practice,

111 whereas cultural levelled adaptation is a deeper practice due to participants’ reported longer learning process required. Participants’ adaptive practice also fall into a spectrum between improvising from the original Western learning, and developed an indigenous understanding.

I first focus on the linguistic level of adaptive practice. It was found that some of participants’ adaptation approaches appeared to be on the micro-alteration level (improvisation), mainly linguistic translation of counselling knowledge. When sharing such adaptive practice, participants appeared to articulate their ‘Hong Kong’ identities and Hong Kong region’s uniqueness. An example put forward was to avoid speaking the stigmatised ‘counselling’ terminologies when delivering counselling to the clients (see Q26). By stating their natural switch between English (academic/professional) and Chinese (daily) spoken language due to their unique bilingual education, their association with ‘Hong Kong’ identities’ was evident.

‘I do not ever think they are different things. They are like [facts] like apple means 蘋

果 [Chinese term of apple]. [I] already got used to it. This (Hong Kong) is a unique

place. Since small till now, we read dominantly in English. I used to go to an English

medium school, read in English. [My] studies are mainly in English, but in living

even at work, Cantonese Chinese is dominantly used. [I] can freely change in between

[the two]. [There is] not much issue [about doing it…] I have to be familiarised with

some vocabulary, to express in Cantonese Chinese. Therefore [I] devote to avoid

speaking in English with the clients […] but I think I can try not to speak in English

at most circumstances. This is actually weird, [that] many Hong Kongers speak in the

fused English language. (3, Q27)

[It happens] quite often, (yet) not to the level that you cannot write out [the

translation…]. Therefore I think the difficulty [of translation] is on the reflection

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level. However, actually [our] medium of learning is in English. Then I do not really

think it has affected the learning efficiency. (4, Q28)

On the other hand, there are some existing confusions around professional counselling terminologies. For instance, ‘student guidance’s teacher’ terminology unveiled the intertwined linkage between counselling terminological translation and the confusing structural professionalism. By clarifying her counselling role, participant 1’s linguistic adoption of terminologies shifted as she navigated the different underlying ideologies of terminologies. In this way, participant 1 asserted her positioning within the cross-disciplinary hierarchy, which then informed her conceptual understanding of the institutional meaning of counselling. This reflects that linguistic translation or its translative interpretations cannot be solely viewed, as they refer to the underlying Hong Kong structural dynamics: Fu-do, sum- lei-fu-do, counselling (in English).

Student Guidance does not reach counselling such a professional level […]. I call

myself doing guidance […]. Guidance and counselling (are two distinct words in

English). However in Chinese (Fu-do also means) counselling. If you speak in

Chinese, Fu-do, I think…I think it [Fu-do] is more similar to this [/guidance], because

if reaching counselling [level…] It is already, ah! It is also called sum-lei-Fu-do [or

psycho-counselling] […] Sum-lei-Fu-do means psychologist [’s doing]. (1, Q29)

I now move on to the cultural level of adaptatve practice. From participants’ sharing, development of cultural adaptive practice varies significantly along the spectrum of improvisation and origination/indigenisation. On the individual practice level, cultural adaptive practice can be regarded as an experiential-based learning (‘skills learning is more than reading textbook theories’ – participant 4). Some participants revealed their formal indigenous theoretical learning which informed their practice. Examples include the locally

113 developed body-mind-spirit model (University of Hong Kong), and CPAI as a replaced indigenous version of the original Western MMPI assessment tool in Chinese University of

Hong Kong (Cheung & Leung, 1998; Cheung et al., 1996). As those training mainly occur in the formal localised academic/structural settings, I note the importance of the localised structural power to reinforce indigenisation. Some participants highlighted the importance but also limited accessibility of such training. Despite no prior indigenous training, participant

3’s sharing reflected his individual improvisation in his own practice. He identified some individual process-oriented qualities (through his work experience, see Q31) in his process- based learning in order to develop his culturally informed practice. They include self- awareness, reflexivity, equality and openness, etc.

While comparing between narratives of participants 3 and 4, it appears that a practitioner’s actual cultural competence in practice stems from self-initative to conduct self-reflection and experiential based learning. Regardless of having formal training or not, this individual quality is a common trait shared between the two. Participant 4’s account also shed light on this. Quotation 30 to certain extent can be regarded as participant 4’s reflective exploration in the interview. When reflecting on ‘loss in translation’ in his clinical practice, participant 4 looked at cultural discrepancy in cultural beliefs and moral values, which then reinforced his highlight of his experiential based self-learning aside his academic training. The participant’s phrase ‘So what, I don’t write it if I don’t know’ indicated his adopted pragmatism at work.

There is local teaching. However, learning is one thing, doing practice [is another

thing]. Therapeutic skills are not language-based learning…it is (sometimes) the

experiential process learning. You have that experience, and then you develop your

framework, (and) you have to look for some system (school of thought) to explain

the unfit areas. The first layer is taught in education […] he [Professor Cheung] taught

us the similar things (process), not only in therapy but also even assessment itself

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cannot just be a duplicate. We initially attend to concepts (as what is indigenous).

Though there is textbook [knowledge], you have to mould (the knowledge) through

daily practice gradually. Therefore I think it is not just merely using language in the

documentation. That is actually the easiest [thing to do]. So what, [I] don’t write it if

[I] don’t know. The most important [thing] is the process itself. We have to be aware,

[that] some words are not learnt via English (medium of learning), and are important

in therapy. Therefore we develop a set of vocabulary on our own.’ (4, Q30)

On the disciplinary level, chaplainry is an indigenous practice, as the profession has successfully established its indigenous expertise in ‘holistic or spiritual care’ by asserting its positioning in the public hospital setting. Its success was not merely a result of counselling’s religious nature, but how religion intersected with multiple external factors (see Q32; more in section 3.3).

While participants mostly articulated their Hong Kong identities in linguistic adaptations, I suggest that their cultural adaptive practice articulated their post-colonial identities. In the interview, participant 3 showed his confidence that adaptive practice required micro- alteration, as he as a Hong Kong individual acquired the ‘flexible Hong Kong culture’ to navigate between the Chinese and Western based experiences, knowledge and lifestyles (see

Q33). He also attributed the fiexibility feature as a colonial product of Hong Kong, which drew him close to the Western influenced Hong Kong system, and alienation from the existing Chinese systems (see Q34),

The application will actually have some tweak or adjustment. I think that the problem

is, whether I have sufficiently understood the essence of the theory [...] this is Hong

Kong people’s characteristic, that Hong Kong people are…[pause] I do not know

other countries’ ways of survival, but comparatively Hong Kong people’s flexibility is

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high, meaning [regarding] the changes, adaptability, different changes. Therefore I do

not feel there will be too many difficulties, or our learning itself does not involve

circumstances such as, we learn Chinese medicine and then go “wah!” when asked to

learn Western medicine […] [we] do not have this shock (in) all these different things

[or situations]. As soon as [we] learn, [we] already learn all the incoming Western

elements, and they become things taken for granted. (3, Q33)

Under the lacking structural support on providing a right training, work experience was vital for some participants’ adaptive practice. For instance, participant 1 highlighted that most of her developed children/youth counselling competence was from her work experiences instead of her original unfit adult-based counselling training. Participant 4 also named his accumulating clinical expertise from his practice, in his words, ‘the primary learning always comes from patients instead of text-book manual’. However, practitioners’ individual levels of adaptation were limited by practical shortcomings. Limited in time for practice, practitioners claim to adopt a more flexible and shortened clinical notes documentation to facilitate their delivery of the effective clinical outcomes. As seen in the dialogue, there was some concern by the participant whether such behaviour was an act of laziness, until the participant re-shifted his attention at flexibility or pragmatism.

Counselling render [means provided], full-stop. Sometimes [I] rather not write so

much, [and just] skip it [or the writing]. Sometimes you eat [metaphor of taking in]

whatever is brought to you, [so that] you would rather have more time to work on the

case(s) more than [filling in] documentation, so [you] do not write those ‘annoying’

things. [I] sometimes make enquiry how to write when everyone faces such a

situation. Sometimes (I) do it slowly, so that it can be written in the right way; some is

dealt for years […] Mostly (we) are just lazy in the practical [work]. They [what was

said] are just excuses [for us not to write] […] certainly there are key facts we have to

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write clearly [...] However, something like he/she (a patient) was too lazy, did not

comply to doing exercise…The (writing) which would cause blaming at the patient,

we do not record that in the formulation. That is communicative psychology. No

one cares about the underlying issue. They do not need to know (the patient’s)

entangled process. (4, Q35)

Participant 4’s flexible approach appeared to be based on his reliance on a localised regulatory system (see Q36, more in section 4.4). Auditing and professional regulatory systems operated within the same team, in his words, “within our rules”. Therefore, one could afford being less mindful about the accuracy or the level of detail in the clinical record, as long as practitioners had some explicit/implicit mutual understanding within the same team.

There was no mention of multi-disciplinary communication regarding such matter.

Theme 3. Practitioners’ Complex Roles As participants explored their understanding of counselling knowledge forms (theme 1), the outer contextual factors (theme 2) and the influential institutional influences (theme 4), they also often related to their professional identities and how they appear in the above different understanding. This section elaborates on the complexity of professional identities. These narratives are mainly contributed by phase one participants who are front-line service providers. They are simultaneously counselling trainees, practitioners and a member of an institution or organisation, which then contribute to these participants’ fluid identities. From looking at participants’ narratives, I indicate their roles can be described as a bridging, connecting and mediating function between theorised counselling, contextualisation and institutional dynamics (see figure 1). Such function reflected participants’ fluid navigation between the different themes.

I argue that theme three is a different theme from theme 4, as I want to highlight participants’ accounts show their ambiguous relationship with institutional power. Although being a

117 representative of the institution or system, participants often reflected their lack of understanding or their helplessness to change the institutional systems and their dynamics.

Their inability to mobilise institutional power only indicates their ‘outsider’ position from the localised institutional power (theme four), and so I placed them (theme three) as a separate unit despite the fact they belong to the institutional systems.

3.1. The Middle Ground Different participants identified with the ‘middle person’ role as they are required to assess, filter, refer, allocate and coordinate cases within the multi-disciplinary structure. For instance, participant 1 (student guidance teacher) highlighted her gatekeeping role to filter different cases in her work setting before making formal referrals. Furthermore, some counselling services are affiliated with the governmental owned Social Welfare Department

(e.g. participant 5, see Q38), and thus the public (and Social Welfare Department, SWD itself) have come to project on the service as ‘the representative’. They are often treated as the ‘emergency unit’ or communicative point. This explains my interpretation of Hong Kong practitioners’ mediating and fluid roles.

3.2.Dual Roles Many practitioners mostly identified with dual roles at work. One is the counselling role, whereas the other one is the professional identity from their original non-counselling training

(such as social work, teaching, chaplinary, clinical psychology). They are required to bear dual or multiple work focuses. The increasingly prominent multiple professional identities can also be due to the corresponding demand from the increasingly integrative services and the diversifying specialties as stated in section 1.3 (see Q39). Therefore, their self- representation can fluctuate in the service and the working organisation. In the current study, most practitioners do not instinctly call themselves as counsellors or counselling

118 professionals, until they are directly asked the question, ‘do you see yourself as a counsellor or fu-do provider?’

A specific example is a social worker’s mixed/雜 identities. Social workers are traditionally linked with diverse roles and tangible services (such as resources allocation, social welfare support) (participants 2, 3, 5, 11). Accordingly, their level of counsellor identification is proportional to the amount of time allowed in the counselling session, and their counsellor or fu-do provider identity can be selective at different times. Social work title would be a secure and permanent professional identity, as it is a necessary accreditation, work title/銜頭 in order for practitioners to deliver counselling (see Q40; more in section 4.2). This case also applies to student guidance teachers. Although participant 1 (student guidance teacher) identified herself as a counsellor rather than a teacher, her lines (in Q41) appeared to reveal her identification with ‘teacher’ (instead of a counsellor). As she tried to compare between herself and social workers, she highlighted that her ‘teacher’ role has served the advantageous insider functionality,

As I am a teacher, I understand a teacher’s difficulties or needs more. In this case,

there is an advantage as I deal with things. That is that I am myself a teacher, I

understand teachers’ difficulties or needs, and thus [my] coordination [with other

teachers] can be better [than a social worker]. (1, Q41)

However, dual roles can be problematic as practitioners build therapeutic relationships with the clients. For instance, one of the job functions of social workers is benefits assessment

(middle ground role; section 3.1). Such role requires control and discipline, in participant 5’s words, a role like a probation officer. Those social workers struggle to gain full disclosure or trust from the clients who have a hidden agenda or particular aims of obtaining benefits.

Some participants reported clients’ attitude negatively affected their judgment, and hence

119 their gradually less effortful counselling provision (see Q42). This could be a significant impact on service quality. Furthermore, participant 11’s reflection shows she fluctuated between supporting and criticising about her dual roles as a social worker and counsellor. Via negotiating between ideology and practice, participant 11 drew to limitation of time as the leading factor of her variant quality as she delivered the service (see Q43). Her emphasis of pragmatism mirrors to participant 4’s pragmatic approach on cultural adaptive practice (Q35; section 2.3). This brings the question of whether time is a justifiable reason of a practitioner’s variant quality in counselling delivery.

3.3.Specific role The term ‘specific’ refers to participants’ exclusive job roles or functionality within the discipline. Such exclusive ownership of the job role was due to the different institutional/disciplinary developmemts. For instance, a social worker’s middle ground role as shown in section 3.1 also refers to the specific role. Given social work as the only profession which has acquired the governmental-accredited status, it serves as the unique mediating role between the public and the government.

The special thing about working in (this) centre is its linkage with the government or

SWD. For instance, queues of [public] service referrals or funding requests are

mandatorily processed by us. This [/our role] is a special position, only I can or am

needed to do this [/assessment]. (5, Q44)

Student’s guidance teachers also appear to hold a specific role in delivering school counselling. From participant 1’s narrative, I suggest that her claimed efficient early intervention/preventive counselling provision was based on its intersection with the former teacher position in the school, permanent staff position etc. Moreover, chaplaincy’s successfully established spiritual care in the public hospital setting was a result of its intersection with other conditions, including the neighbouring clinical psychology’s pure

120 clinical focuses (in the same setting), the public’s traditional myths in religion, and cultural- based mental health stigma. This has led to chaplain participant’s perception of her role as a special function in the work setting. Quotation 45 entails how such intersecting relationship is shown in participant 10’s narrative.

I think my identity in the hospital is very special. Our targets are not just the patients.

Family and staff members are also those we care for, (as we) provide them not just

spiritual care services, but counselling service. It is because some colleagues choose

to look for us for Fu-do more than clinical psychologists. The reason is our roles are a

bit special! As to them, we are religious workers. Religious staff workers, within the

Chinese’s concepts/beliefs, have a special position [in Hong Kong]. They [people]

think that [when] we have a religion, especially Christianity, we would help them

keep secrets, not publicise their things. Certainly in Fu-do, (we) know we would not

tell anyone anything of what was brought to us. However [what I highlight here] is the

distinctive Chinese feature. People think that talking to a pastor would rather be better

than to the hospital staff, because (they are) the hospital’s clinical psychologists.

They think “I only see clinical psychologists if I am ill”, so actually to have the so-

called counselling, they become wary. (10, Q45)

Assessment and diagnosis conducting is an exclusive specialty for clinical psychologists in

Hong Kong. Participant 4 also claimed the profession specifies on evidence-based practice compared with the other general and flexible practice culture in Hong Kong, for instance, his conducted RCT trials research for a stroke rehabilitation service. He highlighted that such

‘tedious work’ is a professional justification for substantial service planning and expansion.

This somehow explains, from clinical psychologists’ perspective, how their specialties and the specific roles have successfully justified their assertion of themselves in the higher position of the cross-disciplinary hierarchy.

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I reckon what a psychologist has more than a general counsellor or therapist, is our

much larger part in assessment, as we are faced with perhaps some IQ [test] request

or the report, court report or child abuse, we often spend much [time] on report.

[This] [role] is unique to [a] psychologist, this is perhaps also, from a disciplinary

perspective, how we are unique compared with the other counselling professions.

From my personal view, actually, the other parts we do by nature are not much

different [from others]. (4, Q46)

3.4.The ‘So-called’ Multi-disciplinary Collaboration Many participants have mentioned about their collaborative roles with other disciplines due to being part of a multi-disciplinary team. However, criticisms on the actual limited collaboration indicate discrepancy between claimed job functions and the actual practice.

Participant 1 (student’s guidance teacher) criticised that multi-disciplinary collaboration was limited to the initial stage of collaboration, for instance, clinical psychologists’ assessment support. However, most actual therapeutic work fell onto her. In the interview, although she mentioned her competence to engage with the students (see Q8), here she revealed her internalised inferior position than, and her expectation of clinical psychology’s expertise.

This shows how a practitioner’s perception of the own counselling work and the own self- representation can vary as the individual relates to another practitioner from a different discipline.

Perhaps the psychologist conducts assessments for our children/students, but then

back to the meeting, (regarding) what problems children face, we actually mostly take

over (on) how to help that child/student. However, perhaps I do not have (clinical

psychologist)’s expertise to help that child, and also perhaps our work is very

superficial, such as [we assign] less copy-writing homework; in teaching, (we) assign

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easier worksheets for the students, narrow down the own taught content, or provide

training in groups regarding the own learning difficulty. (1, Q47)

I find participant 17 (clinical psychologist)’s perspective corresponds to participant 1’s criticism. She raised the same issue and further identified an absent central caseworker was the core cause of the problematic cross-disciplinary communication (see Q48). Furthermore, differences between diverse disciplinary approaches were unclear. Without clarification or initiatives made from any party, there was a lacking centralised direction in regards to service development (see Q49). Participant 17’s narrative serves as an example and a clinical psychologist insider perspective as she self-reported her struggle to extend her role from conducting assessment to providing full treatment (see Q48). Narratives of participants 1 and

17 unveil the deeper inter-disciplinary issues driven by the lack of funding as well as the corresponding insufficient labour (section 4.1).

3.5.Self-initiated Continuous Professional Development Many participants appeared to embrace their identities as a learner. Recognising their insufficient initial disciplinary-led training, they highlighted their sole responsibilities to obtain supervision (participant 3, 17) and further training as sources of guidance and personal well-being, in participant 2’s words, using her ‘heart’ (Chinese meaning of passion and enthusiasm). This shows that a counselling professional’s professional competency and development are intertwined with institutional/structural coordination (section 4.6).

Participants’ narratives again suggest that although they are part of the working institutions or organisations, they individually lack support or guidance on service and professional development. Therefore, although there are abundant trainings in Hong Kong, participants mostly rely on self-initiative motivation in further learning. Participant 3’s lines (Q50) have revealed a wider picture that the existing insufficient structural regulation and reform has maintained the existing segregated and localised cross-disciplinary communication training

123 exchange and planning. Although all disciplines fall under a broad umbrella of the diverse counselling services in Hong Kong, most of the existing cross-disciplinary exchange and communication are on the academic level. However there is a real need but lacking input on forming an exchange regarding the actual practice.

Participants’ narratives reflect that there has been a lack of attention regarding the existing institutional strurcture and management. As most charitable organisations are led by social work profession which is the only statutory governmental register, thus some social workers are in the (higher) managerial and supervisory position than clinical psychologists. Although there has not been any formal address regarding this, participant 17 (clinical psychologist)’s note indirectly indicated her dissatisfaction of the inadequate social worker-led clinical and other supervision for her (see Q51). I link her account to the underlying (and often hidden) conflicts/segregation in the current multi-disciplinary interventions.

Theme 4. Alternative Structural/Institutional Legitimation The fourth level refers to the different disciplinary led or institutional powers which have become legitimised. I place this level at the bottom of the overall conceptual model due to its orchestrating influences on the overall counselling conceptualisation, development and regulation in Hong Kong (figure 2). I used the term legitimisation, not because there has been a formal legitimisation such as accreditation or statutory governmental registration, but I argue how the different sole developments in the local context have become some form of power on their own, and even further orchestrate a cross-disciplinary hierarchy of power. In the interviews, narratives of phase one participants generate an overview of the different structural influences. Phase two narratives were found to greatly overlap with those in phase

One, yet had a more in-depth focus on unfolding the underlying reasons. Results of the two phases are presented together below, with their similarities and differences highlighted. This level reflects the onion-like conceptualisation of institutionalisation, which begins from the

124 obvious description of the different alternative legitimation forms (4.1). The alternative legitimations are a result of the localised power transformations (4.2) which are linked with influences of colonialism. Figure 2.1 specifically elaborated the dynamic power shifts after the impact of colonialism. The last core layer was the fundamental human nature which penetrates the problematic institutional segregation (4.3).

4.1.Different Structural/Institutional Legitimation Forms Although there is no formal system which regulates and monitors the different counselling services, activities and developments, many participants have somehow linked their identities and developments with some form of influence by their belonged institution or organisation

(see themes 1, 2 and 3). I term this as some form of legitimised power. Across the different narratives, I summarise there are two forms of legitimised power. One is power formed by various healthcare disciplines and professions which developed and owned their own internal regulatory systems. Another one is power formed by the academic instiutions.

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4.1.1. Disciplinary-led Internal Regulatory Systems The meaning of the separate internal regulatory systems was termed by participant 4 as the

‘different game rules/個遊戲規則唔同’. The word ‘game’, in this context, implies fulfilment, competition and requirement instead of enjoyment or leisure. Completion of a game or gaining fulfilment often requires tactics and strategies. The separate service focuses or distinctive adherence to ‘rules and regulations’ can be traced back to the distinctive schools of thought from the academia or training institutes (4.1.2). For instance, Hong Kong counselling psychology was reported to follow APA curriculum and practicum criteria

(participant 15). Clinical psychology training had a traditional emphasis on using CBT

(participant 6). Participant 17 openly addressed her discipline (clinical psychology)’s

‘internal regulation culture’, that is, work behind the own closed door/自己閂埋門做嘢. She admitted this has prohibited the profession and clinical psychologists from engaging with other tasks which appeared as outside clinical psychology’s ‘jurisdiction’ or establishing collaborations with other disciplines (see Q57).

I try to indicate here that fulfilling ‘different game rules’ have contributed to legitimation of power. Across different services, counselling’s service quality or outcomes are interpreted differently across various disciplines, due to their different performance indexes on practice/service standards and evaluations (see Q53). Many participants confirmed that most of the performance is solely reviewed by the own institution or profession, and there is no third party which involves with external evaluation. The exception is social work, as its performance index is assigned by the governmental body, which again reveals the significance of governmental or policy level of interventions. Practitioners’ compliance to fulfill those different performance indexes reveals the complexity nature of the institutional dimension of counselling meanings. In the interviews, participants’ views disclosed the significant but unspoken impact of counselling which has become institutionalised, but that

126 was yet to be named or measured. These narratives unveil a critical question, about what counselling meanings have evolved into, when practitioners have come to comply and reinforce (whether voluntarily or forcefully) such institutional dimension of counselling (see

Q54 for the critic at social work). For instance, the legitimised power owned by the healthcare professions can be indirectly seen in participants with dual or multiple roles (see section 3.2). They are more likely to relate to or rely on their dominant disciplinary-led identities rather than counselling identity, hence their lacking or inconsistent self- identification with the counselling provider role. This suggests participant perceptions that their non-counselling disciplinary titles have a higher status than a counsellor. For instance, social work participant (participant 5, see Q52) perceived their roles as ‘more than a counsellor’.

A direct problematic impact shown by the different and separate leaderships and internal regulatory systems is the stalling produced outcomes, for instance, participant 6 condemned such practice as “圍威喂/gather and bluff loudly” (from Q55). Participant 17 also entails how different leaderships have caused a counselling case to bounce between different services without an actual progress made.

The head in each system is different. Schools are under Educational Bureau; hospitals

are under Hospital Authority, the younger children are under the Department of

Health. Therefore, it turns out that each party has a different approach. Often when

problems occur, one would push the case to another. Perhaps a case is generated at

one place, in which someone would say “I cannot help you”, then the case is pushed

to another system to follow. Therefore the help-seeking process [itself] can bring

distress to the clients. (17, Q56)

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Another phenomenon is the prevalent ‘Not Knowing’ culture. Despite being part of the multi- disciplinary collaborations (see section 3.4), participants’ understanding of the differential internal accredited/regulatory systems varies. Many participants across different professions personally admitted the own poor insight or awareness of the other services. Therefore, they may have low incentives to refer out the cases they are limited to handle. In Q59, participant

2’s narrative reflects a picture that a professional’s unfamiliarity with other disciplinary work

(in this case, Student’s Guidance) can reinforce perceptions of it as ‘the other’, as the individual makes different interpretations or assumptions. This somehow explains how professions have become segregated, as the narrative shown here is found to have evolved to segregate between the self/own profession from such ‘the different other’. This suggests narratives on conceptualising counselling meanings shift in parallel with institutional dynamics (see Q58).

(There is ambiguity) when we work with a student’s guidance teacher. [For instance,

one time we worked with a school, and we got confused.] Why did one not

understand another when discussing things? [We] gradually learnt that, ah, he/she did

not come from social work [background], and so he/she couldn’t be clear [about the

role]. Coincidentally we worked with another school, (and) things had been clear

since the beginning. Our goals, discussed items, the process [were] really understood

by [him/her] on how to help the children. Actually [that staff] came from social work,

thus everyone had a common ground […] [I realise that], if the role is carried out by

different people, the impact is huge on how we collaborate to support the children,

how to see such problem or the severity level, or when to intervene? Perspective

taking can be very different [across different people]. As said, Student’s Guidance

Teacher’s Fu-do role depends greatly on the own Fu-do experiences and training. It

turns out that a lot of factors emerge, and whether the role is really [efficiently]

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carried out depends on individual differences and the school’s recruitment process. (2,

Q59)

Practitioners’ understanding of other disciplinary work remained an unclear issue even after they share the common learning platforms in further professional development. This corresponds to participant 3’s comment that academia/training institutes do not emphasise facilitation of cross-disciplinary liaison and collaboration (Q50). It appears that cross- disciplinary segregation is more embedded within the lacking liaision and collaboration. Q60 reveals how a social worker participant voiced her confusion of clinical psychologists’ adoption of psychotherapy terminology and service concept which appeared unfamiliar to other professionals, even when all practitioners participated in the same specific therapy training,

Clinical psychologists seldom say they provide Fu-do. Perhaps (they do) not use this

term, rather ‘therapy’, or use some [specific] therapeutic approaches. Actually, we do

not really know what they are […]. At the same time, we all go for the same therapy

training together. It means social workers, clinical psychologists, educational

psychologists, or some Fu-do workers, and even doctors, everyone learns the same

thing. Outside the therapy (training) there is no indication of examination or how to

qualify. You simply apply what you have learnt. So it turns out that everyone

seemingly shares the same thing, but certainly, we don’t really know that. (2, Q60)

Furthermore, practitioners’ confusion appeared to have reinforced their identity fluctuation between the Chinese and the West (section 2.2). In the interviews, some participants projected to the ‘fantasised better’ overseas accreditation systems/regulations. Compasion appears to be a common behaviour, as participants then criticised the current lacking Hong

Kong structure (see 2.2).

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4.1.2. Alternative Academic Institutional Legitimisation

The public, in general, have limited knowledge of how and who to seek help from.

Participants’ accounts further validated that institutional educational reputation acts as the alternative (and misleading) professional guarantee for the public and even practitioners themselves. Both phase one (such as participant 9, see Q62) and two (such as participant 18, see Q63) participants suggested that an evaluation of a practitioner’s professional competency is mostly based on ‘trust’ (a common adopted term used by different practitioners). This reflects the social phenomenon that the public has very lacking awareness of developments and activities of the professional disciplines or academic training institutes.

In Q64, the phrase ‘They can self-evaluate, meaning there is no third party’ reflects participant 3’s undoubted expectation that training institutes are more than a training deliverers, but also an alternative power. However, despite the expectation that

University/training institutes should act as a ‘gate-keeper’, he criticised that institutions’ reputational influences do not meet up to the expected regulatory functionality. The problematic areas identified are the insufficient/inadequate training provision and gate- keeping the entry and graduating criteria.

Just ‘claiming’ the training’s professional value does not make it (training)

professional. This depends on the school’s self-discipline, as the current so-called

training, in the case of social workers, is after approval by the Social Workers

Registration Board. However, how do you teach (students) [or] recruit students? How

do you utilise your evaluative criteria to guard unqualified trainees as they should not

graduate? The academic institutes do this. Is everyone [/academic institutes]

providing a consistent standard? No, some are loose, that (one) can easily graduate.

Therefore this gate-keeping, in Hong Kong relies on academic institutes’ work. They

can self-evaluate, meaning there is no third party. Certainly, a recognised

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registration system is important, yet who does it? Is anyone doing it? The answer will

always be no. (3, Q64)

Participant’s narrative then changed to defending counselling as a speciality in the overall well-being support, as they criticised non-counselling disciplines’ superficial and over- general counselling training (mainly social work). He was open to admitting non-counselling graduates’ lack of fitness to practice, unless they pursue further independent training (also see

Q66; participant 18).

Social work’s three years of training involves learning a bit of everything […] a

fresh graduate actually is incapable of being a qualified counsellor. There are many

organisations out there to provide training, so we continue to pay, to let ourselves be

a more qualified counsellor. (3, Q65)

Another specific criticism is at the deteriorating academic or professional counselling standard in relation to the current University policies and strategies. Few participants showed critical awareness of this, for instance, participant 3 named the main reasons of the mixed candidates’ selection criteria (of social work) by the different academic institutions, and the rising number of ‘foreign’ Mainland Chinese students (see Q67). His phrase ‘the government does not take much concern’ indicated his understanding of the lacking ‘original’ regulatory power, and University institutes are the alternative power. Furthermore, using participant 3’s narrative as an example (on institutions’ problematic over-emphasis of maintaining financial sustainability and neglect of strategic considerations of cultural adaptation issues), we can see a Hong Kong individual has positioned the self as a Hong Konger, and regarded the Mainland

Chinese as the others. I (and the participants) put the emphasis on the failing institutional obligations which have contributed to Hong Kong individuals’ conflicting cultural identities

(as spoken in section 2.4). One cannot just look at cross-regional hierarchy and segregation as

131 merely a cultural adaptation issue, but its intersection with the problematic academic institutional strategies on ‘Resources are the Key’ (section 4.2.1.3.). In other words, cultural identities are closely shaped and influenced by institutional power and money.

Whether it’s the University or Seminary [Religious Training sites] would really want

to recruit students, and so we would set a lower entrance requirement […] the

government does not take much concern [about training criteria], and so University

recruitment would be lower to maintain the student pool. It [/the training] would be

over if you do not have students coming, right? So you would lower the entry

requirement, and what you recruit would not be really passionate or academically

excellent students. (3, Q67)

The narrataive of participant 18 (phase two), an insider of the gate-keeper, is coherent with participant 3’s critics (see Q68). She showed her awareness of the failing gate-keeper role, in particular to the low entry and graduating requirements, and her wish to enhance such standard. She indicated that academic institutes’ responsibilities should also include graduates’ practice after they exit the training.

Regarding regulating gate-keeper’s role on tightening practitioners’ practice, phase two participants (participants 14 & 18) also seemed to understand the reciprocating relationship between such academic regulations and the wider public’s respect and awareness of counselling as a professional career, in participant 14’s words, domino or chain effect (Q69).

This shows that institutional power in Hong Kong (at least in healthcare sector), at this moment, has a leading and influencial impact on public awareness.

If your gate-keeping is insufficient, it is harder for you to control/handle [what’s] out

there (in public). Once they [trainees] graduate, the public only know this person has

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Masters Qualification, and consider that [this qualification] is extraordinary. (18,

Q70)

4.2. Localised Power Transformations This section elaborates factors of theme 4.1 (a brief picture of the alternative legitimations), as I conceptualise the underlying reasons for formation of the alternative legitimations (see

Figure 2.1. for the conceptual map).

First, ‘Absent Power’ (4.2.1) illustrates the lacking governmental intervention, which briefly indicates that Hong Kong is not fully decolonised from the imperial impact. The notion of decolonisation here does not indicate imperialism’s remained state of power in Hong Kong, rather the localised governmental transformations have yet to fully adapt into the new autonomous leadership. I postulate such localised incongruities which consist of two different forms (including policy making’s outsider status quo and the bottom-up bureaucratic regulations). This contributed to the formation of resource-led culture of counselling and healthcare services in Hong Kong (see 4.2.1.3. Resources are the key). I then explain how the localised alternative powers (conceptualised as 4.2.3. the ‘Historical Legendary Informed

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Professional Hierarchy’) which have acted as a substitute for the Absent Power. Such formation is again a result of the multiple forces as elaborated below.

4.2.1. ‘Absent’ Power I indicate that the absent notion does not mean the absolute zero power. Rather I accentuate the lacking legislative intervention, including implementing a professional accreditation and regulatory system, as well as the equivalent social status. This sublevel asserts that the

‘absent’ power remains impactful. On the superficial level, the absent power serves both sides of a coin. On the one hand, practitioners utilised Hong Kong counselling meanings’ ambiguity/含糊 to establish the sole professionalism and expertise. Practitioners (participants

4, 17) named such a flexible practice culture as with great variation/多樣變化 and having different blossoming streams/各自精彩.

Everyone who has studied some courses can open a company or a Fu-do centre, and

claim himself/herself as doing private practice. It is only a matter of whether one

believes it or not. (2, Q71)

This [situation] is so chaotic […] I think everyone blossoms separately. If your

website is done well and pretty, they (the public) would look at the website and see

you […] so some Fu-do workers, if they know marketing, get a lot of business. [Such

as using] google, meaning [you] put your CV out there, pay HKD 3,000 each month,

then people can find (you) once they go to google. (9, Q72)

A significant loophole regarding professionalism guarantee was also highlighted. Regulatory functionality is mainly dependent on an individual and organisation’s morality and conscientiousness. Participants attributed the public’s lacking insight of service selection to private practice’s failing competence under the lacking structural regulation (see Q73).

Therefore, narratives are more ingrained with their projected expectation that a structural

134 regulatory system should have taken place. The below shows a case example named by participant 9,

One OCD (client) saw a clinical psychologist already before seeing me. Each [clinical

psychology] session was charged HKD 2,400. He/she had 24 sessions and put most of

his money there. The therapy terminated badly/嬲尾. That clinical psychologist told

him, “I would not see you anymore, because this does not help you.” [The client] then

came to me, as I helped him as a volunteer in the Fu-do centre. This place does not

charge. One voluntarily donates in the seminary. When he first saw me, he/she told

me, “That clinical psychologist said it has been 24 sessions, so I had no hope, and

he/she would not see me anymore. Would you not see me?” I said I would not stop

unless he/she left himself/herself […] I think he/she really needed acceptance and

security. (9, Q74)

4.2.1.1. (Phase 2 only) Policy Making’s ‘Outsiders’ status quo Phase two participants mostly pinned down the ‘absent power’ in two aspects. The government is the public policy decision maker in the healthcare systems. However, participants mostly perceived the government as an ‘outsider’, and actively named this in the interviews. One example was the lacking insight,

[The governmental officials] are part of the public after work, means they think on the

same level as the public […] even in strategic intervention, the policymaker does not

really understand what it means to be an independent counselling industry. It thinks it

is an activity that everyone can be part of. (15, Q80)

We [Hong Kong people] were so ridiculous. There has been a debate in Hong Kong

on whether psychologist or counsellor belong to the healthcare professional(s) […]

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I think if the overseas society really sees this, they laugh themselves off! Psychology

is not a healthcare profession? Or counselling is not healthcare! (14; Q81)

Participant 15 argued that there is in fact sufficient available funding in Hong Kong, but the problem lies on a lacking clear orientation/focus in public policy. The government only passively responds to the existing problems or the crisis, named as ‘treat the head when having headache, treat the feet when having foot pain/頭痛醫頭，腳痛醫腳’. There is a lacking incentive to construct a professional counselling culture in Hong Kong. For instance, the government remained its lacking action in response to the licensing request by arguing that the professional bodies’ member numbers were ‘insufficient’ for any formal action to take place (see Q82).

Q83 shows participant 14 appeared to link the lacking incentive culture with the current macro-levelled concept of Hong Kong counselling which lacks strategic considerations.

I am not sure whether things are like this in the West, but the way that Hong Kong

people deal with things, is that emergency explodes, then I handle it. There is no

macro-picture which deals with the mental health issue. (14, Q83)

4.2.1.2. (Phase two only) Bottom-Up Bureaucratic regulations/官寮體制 The bottom-up legislative procedure was addressed regarding the government’s lacking incentive culture. Participant 15 named the mental health professions as below/下面. They are required to proactively establish independent accomplishments/自發攪掂 or be able to deal-it-all, whereas the higher-up government awaits ‘the below’ to convince it regarding any decision making.

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Even legislation is processed via the below professional bodies. It would grant some

authorisation to you provided that you have a certain economic capital or

[understanding on] how to operate sustainably. (15, Q84)

This reflects the government – mental health professions hierarchical structure, and governmental decision making’s reliance on the established work from the lower category, in particular in contrast with the top-down processing in Taiwan (participant 14; see Tu & Jin,

2016). Furthermore, a generalised projection of ‘the West as the better’ again emerged as participant 15 assumed Western policy-making’s top-down processing.

The overseas has already established division, regulation, whatever is done is via

top-down processing (it spots out the specific problem, and it would define the

industry itself), and often legislation is carried out throughout. Hong Kong

is…[pause] you restrictedly wait and wait (the own organisation has existed for quite

some time) the people below submit a [legislative] proposal, then [the government]

would play along if liking it, [or] would not play along if not. Therefore, this

structural/institutional problem has been hanging there for so long […] you hope [the

government] would turn to legislative regulation. In return, the government asks

everyone to chip in, create a self-regulated professional body, and that budget each

year would be no less than HKD 1 million. This is one kind of voluntary society-

based registration. Well, actually not every profession has so many members. (15,

Q85)

4.2.1.3.‘Resources are The Key’ Actually how would we have many psychologists right? Hong Kong does not have many

psychologists. Even one SWD social worker takes up 70-80 cases. They may do in-depth

[counselling] for the most urgent and needed ones, but cannot attend to the rest that much.

Actually, I think resources would significantly affect Fu-do quality and depth. (1, Q79)

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Due to the ‘absent power’, counselling disciplines and practitioners’ focuses become centralised on dealing with money, hence creating a ‘resources-led’ culture of Hong Kong services. I used Q79 as the introductory statement, which briefly captures a practitioner’s primary concern of counselling quality as restrained by budget and labour power. That is to say, service availability and quality is highly dependent on resources (money and labour). On the independent practitioner level, private practitioners (participants 9 and 19) admitted their moderately charged service due to its self-financed/non-charitable business setting.

Therefore, private practice’s status has gone economic to obtain a certain development, and it has become a service inaccessible to the lower class, or a luxury for the affordable.

Phase one participants who come from the institutional settings showed their critical awareness of legislative or policy influences which dictate resources allocation, for instance, the governmental funding’s exclusive resources allocation to predominantly the only governmental accredited social work, or clinical psychology with clinical reputation.

If under governmental funded social services, social workers take the lead. However

on the private setting level, actually perhaps different clinical psychologists or

counsellors take the lead. Such a polarised phenomenon is interesting. The allowed

public funding fails to afford the required labour adequately, thus [NGOs] only accept

social workers [as cheaper labour] as the staff members. If I look for a professional

counsellor I have to pay. Not sure if it’s true or not, you are not entitled to a job

position or lack any space for promotion in SWD or NGO if you are a counsellor. If

you do not work in the so-called private clinic nor open one yourself, you do not have

any chance in the NGO, unless you are a clinical psychologist. Perhaps this is how the

two paths are generated. (3, Q74)

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Furthermore, it appears that participants (1, 4 and 15) were aware of the influential government policy changes, as those changes were brought up as they explored quality of counselling service. Examples included the student guidance’s teacher training funding cut in the local public primary education (see Chapter 2) which has resulted in substantial drop in teacher counsellors due to the changes of practitioner’s eligibility criteria; implementation of lump-sum or one-off funding policy which impacted on social workers’ integrative service quality, and SEN service reform’s resulting opening door for counsellors. ‘Lump-sum funding’ policy (see Chapter 2) was only addressed by phase two participants possibly due to their involvement in the level policy or strategy making. Participants’ narratives reflect a social picture that policies orchestrated resources constraint in most of the social services and most of the services’ integrative nature. Counselling has become an optional service instead of an independent unit since the policy implementation, hence the affected delivered quality, such as inconsistent service, high staff turnover rate, etc (see Q76). In Q75, participant 15 noted the government (funding allocator) would ‘give you money at once, you the organisations deal with it all’. This implies the participant’s least expectation of governmental support aside just ‘giving out the money’. The term ‘deal with it all’ also indicates feelings of dissatisfaction of such disconnect attitude. This will be further elaborated in section 4.2.2.1.

I give you money at once, you the organisations deal with it all. You take care of the

whole operation yourself. Everyone knows that actually, the salary occupies the most

[funding]. Some organisations cannot maintain its service, and they cut the salary

expenditure, so some give entrance salary fee HKD 1.7K to the newer staff members.

[It all depends on whether] you do it or not, haha [For the newer workers,] you have

to temporarily take it if you cannot find anything else, right? Ha! However, honestly,

you work for 1-2 years, [and] if you have a better job offer, these staff would leave.

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Your departure, meaning there are no consistent staffs, would inevitably affect the

service quality. Some organisations actually cannot keep the staff. The turnover rate

is high. (15, Q75)

Other influences of the lump-sum/one-off funding policy included the lacking availability of posts for newcomers in contrast with the longstanding positions held by the more senior professionals, also the discrepant salary standards between the above two groups due to the changing job banding salary systems (participant 18).

Another example is the impact of SEN services reform (participants 4, 15). Participant 4

(clinical psychologist)’s narrative reflects his practitioner attitude that ‘money comes first, the disciplinary-led occupation of service next’. To him, knowing how to navigate funding rules/regulations was important as it informs how practitioners or the separate professions can assert their roles restrictedly within the own territories (which I term to describe the competitive nature of the disciplines). Knowledge contribution or research, in his dialogue, could arguably be perceived only as a side product when such institutional rules are fulfilled.

Hong Kong currently gives most Fu-do funding to SEN students. The absolute

number [of SEN students] increases every year, [and so] the primary and secondary

school service landscape is consolidated. Everyone [/each school] receives money

and then looks for outsource services (the NGOs cover 80%). There is no role to play

(for counsellors and counselling psychologists). These children grow up. After

taking DSE (Hong Kong public examination), due to different reasons they mostly

cannot get into the University. I reckon 80% [of the time] enter IVE … Educational

Bureau’s given financial support to IVE, is horribly large, not just about ranges of 10

million. Therefore how [do we] utilise counselling and psychologists knowledge to

address this? I guess this area will be focused on in these 5-10 years. Recently [Ms.]

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Lam Cheng [the current Hong Kong Chief Executive] has granted HKD 30 billion to

expand service coordination […] I think (this is) the most significant development

area. Such service would fulfil requirement [of needs], so you look for space to

conduct counselling service. You can image whatever studies for those [SEN]

students would be valid, meaning they [would usually] have a high rate of

depression, anxiety. You can do whatever prediction, adjustment need, significant

parental stress [studies]. (4, Q77)

As different disciplines establish their distinctive service areas, they become limited to step outside such ‘territories’. This was confirmed by participant 4 as a clinical psychologist who is compliant to working in his profession’s service area in the clinical and pathological context. He admitted his lacking capacity to expand his current role to his idealistic vision of himself or clinical psychology to provide preventive community intervention. It was implied here that one’s specialty or expertise in this case is regarded as a restriction. He also acknowledged that such limitation or such institutional picture is not shown or conveyed to the public, indicating the public’s lacking awareness in such matter.

SEN Education is not clinical psychology’s orientation […] means you do not see

many clinical psychologists in this area. Where have all the clinical psychologists

gone? Hospitals, Hospital Authority and SWD. Most of them are absorbed in these

[restrictive] sectors. From a psychologist’s perspective, I think what we face is not

just what the public see, which is why the service queue never disappears. Whether

we employ more staff, or referrals are [more quickly] done, we know that the

government would not by proportion enhance staff capacity, and the queue would

only be longer and longer especially in the critical times. Traditionally [clinical

psychology’s remediating] manual model has been condemned. It should be

condemned, as you do not work from the root cause. So ah la, [patients] come via

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A&E and look for us. Sometimes this is how clinical psychology orientation is

restricted. (4, Q78)

4.2.2. Alternative Historical Legendary Informed Professional Hierarchy

Hong Kong is very hierarchical; democracy (to me) does not exist. [This societal

problem] happens everywhere, but it is more extreme in Hong Kong. Psychiatrists

are limitlessly high-up, and then clinical psychologist, and then what’s below would

be perhaps social workers. It is very hierarchical, but actually, in the overseas, once

you have clinical training, even different ones would protect your professionalism.

There is respect to all training, (the place is) integrative; everyone has a different

perspective to see things. (6; Q86)

I suggest that the historically substantial disciplinary development is an alternative power in the form of a cross-disciplinary hierarchy. This replaces the original ‘absent power’. As a result, the alternative legitimation forms on the top layer could be sustained (section 4.1.1.).

The hierarchy begins from the counsellor, social worker, to the highest psychologist levels. In practice, a consensual hierarchical patient streaming also has been formulated in a way similar to the medical system (GP versus specialist). Social workers/other counsellors intervene in the initial and broadest streaming stage, whereas clinical psychologists serve the latter function as they deal with the hardest cases/奇難雜症. The below sections (between

4.2.3.1. to 4.2.3.4) elaborates the different power forms.

4.2.2.1.Disciplinary Prestige The different forms of historic accomplishments in social work and clinical psychology have somewhat reinforced their structural linkage with the governmental legislation, resulting in their more superior developmental status. As the earliest established and most comprehensive developed social services profession, social work is the only accredited profession with its substantial member number which serves as a form of power (compared with clinical

142 psychology; 20,000 versus 400). Clinical psychology, the second established profession focused on its specific clinical expertise in close ties with the medical model, and the corresponding prestigious hierarchical positioning - ‘Well salary is so high so that it can justify [my work]’ (4; Q87). A typical example of clinical expertise cited is adherence to evidence-based practice. Participant 4 revealed the hierarchical superiority of the medical/clinical guidelines over social work profession,

We would not address [things like] how many patients send thank you letters or

patients’ satisfaction survey […] social services units are restrained to this current

position. Social work does not acquire […] actually it does not matter what they

have, as they do not have medical, clinical guidelines for follow-up. (4; Q88)

On the other hand, different forms of historical legacy could cause conflicts of hierarchical ranking. In some cases, social work’ advantageous member number could overpower clinical psychology, for instance, managerial supervision arrangements in NGO setting (section 3.4).

In an NGO, subordinates are from social work [discipline], your head would also be

from social work; the middle is psychologists. Therefore there are a lot of

negotiations on how to work out this situation. (15; Q89)

Such phenomenon reflects that the contradictory power dynamics were contained between two professions, as social work is in the lower clinical ranking yet the pioneering leader in the overall healthcare system; clinical psychology is in the superior clinical position however the supporting profession. In other words, the disciplinary hierarchy is not viewed as a universal fixated concept. One has to consider the other intersecting institutional or contextual factors.

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4.2.2.2. Others who are ‘In Between an Insider and Outsider’ Most of the non-social workers and non-clinical psychologists are classified at the broad level of ‘counsellors’ (for instance, participants 9, 19). Their ambiguous position as both an insider and outsider was not just a result, but also the reinforcement of the prolonged inter-territorial segregation. On the one hand, they are the insiders of the overall counselling field as they have more or less obtained some career status. However, they are regarded as the ‘outcast’ within the professional hierarchy. They are financially excluded from government-funded services and thus look for an alternative route by relying on their individual development.

A case example is chaplaincy profession. A sustainable chaplaincy development depends on its fitness with the Hong Kong context (section 3.3). However, the profession’s positioning remains ambiguous despite that its clinical work was superficially acknowledged and accepted on the public and the profession/clinical levels (by other healthcare professions).

Participant 10’s quotation revealed her fluctuating positioning between an insider and outsider, being needed and not accepted positioning, which tied with her lacking belongingness and powerless state,

There is no such official regulation. Our role in the hospital is only a volunteer. I

work in the hospital, but I do not belong to the hospital staff. The hospital recruited us

to provide spiritual care, which means they regard its importance […] we can

disappear from the system anytime. However, we are also very important! It is

because they think we are important when they need us. (10; Q92)

Furthermore, chaplaincy’s successful differentiation from clinical psychology in the same clinical setting does not appear applicable to individual levels of practice. For instance, participant 9 noted that she remained to be excluded from the social services sector.

Alternatively, she developed in private practice or within the religious institutions. In other cases of non-religious private practice, participant 19 reported foreign clients was her main

144 client group (a minority group in Hong Kong), and she also worked at an international school. Both narratives are in line with most counsellor participants’ description of their outcast status/入唔到主流 due to their non-social work or clinical psychology qualifications, and no legitimisation of ‘counsellor’ accreditation, and thus private practice is often the only alternative.

Counselling psychologists claim to be outside the counsellors’ category, but the profession’s position is also ambiguous in the overall psychology professional field (participant 14).

Between clinical and counselling psychology sub-divisions, counselling psychology was described as a misfit with its stumbling status/論盡 in the ‘pre-established’ professional hierarchy, as it is neither social work nor clinical psychology (participant 4). This again captures the disadvantageous positioning of a newer and latter emerging profession.

Participant 4 (clinical psychologist)’s narrative is an example of the expectation for counselling psychology to meet up to social work and clinical psychology’s historical substantial strength. In the quotation, participant 4 used ‘you’ as counselling psychology, which showed his distancing from and regard of counselling psychology as ‘the other’.

Counselling psychology in Hong Kong is in a stumbling status, which is that it

claims itself as a specialist. Regarding the number it cannot provide primary care, as

you only produce 20ish maximum (of practitioners). You don’t exist when your 20

(members) fall into 20,000 (of social workers), but then it does not reach the specialist

level, as somehow its orientation is, actually how to distinguish between counselling

psychology and clinical psychology? Both are psychologists, so I do not have a

reason to pay a lower salary for you. Then would there be things clinical

psychologists can do but not the counselling psychologists? For instance, clinical and

educational psychologists can do IQ assessment, which officially is their orientation I

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reckon […] everyone can distinguish the administrative division, for instance, Hong

Kong has already allocated (the IQ assessment) for educational and clinical

psychology, then I would think it is a waste if I hire someone (counselling

psychologist) who cannot conduct IQ (assessment). (4, Q93)

4.2.2.3. (Phase 2 only) International/Social Status as a Form of Power A profession’s accumulative established social status also has become a form of localised power. Participant 15 connected counselling psychology’s inferior status with its lacking

‘powerful representatives’, and his correspondingly intention to establish such status to in return change the status of the profession,

However, actually there are very few who are at the international status, social

status and with authority to represent and voice out for our industry. Therefore I think

I have a thought that my future studies would help me establish this status, and help

the profession’s better development in the future. (15, Q95)

4.2.2.4. (Phase 2 only) Apprenticeship-Training Hierarchy Trainees are often immersed in the strong professional hierarchy since the own beginning of training and across their practising careers. Participant 16’s quotation pinpointed the underlying human nature of “I am the elite” (see 4.3.1),

On the mentality/心態 level I think someone would inevitably be the “big brother”:

“you cannot challenge me, I am already up on the altar”. In that case, everyone

cannot be on the same level. Many are afraid of being challenged. This learning

atmosphere, if you are used to it at school, you also have this attitude in practice

[…] I follow this teacher, I am this way; another group follows that teacher, they are

this way. This affects the whole education. (16; Q96)

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Participant 16 further suggested that the Hong Kong situation is a miniature of the global dynamics, for example, the conflict between Minuchin and Satir family therapy approaches,

Hong Kong (a piece of sand) reflects the situation out there (the overseas). It is the

same, right? In Hong Kong, some feel they are the superior ones, “ah as I am

AAMMT” […] they continue to feel comfortable in their zone, but there is no

resolution (to this). I have seen this (problem) remaining the same for years, so as

history. (16; Q97)

4.3. ‘This is dealing with human nature problems/呢啲deal with 人性嘅問題’ Everyone respects each other. Everyone’s needs are different, actually different fields can

provide services together. Why should we think that ‘I am the unique and only elite? (9;

Q98)

The relationship in between professions was named as ‘sand on the tray/一盤沙’ (participant

16). When discussing cross-disciplinary segregation and the maintained hierarchy, participants commonly addressed a common theme named ‘human nature problems’. I summarise the views into different forms of negative core attitudes (human nature problems).

4.3.1. ‘I am the unique and only elite/唯我獨尊’

The penetrating attitude, ‘I am the unique and only elite/唯我獨尊’ (participant 9) was found as the core orchestrating string of cross-institutional segregation and oppression. Such power is illustrated through one’s priority on the own agenda. As a result, a consequential culture of intolerance of the others was fostered. One example is given by counselling psychology participant (participant 15), who indicated the profession’s attempt to invite cross- disciplinary collaboration with social work discipline on counselling psychology’s standardisation movement. The attempt failed due to, from participant 15’s viewpoint, the

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‘own agenda’ culture. This suggests that ‘own agenda culture’ means an individual or a profession struggles to engage or be involved with another individual/profession.

Actually, such typical counselling psychology standardisation or professionalisation

movement lacks support from the NGOs or social work […] as they think they are

doing it already. (15; Q99)

4.3.2. Beneficial Conflicts and Competition (phase 2 only)

Another example of the human nature problem is the conflict of interests. This became evident in professions with the established reputation, in participant 16’s words (see Q102),

‘on the altar (indicating one’s high social status to the level of being worshipped in the temple)’. Professions or individual practitioners were reluctant to take part in collaborations for fear of reducing/losing their existing benefits, or are unwilling to take an extra effort for less return. Participant 15 identified beneficial competitions which turned into the prolonged disciplinary conflicts were derived from the multiple disciplines’ priorities to secure their territories as an act of ‘own agenda’ practice (4.3.1.). As a result, the actual disciplinary focuses have derailed from devoting to enhance public understanding, rather fixated at such conflicts.

[I think) why the whole Hong Kong [professions] has turned into a war, is because

[when the professions promote, they] do not [really] aim at enhancing public

awareness. Rather they themselves just want a stepping foot into the industry. These

two things’ underlying intentions are very different, for example, the discipline wants

to protect its people. This problem is that acknowledgement only reaches the own

people [in the discipline], but there are no changes in the public. (15; Q103)

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4.3.3. ‘My field has the Better Expertise.’

Participants have given the most elaborative account on the professions’ stemming drive to be ‘the better expertise’. The most recorded constrained relationship is between the two longstanding professions, social work and clinical psychology. Clinical psychology’s critics are mostly at social work’s mixed professionalism which can be shown in some participants’ views. When raising the difference from social work, a clinical psychologist participant noted social workers, in general, are not equipped with in-depth psychological knowledge (Q104). I suggest that by highlighting social workers’ incapability to carry out psychological assessments, inevitably the participant has somewhat distanced the self as well as clinical psychology from the social work discipline by asserting clinical psychology’s superiority. In other parts of the interview, the same participant also recognised clinical psychology’s limited service expansion due to resources restrain on the narrow pathological focuses. Such narrative, however, deviated from being in an inferior position, as his use of word was

‘orientation’, a neutral word instead of negative or positive wordings (such as limitation or expertise). From the quotation lines, I argue that the participant appeared to have externalised the responsibility to the disciplinary level of shortcoming, instead of an individual problem.

This shows how the narrative of ‘being a better expertise’ is conveyed as an individual relies on the institutional/disciplinary identitites.

I think (one) needs to know what ADHD is. Social work does not know [this], social

work would not know such in-depth, specific things, that actually SPLD requires this

educational tool, this tool goes for that […] you suppose that general social worker

does not know about this. Some social workers have great fitness [in practice], as their

studied Master’s programme covers SEN [topics]. On the service level, the NGO

wants to provide a service; from the business (perspective) this is a good passion

shown: “I would do it if [I] have money”. The (service) landscape then gradually

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changes while through development. [However] this is an area which clinical

psychologists cannot reach, as SEN education is not clinical psychology’s

orientation […] Where have all clinical psychologists gone? Hospitals, Hospital

Authority, [and] SWD absorb all the labour. (4, Q104)

Segregation also could be seen among sharings of social worker participants (2, 3, 5). While addressing their roles of ‘errands work/打雜’, they then added clinical psychologists’ ability to conduct ‘pure’ counselling. This suggests they may have internalised their inferior identities and positions than clinical psychology, given that ‘allowance’ to deliver pure counselling has been used by them to evaluate professionalism. Participant 3’s quotation revealed his negative self-impression as he stressed social work manager’s obligation to clean the toilet.

I see (social worker) as a name/title. [Social work] manager needs to clean the toilet.

However, this is also how people see social workers’ unprofessionalism, such as

clinical psychology. Their work is more single tasked or more focused. That is,

clinical psychologists would not clean a toilet, but social workers have to. Clinical

psychologists are not required to do our so-called resources allocation work. (3,

Q105)

Furthermore, criticisms were cast between social workers and teachers on their differential expertise in the school setting. For instance, participant 2 (social worker) showed her doubt about a teacher’s role in counselling, as such role was only on management and not the therapeutic level (see Q106). The used word ‘just’ in the phrase ‘rather just management work’ reflects the social worker participant’s implication that a teacher’s role cannot provide a sufficient counselling support, meaning ‘you are not a good expert’. On the other hand, student’s guidance teacher participant (1) noted her former teacher role’s superiority than a

150 social worker (see Q107). Her used phrase ‘school setting is different’ reflected the belief that a teacher’s counselling specialty in the school setting is a prestige. Aside from criticising social workers’ incapable adaptation to the school setting, and their staff’s high turnover rate, the quotation shows that the teacher participant has segregated herself (as an insider of the school) from social workers as the ‘outsiders’ (by referring to the local community as ‘the outside’ in the interview).

4.3.4. Securing the Existing Status quo

This trait ‘securing the existing status quo’ refers to the mindset or mentality of professions or individuals who tend to insert hierarchy to secure the hierarchical status quo. Counselling psychologist participant (in phase 2)’s given example reveals a picture that local clinical psychology profession’s hierarchy power has somehow been inserted to counselling psychology profession as it attempted to secure its historical legitimation (see Q94).

Counselling psychologists’ inferior position, named as ‘second-class psychologists’ by participant 14, is not just because of a problem of clinical expertise, but that clinical psychology has little room for an alternative development. In Q94, the traditionally approved scientific approaches (by clinical psychology) were used as an example to indicate clinical psychology’s refusal of other new suggestions raised outside the field.

Frankly, clinical psychologists would think that we counselling psychologist like a

second-class psychologist, like something not scientific. They would name us as

those who cannot handle challenging cases. The current Hong Kong clinical

psychologists, regardless which University training is provided, have a great

emphasis on CDP as a more scientific approach. If you use other approaches, some

in the field will criticise these approaches are not appropriate or qualified. (14; Q94)

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Furthermore, this section refers to inter-disciplinary rivalry not just due to the different theoretical or clinical training, but also the muddling pragmatic factors, including the number of secured job posts and institutional reputational impact. Participant 6, a non-locally trained psychologist’s narrative is in line with the above example regarding the rivalry between the two psychology professions. He described clinical psychologists believe that “I am a clinical psychologist; you are counselling psychologist, you are nothing.” as counselling psychology attempted to access authorisation to use neuropsychological assessments (also see section

4.3.6.3).

If comparing [between clinical and counselling psychology] like orange to apple,

you can see that counselling (psychologists) are better than clinical psychologists (in

counselling) due to their focus [in counselling]; clinical psychology focuses on

assessment. Counselling psychology wants to conduct the assessment, but only it

has no position [to do so] in Hong Kong. Those clinical psychologists do not want

counselling psychologists to take away their places. “I am a clinical psychologist;

you are counselling psychologist, you are nothing.” But hey, things are the same

from programme to programme, training to training. Then what’s the difference?

Nothing is better [from one to another]. It is just a different name. (6; Q112)

4.3.5. Deeper Training Developmental Disparity (phase 2 only)

I reckon training itself determines one’s [particular] perspective taking and the different

cutting points of a scenario. The struggle is not just about resources or disciplinary

territory (meaning territorial competition), but also such different ways of perspective

taking. (15; Q100)

This trait addresses issues caused by the diverse multi-national training backgrounds and philosophical underpinnings. Practitioners in Hong Kong own distinctive working styles and

152 priority of focuses. Participant 15 pointed out that individual difference in training goes to the deep level of thinking and mindset, as it involves perspective taking and judgment (see

Q100). This has appeared to cause problems in cross-disciplinary collaborations (as identified in section 3.4). An example is social work’s strong problem-solving focus under its adherence to guidelines like statistics (see Q101). This also corresponds to participant 17’s address of the problematic multi-disciplinary intervention and the struggle to resolve cross- disciplinary differences (17, Q49).

4.3.6. The Consequential Behaviour of Extending Territorial Segregation

Here I provide a summary of consequential behaviour or actions which could be conducted by professions or individuals as the different traits of the human nature problems have been triggered (sections 4.3.1. to 4.3.5.). The examples come from participant accounts, including cases directly named by participants, as well as the ‘unspoken’ thoughts or behaviour within the interview dialogues.

4.3.6.1.Identity Dissociation In the interviews, many participants, especially those with non-counselling training, were noticed to commonly separate from their counselling professional identities, as they discussed about the different problematic issues within or between disciplines. For instance, a social worker participant recognised counselling as a separate speciality, which could be shown in his phrase ‘It is actually strange, that social workers have done other people’s (work)’ (see

Q90). This somehow reflects his open (and somewhat doubtful) attitude that social workers have taken up such role due to historial legitimation. However, he made a conscious choice to identify himiself as a social worker. In the lines (Q90), he addressed a counsellor’s disadvantaged position to gain a career role in most organisations. Then by justifying social work’s ‘somewhat’ level of professionalism, he also justified his distancing from a counsellor role and the preference to be a social worker. I point out that his reference to social work’s

153 professionalism did not indicate professionalism in counselling, rather the historical disciplinary reputation. However, this also implies how an individual’s shaping thought and behaviour could potentially lead to justification of a profession’s dominance in the public services to prolong. I suggest that participant 3’s narrative is an example to indicate how a practitioner became compliant to the unequal inter-disciplinary hierarchy (and extending territorial segregation).

The most professional Fu-do conductor perhaps really would be a clinical

psychologist; Educational psychology is not Fu-do. Then the next level is probably

social work, and Fu-do worker would possibly be the most unprofessional ones. But

actually, their training is professional. If heard about Fu-do worker, social workers

say, “Oh, help people ma, it’s the chatting ah!” It is actually strange, that social

workers have done other people’s (work), or Hong Kong is led by social work, to

create a social welfare service led city […] if you study counselling, you cannot be

qualified in many positions. “I am a counsellor can I (work) in the organisation?”

Sorry, organisations only employ social workers, if not (one) goes to the lower

supportive levelled work. Social workers are not on the too-bad professional level.

Such a strange thing has occurred [here], although that counselling itself is a very

professional thing. Therefore I would say I am a social worker. (3; Q90)

4.3.6.2.No Sharing Culture This section appears to link with some particular problematic human nature traits (for instance, 4.3.4. Securing the Existing Status Quo). No sharing indicates behaviour or an action as the discipline or an individual enacts to show it is not open to sharing its expertise or the existing status quo, such that other alternative development does not occur. In the interviews, participants commonly addressed such behaviour refers to the pioneers/establisher creating separateness from the other professions. For instance, a clinical psychologist

154 participant disclosed that clinical psychology has historically dominated the University level of educational counselling setting, and the latterly developed professions would be obligated to look independently for gaps/holes for an alternative growth. He used the term ‘territory’ to describe the University counselling setting, which indicates his awareness of cross- disciplinary rivalry and separateness. This means that sharing behaviour is not simply a direct behaviour being acted to create separateness, but nothing is being done (for instance, by remaining a closed dorr to the other incomers) is also a behaviour. Again this behaviour may be an explanation how counselling meaning is heavily institutionalised, as the service is dictated by which political or organisational power takes place.

University counselling centre specialist(s) should be (counsellors), but due to

historical factors, the decision makers are mostly clinical psychologists as they firstly

dominated the territory. Therefore the most significant potential development actually

is […] I think they would be outside the big eight Universities […] IVE is actually a

very very big educational provider. You can assume only 2,000 out of 10,000

(secondary) graduates enter the Universities, but at least 50% if not 70% (of the

secondary graduates) enter IVE. There are not many psychologists in IVE, the

decision makers are counsellor […] they really do counselling […] I think they have

somehow survived within the gap in Hong Kong, also because they have much

money. (4, Q91)

Another example, described as the longstanding unspoken injustice by a counselling psychologist participant, is that non-registered clinical and educational psychologists could not have authorised access and administration of the American Intelligence assessment tool

IQ testing (see appendix 7, 14, Q136 for a reported particular case by a counselling psychologist). In other words, an assessment tool has been an exclusive product and psychological service by the clinical/education psychology disciplines. Aside from the debate

155 of discrepant clinical expertise (counselling psychologists are not qualified or competent enough to conduct assessment), one could argue that such a non-sharing culture is a form of rejection from the legitimised professions (clinical/educational psychology) against the newer and inferior profession, and hence the further segregation. In this case, the no sharing behaviour means that the legitimised professions externalised responsibility to other parties by acting the gesture of ‘I don’t know how to deal with it’. Therefore, this creates ambiguity in communication as one may struggle to pinpoint at a particular party to address the issue.

This was how communication became lost and the process of the action became stalled, and then the issue could be easily put aside with time. However, it is clear that the legitimised professions are part of establishing the authorisation regulations and boundaries. Such responsibility transference is interpreted as the professions’ rejection to allow any constructive cross-disciplinary dialogue or any change to occur, and its reluctance to take up responsibility for its role which has created historical legitimation. I note that such action was not just enacted by a sole professional body (either clinical psychology or American

Intelligence assessment institute), but the intertwined institutional powers, hence the further complication of putting a finger at the responsible party. I recognise that this narrative is contributed by a single subjective viewpoint, and a wholesome picture is required to investigate this this matter (which will involve all parties). This example again brings up the concerning loophole that no public and independent regulatory system (4.2.1. the absent power) is in place to monitor and ensure ethical practice by an individual or a discipline takes place.

4.3.6.3. Re-asserting the Own Expertise This behaviour shows the legitimised party’s highlight of the own expertise as a justification of its separateness. Again clinical psychology’s separateness from counselling psychology was used as an example as it has been repeatedly raised by different participants. A clinical

156 psychologist perspective can shed light on how the profession or its members enacted superiority to reassert the profession’s expertise, in other words, its institutional power. From

Q109, the clinical psychologist participant shifted from using ‘they’ to ‘you’ position in the initial line simulated his direct dialogue with counselling psychology or counselling psychologists. He repeatedly listed the different criteria for one to professionally conduct an assessment, followed by the critic that counselling psychology did not meet such requirements. Although those named criteria were factual learning factors or processes of a trainee, I argue that the underlying attitude reflects the human nature trait that ‘my field has the better expertise’ (4.3.3.), and that the IQ assessment has been postulated (at least in this dialogue) to an impossible competence for non-clinical psychologists to achieve, instead of realistically reflecting its actual requirement. In reality, the orchestrating factor of one’s expertise stems from institutional arrangement, which was briefly stated by the participant that there is lacking capacity or opportunities for counselling psychologist trainees to take part [in taking up the role]. Either the counselling or clinical psychologist’s competence is more than just an individual quality, but a result of whether its belonging profession has the historically established legitimation on conducting assessment or providing such platform to do so, such that the psychologist trainee could have such a learning platform to develop.

However, this aspect appeared to be overlooked compared with the repeated statements of expectation in the narrative - ‘You have to do (this)’. From this case, the question of who conducts the assessment is not factually based on the actual competence criteria, but who has the better expertise to do so.

I know they (counselling psychology) teach psychological assessment, but the

experts would criticise you, and say “aren’t you focusing more in counselling? Who

teaches you? (Are you) qualified?” It is normal to ask these questions. Your IQ

(assessment) training is not about answering the 11 tests, [it is] not just about

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calculation. (You) have to read (client) profile; (you) have to accumulate cases (case

experiences). Then how can you accumulate cases in Hong Kong? You have to return

to the supervision site. If about supervision, we are then talking about Department of

Health child assessment with roughly a few hundreds of cases per year. In your

position, you may see not hundreds (of cases), perhaps 50. You learn that this is how

a case unfolds, this is ADHD, delay, speech problems and such profile. Then this is

how you have mastered this set of techniques, meaning you know how to calculate

IQ (assessment) and differentiate social index. The disadvantage of counselling

psychology is its ambiguity, (and) I think nobody would release/open up space for

(the assessment conducting authorisation). Therefore you may say in theory

(counselling psychologists) can do it, because you are a psychologist. You know

about psychometric properties, test administration. (This is) not a matter of skills;

instead, whether your placement itself includes sufficient profiling, and whether you

can incorporate it to the issues. Therefore it is hard to set the orientation for

counselling psychology [in the assessment area]. (4, Q109)

On the other hand, the cross-disciplinary tension between counselling and counselling psychology indicates that counselling psychology is not the sole recipient of cross- disciplinary segregation. Counselling psychology also extends territorial segregation by highlighting counselling profession’s lack of scientific base, and reinstating counselling psychology’s adherence to scientific practitioner model or scientific oriented research/practice (see Q110). In other words, scientific oriented research/practice represents the meaning of superiority in the relationship between counselling psychology and counselling professions. Q110 shows how a counselling psychologist participant has positioned counselling psychology in a way which segregated the profession from counselling, by stating both professions ‘should go separate professional paths’. The words

158 used ‘allow fusion of everyone’s professionalism’, as well as the directly negative attitude that both professions are regarded the same field or same setting reflect the counselling psychologist participant’s negative perception of its counselling psychology expertise being mixed with counselling’s, and also reflects his perception of being the superior party.

For counsellor, I think if looking from counselling psychology position, [one] should

look at them (counselling and counselling psychology) separately, and they should go

separate professional paths. However, we are dissatisfied by the governmental

feedback, which is that it so far regards counsellor and counselling psychologist as

from the same field and same setting. What is the problem? What problem would be

generated? In the future, first, the existing counsellors would ask for a counselling

psychologist title. However, it is true that counselling psychologists and counsellor

have different training, for instance, counsellor’s academic work does not include

our research requirement. Then is it the best thing provided to the public, if we allow

fusion of everyone’s professionalism? (14, Q110)

It is noted that shortly after the superior comparison with counsellors, participant 14’s identity was then shifted to the inferior positioning as he/counselling psychology was compared with clinical psychology (see Q111). This implies the fluidity of institutional counselling’s hierarchical state. Counselling psychology illustrates a profession’s complex superior and inferior identities in the face of the different neighbouring professions.

Theme 5. Towards the Future: Remaining Discrepant Voices This section signifies my emphasis of drawing participants’ attention to change and action in the interviews. I clarify that not all participants contributed to discussing (or at least in length) regarding this perspective. This section therefore does not just consist of summaries of the actual discussions, but also I made a conscious effort to conceptualising their revealed views, thoughts or behaviour as they appear in this context of change and action.

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Views on the future of Hong Kong counselling were mixed. The relatively optimistic views

(participants 1, 4, 5, 7, 10) commonly addressed the need to increase counselling and public receptiveness or reduce mental health stigma, for instance Q113 and Q114. Such views are derived from participants’ longstanding and still developing counselling work on empowerment and personal growth (a kind of preventive intervention), hence their belief in change which occurs from spiritual growth and more self-understanding (see Q113).

Actually I think the prospect is quite good, which is relatively (I think) optimistic […]

Therefore actually there are many (people) who have spiritual growth and more self-

understanding via Fu-do and personal growth […] so in the recent 10 years (people)

have slowly started to talk about these topics in Hong Kong. It means that more

people get to learn and understand this area, and so [become receptive] to seek for Fu-

do […] they would not see it as an illness. [This] is a good conceptual change. (10,

Q113)

I think Hong Kong people’s knowledge standard has been increasing. They would

have a mindset to slowly downplay the Chinese culture, meaning they would seek Fu-

do, look for people to chat. (5, Q114)

It was found that different participant views in the interviews have simulated a cross- disciplinary dialogue as they commonly addressed some certain common issues, which to certain extent becomes a form of social action. Clinical psychologist accounts can be used as a direct response to criticisms on clinical psychology’s restrictive clinical/pathological focuses. As seen in the quotations, clinical psychologist participants’ positive attitudes are consistently shown with their actions and initiative to act as a more active communication role. Examples included a self-initiated multi-disciplinary early intervention project on

160 exploring students’ anxiety level as an indicator of their depression and suicidal tendency.

Another example is the participant’s public engagement work to enhance public awareness,

I am positive, [that] the society should change for better […] these years we are test

running a model, (so that) clinical psychology could move forward [to become more

proactive in preventive intervention]. Our model has three parties, NGO, clinical

psychologists and an academic psychologist. (4; Q115)

Actually [we] make an effort to enhance public awareness. I provide [voluntary]

support in the [professional psychological] association, for instance making leaflet, or

people would post on Facebook. [We] would inform organisations what makes a

qualified clinical psychologist. (17; Q116)

On the other hand, negative views mainly (participant 3, 9, 11) cast doubt on the commitment to change. From the lines of Q117, participant view showed his remained doubt at the problematic institutional nature of counselling (such as the hierarchical system and practitioners as the expert).

The below sub-themes deconstruct participants’ viewpoints and attitudes regarding the current challenges (5.1.), which include the current cross-disciplinary dynamics as well as the wider relations between Hong Kong and the Mainland professions. Another focus is their interpretations of change and action (5.2.), which are divided into different levels of small alterations, different reforms which relate to structural changes, as well as the unchanged stances (5.3).

5.1. Addressing the Current Challenges When linking with change and action, many participants mostly drew to or related back to the existing challenges. They addressed such problems by externalising them to the wider macro-

161 levelled dynamics. Furthermore, they also incorporated the wider socio-political dynamics with the Mainland China.

5.1.1. Problem Externalisation Participants commonly related to the wider institutional level of dynamics when addressing their faced problems, and thus the direction to a solution would also be dependent on such

‘higher’ level of intervention, in particularly the government. I use private practice as an example. While asked about the issue of private practice’s accessibility to the wider public, private practitioner participant’s attention quickly shifted from looking at individual responsibility of not including clients from the lower class backgrounds, to being dependent on the external scale of decision making, as she pointed out the need for more funding and more acts of good intentions. From the spoken lines, I suggest that the used subject noun

‘they’ by the private practitioner indicated her distancing from the group while she was one of them.

Yes, it is difficult, as they (private practitioners) would not be worried about not

having clients. [They would say,] “why would I have to serve you the lower class!”

Therefore the government would take care [of this need] instead. So everyone’s

service target groups would be different, which is great. Services cannot be for only

one target group. I think resources allocation can be decentralised: those who can

afford more could be allocated to a particular service […] people with the good

intention can donate money to the private organisations to set up funding. For some

target groups with significant needs, such funding can support their payment. Then

private practice could help the lower class. However, this really requires such

hardware. (9, Q118)

Externalisation of the problem was particularly apparent when I further clarified on the discrepant quality of counselling services between private and charitable services. Private

162 practitioner participant turned to point at Hong Kong city as a non-socialist system compared with the Western countries, hence the limited scope for change (see Q119). This again indicates that the problem has been externalised to Hong Kong city’s economic system.

Participant reiterated such societal level of concern by naming Australia’s ‘socialist’ practice

(though the country does not practice socialism, rather practices free market economy with a partial welfare state). Aside the factual accuracy issue, I focus on the assumption made, that generalisation of private practice only works in a socialist system which emphasises equal resources allocation or access to support. I highlight this interpretation derives from purely challenging the externalisation behaviour, but gently point out there is no consideration of the impact of individual practice. Although this narrative may advocate an independent practitioner’s limited individual capacity, I also indicate that at the point of the interview, the participant may not have demonstrated some scope of extending individual reflection to the self. This could indicate the individual’s helpless or paralysed state as in face of the complex macro-levelled dynamics. While there is no change in the system, there is no change for the self either.

5.1.2. Relating to Mainland China

Some participants began to draw to the existing Hong Kong and Mainland China’s relationship when addressing change and action. Some concerns were related to the current tension between Hong Kong and Mainland China. For instance, participant 9 showed her worries over the city’s integration with China, which could be viewed as an act of segregation of the self or Hong Kong city from the Mainland. This was particularly evident as she praised

Hong Kong’s sufficient resources and learning by using the word ‘blessed land’ (Hong

Kong), and argued that the unified Hong Kong system was not to be affected by ‘the significant other’ (see Q120). The words ‘not to be affected’, I highlight here may indicate the underlying feelings of being threatened, or alarmed by the ‘terriory being intruded’. At

163 this point of discussing the dynamics across the border, it could be seen that the participant’s view of Hong Kong counselling became unified again in the face of the ‘bigger’ others. The act of segregation between Hong Kong and the Mainland counselling practices was similar to the behaviour described in the cross-disciplinary segregation (theme four).

Actually, Hong Kong is a blessed land. The meaning of the blessed land is that (it has)

strong Fu-do theory, as many theory masters would come to Hong Kong to provide

training. Hong Kong can connect with many new spiritual/Fu-do theories. I think that

Hong Kong, compared with Mainland China, has much more access to psychological

theories. At the stage of returning to China, I think we would continue our

development, but it is hard to say about the future. The Mainland China, whether they

would have policy changes, or those practitioners set up private practice in Hong

Kong […] Therefore our local social workers, Fu-do workers all have noted the desire

to set up (our) association, therapy licence, (and) hope that Hong Kong has its

professional regulation and quality, and so our professional level and position would

not be easily affected by the Mainland’s psychological consultants. I notice that they

(Hong Kong practitioners) have this preparation, so an association called Family and

Marriage Therapy association was established last year. (9, Q120)

Regarding the situation in the Mainland China, two additional interviews were conducted with two professionals in a non-governmental organisation in the Mainland, in which participant 12 is a local front-line practitioner, and participant 13 is the head of the organisation. Their views shed light on the current development of psychological consultation

(the adopted terminology in Mainland China). From participant 12’s perspective, psychological therapy was in the similar two streams in Hong Kong, as most public services were run under NGOs (mainly led by social workers). The services face similar struggles of resources constraint, and practitioners had limited capacity to deliver the actual consultation

164 services. Even though qualified as a ‘psychological consultant’, participant 12 had minimal practical experience, and he described his job role as no different from a social worker in his work setting. For participant 13, psychological consultation was a functional element of her expansion of services, and she was keen to extend ‘psychological consultation’ for the particular public needs. However, owing to the current lack of guarantees of a professional standard, participant 13 highlighted her policymaker role, claiming that ‘professional expertise’ was not her responsibility/jurisdiction. The two narratives show the significant discrepancy between policy-making and professional standards holding within a psychological consultation practice. Although participants’ claimed training or policy in place, the actual counselling service being applied into the context does not fully match with such the formal structure.

5.2.Towards Changes and Action 5.2.1. Small Alterations

Some participants’ views fall into the level of making small alterations in the existing systems. Participant 6 argued that his small acts are due to the current complex entangled state between the disciplines, which again reflect individual feeling of helplessness when facing the macro-levelled dynamics. However, he noted one ought to ‘swim with the current’, meaning flexibility is required first as one fits with the system, before any small change can take place. There appears to be consideration of the long term development when thinking about change, as participant 6 hinted on the small change could facilitate the less tension or competition or prevent abrupt defence.

Actually, it requires top-down progressive change. [This in fact] involves many

entanglements [meaning conflicts of interests]. [Therefore, we] swim with the current

[as we] use the existing system, but with slight alterations such that people would not

use the competition lens at this [change]. (6, Q121)

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Small alteration approach mainly came from those with counselling backgrounds and views were centralised around improvising the educational programme. A teaching fellow and programme developer participant turned to self-reflection on her professional role. As seen in

Q122, she pondered on maximising the impact of her role by strengthening evaluation and assessment on other teaching professionals’ performance. Her views corresponded to her earlier description of herself as a gate-keeper of the teaching programme’s quality guarantee, and this alteration suggestion constructively responded to the raised limitation of such role

(theme 4.1.2).

I repeatedly reflect there, what do they need? Ha! Can my provided programme meet

their requirement? Ha, it is because, many subjects are not (directly) taught by myself,

and so I would also have to [think of] how to teach [the other] teachers. (18; Q122)

Another teaching fellow participant emphasised theorisation or philosophical underpinnings of ‘change’. She emphasised that one’s mindset to ‘change’ should be amended to ‘growth’, as change implies a development with different directions including reversing to the original state, whereas growth is a positive natural direction (see Q123). It is noted that such view shown was a response to my direct question of ‘what needs to be changed and done?’ in the interview, specifically at cross-institutional segregation and marginalisation. She reiterated her answer on personal growth (Q124) when I repeated the question on addressing cross- institutional segregation and marginalisation (see Chapter Four: personal reflectivity).

If you highlight that [growth], then they would naturally grow. [Including] industries

and professions. Yes, if you do not stress this, [but on] only qualifications, what

license, school, this goes another way [/astray] […] (it is about) in overall not

focusing merely on qualifications, meaning the so-called reputation or other things.

(16; Q124)

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On the service level, some participants (2, 7) stated that collaborative/multi-disciplinary intervention would remain as a significant approach in the future (see Q125). However, there was no mention regarding the current cross-disciplinary discontent.

Especially many different services talk about collaboration nowadays in Hong Kong,

even about working with non-Fu-do organisations. For instance, there is a scheme

which involves Hospital Authority, Doctors, psychiatrists, nurses, paediatricians, staff

from the Department of Health, social workers from integrative family services.

Others include rehabilitation services, young mothers. [We] then work collaboratively

to handle highly complex and risky families. (2, Q125)

5.2.2. Structural reform

Structural reform refers to changes and actions described by particopants which could lead to institutional level of reforms. I summarise those described changes and actions into different levels, including individual level of reform, reform in the discipline(s), reform in the academia and reform regarding accreditation and regulation.

5.2.2.1.Individual Reform I suggest that the individual level of reform as illustrated by the participants is personal reflexivity. It was demonstrated by a clinical psychologist participant who put forward the constructive implications for future development of the self and the discipline. She addressed clinical psychology’s limited scope and devotion to promoting inter-disciplinary cooperation.

Her critical engagement reflects her understanding of the underlying reasons, multi- perspective taking by including non-clinical psychology’s perceptions, before channelling with future planning.

[I] have to coordinate with other different systems for cooperation. I would say this

is a weak point for the whole clinical psychology field. Most people from the other

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professions would think that clinical psychologists work behind closed doors. Clinical

psychologists rarely enter schools or accompany clients to the hospital follow-up

appointments. I think these are also essential tasks, and collaboration is needed such

that [we can] handle [the problem] at once. (17, Q108)

5.2.2.2.Disciplinary Reform Counselling psychologist participants showed proactive attitudes on change and action in the field. They pointed the direction towards bypassing the current inter-disciplinary competition, to exploring new services (see appendix 7, 14, Q135 for a particular counselling psychology narrative). A participant highlighted that by clarifying each discipline’s separate functions and strengths, no one needs to ‘fight for the rice bowl/搶飯碗’. His view reflected his expectation of an idealistic equal state among all professions and the sufficient space for different development, also in his words, ‘No one needs to compete’ (see Q126). His view of

‘counselling psychology not to forcefully interfere with the existing work’ came directly from his previous negative and failing experiences as he struggled to challenge against injustice

(see appendix 7 for a particular example, 14, Q136). Accordingly he then turned towards the disciplinary level of reform in counselling psychology by developing in school preventive intervention and establishing new working relationships with some local charities (see appendix 7, 14, Q134 for a reported particular case).

Actually, I think our industries are diverse with the respective strengths and

weaknesses. I think if devoted to the society and community, no one needs to

compete, [instead] seek for the own survival space, and the role which can allow our

[specific service to be provided] to the public. (14; Q126)

Furthermore, counselling psychologist participants suggested a unified structural reform between counselling and counselling psychology professional qualification systems (by

168 referencing Australian counselling professional accreditation system and employment guidelines), which goes side-by-side with enhancing public information (schools),

About organisation recognition, I think these guidelines (The registration system guided

employment criteria) should be disseminated to the educational institutes first. It is

because they are the existing biggest customer of the counselling industry […] and so I

think [counselling psychology development] can begin from this area and then expand to

some NGOs, and other social welfare organisations. (14, Q127)

Furthermore, there is lacking emphasis on structural reform by the other disciplines. Noting counselling psychology sits within am ambiguous professional position, a question is brought forward that big structural level of changes often occur among the ‘minority’ or the marginalised ones so as to create significant advancement, whereas the majority or those already holding power often ‘claim’ or argue little can be changed.

5.2.2.3.Academic Reform Aside a clinical psychologist participant (17) who has noted the need for clinical psychology qualification to be upgraded to the PhD level, no other participant has provided any view regarding reform in the academia.

5.2.2.4.Accreditation and Regulation Reform Most of the participants have criticised the absent counselling accreditation and regulatory systems in Hong Kong. Some have named the need for such systems to be established to serve functionality of ethic or professional practice monitoring (see Q128). However, little has been provided by participants regarding the more elaborate description of the procedures, except participant 17 who expressed the own preference that separate legislation of each discipline would to be done before cross-disciplinary dialogue was to occur regarding ‘fu-do’ provision (see Q129). This attitude could arguably relate to the suggested human nature traits

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‘4.3.1 to 4.3.5’, meaning that the tendency for one/a discipline to undergo the localised development is an act of segregation.

I think that regulation or legislation aspect should be done separately by each

speciality, for instance, regulation of qualifications of CP [/clinical psychologists],

speech therapist. […] I think the matter of which speciality provides Fu-do would be

the next step. (17, Q129)

5.2.3. The Remain Unchanged Voices

I don’t know. I always have and will walk this way. To me it has never been changed, [it]

has been about training one’s heart [/inner-self]. (16; Q130)

It appears that participants’ doubt and uncertainty were the significant contributing factors to their restricted actions within the own discipline or territory. For instance, some participants

(7, 18) stated the government’s lacking recognition in counselling, and then reinstated their remained focus on their own work. In Q131, participant 18 used the word ‘rather’ which more or less reflected her pessimistic attitude on Hong Kong counselling in the future.

Drawing to her lines ‘hope that they (other professionals in the industry) could, I mean because there are currently many colleagues who persistently discuss with the government…’, I suggest the root of her uncertainty could also be attributed to her awareness of other people’s existing involvement in structural reform, hence the gesture of externalising the responsibility (‘this thing is not for me to be responsible for’), and the lacking incentive to initiate reform by the self.

I would rather properly attend to my students, that professional or personal growth

[…] perhaps I would focus more on conveying my expectations […] [I] hope that

they (other professionals in the industry) could, I mean because there are currently

many colleagues who persistently discuss with the government (on licensing).

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However, this thing is not for me to be responsible for. I would only be cautiously

optimistic (about it). (18, Q131)

A similar attitude was also conveyed by a counselling psychologist participant despite the simultaneous proactive stance regarding structural change and actions (5.2.2.2.). The below quotation showed his concern of mistakes in counselling psychology being spotted (Q132).

This reflects the participant’s belief that counselling psychology continued to be negatively perceived and judged by the others. This means that from participant’s perspective, some covert discontent across disciplines prolonged. It could be common practice in Hong Kong as professions tend to watch over and monitor each other’s professional conduct or work in general, particularly when there is no formal regulatory system in place. However, such

‘unofficial’ monitoring role appeared to have a suppressing or silencing power on the monitored profession. This means the monitoring influence turned out to be a non- constructive influence on a profession’s development. Furthermore, there is a contrast between participant 14’s proactive attitude, and his defence against mistakes being spotted

(hence the protective response to just do the ‘right’ thing). This reflects the complex dynamics of narrative on navigating different forms of changes and action.

However, if you say what you can actually do in person, (it’s a cliché but) it is about

doing our own jobs, fulfilling our responsibilities. In particular, we have a very clear

goal for each other when providing (service), [which] is about everyone doing the

own best not to step out of line. Indeed really! It is because there are so many people

watching what we are doing. Many people would spot our mistakes! (Like) some

unethical conduct! This actually really affects our overall profession. (14, Q132)

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Chapter 6. Discussion

This thesis has attempted to offer an alternative conceptual and empirical basis for understanding counselling. By using Hong Kong as a postcolonial case study, I indicate that counselling in Hong Kong is not a one-way recipient of Western ideas and customs. Quite simply, indigenous counselling constructions hold the promise of identifying alternative normative frameworks that could allow Hong Kong counselling to project its unified and independent identity notwithstanding a structured, hierarchical and segregated society.

This thesis has provided a new angle to the literature by empirically explicating the socio- political perspectives of counselling. Not only is it one of the first attempts to interrogate the institutional nature of counselling meanings in Hong Kong, but also in the overall counselling psychology, counselling and psychology literature. Due to Hong Kong counselling’s absent regulatory structure, a range of professions have historically developed different forms of

‘Fu-do’, counselling or psychological services. This thesis clearly addresses this matter by including such range of professionals, such that a fuller explanation of counselling can be provided. Findings critically inform a macro-societal level of conceptual understanding, but I argue this is how the interplay of inter-institutional hierarchy and segregation in the healthcare field can be unfolded. In this section, I further explicate how such interplay impacts on the overall public awareness on counselling in Hong Kong. First, I look at some methodological reflections on the systemic levels of conceptual understanding. I recapitulate the current thesis’ systematic and indigenous framework adoption has been able to clarify the institutional nature of counselling and psychology. Second, I continue to engage with the socio-political agenda of counselling in Hong Kong by relating to the findings, which are summarised into different sections, including implications to the theoretical knowledge forms

(Counselling is institutionalised; 6.2), knowledge contribution to postcolonial studies (6.3.),

172 and these findings then inform critical pedagogy of counselling, psychology and counselling psychology (6.4.).

6.1. Methodological Considerations

This thesis has the methodological advantage to interrogate with the socio-political dynamics of Hong Kong counselling. Such systemic enquiry has reinforced a holistic conceptualisation, as it represents the multi-levelled and multi-perspective meanings of Hong Kong counselling.

The methodology adopted here also deviated from merely exploring patterns of individual narratives that belong to a single part of a system. Instead, subjective accounts were seen to act as interconnecting points. These points helped reconstruct patterns of behaviour which belonged to a collection of the interdependent parts. I address that this thesis has a discernible bias of only recruiting counselling professionals as first-person narratives. Such bias was made after I considered the current poor public awareness. The analysis (Chapter 5) showed practitioner participants, on the one hand, held a fixated belief that the public’s resistance against counselling was due to cultural stigma. On the other hand, when analysing the interview dialogue as a whole, participants’ critical views of pro-social justice values were somewhat reflected, even they did not state their understanding of them. They were aware that clients’ vulnerability was a result of the intersecting socio-cultural-political external factors (2.1 in Chapter 4: Analysis). Such findings (that stigma is a complex concept) correspond to my arguments made in the literature review (2.2.2: What is Exactly Stigma against Counselling?). Another interesting point is that participants’ critical views mostly occurred when they discussed their direct work experiences (instead of from theoretical learning). I will later reconnect with this by putting forward a critical pedagogy of counselling and psychology, in particular on personal reflexivity (6.4.).

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By claiming this research’s social action purpose, I have attempted to explicate methodology which directs to re-politication movement among the interviees. Therefore, knowledge forms produced by this thesis are socially and politically informed. I suggest that such research approach has facilitated my advocating role to critically challenge the current institutional status quo. For instance, the complex concept of the public’s resistance against counselling, or what is claimed as a cultural stigma, is able to reflect layman/the public which has been positioned as ‘outsiders’ of the structural systems. Participants criticised how most of the existing counselling developments/movements mostly occur within institutions, that is, institutionalisation of counselling. I question whether the public can, or even have ever been able to infiltrate institutional systems to become part of the societal process in which counselling is developed, evaluated and reshaped. The challenge here is that public awareness and engagement are still low in Hong Kong, and they need to be enhanced and promoted.

Some research may have attempted to address this by stressing the importance of advocating public engagement with the overall counselling development (Kaplan & Gladding, 2011;

Macleod, McMullen, Teague-Palmieri & Veach, 2016). However, my focus in this thesis is on the roles of professions and practitioners. The third level of counselling meaning

(practitioners’ complex roles) reflects practitioners’ collective identities, as they mediate knowledge, social context and structural levels in order to market themselves in service delivery. In reality, gaps and miscommunication between professions have been identified. I further argue that transformative change for public resistance, or what has so far been revealed, should begin with transformative change from both the ‘internal’ and ‘external’. A holistic picture of counselling includes both the public/client and professional perspectives.

From the perspective that public awareness is constituted through enhancing public transparency, I further assert that more work should also begin from within the professional system (Macleod, McMullen, Teague-Palmieri & Veach, 2016; Myers et al., 2002; Reiner,

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Dobmeier & Hernández, 2013). In short, the methodological implication here is that researchers should carefully attend to the ongoing wider contextual influences as they develop methodological framework, including pragmatic issues of participant selection.

As spoken, the thesis has a particular focus to articulate ways to draw counselling close to re- politicisation. Therefore, methodological development more or less requires consideration whether this research design has richly reflected an accurate account of institutional dynamics. Here I draw the attention to guidelines and implications for the similar research which aims to look at politics, the socially sensitive or the unspoken. In the interviews, most participants showed some awareness of the structural politics, yet their disclosure levels varied. Some actively commented on and related themselves to the current disharmony and conflicts. Most protagonists were men. This observation on the relationship between gender and political disclosure, however, could possibly be just a non sequitur. Aside from gender differences, I also suggest collectivism could also have perhaps inhibited subjective articulation. Despite China’s tremendous economic growth and the increasing individualistic identity association, the country retains a self-representation as collectivistic. Analytical findings of this thesis are in line with the argument that Hong Kong overlaps with Mainland

China in its subscription to Chinese traditional values and beliefs, including public disclosure.

Therefore, one could also argue that participants inhibited their disclosure in an unfamiliar interview setting; in particular since discussing political agendas is a socially sensitive area.

Furthermore, from a collectivistic perspective, there could be expectations to give up the individualistic pursuit for the requirements of the collective (Hutchings & Weir, 2006).

Therefore, participants in portraying themselves as representatives of the Chinese culture could exhibit a mixed form of the individualistic and collectivistic selves. This could be seen to indicate significant implications for the methodological design as well as theoretical understanding on exploring structural conditions of and for counselling. How do one’s

175 complex individualistic and collectivistic identities impact on the own perception and situatedness in the structural context? How do the evolving mixed narratives inform structural counselling meanings and its development? I note the current thesis’ limiting role only to put forward a hypothetical relationship between the level of political disclosure and socio- cultural hybridity. I note this as indicating a stimulating platform for future research, in particular for developing, creating and using more innovative methodologies. I return to implications of the introductory chapter, in which I critically addressed counselling studies in

Hong Kong. One exemplary approach is democratic research practices, a critical broad methodological umbrella developed among a few sexuality researchers within the East Asian region (e.g., Berry, 2013; Brannelly & Edwards, 2017; Huang & Fang, 2016; Jackson & Ho,

2018; Jackson, Ho & Na, 2017; Kong & Hooper, 2017). Such developments emerged as a critical response to the unbalanced research output between the East and the West and asymmetrical dynamics within the East. I see that counselling research and other applications can learn from this innovation and creativity. I will further engage with this area in the upcoming section, critical pedagogy of research areas (6.4.2.). In the upcoming sections, I put forward the theoretical implication on the impact of institutionalisation in Hong Kong counselling. This connects with the next section as I draw on colonial literature to propose that counselling is inherently politicised.

6.2. Counselling is institutionalised.

In the analysis, institutional counselling appears as the bottom and leading layer as counselling graduates across four levels of meaning. The institutionalisation of counselling in

Hong Kong is the orchestrating factor of the relationships between organisations which are contradictory together and separated. Such a status quo is more than pre-determined factual knowledge. To address this, I make clear of the underlying reasons for inter-institutional

176 segregation. Multiple forces maintain the inter-disciplinary hierarchy of Hong Kong counselling. The current analysis has shown a cross-disciplinary hierarchy which is consistent with the hierarchical structure proposed in Leung et al. (2009)’s theoretical critique. First, I restate the theoretical advantage of adopting qualitative methodology as a critical enquiry. A person’s narrative does not just reflect the own subjectivity of the perceived reality, but also part of the systemic dynamics and interplay which continue to undergo construction and reconstruction. Therefore, the constructed onion-like conceptual understanding of institutionalisation would clearly elicit processes and relations of territorial segregation. I draw a parallel between practitioners’ self-representations and their professions’ position as they appear in the complex inter-disciplinary hierarchy. In light of the sublevel ‘localised power transformations’, power leads and reinforces inter-disciplinary segregation. Where does the power stem from? In the case of Hong Kong counselling, I propose that a few conditions had to have occurred for the existing power relations to take the shape they have: firstly, the original power (the government) was lacking or insufficient. Then, localised structural power was set up as an alternative (condition two). Thirdly, a prolonged development occurred, in which multiple professions became involved at different times for a cross-disciplinary hierarchy to be established (condition four). Henceforth, alternative power became more than a substitute, as the derived localised power grows in parallel with the extended historical legacy, for instance, the increasing membership of social workers or social or international status of the profession. The two alternative legitimation forms are thus a product, not the cause of the hierarchy. I suggest that my proposed ‘conditions of power’, as stated above, may offer a useful conceptual framework to look at localised power and its formation.

I give emphasis to the sub-theme, ‘human nature’ as a contextually constructed concept of

Hong Kong institutional counselling. Accounts of different bad practices of human nature

177 reflected participants’ moral stances as they articulated cross-institutional segregation and hierarchy. Here human nature refers to the integrated concept of Chinese morality (Liu, 1993;

2017b). It emphasises a person’s purpose of living based on the own pursuit of ‘good’ conduct. Chinese moral philosophy’s prominence can be shown in China’s historical development, as ‘moral character and values’ were claimed to impact on individual behaviour as well as a nation’s rise and decline (You, Rud & Hu, 2018). Morality’s prominence has long been ingrained within all socio-cultural developments (You, Rud & Hu, 2018), ranging from the everyday practice of traditions, the way of living/lifestyle, social norm, to the structural monitoring including philosophy, education, and political agenda, etc. For instance, traditional Chinese philosophies and ancient education were both described by scholars as morally focused (Cui, 1999; Deng & Yin, 2015; Wang, 1996), for instance, knowledge and knowledge production of Confucianism prioritise on the higher goodness and developing a person’s ethical and moral self (Hwang, 2012). In other words, an individual’s holistic way of living can be attributed to morality’s integrating role as it penetrates all areas, meaning that human nature can be a common concept raised in different situations, relations and time.

Despite claims that Westernisation has greatly influenced modern China, traditional moral values remain prevalent in most Chinese individuals’ lives (Lai, 2006).

I argue that participants’ moral judgment of goodness and misbehaviour reflects that morality/human nature is placed as the fundamental block of individual practices and systematic operations. The current thesis deviates from underpinning relations between

Chinese morality and social/psychological practice, and more research in moral philosophy is needed to look at counselling and morality/ethics. I rather reiterate the importance of using moral stance as ethical advocacy of negatives of institutionalisation (see Prilleltensky, 1997).

Chinese moral philosophy (Liu, 2014) can shed light on guidelines of critical consciousness as one investigates power orchestration in institutionalised counselling. Here I should point

178 out that the implications of Chinese morality are not culturally exclusive, but overlap with

Western moral philosophies (Rachels, 1993), including psycho-physical unity (Hickman and

Alexander, 1998; Merleau-Ponty, 1996; McLaren & Leonard, 1993), actualisation (Rogers,

1957; 1995; Maslow, 1977), moral implications of psychological discourse and action

(Prilleltensky, 1997), and reflexivity’s monitoring role of the own awareness and behaviour

(Giddens, 1991), etc. Differences between Chinese and Western philosophies probably do not just lie in epistemological differences, but also levels of social impact. This empirical study serves the purpose of grounding counselling and psychological research in lived experiences of Hong Kong Chinese people.

Therefore, I extend the implications of Chinese morality to deconstruct the overall structural power distance. Could Chinese morality indicate a universal human quality? Knowledge of

Chinese moral philosophy needs to be further understood as it informs the structural dynamics and local politics. I take a more proactive stance towards global applications of counselling, which involves internationalisation of Chinese epistemologies and psychological sciences (Liu, 2000; 2017a; Liu & Berenardo, 2016). For instance, the moral philosophy of human nature in the current study overlaps with conflicts of interests in egoism (Baier, 1965).

Such theoretical intervention is not just on the level of cross-cultural knowledge translation, but also part of the global agenda to break down institutionalisation. There is a need that we return to the fundamental moral question of the purpose of counselling: Why do we need to be morally right/good?

Here it is also worth reflecting on another example of participants’ perception of cross- disciplinary segregation and hierarchy alongside the concept of power distance. In the analysis, a historical legacy was shown as a socio-cultural process of forming the cross- disciplinary hierarchy in Hong Kong, whereas human nature was an imperative condition

179 such that these processes occur. Cross-institutional hierarchy involves a reciprocal dominant

– inferior relationship. In addition to implications of reflexivity (Chapter 4), the relationship systems at play make clear of the dominance dimension of cross-disciplinary interactions which reinforces segregation and marginalisation. In the thesis, sublevels (4.2.2) ‘disciplinary prestige’ and ‘others as in between an outsider and an insider’ represent the dominant – inferior relationship. They mirror to dynamics of clinical psychology and social work (the dominant) versus counselling, counselling psychology and other equivalent professions (the inferior). From the perspective of the dominant, any attempt made to cause a change in the cross-disciplinary hierarchy would be regarded as a threat to self-interest. This refers to the common human nature: the need for power.

In this thesis, however, power has been illustrated in different materialistic and psychological forms, including social status, utilitarianism and uniqueness. When any change attempts to occur, which often comes from the inferior, the dominant’s reactive psychological/emotive mechanism of the need of power is triggered. In light of participants’ narratives, a common reaction is fear of the own/institutional power being taken away. In response, the dominant would attempt to maintain or re-assert hierarchy via different forms of thinking, emotional expression and actions: ‘You are lower than/different from me/us’. In other words, distancing, dissociation and other forms of segregation can be a defence against the dominant’s existing status quo to be shifted. It could be argued that counselling is an institutional tool/means for hierarchical power to be secured and maintained. Due to the hierarchical nature of cross-disciplinary relationships, tolerance of marginalisation or cross- hierarchical interplay would be reinforced and then further turned into an unspoken ‘social’ norm.

From the perspective of the inferior, little was shown regarding its reciprocal role. The current thesis’s macro-lens approach offered a parallel picture to the real-life dynamics: the

180 dominant was widely discussed as they appear in the society, whereas the inferior’s presence was minimalised, as their presence only reflects what is done by the dominant. The literature review in the current thesis (Chapter two) also addressed the absent presence of non-social work or clinical psychology studies (notably chaplaincy) across the literature. Such a phenomenon can thus shed light on the inferior professions’ minimal presence as they are reflected in the analysis of institutional power. I propose that the inferior’s identity appears to be established on the dominant’s projection of an image of the inferior. This reflects the inferior’s lack of independence, which is an accurate mirror of its minimal role. From the moral viewpoint, different methodological approaches/analyses should be involved to focus on not just articulating, but also cultivating the voices of the unheard.

Nonetheless, some traces of the inferior narratives could still be found across the overall analysis. For instance, social work participants appeared to have internalised the stereotype of being labelled unprofessional. Furthermore, counselling psychology’s segregation from counselling profession mirrors to its state of being segregated, which reflects its disparate identity. One could argue that segregation is a reactive extension of the profession’s segregated state. This briefly demonstrates the act of segregation can cut both ways. The experience of segregation reinforces the individual or a profession to reinsert segregation by creating another form of territorial hierarchy, as the individual or the profession’s primary focus is preoccupied to secure its ownership. There is a danger that disciplinary boundary assertion only leads to a vicious cycle of segregation and marginalisation. On the other hand, due to the thesis length, the current thesis focuses on the macro level of methodological focus and has postulated an overall picture of the relationship system. Its theoretical implications emphasise counselling’s institutionalised nature as an unjust phenomenon. The next step in research would require an in-depth account of linguistic interpretations and socio- psychological processes.

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Furthermore, the inferior’s ambiguous insider and outsider positions mirror to the overall picture of ‘navigation between contradictions’ which I then elaborate on. In the interviews and my personal reflexivity chapter, participants and I repeatedly raised our experiences regarding the pattern of ‘navigation between contradictions’. Accordingly, such patterns were also reflected across different interpretative levels of counselling, including 1) services’ holistic/integrative versus diversifying development, 2) practitioners’ cultural identity association between the Chinese and Western dichotomy, 3) practitioners’ alteration versus indigenisation approaches in their adaptive cultural practice, and 4) Hong Kong structural counselling’s sharing and territorially separated status quo. I suggest that such pattern was made possible because the Hong Kong socio-political state is stuck with contradictions in a similar way. Individuals (practitioners), counselling (a group of structural constitutions), and

Hong Kong as a whole are under contradictory calls from the higher authorities. Regarding participants’ common criticism on the local government’s lack of intervention, a question arises, ‘Is the government responsible for Hong Kong counselling’s stuck status?’ Taking into the account such ‘conditions of power’, such arguments only superficially reflect the first condition of the framework (the original power’s absence is acknowledged). Localised power only would have existed when all conditions co-occur. To take this discussion further, I explore Hong Kong counselling’s inherently politicised nature by drawing to colonial literature’s relevance.

6.3.What Can We Learn from Colonial Power?

The institutional dimensions of counselling show how Hong Kong has moved beyond merely converting colonial power into localised cultural and political collaborations. Here I revisit the conceptualisation of local relations and further advocate the need to look at cross- institutional hierarchies and segregations. Looking forward, Hong Kong (counselling)’s

182 current relationship with Mainland China extends the political dialogue on counselling’s future.

Historically, British colonialism created an absent local political power in Hong Kong. At present, colonial legitimation appears to have converted its form to modern white supremacy.

This would be seen in the analysis here as participants expressed fantasised projections of the better ‘West’. Such notions do not refer to any non-eastern societies, but rather specifically white-dominating nations. On the other hand, recent discussions in colonial/postcolonial studies move beyond only focusing on strategies of colonial legitimacy (e.g. Law, 2009;

Southall, 2003). First, drawing from Foucault’s theorisation of power, colonial power can be seen as a phenomenon in which effects and actions are exercised, and its presence would be seen through its dissemination across local spaces and domain. This means that such dissemination is in the form of converted complex collaborations between local movements and colonialism. Therefore, the in-between dichotomy picture would be a simplistic theorisation of Hong Kong’s relations with colonialism and the Mainland China, especially as

Hong Kong has been removed its colonial status (historically and politically) for over 21 years.

Second, Southall described two competing paradigms (national liberation and democracy) of colonial legitimacy in South Africa which could shed light on Hong Kong’s complex power legitimacy (Southall, 2003). In South Africa, liberation and democracy are two competing and coexisting paradigms in southern African politics to deploy continuity of liberal democracy. The liberation paradigm celebrates past leadership and the movement against colonialism (prioritising past over present); democracy exists as the current state power which enjoys the ongoing active support of people (prioritises of the present over the past).

The former one is the dominant power which overshadows the latter, meaning that South

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Africa currently prioritises the past over the present, as its liberation experiences have solidly determined the existing dominant parties as the legitimised power.

I propose that Hong Kong is a similar situation. Law (2009) argued that Hong Kong’s colonial power is more than a legitimised unidirectional political influence, but rather is a series of network relations between colonialists and nationalists. The spatiality of colonial powers should not be conceived as a passive particularity to specify the past. One should remove the dichotomous local/national or global/local boundaries to open up new possibilities of remaking meanings of a Hong Kong Chinese. Hong Kong counselling represents in miniature of the overall Hong Kong picture. The current study’s macro-systemic enquiry has therefore explicated interrelations between colonialism and local cultural- political collaborations. Hong Kong counselling’s diverse yet disjointed structural development is not only due to counselling’s origin which was a Western product. Colonial power appeared to be diffused into the different local healthcare professions. One can argue that colonial power became locally converted and exercised between the government and healthcare professions; between professions; and between the government/professions and the public.

The current analysis of institutional segregation and distancing between local disciplines offers some key examples of how power is redeveloped and further exercised in a localised cultural-political manner. Implications from this include highlighting the complexity of such forms of power, and that it is far from a social transformation product of liberal democracy.

Recalling Southall (2003)’s differentiation between liberation and democracy paradigms,

Hong Kong’s colonial legitimacy is stuck in the clash between the two: on the one hand, national liberation in Hong Kong refers to the historical legacy of local structural constitutions as they became the legitimised alternative. In contract, democracy in Hong

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Kong counselling appears to find the right to remain in the current status of seemingly absent power, as it continues to build upon successes of the various and multi-perspective development of counselling. Therefore, even as I recall Hong Kong’s similar situation with

South Africa due to the shared colonial history, the converted localised power is presented in different ways.

Due to the limited thesis length, I invite further research to elucidate the close relations between the politics of psychology and cultural studies. I notably cast doubt on history’s role of fulfilling justice. While colonial power continues over time, local structural conditions also play an equivalent historical role in reinforcing inter-disciplinary segregation, marginalisation and discontent are also revealed, as it serves as the central dimension of Hong Kong counselling. Hence regarding the future development of Hong Kong counselling, the coexisting nature of these two paradigms should be more balanced. Therefore, I assert that the focus of moral philosophy should not be at resolving the absent power which was predetermined by history, instead, at the present discontent between the local structural powers. I extend the theoretical implications by revisiting different local relations.

a. Facing the Public: What is Counselling?

It is essential to return to the question of the lack of public awareness and public resistance against counselling in general. In view of the analysis, the most significant hindrance of public awareness and access to counselling is never only attributed to old fixed beliefs.

Cultural stigma is instead put forward as intersecting with other socio-cultural factors. Here it is relevant to note Hong Kong consumerism culture. Consumerism is a notable example of

Hong Kong’s successful endorsement of the new sets of beliefs and values. During colonisation, Hong Kong was still regarded as a city which shared many cultural characteristics with China while it became closely tied with Western acculturation and

185 cosmopolitanism (e.g. Lau & Kuan, 1988; Li, 2002). On the other hand, Hong Kong’s most economic success occurred in the late colonisation stage (the 1970s; Li, 2002), in which public housing, educational, medical and legal sectors flourished. Under the colonial- capitalist influences, consumer culture arose as an typical lifestyle.

On the individual level, materialist consumption practice has become an integral impact on identity development, which then further consolidated the society’s dominant capitalist logic

(e.g. Fung, 2002a; Wong, 2000). Citizens, in general, hold strong expectations of good service quality and complain when feeling dissatisfied, known as normalisation of consumer complaint behaviour (Chan, Lee & Wong, 2016). Furthermore, consumer culture was influenced by the city’s active policy interventions on consumer welfare and protection, particularly in response to economic recovery after the SARS epidemic induced financial crisis in 2003. Such interventions include the strong existing function of Consumer Council

(an independent statutory authority), as well as the active implementations of ordinance/policies, including the Trade Descriptions (Unfair Trade Practices) Ordinance 2012 on 19 July 2013 (Customs and Excise Department, 2018).

Consumerism’s rising popularity at the time did not replace or contradict the traditional virtues of saving and working hard (Leiss, Kline & Jhally, 1990; Wong, 2000). Its fitness with the society was situated alongside Hong Kong’s successful economic and globalising transition since the 1970s (Li, 2002; Tse, Belk & Zhou, 1989), and in face of the newly created social formations, for instance, a rising middle class (Leung, 1996) and Western

Christian education (Yip, 1997). Accordingly, consumerism successfully acquired acceptable and practical values, as it acted as a clear facilitating channel for individual adaptation into the Western and modern ideals. Such transition of values required time and the effortful business, commercial and policy levels of interventions (e.g. Wong, 2000).

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Recently commercialism studies (Campbell, 1997; Fung, 2002b; Gopaldas & DeRoy, 2015;

Littlefield & Ozanne, 2011; Thompson & Tambyah, 1999) have attempted to take a more proactive role about social changes by paying attention to the close ties between consumer behaviour and identity construction. Similarly, the main point of looking at consumerism here is not just to underpin its relationship with counselling construct, but to draw parallels between consumerism and counselling as a lifestyle, a way of living. From the perspective that identity construction is a gradual developmental process regarding social practice (e.g.

Bourdieu, 1986; Fung, 2002, etc.), public awareness is viewed as a bilateral process between the individual choice of participation and social construction. In other words, consumerism is a successful Western ideology turned local, as it has fostered an alternative lifestyle or identity formation by putting external Western changes. Correspondingly, individuals’ subjective perception and participation are positively articulated and reinforced, which further reinforces consumerism. If consumerism and counselling were really parallel to each other, counselling’s creation of a similar social formation would have been a logical process.

From the perspective of low public knowledge and awareness, I argue that the challenge of counselling to deliver a transparent overview of different disciplinary work is not the actual task itself, but rather requires cross-disciplinary collaborations and a mutual decision making.

I now turn to how the institutional level of social construction has made counselling’s identity construction problematic.

b. Is Money/Resources the Ultimate Struggle for Practitioners?

From the empirical analysis, counselling construction in Hong Kong appeared to involve domination and resistance in multi-dimensional and multi-perspectival ways significantly.

From the perspectives of participants, a prime concern is the pragmatic counselling service availability. Phase one participants attempted to provide counselling based on the accessible

187 funding/resources allocation, and successively consolidated their funding/resource-led viewpoints on counselling, ‘money first, service next’. The derived funding-led working ethic reflects a practitioner’s more or less compliance with the current governmental status quo, despite their criticisms of its lack of function. Such participants’ expressed views reflect an alternative perspective of a capitalist-based commodity in the daily practice. In the analytical findings, traces of consumerism were evident across the analysis, for instance, participants identified the emergence of a particular service, or speciality was based on consumer market values; training opportunities in counselling was a financial priority in structural development. Consumer culture was also particularly apparent among private practitioners who develop their ‘branding service’ based on the ongoing market-driven trends, and under a legislation-free culture. On the other hand, phase two participants’ viewpoints on service availability suggested indications of having surpassed perspectives of money/resource restraints, to focus more on problematic social policies. For instance, a matter participants all spoke about in relation to the problematic funding policy was ‘Lump-Sum grant’ launched in

2001 (see 2.3.5; Chapter 2), which has led to the overall Hong Kong counselling’s structural shrinkage from an independent service to a part of the overall social welfare structure.

Consequently, counselling in most of the existing public or charitable settings is oriented to funding-based service planning and sustainability. To fit with the statistically based governmental criteria, services became lessly favoured to counselling or preferred cutting off it completely, as its qualitative evaluative outcomes was a misfit.

What can be concluded from the multi-perspective narratives? First, Hong Kong counselling, in fact, celebrates the well-established wide range and sophisticated practices which cover different groups and backgrounds. However, service needs as they appear in counselling services, and public receptiveness regarding their awareness, knowledge, attitudes and behaviour, remain discrepant. This challenges Hong Kong counselling’s fundamental

188 rationale of identity construction: what is its identity truly reflecting? Second, practitioners are also individuals in the Hong Kong capitalist-based society, and their narratives are established based on not just the dynamic professional practices and activities, but as they identify with the local community. Therefore, practitioners’ roles are reinforced by complex processes of bilateral socialisation. The different perspectives from phase one and two participants on service availability issue indeed show different levels of understanding of the counselling field (Brat, O’Hara, McGhee & Chang, 2016), as well as the underlying hierarchical structures. The empirical analysis also illustrates such hierarchical differences, as phase one participants’ identities construction (layer three) was a fluctuating fluid dimension which navigates between different contexts, yet also outside the institutional dimension (layer four). Critically speaking, practitioners’ current identities are constructed ambiguously inside and outside the institutional system as they appear in the framework (figure 1). They are counselling operators in the institutional system, but their lack of awareness of the underlying dynamics shows they do not infiltrate the so-called ‘structural system’.

This leads to the third point that the impact of institutionalisation is not a direct, but a highly complex multi-dimensional structure. While the existing healthcare constitutions should enact a strong counselling identity through the delivered services, its current identity reflects disorder, ambiguity and turmoil. Instead, institutions rely on their developed legitimation of power, which I suggest conforms to hierarchy and segregation. However, Hong Kong counselling and psychology would only show its failure of addressing social-political issues by sitting within the socioeconomic and class distinctions of its practitioners and researchers

– that is, in the form of the remained if not strengthened structural hierarchy, segregation and marginalisation. Furthermore, the current diversifying counselling culture is driven by popular trends and funding. It only exposes a potential risk that professional development has

189 become part of the media marketplace of ideas under the interplay between capitalism and consumerism.

In response to the phase two participants’ common criticism at the government’s ‘absent role’, I now make clear relations between the government and healthcare professions to maintain my prime focus on the problematic cross-disciplinary relations.

c. Between Government and Professions: Alternative to Statutory Registration System

The recurrent refrain of ‘absent’ power (4.2.1; Chapter 4) challenges against the lack of local government’s proactive legislative planning and reform. At present, most healthcare professions except social work are not included in any statutory registration system, and thus practitioners from those systems have failed to receive some level of professional regulation.

All practitioners interviewed across disciplines called for a unified system to serve the monitoring, regulating and advisory purposes. An existing association is a voluntary professional body called HKBCA. However, not only does it lack in political and social impact, but such a professional body is also by nature self-regulated. Accordingly, many look to the government as the only existing independent body to fulfil the role. The current lack of change from the government is based on the argument that a statutory registration system is only established when the applied profession consists of sufficient manpower (members numbers). In a press release which recorded an official dialogue on regulation on healthcare professions (The Government of the HKSAR press releases, 2017a), it appeared that such criteria would remain unchanged. Instead, the government-led professions which are unregistered statutory registered members to an alternative voluntary society-based system, known as the pilot scheme of the Accredited Registers for Healthcare Professions. Five professions were selected for a preliminary assessment of the criteria for accreditation, including clinical psychology, educational psychology, speech therapy, audiologists and

190 dietitians (The HKSAR press releases, 2017b). Until now, the speech therapy profession is the first, and the only profession accredited under the pilot accredited scheme (The HKSAR press releases, 2018). I take this as the government’s dedication of some official power to a newly generated system as an independent, autonomous professional body. I do not intend to directly discuss the operational procedures, rather question if the newly developed system could sufficiently create an impact on the existing inter-institutional discontent. The current analysis has reflected a dynamic process of local power transformations. Although the alternative legitimation perplexes meanings of structural power and makes it difficult for one to define or understand, it is necessary we address both the absent power and a series of consequential structural reformation/movements. There is a moral question: Should disciplines take responsibility for their historical privilege? The current thesis has provided a brief conceptual view of how inter-disciplinary segregation obscures dynamics of institutional counselling. I suggest that the need for an open and continuous inter-disciplinary dialogue is not a trivial point, nor do I believe that inter-disciplinary segregation is an easy/naïve matter to resolve.

d. Between professions: Beyond the unifying – diversifying discourse

I return to the question of Hong Kong counselling’s controversial unifying versus diversifying discourse by looking at the current global development of counselling/counselling psychology professions as a whole. Scholars have commonly pointed at the significance of a stronger professional identity for a counselling/counselling psychology profession’s survival (Brady-Amoon & Keefe-Cooperman, 2017; Gazzola et al.,

2011; Hiebert, Simpson and Uhlemann, 1992; House & Feltham, 2016, Maples, Altekruse &

Testa, 1993; Mrdjenovich & Moore; 2004; Nielsen & Nicholas, 2016; Seay, 2010; Woo,

Henfield & Choi, 2014). It was highlighted that counselling profession’s growth and success

191 relies on its ability to make clear its identity, as it associates with or distinguishes between counselling and other professions. Clarity should also be made within the profession (for instance, trainees’ growing sense of identity), and with third-party payers of counselling services (Woo, Henfield & Choi, 2014). On the other hand, definitions and sets of criteria for a professional identity vary across different researchers and under different structural conditions. Hong Kong counselling is a unique case owing to its multidisciplinary driven development, hence the multi-dimensional and multi-perspective conceptualisation. This does not only show how Hong Kong counselling is highly contextual but also how its development is far from the existing global direction.

On the other hand, Hong Kong counselling’s diverse nature also exposes itself to a lack of independent ground. Diversifying characteristics of Hong Kong counselling penetrate all levels of the conceptual framework (theoretical/philosophical underpinnings, cross- disciplinary/multi-disciplinary services and the institutional structures). Examples of

‘navigation between contradictions’ are parallels with such diversifying status. For instance, participants revealed their alternative adoption between micro-alteration and indigenisation in their adaptive cultural practice. ‘The flexible counselling practice culture’ mirrors the absent accreditation/regulation. While the ‘flexible’ notion indicates practitioners’ free practice, their alteration level is limited to individual power, hence their developed micro-alteration approach. In other words, the micro-alteration approach was an individual choice as well as a result under the outer structural influence. On the other hand, the indigenisation approach was mostly a formal structural product, as most of the reported learning or development by participants occurs within an academic/institutional setting. Then one may cast doubt at individual power’s capacity to create indigeneity, in other words, the development of indigeneity requires structural power. Furthermore, I highlight the structural level of diversifying notion which refers to Hong Kong healthcare professions’ sharing and

192 territorially separated status quo. Hong Kong counselling is evidence different from the global development, as it has apparently survived without a unified professional identity, and even developed into the own indigenous form. However, it does not mean that its diversifying status should not be challenged.

In view of structural dissonance as the central theoretical message, I reiterate the current research has made transparent its critical attempt to expose the challenging politics and structural power. It is not only the first empirical study in Hong Kong to focus on the institutional dimension of counselling but also a rare attempt to expose power interplays between institutions. Recently The American Counselling Association has addressed

American counselling profession’s insufficient national recognition and credibility (Herlihy

& Dufrene, 2011), which has consequentially led to development of a consensual counselling definition released by 31 major counselling organisations (Kaplan, Tarvydas & Gladding,

2014; Macleod, McMullen, Teague-Palmieri & Veach, 2016). A similar global action was done across different counselling psychology professions (Savickas, 2017). This more or less shows some joint initiatives to establish a unified professional identity. However, Hong Kong counselling status is stumbled by the lack of communication between professions. Again I do not intend to impose unification as Hong Kong counselling’s sole way out. Via my attempt to address the existing segregating state in this study, I argue that such research does deliver theoretical and societal level of significance. Therefore, I naturally put forward the invitation to further research to add value in this area. On the other hand, institutional oppression and marginalisation also serve as a drive for change and action. An example is counselling psychology’s segregation and isolation from the mainstream healthcare professions.

Counselling psychology participants’ active participation in advocating dissatisfaction and necessary changes in the interviews made a contrasting view from the reluctant/reserved attitude of those from the other disciplines. With the built historical reputation, participants

193 did not express a need to break from the current state, rather compromised to place counselling as part of the non-counselling healthcare driven system.

I also shed light on participants’ complex expressed views as they engaged with the current interwoven social and political orchestration. Participants appeared to divert their responses on inter-disciplinary segregation to the overall negative cultural stigma. On the superficially linguistic understanding, participants attempted to show that inter-disciplinary discontent was a partial picture of the overall Hong Kong community’s unwelcoming social perception.

Most of the current academic and professional activities also mainly targeted at addressing or working on the latter. Professional responsibility among many professions have become oriented to clarifying public knowledge and perception of professional counselling, for instance, the recent research activities on collecting public perception and understanding of

Hong Kong counselling (Yu, Fu, Zhao & Davey, 2010). Owever, I take a radical outlook on such participants’ responses as an indication of their stuck reaction to inter-disciplinary discontent. I challenge that such responses expose a potential risk that the former (inter- disciplinary discontent) is disregarded or obscured due to the stuck situation of the latter

(social perception). Further theoretical implications will make clear how professions should be more intentional in resolving the internal disciplinary discontent (as opposed to the public), instead of solely gaining credibility in the healthcare market. I further address Hong

Kong’s relationship with Mainland China to reinforce a unified professional counselling image as a way forward for all Hong Kong professions.

e. Facing the Future: With Mainland China

Extending the lens across the region, Hong Kong’s relationship with Mainland China remains ambivalent in the postcolonial era. Due to Hong Kong’s historical successes in the economy, healthcare, educational advancement during British colonisation, the city has long been

194 regarded as a prosperous ‘Westernised’ city to Chinese nationals, whereas Hong Kong individuals mostly distinguish their superior ‘Hong Kong identity’ from the rest of China.

‘One country, two systems’ policy is an example of Chinese central government’s attempt to fit such parallel developments. Again Hong Kong counselling is a miniature of the overall national politics. At present, Hong Kong’s and Mainland China’s healthcare professions are separate. National superiority is arguably converted into the form of clinical superiority, as participants commonly addressed the overall Hong Kong counselling’s historical legacy compared with the mainland profession. Despite a lack of unified counselling accreditation system, Hong Kong practitioners have relied on the city’s regional legacy as they expanded their practice or businesses in mainland China. That is to say, ‘Hong Kong identity’ was an alternative accreditation legitimation for Hong Kong practitioners’ cross-regional practice and service development. In this case, Hong Kong counselling identity is unified and positively adopted. On the other hand, upon Hong Kong’s return to the Mainland China in

1997, as well as the rapid economic expansion in the country as it opened to the global market at the time, Hong Kong’s prestige is in many ways challenged. In the healthcare sector, China has recently approved and implemented an official national accreditation system for local practitioners, known as psychological consultant/心理咨询师. By September

2017, a three-levelled accreditation structure was introduced, (the highest 1st level of national accreditation was yet to be officially launched). At the same time, thousands of trainees have obtained other two levels of qualifications by passing written examinations as the only requirement. Much criticism casts at the accreditation system's failure to reflect professional credibility, most notably quality assurance of clinical competency.

I pick up a similar layout of dominant – inferior dynamics between Hong Kong professions and those in Mainland China. As the Chinese national counselling development explicitly shows some signs of unification, Hong Kong practitioners’ local identities then emerge, as

195 participants in the interview were found to assert Hong Kong counselling’s more historically established state as a superior power over the Mainland professions. On the other hand, beyond the claimed clinical efficiency reveals fragility, uncertainty and defence of Hong

Kong identities. Without a recognised professional accreditation, Hong Kong faces the risk of its power being taken away. Furthermore, it can be suggested that the fear among Hong Kong mental health professions is further complicated by Hong Kong’s overall political status with

Mainland China. After colonisation, there have been multiple political resistances again

Mainland China, since the first large-scale pro-democracy movement called ‘July 1, 2003 protest’ (Cheng, E.W., 2016; Lam, 2015; Chan & Lee, 2010), till the more recent umbrella revolution turned movement since the year 2014 (Chan, 2014; Lam & Cooper, 2018; Yuen,

2015). There is a general fear that China’s political dictatorship would ultimately remove

Hong Kong’s unique sovereignty. Again I uphold the need for healthcare professions to pay attention at Hong Kong counselling and psychology’s parallel dynamics with the overall complex political relationship. Hong Kong counselling/psychology has enjoyed its privileged position as it crossed across the regional border. However, it is foreseen that China will only extend to full implementation of the nationwide adoption of the professional accreditation.

Hong Kong’s 'word of mouth' reputation will be further challenged. I suggest that Hong Kong professions should take this time to revisit meanings of cross-regional exchange, such as mainland Chinese qualifications in Hong Kong and vice versa. Hong Kong should be realistically aware that our historical legacies of professionalism are not permanent, and they are in fact fading. Instead of seeing this phenomenon as a threat, Hong Kong professions should instead return to examine the values of counselling as a whole. This involves an in- depth understanding between professions/disciplines on different levels of identity construction, as well as multi-perspectives of conceptual understanding. Therefore, aside

196 from the diverse development, it is vital Hong Kong counselling somehow gains synergy to facilitate bridging its regional identity with Mainland China.

6.4.What is Critical Pedagogy of Counselling?

In this section, I put forward the implications on critical pedagogy. I suggest that communication is an education itself for one to constructively put forward the agenda of the existing domination. Such approach is elaborated on three levels of professional development and education, research areas and social practices, to invite engagement from multi- disciplinary parties/research.

Regarding the ‘stuck’ notion of Hong Kong which has been repeatedly stated by the participants in this study, I advocate that changes and actions are indeed possible and need to happen. Therefore, core values of the counselling and psychology curriculum should be established on a good understanding of such wider societal context. Particularly analysis of human nature in this thesis reflects that institutions are formed by professionals who are humans too, and they themselves are involved with conflicts. It is imperative that we direct our attention to exposing the present structural discontent. I return to the fundamental moral question: how should Hong Kong/Chinese counselling and its values and beliefs be constructively developed? I first propose that counselling’s pedagogical framework should take an equal value of context as theorisation. Counselling learning should involve a critical engagement with local history, national context and linkage with the globe. In the case of

Hong Kong counselling, I directly respond to cross-disciplinary hierarchy and segregation, and highlight that critical pedagogy of counselling and psychology should be strongly established on enhancing communication which compiles a few fundamental principles: 1)

Communication first involves intrapersonal processes, as a profession/counselling professional is required to explicate the own professional identity, goals and purposes; 2)

197 explication needs to extend into a form of explicit communication with another party, which implies how views, values and priorities can be converted into constructive forms of dialogue; 3) there is a particular focus for professions to carry out effective communication in between disciplines, as well as with the government and the public. I then elaborate three levels of approaches involving professional development/education (advocating professional identity), research areas (cross-disciplinary interaction/collaborations) and social applications/practices. I suggest that this contribution to knowledge is not restricted in application to the local Hong Kong context. I suggest that implications can be extended to most of the other regions which are under different extent of institutional influences (or orchestration). In this section, I further elaborate how critical pedagogy can consist of different levels, including a form of professional development or education (6.4.1.), research areas (6.4.2.) and the wider social social practices or applications (6.4.3.).

6.4.1. Professional Development/Education ‘Clients have different views of social workers and counsellors. Perhaps clients think

that social workers would often leave the office and do not stay within the room.

However, for counsellors, clients may think that they (counsellors) see them in the

office, they do not come out (from the office)…’ (11; Q133)

Cynical public perception of a counsellor’s image was described by participant 11 (Q130) above. In response, I extend from theoretical implications of the discourse of human nature to urge Hong Kong professions to orient to professional advocacy (Myers, Sweeney & White,

2002; Sweeney, 2012) to constructively address cross-institutional dynamics. However, I clarify the gap here is advocacy within or among the professions themselves. Professional advocacy involves developing and strengthening counselling profession itself before it fulfils its purposes of serving the public populations. Some studies (Brat, O’Hara, McGhee &

Chang, 2016; Chang et al., 2016) have pointed out that developments of practitioners,

198 services, institutions are professional imperatives which impact on client and social wellness too. Studies called for more effort paid at a counselling trainee’s development and advocacy of professional identity. This implies the crucial roles of training/educational institutes on developing trainees’ continuous professional development, including acquiring a strong professional identity, which means having a well-defined awareness and insight of what their professional roles as counselling practitioners are. In the current study, participants’ varied roles depend on their increasingly diverse backgrounds and work setting, but efforts on collaboration and coordination fell short. Academic institutes’ involvement in professional development or advocacy was significantly lacking and disconnected. Therefore, many participants remain unclear of their or other professions’ roles even when they are in collaboration with each other. Regarding a lack of existing literature on this matter, the current research fills the gap and further (secondly) argues that counselling and psychology should situate themselves at a frontier role to create changes. Such changes specifically focus not on disciplines’ lack of engagement with professional advocacy, but their territorial focuses which create cross-disciplinary segregation, marginalisation and discontent. Actions and changes do not occur themselves from the current social phenomenon if there is no incentive. I stand with the stance that explication of the current phenomenon serves as a vital pedagogy as well as stimulating force. Institutional influences should be elucidated not merely to report on injustice, but such action is necessary before any space can be fostered for more constructive change and action to take place. Hong Kong professions should take proactive steps to deliver thought and action consistently.

Another reason that efforts are needed is that counselling is highly indigenous and requires local development. Currently, professions in the US and UK have devoted efforts to explicate a stronger unified professional counselling/counselling psychology identity within the nation

(Brady-Amoon & Keefe-Cooperman, 2017; Brat, O’Hara, McGhee & Chang, 2016; Myers et

199 al., 2002; Woo et al., 2014). I extend theoretical implications to Hong Kong but also remind scholars not to merely adopt analytical or conceptual understanding, particularly given the current situation that many Hong Kong existing scholars are American educated (Willnat &

Aw, 2009). For instance, counsellors in the US are somehow perceived more educated than social workers (Fall et al., 2000); the current empirical study shows that the social position of

Hong Kong social workers is higher than counsellors in the professional hierarchy. Therefore, to advocate a clear professional counselling identity, healthcare professions should focus on empirical studies and creating their definitions. For instance, clarification of counselling in

Hong Kong is a critical theoretical and structural engagement. In this thesis, counselling’s linguistic translation (Fu-Do), as well as differences in professional practice across different disciplines unveil the more profound institutional interplay. Hong Kong counselling is historically a broad umbrella which covers diverse perspectives and multi-layers of understanding. In contrast, cross-institutional dynamics orchestrate the notion of difference regarding the hierarchical relationships and historical legacy. Therefore, while I agree with current calls for Western counselling and psychology’s unified or even globalised development of counselling, I state that the prime focus in Hong Kong is to reinstate communication between different local disciplines itself. The upfront agenda is not only to seek for a clear outcome but more importantly to cultivate space and tolerance, before a solution or direction can be generated.

Third, more scholarly and professional engagement should prioritise professional advocacy on unveiling inter-disciplinary constraints. In light of the interviews, participants gradually engaged with cross-institutional discontent; many remained in their sole disciplinary orientation by the end of the interviews. I point out that this was not an ultimate definition of the cross-institutional status. I take an open stance that the current methodology must fall short of articulating the potential fluid process of change and growth with its single interview

200 design. As participants continuously engaged with the topic, I ponder the question of how the more innovative or process-oriented methodologies can stimulate a meaningful process of engagement, exploration and integration. In fact, I noted in Chapter Four: personal reflexivity that many participants revealed more institutional dynamics after the recording. Whether it was a conscious or unconscious act, I focus on the question of efficiency on capturing political disclosure in the interview. It could also be possible that the interview setting itself is limited to documenting any potential re-politicisation process, or has inhibited some conscious disclosure. Further research might consider how else biographical methods can engage participants’ critical reflections in a process, phase or time-frame, including art methods or relational reflexivity (e.g. Dominice, 2000; 2007; Heron, 1996; Hunt & West,

2009; Merrill & West, 2009; Richardson & St. Pierre, 2008, etc.). On the other hand, due to the fact that this study is the first of its kind to expose socio-political aspects of counselling, my development as an early researcher would be limited to the lack of literature or practice based inform. This means that the current methodological approach remains as a tentative anchoring point to explore possibilities of other innovative and creative approaches. In this study, I have attempted to explicate my methodological development and formation (as a mixed methods approach) which mirror my academic and clinical training process in real life.

Drawing from psychology’s adopted scientific-practitioner model (Boyer, 1990), researchers who are also practitioners should explicate such integrated identities as a theoretical and methodological strength.

Further, I highlight that advocacy should arguably be a professional imperative for all practitioners in practice and other activities (Lee, 1998; Ratts & Pedersen, 2014). Research should make clear its links with such values and the current knowledge base to support practitioners’ optimal development; even it involves challenging the existing methodologies to reflect the real-life issues, including role overlap, systemic issues, identity construction,

201 etc. Furthermore, I also draw on multicultural counselling literature as a relevant structural reference of understanding structural or institutional development of counselling. In the US, multicultural research identified counsellors who see multicultural clients were more confronted with the negative societal phenomenon, such as racism or other structural oppression (Sue, Arredondo & McDavis, 1992; Sue & Sue, 1990; Vontress, 1976).

Accordingly, multiculturalism development positioned practitioners as systemic change agents (Gunnings & Simpkins, 1972), and shifted the therapeutic lens towards confronting the restrictive external environment. Multicultural counselling’s foremost agenda has since been clearly stated, which was to maximise clients' conditions via eradication of the systemic impediments. I suggest that multicultural framework is more than a useful counselling education on equipping trainees with critical awareness. Its clear professional identity also reiterates the need for Hong Kong counselling to first focus on professional advocacy as a fundamental block to articulate social advocacy.

6.4.2. Research Areas

Critical pedagogy informs research can be conducted under a clear direction towards challenging the current domination. I propose reflexivity (Bourdieu, 2004; Cunliffe, 2004;

D’Cruz, Gillingham & Melendez, 2007; Door, 2014; Gilbert & Sliep, 2009; Norton & Sliep,

2018; Schon, 1983; 1987) facilitates articulation of critical pedagogy. The current thesis finding on adaptive cultural practice is an exemplary case. It shows a practitioner’s intrapsychic focus of breaking away from Chinese - West dichotomy by attending to their pre-informed beliefs. In the interviews, pre-informed beliefs and the shifting subjectivities were both captured in the bilateral interview processes. They represented participants’ paradoxical constitution/construction of identities as they navigated between different interview information. This shows that narratives can be twofold. In line with Nind (2017)’s proposed mode of knowledge production, participants from the current empirical study

202 offered narratives and worldviews which are in the forms of both an absolute fixated entity and the evolving interrelations. In other words, instead of pinpointing how participants incline to either one or another epistemological paradigm, personal reflexivity encourages one to be receptive of co-existence of both, before a constructive compromise is reached. To draw ties between thinking and social practice, I propose that personal reflexivity, as a pragmatic, experiential pedagogical approach, can cultivate one’s inner change as well as their re-construction of language (e.g. Freire, 1970/2000). Interviews in the current study represented as an artificial social condition in which different beliefs/ideologies were contained, articulated and reflected upon via process of personal reflectivity. Personal reflexivity serves to integrate the parallel processes of adaptive cultural practice and the navigation of national identities. I propose that future research could expand to applied research and focus groups design (Kitzinger, 1995; Krueger & Casey, 2014; Morgan, 1996) and invite different disciplinary representatives into the same discussion. This does not just shed light on cross-disciplinary dynamics, but could also work a social practice to inform how cross-disciplinary communication can be facilitated, and multiple perspectives can be integrated.

Furthermore, I suggest that personal reflexivity goes hand in hand with conscientisation

(Alexander, 2004; Dewey, 1929; 1933; 1957; Foucault, 1995; Freire, 1972/2000; 1974;

1976). For practitioners to match their actions with their moral stance, in other words, grasp the direction of reflexivity, Freire (1998) advocated the concept of conscientisation which encourages an individual’s transformative practice in line with their deepening awareness of the outer world and their potential of transformation. In response to practitioners’ ambiguous insiders and outsiders’ role in the institutional dimension of counselling, I argue that practitioners’ critical awareness of the institutional interplay should not be separated from action. In line with Freire’s writing, the purpose of upholding ethical principles is given by a

203 person’s belief of hope to contribute to the better future (McLaren & Leonard, 1993). As social change begins from within an individual himself/herself, personal reflexivity sets up as a bridging channel with the delivery of conscientisation. I suggest that reflexivity and conscientisation together can constructively respond to, and take further empirical findings of human nature (Door, 2014). While reflexivity is suggested to foster change and possibilities, conscientisation is a critical response to injustice and inequality. Accordingly, attendance to both can allow one’s balanced and consistent operation between thinking and action.

Counselling and psychology research is unidimensional when it remains disengaged from other disciplines. I turn to quantitative studies to highlight potential multi-disciplinary collaborations. For instance, some quantitative research has proposed using the network model to conceptualise clients’ intra- and intersession processes logically in psychotherapy

(Kaiser & Laireiter, in press; Desmet, in press). There appears to be a radical attempt to shift quantitative research away from methodological paradigms which primarily defend exclusive quasi-objectivity. There was an open acknowledgement of risk and existing problems, as the current complex psychic phenomena are mispresented by quantitative research’s specific stimuli testing and psychological measurement. At the present stage, quantitative network model’s analytic technology and the resulting quantitative implications fall short of reflecting the real-life systemic inter-relations which consist of multiple external variables. I also draw to another potential approach, system-based framework to facilitate structural analysis of complex issues (Keating, Kauffmann & Dryer, 2001). Currently, systems-thinking was applied in various structural managements, including human resource management, engineering system governance, social network analysis (e.g. Alali & Pinto, 2009; Hurst et al., 2017; Katina, 2015; 2016; Knoke & Yang, 2008; Trim, 2004). On the other hand, there is no literature on investigating the structural levelled management of counselling/healthcare practice. I address quantitative research’s shortcoming not to legitimise qualitative

204 approaches, but rather point out qualitative and quantitative approaches can complement each other on bridging the gap between theory and practice (Burman, 1998). I invite future scholars’ interests to expand quantitative focuses on mental health’s conceptual understanding of the multi-dimension and multi-perspective levels of inter-relations in real life. For instance, how can systemic levels of inter-relations be described mathematically?

How can measurement paradigms be set up in line with the naturalistic approach?

Furthermore, I suggest some existing literature to encourage multi-disciplinary approaches.

From the perspective that reality is co-constructed via communication, mass communication and critical cultural studies advocate that individuals are both recipients as well as creators of their social and cultural world (Jankowski & Jensen, 2002; Steiner & Christians, 2010), and dominant or powerful classes/groups serve as the main orchestration (Grossberg, 1984; Real

& Christians, 1986). From the empirical point of view, the solution to Hong Kong counselling identity reformulation relies on more than an absolute route. Change and action require multi-layered interventions and multi-party participation. I draw to the substantial local (e.g. Lai, 2007; Chan & Lee, 2010; Ma, 2005; Sing, 2004; Willnat, 1996) and global political communication studies (e.g. Bull, 2003; 2011; 2012; McLeod, Scheufele & Moy,

1999; Willnat & Aw, 2009). Diverse discussions have been generated to investigate different channels of communication and their public impact, for instance, microanalysis of nonverbal and verbal communicative delivery and impact on political communication (public reciprocation and political outcomes; Bull, 2003; 2011; 2012). Another significant example is the media (Boulianne, 2015; 2019; Chan, 1992; de Zuniga, Copeland & Bimber, 2014;

Dahlgren, 2005; Kruikemeier, van Noort, Vliegenthart & de Vreese, 2014; Tang & Lee,

2013) which has influenced public participation and constituted the current political setup.

Corresponding to the rapidly rising trend of social media usage, I call for cross-disciplinary input to investigate research overlaps, including a conceptual understanding of the interaction

205 between mass media and political formation (Chan, 1992). A good example is the role of social media usage in the Hong Kong umbrella movement (Lee & Chan, 2016; Lee, Chen &

Chan, 2017; Lee, So & Leung, 2015; Tsui, 2015; Zhang & Lee, 2018).

Last but not least, counselling and psychology can work hand in hand with critical social identity theories, (Bartlett, 2005; Beijaard, Meijer & Verloop, 2004; Erikson, 1989; Gee,

2001; Rodgers & Scott, 2008). Traditional social psychologies theories (Stets & Burke, 2000) could have interpreted cross-disciplinary segregation as an intrapsychic process of attitudinal reinforcement, as participants’ social identities were affected by their cognitive perceptions of in-group and out-group dynamics, as well as the behavioural assertiveness of their roles within or outside the groups. Counselling and psychology can expand into such research area, for instance, in professional advocacy development. Furthermore, the current study further shows the importance of the contextualised nature of social identity by highlighting the significant influences of inter-institutional orchestration and historical legacy. According to

Bernardo & Liu (2016), a series of social psychological studies in the published journal, ‘The

Social Psychology of Social Change: Science and Practice in Asia’ have recently devoted to elaborate indigenous perspectives on different social concerns (e.g. English & Worlton, 2017;

Reyes, 2017). I agree that social psychology research’s main focuses do not have to be overshadowed by Western dominant theoretical frames. Alongside the current thesis’s significant structural and socio-political implications, I invite social psychology research to further move beyond the local versus Western contradictory to join the challenge against socio-political inequality and oppression.

6.4.3. Social Practices/Applications

I make clear the purpose of social practices which can be a constructive action response to the segregated and dismembered state of Hong Kong counselling. I suggest that counselling can

206 become a socio-political practice by making a clear stance (as an individual or profession(s)).

In the above sections, I have explained a series of social and institutional relations and pointed out that counselling in Hong Kong is highly hierarchical, segregating and unclear. I further showed how oppression, privilege and discrimination do not just exist in the outer social phenomenon, but also within the institutional systems. Drawing from the interviews, I question most participants’ lack of initiative to relate counselling with social justice. I am concerned if Hong Kong counselling remains within a clinical/therapeutic context, while the socio-political agenda is perceived as exclusive to non-counselling tasks. In line with Banks

& Martens (1973), the challenges to social inequality may need to take a form of social and political activism to help empower clients in the fight against negative societal forces.

Therefore I question the notion of value neutrality in counselling (Lee, Baldwin, Mamara &

Quesenberry, 2018; McClure & Russo, 1996). Counselling cannot operate free from socio- political considerations; it would even inevitably support inequality by maintaining its neutral status quo. I restate the need for actions to occur, which further moves counselling notion beyond addressing socio-political issues. I draw on the fundamental value of social justice and its meaning to a counselling professional. As the fifth force of counselling in the US

(after paradigms of psychodynamic approach, cognitive behavioural approach, humanism and multiculturalism; Lee, 2012; Ratts, D’Andrea & Arredondo; 2004), social justice further takes oppression and marginalisation as a more specific revolutionary mission after multiculturalism movement. Theorists (Lee, 2018; Miller, 1999; Watts, 2004) argued the importance of social justice values is to extend from critical address to social action. This means that professionals should effectively and actively confront and challenge the existing systemic inequities (Lee, Baldwin, Mamara & Quesenberry, 2018; Lewis, Arnold, House &

Toporek, 2003; McClure & Russo, 1996; Vera & Speight, 2003).

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What does it mean as counselling in Hong Kong is to be political? Empirical understanding of this thesis, cross-hierarchical oppression and segregation, clearly indicates the need for political and structural resolution. I strongly object to the ideology of hierarchical harmony, as it only prohibits mutual decision-making, autonomy and open dialogue. As a participant addressed, ‘actions and changes derive from the original suppression and marginalisation/其

實都係由一個打壓底下先有一個創新出嚟’ (participant 14).The product of this thesis is in the form of a research study, but its ideology bridges with socio-cultural transformation.

Social practices further illustrate how engagement with the politics of psychology can be multi-dimensional/multi-perspective. I remind a common potential pitfall, as practitioners often become fixated at resolving outer problems, which I challenge as also an act of externalising social problems. Social practices should also start within us, and we need to take equal responsibility for our structural monitoring. We should take up a responsible role to challenge institutional/cross-institutional interplay.

Extending from implications of reflexivity, I give an example of the existing non-academic based social practice which devotes to creating new possibilities. In 2018, the NHS

Leadership Academy and Sea Salt Learning (2018) led a workshop for NHS employees on

“social age movement” (a movement which provides social interaction and connectedness).

Julian Stodd (Founder of Sea Salt Learning) proposed such movement to change the existing leadership culture’s segregating status. He argued that effective network relations are necessary for an organisation’s success, including holistic approach, professional connectivity, trust and reputation based authority. In training, professionals from different departments, hospitals and regions gathered to give time and space for social networking.

Through face-to-face storytelling in the form of different group activities, NHS participants gradually established some contact among one another and opened up challenges and frustrations in their daily tasks. Although the limited length of training for any obvious and

208 sustainable network or connection to occur, I regard this event as an existing non-academic activity which attempts to address professional advocacy. It also builds a constructive/positive social action beginning within the organisational perspective to address institutionalisation, oppression and segregation. I put pondering thought on linking academic research with the existing practice in institutions such as the NHS to create more impact on the institutional nature of counselling and psychology, as well as mental health in general. I suggest that the academia can take a frontier stance to create social impact with the similar activities, or by forming collaborations and partnerships with the community based groups or organisations.

I also draw on another Hong Kong local socio-political project developed by Ho (in press;

Ho, Chan & Kong, 2017). The research project was a ‘collaborative focus group analysis plus theatre’ in which female activists, minority groups and those who have experienced political persecution participated in the experimental, democratic and empathetic performance space.

In the performance, other researchers from the sexuality and intimacy fields were invited to view and respond by contributing their analysis. Such an analysis was presented back to participants who then participated in a reflecting meeting in the form of a focus group (an adoption from family therapy). The produced data was a significant reflection of social practice, as participants gradually built their constructive politic expressions through articulating their commonly shared emotional turmoil, struggles and solidarity. Furthermore, research data reflects as a critical co-production of knowledge forms by researchers and participants, as critical reflections were process-oriented and multi-dimensional

(conversational/linguistic, performative and emotional exchanges). Further research or other activities can learn from such innovative methodological design (participatory theatre for transformative social research; Erel, Reynolds & Kaptani, 2017), but also Ho’s clear yet rare-

209 to-find political stance in contrast with the academia’s increasingly conservative attitude on involvements with socio-political movements (in East Asia).

Ho, Chan & Kong (2017)’s research is part of the limited existing academic-political movements in East Asia (e.g. Brannelly & Edwards, 2017; Ho, Jackson & Lam, 2018; Ho,

Kong & Huang, 2018). Hong Kong is currently under the eye of turbulence. Since the

Umbrella revolution, Hong Kong’s political status was radicalised by not just scholars, but the public including young people. Where is counselling and psychology’s role in this?

Indigenous research should not be just highly contextual, but with a specific purpose of producing ethical, pragmatic and political resistance against power imbalances (e.g. Smith,

Tuck & Yang, 2018). Research delivery can be intentional as it effectively exposes, copes with and takes actions against adversity and authoritarianism. Academic freedom should be upheld, in which researchers are free to orient their intentionality of knowledge production towards creating social impact. At present, it appears that counselling or psychological research in Hong Kong is still independent of political advocacy. Most of the reported activities have been focusing on seeking legitimation exclusively for the sole disciplinary structure. I advocate different counselling branches and professions return to revisit meanings of counselling in the political era. I take the stand that counselling can also openly take a political position. On the other hand, I want to remind the readers that academic institutes should also critically revisit its internal regulation on counselling proficiency, such that the already ambivalent professional credibility is not further exhausted by the embarrassing discrepant reputation or competence between graduates. Professional obligations of academia include its provision of education or training, and an effective bridging platform with professional practice and continuous professional development. It has long been claimed that training/academic institutes’ disconnect from trainees upon their graduation (Aubrey, 1983;

McClure & Russo, 1996). Technically, academia is the first gatekeeper of professional

210 qualities and competency, ranging from maintaining good entry standards to involving beyond the graduation prospectus.

6.5.Conclusion

In conclusion, this study has revealed a counselling structure which is institutional, hierarchical and segregated. It further shows that instiutitonalisation is a multiplex concept of power in the forms of hierarchical domination, inequalities and resistance. To address this, I propose a three levelled model of critical pedagogy of counselling and psychology

(professional development/education, research area and social practice) as a constructive approach to political change and action.

Before ending, I clarify that the call for professions’ necessarily public stance towards professional advocacy and social justice is not an intention to blindly push counselling towards a unidimensional direction. While the central theoretical implication of the current study openly advocates a socio-political agenda to break traditional structural boundaries, it remains mindful of the existing different socio-political stances and diverse perspectives on changes and actions. Some participants indicated politically neutral views on systemic change and actions, including tightening internal regulation, supervision and academic training management. Such different perspectives reflect how counselling is a multi-perspective structure and with different dimensions of application. The main point is not to rectify or harmonise such differences, but rather to allow an open and just communication between variations of age, experiences and expertise to discuss the future of Hong Kong. In line with

Batson (1990), the point is to move beyond a profession’s past, to construct facilitative communication which is based on mutuality and genuine reciprocity. Although one may argue that it is impossible for a counselling profession to justify political neutrality (McClure

& Russo, 1996), I reiterate that communication is the key to change and action, as it

211 purposefully allows one to put himself/herself in another’s shoes, and spread awareness not to let judgment dictate interpersonal and cross-disciplinary relationships. Some participants in the current thesis have expressed optimism towards the future of Hong Kong; professions/professionals should not cease to seek innovations and creativity for constrictive social actions and movements. I share Lee & Richardson (1991)’s lines on social justice to end this thesis,

...a counsellor must be willing to act on behalf of disenfranchised clients in an

advocacy role, actively challenging long-standing traditions and pre-conceived

notions that may stand in the way of optimal mental health and development (Lee,

1982, 1989b)...mental health professionals are beginning to understand that if they are

not a part of the solution, they are part of the problem.

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Notes

Note 2. The profession has long been struggling with academic and public critics regarding its professionalism as no more than the unskilled resource distributor (Hodge, 1976), until the government made its first official attention at social welfare via policy or formalisation approach, for instance, the first White Paper on Social Welfare was published in 1965 (Hong

Kong Government, 1965), and University social work graduates’ eligibility to apply for governmental officer positions in 1972 (Hong Kong Government, 1973). Since then, social work’s professional status blossomed as the government continued to put social welfare infrastructure as an essential policy agenda, as well as Hong Kong entered its golden economic era as it transformed into an international manufacturing and commercial centre

(Chow, 1980). By the end of the 1980s, social workers’ professional status was claimed to have obtained general public and governmental recognition alongside its most substantial development with a rapid increase of professional members. In 1981, governmental decision announced legitimisation of social work’s official functionality in social welfare (Hong Kong

Government, 1979). Social welfare positions were renamed social work, which signified the government’s officially allocation of social welfare services to the profession. Furthermore, its professional accreditation was solidified as job positions in the governmental and subsidised sectors were tied with mandatory professional social work training. However, it took a further two decades for social work to formally establish its professional status as it became a statutory body under the Social Workers Registration Ordinance effective on June

6, 1997 (Social Workers Registration Board, 2016), a milestone regarded in Asia (Chow,

2008), while social work education was officially assigned as a specialised training route in the tertiary setting, including masters training established in the 1990s to offer specialised counselling services such as family therapy and clinical mental health support.

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Note 5. Guidance service was initially implemented in year 1978 in Hong Kong. Student guidance officers of the Educational Department offered personal, educational and vocational guidance to primary and secondary students. An officer served multiple schools, and the manning ratio was one officer and 2000-3000 students. In 1990, a guidance policy called whole-school based curriculum was firstly recommended in public (Education Commission,

1990; Hui, 2000). The whole-school curriculum was a series of research development under the significant US research influences, mainly Professor Norman Gysbers of the University of Missouri who was also the consultant of Hong Kong research development. Other influences included Shaw’s (1973)’s three levels of preventive guidance and Young’s (1994) integrated intervention. Since then, the curriculum was gradually implemented in local schools and involved continuous collaborative developments with school heads, teachers, psychologists and university scholars (see Lee & Wong, 2008). By 2007, 96% of the schools reported their adoption of the whole school approach (Audit Commission Hong Kong, 2007).

Other additional implementations were collaboratively produced between governmental sectors and scholars, including Basic Life Skills Training and Training through Holistic

Social Programmes (Shek, 2006; Yuen et al., 2004). The initial one was run by the Health

Department which covers skills training ranging from emotion management, stress management and healthy living, etc. The latter consists of various classroom-based guidance activities. Furthermore, diversity of school was limitedly investigated, for instance, guidance and counselling in the international school settings (Ng & Yuen, 2016).

Note 8. There is currently a lack of the most updated list for counselling and psychology training in Hong Kong. The last one recorded in the literature was by S. Alvin Leung (2003b) who generated a list in the year 2003 in his paper on counselling training in Hong Kong. He also provided a list focusing on career counselling speciality in Hong Kong (Leung, 2002).

214

Here I attempt here to list a brief (but not full) overview of the counselling and psychology training in Hong Kong,

Clinical psychology: masters and doctoral programmes in Hong Kong University; masters programme in the Chinese University of Hong Kong

Counselling psychology: counselling and psychology (bachelors’ degree), masters and doctoral programmes in counselling psychology, all in Hong Kong Shue Yan University

Social Work: bachelors’ programmes in all Universities (and some private/public colleges and higher education institutes) in Hong Kong (see full list on the official social work discipline website: https://www.swrb.org.hk/en/hk.asp); postgraduate training: masters programme in Hong Kong University, the Chinese University of Hong Kong, The Hong

Kong Polytechnic University, City University of Hong Kong, Hong Kong Baptist University.

Counselling/psychotherapy: (Master level) Master of Arts in Guidance and Counselling, and

Master of Arts in Social Work (Family-centred Practice and Family Therapy) by the Hong

Kong Polytechnic University; Master of Social Sciences (MSocSc) in Counselling by Hong

Kong Baptist University; Master of Philosophy and Doctor of Philosophy (research only;

Department of Special Education and Counselling) from The Education University of Hong

Kong; Masters (MSc) of Counselling by City University of Hong Kong; Masters in

Counselling, Masters in Buddhist Counselling by Hong Kong University; Family Counselling and Family Education, Masters of Arts in School Guidance and Counselling, Specialized

Stream: Counselling and Comprehensive Guidance, Master of Arts in School Guidance and

Counselling, Specialized Stream: Special Needs by the Chinese University of Hong Kong;

Others: Bachelors’ and Masters programmes in Christian Counselling by Hong Kong

Institute of Christian Counselors; Master of Christian Marriage & Family Therapy, Masters

215 of Arts with a Specialization in Pastoral Counselling, Masters of Theological Studies with a

Specialization in Pastoral Counselingl by Bethel Bible Seminary; bachelor’s programme in counselling and psychology at Gratia Christian College

Note 13. Bodhisattva-Spirit-Oriented Counselling framework by Cheng (Cheng & Tse, 2014;

Cheng, 2014a): The model is a Buddhist-informed intervention (Cheng, 2015a; 2015d) in line with the increasing global studies in using meditation and mindfulness in diverse physical, clinical and other psychosocial applications (e.g. Kabat-Zinn, 2003; 1990; 1982; Keng,

Smoski & Ribins, 2011; Baetz & Bowen, 2008; Balboni et al., 2007; Collip, et al., 2013;

Cramer, Haller, Lauche & Dobos, 2012; Teasdale et al., 2000; Hayes, Luoma, Bond, Masuda

& Lillis, 2006; Baer, 2015). In his various publications, Cheng advocated the inherent therapeutic functionality of Buddhism in diverse issues ranging from cancer-induced Bone

Pain Management (Cheng, 2017b), Compassion fatigue (2014b), depression (2015c), alcoholism (2016a), and death anxiety/palliative (2017a; 2018), as well as diverse populations including women and adolescents (2015b, 2016b). The significance of Cheng’s work is marked by his particular Eastern origin in research. Unlike traditional Western research which has converted ancient origins into a modified secular practice, Cheng openly re-brought Eastern traditional philosophies, religions and education into the contemporary interventions.

216

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Appendices

Appendix 1. Information Sheet Research Title: The Meanings of Counseling: A Hong Kong Contextual Perspective

Participant Information Sheet

You are being invited to take part in a research study which aims to explore Hong Kong mental health professionals’ views on the indigenous meaning of counseling and wellbeing. The research study is the thesis study of my doctoral training in counselling psychology (University of Manchester). Before you decide, it is important for you to understand why the research is being done and what it will involve. Please take time to read the following information carefully and discuss it with others if you wish. Please ask if there is anything that is not clear or if you would like more information. Take time to decide whether or not you wish to take part. Thank you for taking the time to read this.

Who will conduct the research?

Tiffany Wing Sum, Leung

Ellen Wilkinson Building School of Environment, Education and Development The University of Manchester Manchester M13 9PL

What is the purpose of the research?

Current research serves 2 purposes: one is to empirically explore the different Hong Kong counselling and relating mental health service providers' counselling provision. Local practitioners across the different related disciplines/fields will give the narrative account of their practice experiences and the underlying theoretical/epistemological influences. In the second phase, counselling psychologists and teaching fellows will be invited for individual interviews to focus on future changes and action in relation to counselling development.

Separate semi-structured interviews (45-60 minutes) are conducted for counselling practitioners from different counselling/related mental health fields. The data collected will be used for my final research analysis.

Why have I been chosen?

In the first phase, different mental health professionals who provide counselling (fu-do) or well-being services in Hong Kong are invited to participate in the research. The considered professional fields are diverse, ranging from social work, clinical psychology, to counseling psychology, counseling, pastoral or educational fields. Participants also fit into the criteria as followed,

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1) are accredited counseling practitioners, e.g. clinical psychologists, social workers, counselors, counseling psychologists or any related professions;

2) are current counselling practitioners in practice (or counseling is one of your major work focuses), and have accumulative relevant experiences for no fewer than 5 years;

The second phase includes counselling psychologists and teaching fellows with criteria as followed,

1) are an accredited counseling psychologist or teaching fellows in a registered educational institute; 2) are currently counseling practitioners in practice, and have accumulative relevant experiences for no fewer than 2 years

What would I be asked to do if I took part?

You will undergo an individual interview. Before the occurrence of the interview, you will be briefed in detail the research rationale and participant roles. Then written consent form is provided to ensure your confidentiality and right to withdraw from the study at any moment.

Followed by that is a separate interview scheduled lasting for 45-60 minutes, in which you give the narrative account of your own practice experienced. You are also encouraged to engage with self-analysis on your own thoughts, feelings and other reflections. The recording will be transcribed and it is conducted by main researcher. You will be contacted upon the end of data transcription to look at the transcript and decide whether to allow the usage of the interview sections or not.

What happens to the data collected?

The recorded interview sessions will be used as the main material for my research analysis.

How is confidentiality maintained?

The audio recordings are kept confidential and will only be reviewed by myself (researcher). The recording will only be stored upon the recording, and until the end of my interview phase with the interviewer when the recordings are to be destroyed. Otherwise, all attempts will be made to maintain anonymity and confidentiality.

Only due to the following circumstances then confidentiality will be broken: 1) there is a risk of harm to self or others, that the recordings may need to be disclosed as part of a safeguarding process, or 2) there is a risk that reportable professional misconduct is disclosed.

What happens if I do not want to take part or if I change my mind?

It is up to you to decide whether or not to take part. Here you can decide to take part in the current research. If you agree you will be given this information sheet to keep and be asked to sign a consent form. At any point after your agreement you are still free to withdraw at any

281 time without giving a reason and without detriment to yourself. All research material related to you will be withdrawn and erased.

Will I be paid for participating in the research?

You will take part in the research on voluntary basis only.

What is the duration of the research?

The recorded interview session you take part in will last for an hour. Briefing and debriefing procedures have been given for a sum of around 5-10 minutes.

Where will the research be conducted?

The research procedure will take place in Hong Kong (venue to be confirmed between you and main researcher.

Disability and Barring Service (DBS) Check

I have undergone a satisfactory DBS check with the University of Manchester.

Who has reviewed the research project?

The project has been reviewed by the University of Manchester Research Ethics Committee. If there are any issues regarding this research, you should contact the researcher in the first instance - Tiffany Wing Sum, Leung (E-mail: [email protected])

However, if you would prefer not to discuss with members of the research team, please contact: Erica Burman, Professor, University of Manchester ([email protected])

If you wish to make a formal complaint about the conduct of the research you can contact a Research Governance and Integrity Manager, Research Office, Christie Building, University of Manchester, Oxford Road, Manchester, M13 9PL, by emailing: [email protected] or by telephoning 0161 275 2674or 275 8093

How can I contact you?

Tiffany Wing Sum, Leung E-mail: [email protected]

Telephone/whatsapp: (44)7548135879 Appendix 2. Consent Form

Research Title: The Meanings of Counseling: A Hong Kong Contextual Perspective CONSENT FORM

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If you are happy to participate please complete and sign the consent form below.

Please initial box

1. I confirm that I have read the attached information sheet on the above project and have had the opportunity to consider the information and ask questions and had these answered satisfactorily.

2. I understand that my participation in the study is voluntary and that I am free to withdraw at any time without giving a reason and without detriment to my treatment/service/self.

3. I understand that my data will remain confidential and only disclosed to researcher involved in the experiment study. 5. I agree to the use of anonymous quotes.

I agree to take part in the above project

Name of participant Date Signature

Tiffany Wing Sum, Leung Name of researcher Date Signature

Appendix 3. Email and Poster Promotion

Phase 1 email invitation

To whom may concern,

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I invite you to take time reading the email or circulate the email to any relevant interested parties.

I am Tiffany Leung, a professional doctorate and counseling psychologist in training from the University of Manchester. I am going to Hong Kong on upcoming August to conduct fieldwork research on Hong Kong mental health professionals’ views on the indigenous Hong Kong Chinese meaning of counseling and well being.

I am now recruiting Hong Kong local practitioners to give their narrative account of their practice experiences, and I invite you to take part in the research if you 1) are accredited counseling practitioners, e.g. clinical psychologists, social workers, counselors, counseling psychologists or any related professions; 2) are current counselling practitioners in practice (or counseling is one of your major work focuses), and have accumulative relevant experiences for no fewer than 5 years;

The interview takes place either at your suggested venue for your convenience, or in the Chinese University of Hong Kong. The interview period is between July 30 – Aug 19, 2017 (can be further discussed). The interview lasts for around an hour and will be recorded and transcribed. You will be given briefing, elaborated research introduction and consent form before you attend the interview.

Please find the attached file for interview details and material for circulation (if possible).

I again sincerely invite you to take part, or pass on the information to anyone who you think could be interested. Please do not hesitate to reach me for further enquiry. My contact details are: [email protected]/[email protected] ; or (44) 7548135879.

I thank you for your time and I look forward to hearing from you.

Yours faithfully,

Tiffany Leung Doctoral Candidate & Counseling Psychologist in Training University of Manchester

Phase 1 Poster Promotion

YOU MAY HAVE YOUR SAY! Counseling practitioners wanted

I invite you to take part in my thesis research on exploring Hong Kong mental health professionals’ views on counseling in relation to theory, philosophy and culture in Hong Kong.

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Your contribution will provide some meaningful information about the indigenous meaning of counseling (Fu-Do) and well-being in the local Hong Kong context.

The eligibility requirements are as followed, 1) you are accredited clinical psychologists, social workers, counselors, counseling psychologists or any related professions; 2) you are current counselling practitioners in practice, and have accumulative relevant experiences for no fewer than 5 years;

I again sincerely invite you to take part in this meaningful project, or pass on the information to anyone who you think could be interested.

Further information regarding the interview arrangements:

Venue: Chinese University of Hong Kong, or other suggested places (for your convenience) Date: between July 30 – Aug 19, 2017 Duration: an hour Used Spoken Languages: Cantonese Chinese or English language To contact Tiffany: [email protected]; (44) 7548135879

Tiffany Leung Counseling Psychologist in training University of Manchester

Phase 2 Email Promotion

Re: Seeking Counseling Psychologists/Teaching Fellows for Research Participation/Contact Referrals

I hope you may be interested in taking part in my research or kindly circulate the email to other potential participants.

I am Tiffany Leung, a professional doctorate and counseling psychologist in training from the University of Manchester. I am currently conducting fieldwork research in Hong Kong on local mental health professionals’ views on counseling/sum lei fu do and well-being concept in the Hong Kong context.

I am now recruiting Hong Kong counseling psychologists and experienced teaching fellows to give their narrative account/experiences on ‘fu-do’/counseling’s development/future. The interview is anonymous and is strictly kept for research purpose. I sincerely ask for your insightful input on what can be proactively changed or taken action about.

The interview can be taken place at either your suggested venue for your convenience, or in the Chinese University of Hong Kong. The interview lasts for around an hour and will be recorded and transcribed into Cantonese Chinese and English languages. You will be given briefing, elaborated research introduction and onsent form before you attend the interview.

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I again sincerely invite you to engage in this meaningful dialogue. Please do not hesitate to reach me for further enquiry. My contact is [email protected]. I thank you for your time and I look forward to hearing from you.

Kind regards,

Tiffany Leung Trainee Counseling Psychologist Professional Doctorate in Counseling Psychology University of Manchester

Phase 2 Poster Promotion

YOU MAY HAVE YOUR SAY! Counseling psychologists/Teaching Fellows wanted

I invite you to take part in my thesis research on exploring Hong Kong mental health professionals’ views on counseling psychology's development and future in Hong Kong. It is hoped that the focus of research is about your views about actions and changes for counseling/counseling psychology’s development.

The eligibility requirements are as followed, 1) you are an accredited counseling psychologist or teaching fellows;

2) you are current counseling practitioners in practice, and have accumulative relevant experiences for no fewer than 2 years;

I again sincerely invite you to take part in this meaningful project, or pass on the information to anyone who you think could be interested. Further information regarding the interview arrangements:

Venue: Chinese University of Hong Kong, or other suggested places (for your convenience) Date: between July 30 – Aug 25, 2017 Duration: an hour Used Spoken Languages: Cantonese Chinese or English language To contact Tiffany: [email protected]; (44) 7548135879

Tiffany Leung Counseling Psychologist in training University of Manchester

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Appendix 4. Profile of the Participants A: Participant number; B: Their participated phase of interview; C: Professional Role; D: Discipline/Qualification; E: Work Setting; F: Target client group(s); G: Major Presenting Issues; H: Counseling Approach; I: Referral Sources; J: Supervision and frequency; K: Recording (Audio) a b c d e f g h i j k 1 1 Student Guidance Teacher Education Primary School Primary learning difficulties and Individual and In-school Y (Teacher) school family problems family teachers es students and approach; Parents groups and organisational setting 2 1 Social Worker Social Governmental linked Local Parental and marital Individual and SWD and self- Peer Y Work Integrated family community issues; career couple referrals supervisio es (Masters); support unit (family) counseling n (8 times non-social per year) work bachelors' degree 3 1 Social Worker Social NGO: Family and Perpetrators Relationship crisis Individual and Social Welfare Peer Y Work Crisis Intervention from intervention, Parenting group setting; Department supervisio es (Masters) Services Domestic and marital relationships Satir/CBT n (once a Abuse model month); self- seeking for individual supervisio n 4 1 Clinical Psychologist + Clinical Local public Hospital Patients Assessment; Inpatients Peer Y Researcher Psycholog Individual support es y counseling 5 1 Social Worker Social Governmental linked Local Individual and Self-referrals Peer Y Work Integrated family community couple and SWD supervisio es support unit (family) counseling n

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6 2 Counseling Counselin Private/freelance Family training and supervision Individual and NA Supervisio Y psychologist/Clinical g intervention group setting n provider es Psychologist/Therapist/Trai Psycholog ner y 7 1 Social Worker/ Social Freelance (working Social Supervision Supervision/gr NA Y supervisor Work with NGOs) Workers oup es (supervision ) 8 1 Social Worker Social NGO: SEN support Parents of Emotional support related Individual Organizational Y Work SEN to children's diagnosis counseling referrals/self- es children referrals 9 1 Social Worker/ Social Private Practice Private Marital relationships Individual/coup Y Group Facilitator Work clients + le counseling es Church 1 1 Pastor (Christian) Chaplain Local public Hospital Patients Spiritual issues Individual In-hospital Y 0 counseling staff: es Doctors/clinic al psychologists 1 1 Social Worker Social NGO: offenders/ex re-integration Individual Governmental Y 1 Work rehabilitation/Governm - (relationship/career)/integ counseling referrals es ental welfare services offenders/lo rative services 社會福利署 cal community (family) 1 1 Psychological Consultant Psychologi NGO: SEN support Local SEN needs group Y 2 (same as counselor) cal community intervention es Consultan cy 1 2 Director Social NGO: SEN support Local SEN needs, forensic policy and NA N 3 Work community related issues decisional A making

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1 2 Counseling Counselin University (Counseling Local Supervison, personal Individual/grou self-referrals Y 4 Psychologist/Lecturer/Supe g psychology) community therapy, SEN p counseling, es rvisor Psycholog (SEN), supervison y counseling psychology trainees 1 2 Professor Counselin University (Counseling students Academic research; Researcher/trai NA Y 5 g psychology) teaching ning es Psycholog y 1 2 Professor, Service Counselin Christian educational students Teaching, Individual Service NA Y 6 developer g institute (Counseling) issues, relationships developer es

1 1 Clinical psychologist Clinical NGO: SEN support SEN SEN needs, Parental Assessment; Governmental By social Y 7 Psycholog children and issues Individual and referrals/Self- worker es y parents group referrals (no counseling clinical supervisio n); self- seeking 1 2 Lecturer Counselin Christian educational students Teaching Individual Y 8 g Institute counseling and es public information 1 1 Counselor Counselin Private Practice Private Specific individuals Individual Y 9 g clients needs counseling es

L: Gender: 8 males and 11 females

M: Age: 20 – 30: 2; 30 – 40: 8; 40 – 50: 7; 50+: 2

N: Years of experiences: 1-2 years: 2; 5 years: 5; 10/10+ years: 11; 25+: 1

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Appendix 5. Interview Arrangements (also the partial interview notes/jotted points made right after each interview) No. Date Participant background Notes 1 07/24/2017 Student Guidance Teacher - Teacher’s role as an advantage - No in-depth counseling - Cultural issues: gender/age in relation to Chinese context - Impact of gov. funding: training, roles/job vacancy 2 07/25/2017 Social worker (focused on - Integrated case approach: counseling as one major element, together with other case intervention counseling) - Counseling: family/couple therapy as major; From integrated family - Highlight of self-development in counseling + financial support from work + allowance of application in the support unit work context Gov – linked - Chinese cultural factor - Lack of awareness of other professionals’ work: future on cross-disciplinary work; counseling should not be independent, rather one within the whole support services 3 07/25/2017 Social worker (50/50 - Counseling – adaptation of Western model into practice; flexibility is the key counseling v.s. other work) - Awareness of self/reflection/growth From domestic violence - Limitation of social worker’s roles support center - Lack of regulation of counseling – everyone can do it (student guidance teacher does not equal a counsellor) (NGO) - Subjective view – counseling is needed PLK - Counseling professionals’ reputation/quality service depends on educational institute and title 4 07/27/2017 Clinical psychologist - Problem solving role of CP – back door stance (need to go to frontline role) (In hospital)/researcher - Difference between counseling and therapy? CP also provides counseling - Advantage of quantitative research, hence solid structural development of research on informing practice - Hierarchical state – CP’s work starting point is high versus other professions – easier to develop based on the intrinsic values - Question of counseling’s values: Counseling is luxury – people look for basic survival needs 5 07/29/2017 Social worker - Some counseling background, but mainly provide integrated support (social resources) (integrated family services) - Counseling need? People focus on basic need – lack of psychological awareness (mix all problems together); (Gov linked) self-referrals mainly come from middle class backgrounds - Conflict of roles – as counsellor and program deliverer - Conflict of Chinese values (intergenerational) 6 07/31/2017 Counseling - Counseling within the Socio-political issues psychologist/Clinical - Struggle within institutional oppression -> independent wayout psychologist/ - Lack of clinical supervision therapist/trainer - Hong kong’s hierarchical state and colonial legacy (lack of initiative): institutional settings’ lack of openness to new comers - Problematic competence standards within professionals/service providers

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7 08/01/2017 Social - No counseling experience (case work as major work), but supervisor and demonstrator of counseling skills worker/freelance/supervisor - Usage of counseling skills/knowledge onto case work of social workers in training - Problem of counseling culture – no regulation body - Future: linkage with the mainland China: what should be developed? - Commercial values of counseling? (from freelance perspective) – psychoeducation on people’s reflection of dreams - Hong kong from postcolonial era to Chinese modern era - Cross-regional development of counseling 8 08/03/2017 Social worker - Distinction from other NGOs Counseling provider for - Much focus on pure counseling work SEN children’s parents - Broker identity of social worker V.S. counsellor – more on holistic support (NGO) - More than a counsellor - The need of such role (social worker) to fit in clients’ background as parents and Chinese parents with lack of psychological awareness (lack of self-care) - Counseling experiences from work/self-learning - Focus of counselor’s personal values (the self) which was a integrated learning from training, personal experience (personal therapy) - Positive future on growing counseling need - Political influences 9 08/04/2017 Private practice (social - Private practice for middle class (not available for all people) worker) - True value of counseling – people need spiritual care - 10 08/08/2017 Pastor (hospital pastoral - Religious counseling owns a place in public hospital setting care) 11 08/11/2017 Social Worker - Counselling as part of the rehabilitation services (rehabilitation - Not in 1-1 therapy setting, it’s a general ‘counseling’ concept, although interviewee could not really provide a services/governmental solid picture on what is ‘counseling’ setting) 12 08/14/2017 Psychological consultant - 1 year of experience (limited insight) (Guangdong) in social - Discrepancy between training and practicum service unit - Problematic clinical practice standard in the community 13 08/14/2017 Director of social service - Social policy decision maker unit (Guangdong) - Lack of insight of counselling practice/standard 14 08/25/2017 Private practice (ex- US - Cultural difference in terms of practice, but not an issue educated trainee) - Gap to integrate with the mainstream services

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- Counselling is not recognised in Hong Kong 15 08/19/2017 Clinical psychologist - Slight isolation from the other fields – room for improvement - Good work from clinical psychology – promising development Second Phase 08/14/2017 Head of social service unit - Recording could not be done due to confidentiality - There was a clear emphasis on organizational policy making - Lacking understanding of training quality and service quality was identified 15 08/15/2017 Lecturer in counseling - Start from self psychology - Institutional oppression among the different counselling providing fields - Counselling psychologists as second class citizens 16 08/18/2017 Professor in counseling - Good development in counselling (in the past) (Christian institute)/educator - Lack of consideration of counselling in the future - Future china-hong kong collaborations (consultant accreditation) 17 08/17/2017 Professor in counselling - Cross-disciplinary collaboration is needed psychology 18 08/21/2017 Professor in counselling - (Christian institute) Discussing Sections

1. Counseling as a multi-layered concept; involved by different professionals. Reflection of socio and political-institutional influences 2. Counseling professional’s identity and impact of environmental factors (political strings) 3. Hierarchical culture among the professionals (among counseling professionals; job positions 4. The existing problems are acknowledged, due to counseling professionals’ training/dual roles in relation to the institutional constrains: but the point is not about developing an independent identity, rather appreciate and correspond to the existing dynamic/transformative development of ‘counseling’ among the different professions 5. Current state – there is certain space for professionals to develop their counseling roles: their roles can be no different from a typical counsellor. However, they also add in elements from their original backgrounds – provide something more than counseling. However, this is rather rare occasion among the whole picture. Many are still restrained to providing superficial services/program led services (still known as counseling support) 6. There is still lack of consensus between different professions on what they do in counseling – political/institutional factor; exchange is limited to academic base and there is lack of actual practicum exchange (between CP, social worker and guidance teacher/counsellor) 7. Dealing with Chinese culture and adaptation of practice: some adaptation has been processed among the practitioners (post-colonial legacy; Western education). However, some problems exist and identified by practitioners; flexibility is the key 8. Mention about political factors: hong kong – mainland china relationship – what’s the future?

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9. Multi-layered Counseling concept – an independent concept/application; also as a partial element among all practice (nurse, pastoral care, social worker in case work, teachers etc.) 10. Highlight about counsellor identity’s personal values – it’s not just a clinical practice, but also a demand on the personal values/self-development (UKCP’s integrative CP model) 11. Counseling development: reflection of institutional isolation/oppression. Changes and actions are required in terms of policy, governmental structure making, yet at same time space should allow and fit in the existing transformative development among the professions 12. Cross-disciplinary work – what will happen in the future? 13. The only way out – governmental reform – on structure: recognizing the role of counseling and has certain attention/allocation of separate counseling funding

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Appendix 6. Analysis Extract First coding:

The relevant phrase was highlighted with yellow and added with keyword – hierarchy, and a further note was made underneath the keyword. I put English interpretations next to the phrases, while the extractions were expressed in the original Cantonese Chinese language.

Second (further) coding:

All phrases were re-read again. I highlight important words to note in red to highlight their importance. All highlighted (yellow and red) phrases were extracted and placed in a separate analysis document. These phrases were organised, grouped into different levels. Then the phrases were added with explanation (in English) of their importance and why they fall into the particular levels.

The phrases remain in Chinese, the original language as I remain immersed in understanding their interpretative meanings and how they appear in the conceptual levels/sub-levels.

Next, all phrases have been extracted and I began to focus on the generated analysis document only. The five broad fields were generated–

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Furthermore, an initial attempt was done to organise the sub-levels as shown below,

Finally, quotes in the similar sub-category were revealed, until a most representing quote was selected and others were dropped.

Last, translation of the quotes was done from Cantonese Chinese to English language.

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Appendix 7. Full Translation of the Extracted Quotes

The below section consists of a full report of translated quotes from Cantonese Chinese to English languages.

Qu Partic- Cantonese Chinese (Original) Quotes English Translated Quotes - ipant ote no. no. 1 1 ‘我覺得自己有啲係已經融入即係點樣融匯左係當時應該用 ‘I think I have somehow integrated the approaches when I speak to the client. I 邊一套嚟同佢傾，真係唔可以一味淨係empathy，啫係可能 can’t simply use empathy, I mean it is needed at the beginning relationship 初頭嗰個建立關係係需要，咁但係後來可能就真係要有啲 establishment, but later (it) maybe needs CBT element…meaning you need to rationally analyse things with the client, conveying messages of self-choice, CBT嘅元素…即係你要同佢理性啲去分析嗰啲嘢, 要去選擇 self-responsibility bearing to him/her…(I) usually use these skills…classical 自己負番責任呢啲咁嘅訊息畀番佢哋成日都用到 … conditioning something like that (reward scheme, long term planning)…so it’s …Classical Conditioning嗰啲咁樣嘅都會獎勵計劃喺長程計 a widely mixed adoption.’ (1) 劃…所以差唔多係大雜會咁用…’ 2 2 ‘拍打幫佢抒緩D壓力…經脈血液運行好D，肌肉會放鬆D， ‘patting to help him reduce stress…better blood and ‘chin’ circulation, relaxed 等個人抒緩左D壓力，佢即時覺得有D效果。或者一D muscles, so that the person’s stress is released and experience immediate stretching, 幫佢抒緩之後，或者十巧手係香港巳經係好普 effect. Or there is some stretching, or ‘ten skillful hands/十巧手’ is already 遍，係醫院醫生都會教D病人做…’ very common in Hong Kong, most doctors/hospitals teach patients this…’ (2). 3 10 從佢哋嘅心理情緒狀態…了解下佢點解會成日會覺得身體 ‘From their psychological emotional status, to understand why they often feel 呢度唔舒服/嗰度唔舒服. 中國人有句說話特別老人家成日 the physical discomfort…Chinese people often say, especially the elderly 都會講話我成日覺得個心囉囉攣…其實我最初都唔係好明 often say ‘I often feel “囉囉”…actually I initially did not really understand, as ，因為我都係年輕…我就會問去了解一下聽下婆婆講或者 I am also young…I then go ask and understand, listen to the elderly’s 囉囉攣個老人家講咩叫囉囉攣？咁佢哋自己都講唔到㗎…即係好 explanation of “ ”. They cannot say it themselves…something something like an ant bite, bite at them. It means sometimes it hurts, 似好似有蟻去咬咬佢哋咁樣。即係有陣時會痛有陣時唔痛 sometimes not…when there is more patient listening to their talk, actually they 多啲去耐心啲聽下佢哋講多啲嘅時候其實佢哋講講下就 … talk and talk, and no longer talk about that illness. They often then raised, like 唔係講個病. 佢哋好多時係講番即係你遇到啲唔開心嘅嘢 your faced sad things, like bad relationship with the family, or no one to take ，例如就係同屋企人相處得唔好，或者冇人照顧自己…囉 care of themselves. “囉囉攣” reflects their much inner concern…’ (10) 囉攣就係反映緊畀佢內心其實係好掛心…’

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4 9 ‘我覺得我作為一個基督徒嘅輔導員，我都要喺治療嘅過程去接觸受助者，但係有啲基督徒輔導員話一講離婚佢就唔做,咁我就唔係咁嘅態度。即係我覺得我咁樣可以真正幫到一個人,好整全咁樣去…成長，而唔係頭痛醫頭! 腳痛醫腳 …’ 5 10 無論佢有冇信仰，其實每個人有個靈性，嗰個靈性都會病 ‘Whether one has/has not got religion, actually everyone has a spirituality, that ，好簡單舉個例，中國人病就會成日講我係唔係做咗啲唔 spirituality would turn ill, for example, the Chinese often say when ill, have I 好嘅嘢，所以我會病,我今生我就要受呢啲苦。呢個係人 done something wrong or not, so I get ill, I have to bear this suffering in this life. This is a spiritual sickness, but actually a ritual belief concept…’ 出現咗靈性嗰個病，但其實只係一個民間信仰觀念…’ 6 10 ‘佢哋會覺得有一啲patient 可能精神狀態唔好make sense. ‘They feel that some patients’ psychiatric conditions do not make sense. They 佢會講嗰啲靈界嘅嘢…其實可能係幻覺，幻聽，不過個 may speak ‘paranormal-spiritual’ stuff. Actually it can be psychosis, but as the patient不停講佢見到嗰啲嘢嘅時候，因為我哋係一個宗教 patient speak about their seeing things non-stop, as we come from a religious belief perspective, then this has become our difference from clinical 信仰上面去睇呢啲，變咗呢個就成為咗我哋同CP有啲唔同 psychology.’ …’ 7 11 ‘可能呢個都係我理想好ideal嘅模式…但可能喺現實生活中 ‘Perhaps this is my ideal mode…but perhaps in real life, as you are busy at , 你因為工作繁忙, 其實你冇可能可以好輕鬆好free咁樣讓 work, actually you find it impossible to relax and be free to give clients 45 client 有九個字時間去表達自己嘅困難…因為其實都有好 minutes to express their problems…because actually there is much paper to do…’ (11, Q7) 多paperwork要做…’ (11) 8 1 ‘你真係由細睇到佢大，嗰幾年其實我都唔使諗咩技巧去同 ‘You really see them from young to older. (These years) actually I don’t really 佢傾, 根本好容易已經幫到佢, 即係好容易同佢傾到嘢即係 think of using much skill to talk to them. It’s so easy to already help them. To 轉化佢啲行為…其實有時細路仔需要好易做. 你畀時間佢、 be honest it’s easy to talk about things, meaning transform their behavior…actually it’s easy to work with children. You give them time, 即係大家有個mutual understanding，建立咗個rapport其實已 everyone has a mutual understanding, and the rapport is already established. 經細路仔係好易做嘅其實、就唔洗咩啲好艱深嘅輔導理論 . It’s actually very easy to work with children, and difficult counseling theories 我自己覺得. 大人就唔同…’ are not needed (I think). Adults are different…’ (Q8)

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9 4 ‘心理健康其實係一個好貴既concept。大家聽得最多就係生 ‘Psychological health is actually an expensive concept. Everyone hears mostly 存佢個層次，未去到生活。輔導你講緊D self-actualization survival, not living. You talk about self-actualization in counseling. That is ，果個其實係一個奢侈品，我做哂D暑期作業先，我考好D actually a luxury. I complete summer assignments first, I take examinations 試先，究竟我興趣係咪，我應該點，我諗我老爸十點都未 well first, what are my interests, what should I do, I think my dad is not off work till 10 p.m., how can I talk about parenting time? How can I talk about 放工，我點樣講？我點樣講，係 parenting time inspiration hk inspiration. This fact is tricky in Hong Kong, meaning (my company does not 個fact就係有時好吊鬼，姐我就算見CP我公司都唔批假去 grant holiday) even I see a clinical psychologist, as 2 days of sick leave is used 見，呢個月己經用左兩日病假，精神科醫生覆診左一次， already, one day for psychiatric consultation, 1 day for diabetics follow-up, I 糖尿覆診左一次，我用左兩日，我冇病假黎見。你仲叫我 used 2 days, I do not have sick leave anymore. You still tell me to go for 去見輔導。我估大家都知心理健康係好…大家都明既。但 counseling. I reckon everyone knows psychological health is good…everyone 背後就去到社會有幾尊重人，比幾多allowance個人. 咁但係 understands. However, the underlying issue is how respectful society is 呢個就，姐理想地就應該多一D人見輔導，小一D人見心理 towards people, how much allowance is given to a person. In the ideal stage more should go for counseling, fewer go to see psychologists. Meaning fewer 學家。姐小人心理有病。但依家己經去到個system 冧左就 people with psychological illness. However the system is collapsed due to too 係太多人，個個都唔掂病緊唔係好嚴重果咪排啦，小朋 . D many people, everyone’s not well. If your condition is not too severe then you 友就排住10個月先，唔急就一年半，有事想死咪打尖入黎 go queuing, children queue for 10 months, 1 year and a half if not urgent. If 先…你係呢個context裹面講輔導其實對我黎講其實都幾奢 suicidal then you jump in the queue and come in first…for you to talk about 侈。’ counseling in this context, it is actually quite luxurious to me.’ (Q8)

10 5 ‘好多情緒問題，通常純粹叫佢黎個輔導室同佢傾啲問題， ‘Many emotional problems, (if) simply ask them (clients) to discuss problems 其實佢入唔到或者吸收唔到。其實依家啲resources去幫到 in the counseling room, actually they do not and cannot absorb (the 佢，咁跟住可能解決咗啲最迫切個步，佢就願意留低去參 conversation). The existing resources actually support them, the most emergent needs are then solved, such that they are willing to stay in the center 加中心一啲group and program ，就會慢慢可以先至會有返 to join some groups and programs, and then gradually get a sense of 歸屬感，或者肯同你傾一啲深入啲嘅問題有啲好具體有 … belonging, or be willing to discuss some in-depth problems.’ (Q10) 啲好實質嘅嘢幫到佢，咁佢先至會可能會較為放鬆，或者可能咁先會同你傾一啲內心嘅問題、或者家人關係嗰啲困難。’

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11 9 輔導就五花八門，百花齊放好多名堂…因為作為一個輔導 ‘counseling involves such great variety and diverse availability/五花八門，百員我哋要涉獵嘅範疇會好大，所以而家就變咗斬件式，你花齊放…as a counselor we are required to cover great variety (of issues), so 原生家庭就還番原生家庭嗰舊嘢去睇，個人成長就睇番你 (services) are changing to ‘cutting edge mode’, original family tree belongs to 個人成長、你婚姻家庭又重番婚姻家庭、你工作或者讀書 family structure approach, personal growth belongs to the separate personal 咁又斬件咗工作同讀書. 乜嘢歷奇呀嗰啲名目出咗嚟…所以 growth issue, marriage and family approach…your work or studies are cut off to the separate work and studies also. All the innovative new naming are out 普遍而家啲人就會從呢啲角度去睇輔導 …睇一個輔導員你 there…therefore in general people use this approach to see counseling…see 專係做乜嘢變咗嚴重啲就唔係輔導，因為佢哋會去咗精 … what a counselor’s specialty is. So it turns out that the severe cases are no 神科…’ (9) longer counseling, as people go to psychiatry…’

12 4 '純綷我自己既分法, 當去到一D所謂in-depth D, 入肉D既 ‘It is just my division, as (it) reaches somewhat in-depth things, reaching flesh emotional process，中間又用D terms可能，中間牽涉到一D level of emotional process, and in the process there is adoption of some terms, changing，一D core既schema，姐無論schema 又好， changing or core schema…whether scheme or emotional schema, that we would generally regard as beyond counseling level.’ emotional schema又好，果D我地一般就開始覺得可能 beyond左輔導果個層面. ’ 13 5 ‘我覺得輔導唔係專有化…有一D比較傾向精神問題好嚴重 ‘I think counseling should not be 專有化…some severe psychiatric conditions ，可能就需要一D專業既人去做。但係我自己覺得就其實 , may need some specialists’ work. However, I believe both (specialist and 兩樣都有存在價值，姐我覺得需要layman D去，因為而家 generic) approaches have their respective values, meaning I think it needs an 我覺得面對一D client就其實有時有D感覺佢係太過迷信專 layman approach, as I feel that some clients I see over-believe in specialty, or (practitioners) refer cases to external parties, so they do not do it themselves.’ 業，或者將果樣野外判左比人做，而自己唔洗做。’ (5) (5, Q13) 14 9 ‘有個危機，好多輔導嘅人可能有陣時唔係好明白受助者 There is a danger, many practitioners sometimes do not understand help- 嘅心理狀態！其實好容易就會亂診斷…簡單舉個例：譬如 seekers' psychological condition! This leads easily to mis-diagnosis. For 佢話俾你聽佢個兔仔死咗，好傷心好難過. 啲人就話, 你應 instance, you hear someone's rabbit died, (she/he) was very upset and sad. People then say, you should not see 'human' counseling, you should look for 該唔係去見人嗰個輔導，你應該搵一個專做一啲寵物哀傷 specific pet bereavement counseling, as some books teach people how to do it. 輔導去做，因為有啲書係教人點樣去做呢個咪好危險因 . , This is dangerous, as there is no wholesome understanding of individual 為冇嗰種整全對人哀傷個理解…歸返係我哋要從返人性， grief...this returns to human nature, emotions and attachment to things. This is 對每一樣嘢嗰種情感，依附。其實呢個唔係淨係單單講個 actually not just about the pet, but a return to the inner individual on helping 寵物咁簡單, 要重返個人本身裏面出發點樣去幫佢係迷團 him/her clarify the own needs within the confusion. Therefore this area is not 裏面去澄清返自己個需要. 所以呢個牽涉個範圍唔可以話 really to the 'specialty' stage.' 真係去到一個咁專嘅地步…’ (9)

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15 4 ‘我估好難畫一條清晰既界。好多時果個所謂既分差，個分 ‘I reckon a clear boundary is difficult to be drawn. Often the difference is 別可能係果個人既background唔同，或者佢要conduct既 about the different (practitioners’) backgrounds, or they have to conduct research，佢可能要advocate某一個approach或者係test某一 research, they maybe required to advocate or test a certain approach, then we can gradually seemingly differentiate between the two, but then on the realistic 個approach既時候，咁然後我地慢慢就好似可以好分得好 operational level…you can imagine a 70 years old elderly is hospitalized after 清楚兩者，咁但係實際個運作上面你想像一個可能幾 … 70 he fell, and he was very upset in the ward. We arrive beside the bed, the 歲既老人家跌親入左醫院，係病房好唔開心. 我地黎到床 support provided at that point, is it actually counseling, or psychotherapy? This 邊，果一刻我地比到個support，其實係一個輔導，定係一 (answer) varies across the different people. Such difficult differentiation I 個治療？呢個都係好見人見致。我講緊好難分辦輔導治療 mentioned mostly occurs in cases not even carried with a DSM label, a 既時候，好多時就係佢not even carry with 一個 DSM label。 diagnosis...In these conditions, we often act as a back side support. Under this 一個diagnosis...呢D情況，我地好多時係會覺得係一個back nature our work is maybe close to counseling.’ (Q15) side既support。如果係呢個nature既裹面，可能我地做緊既野係貼近於輔導都唔定。’ 16 10 ‘所謂冇辦法搵到啲資源：第一接觸唔到；第二就係冇人明 ‘What it means by incapability to find resources: first he/she cannot reach it; 白佢，所以久而久之佢可能會成為一啲我哋成日講叫做隱 second no one understands him/her, so gradually the person should become 形長者，就係成日自己一個人喺屋企, 唔出街唔見人… 呢 what we often call as ‘invisible elderly’, those who stay at home alone all day, never go out nor see anyone…this condition is not just applied to the elderly. 個情況唔係淨係老人家. 香港越嚟越多呢啲嘅人…有年青; There is an increasing number of the similar people in Hong Kong…the youth, 有中年大家唔同嘅都會有呢啲狀態 … age group …’(10) middle-age groups…people get the similar conditions in different age groups…’ (10, Q16) 17 11 ‘純粹係我自己嗰刻, 我覺得我 assess過, 覺得可能以我嘅空 ‘At the point of assessment, I used my capacity and knowledge, and 間同埋知識, 我未必可以足夠去處理一啲可能有偷野癖好 determined my incapability to handle ‘stealer’有偷野癖好嘅人…there is no 嘅人…其實冇指引, 都係靠我哋自己…其實係需要可能好 actual guidelines/manual, we relied on ourselves…actually this requires long long term , 同埋好intensive啲 session去幫佢處理, 但可能我 term or intensive sessions of support, but we (family integrative service) handle non-crisis level of family cases, but if dealing with abuse, we have a 哋…家庭服務中心,處理可能唔係crisis嘅 family case, 但可 specialised department to handle cases with different levels of abuse. Perhaps 能如果係處理一啲我哋專係有個部門去處理一啲受 abuse, those staff have more time and more special training to handle these (cases).’ 過唔同程度abuse嘅case. 可能嗰啲同事就有更加多時間, 同 (Q17) 埋佢哋有更多 Special training 去處理呢一啲.’

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18 1 ‘佢又話你都唔知以前捱得幾辛苦，講左好多以前可能好辛 ‘They say “You don’t know how much (we) suffered in the past”, (they) talked 好窮困嘅生活…意思即係話我哋年紀大食鹽都多過你食米 much about the old days of poverty…meaning that “we are the old, (we) eat . 你教訓返我唔好食煙，即係會係咁，你有時講唔到。佢哋 salt more than your rice intake. You in return teach me not to smoke…” You sometimes cannot communicate like in this case. Their hierarchy is strong and 嗰個謙卑分得好階級好清楚，即係你咁後生你教番我點照 clear, meaning “you are so young you teach me how to take care of the 顧個仔個孫佢覺得你使乜教我，我唔洗你教我，我覺得 … sons/daughter/grandchildren”…they think, “how do you need to teach me, I 你叫我唔好食係你嘅問題…’ (Q18) don’t need your teaching, I think (it’s your problem) you telling me not to smoke…’ (Q18) 19 3 ‘就算係同一個culture 所謂我地同香港長大，差唔多年紀， ‘even the same culture meaning we grow up under same Hong Kong, with 背景佢地都會唔同，佢地對於家庭伴侶既睇法都可能有分 similar age, people’s backgrounds are still different. Their perceptions of 別。大家成長都可能有差別，所以與其講話個傳統上有分 family/partnership can vary. The growing experiences are different, so rather than simply noting the differences in traditions, I rather think it is the 別，我反而認為個人差異係會有. 所以我對既可能係因為 individual difference. Therefore I regard the variations of traditions, religions, 係傳統既差異，宗教，佢成長而黎既差異，我都覺得都係 growing experiences, I think I deal with all of them to fulfil my work…’ (Q19) 我工作上要去面對同埋完成到我既工作…’ 20 4 ‘或者shame base既情緒，我自己既感覺係外國既approach就 ‘guilt base(d) or shame base(d) emotions, I think there is lacking in-depth 唔算好深入去explore。咁但係你想像係呢個collective 既 exploration in the Western approach. And yet you can imagine this collective culture或者society其實有好多family related既野，好多其實 culture or society consists of many family related things, many depression related, meaning that kind of despair, at most times predict depression or even 係好depression related，姐果種despair其實好多時都係 suicidal behaviour…I think that Chinese commonly think/feel that, “I die and 或者行為中國人我覺得 predict of depression even suicidal … will not drag down my family to suffer from visiting me, looking after me, 好common就係我走左就唔洗累到屋企人咁辛苦黎探我, 照 they need not waste much money, money is left for the grandchild, the son’s 顧我，唔洗用左佢地咁多錢，留返D錢比個孫，比個仔讀 studies, business. This theme is salient…Hong Kong China have one more 書，做生意. 呢個theme其實係好salience…香港中國可能再 moral (thing), that value…this fundamental value is very different among 多一分moral，果個份量係到…大家有D好fundamental value all…in China/Chinese, even non-religious, even in a Christian family, they 好唔同…中國裏面，假設佢唔係…甚至乎even係一個 regard highly the role, which is I am accountable for the family, I have to Christian既family，佢地都會好重果個role就係我係要 lesser their suffering even though I reduce my life span, this foundation is quite different…’ (Q20) accountable for個family，even我減低我既壽命我都要lesser 佢地既suffer，姐果個根底上會係幾唔同…’

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21 10 ‘有個patient話畀個姑娘知：我琴晚見到兩隻撈撈 …佢嘅詞 ‘A patient told the nurse, “I saw 2撈撈/low-low last night…the used word was 匯用咗個鬼字。作為一個中國人，我哋有個觀念就係點解 ghost/guai-chai. As a Chinese, we have a concept as “why do we see these 會見到呢啲嘢。但係個病人會話畀你聽佢真係好實在見到 things”. However the patient would tell you, he/she really saw one boy and girl 一男一女嘅鬼仔，喺佢床邊企喺度望住佢. 當我同事聽到呢 ‘guai-chai’, looking from the edge of her bed. When my colleague knew about this, they referred us to provide care, as they evaluated it as a spiritual 啲嘅時候，佢哋會refer我哋去關心下佢, 因為佢哋評估為 problem…what was actually the reality? That patient really saw (them), but 一個嘅問題咁其實真實係乜嘢？佢真係見到，不 spiritual … those were the grandchildren. The own son got married with a foreign wife, 過嗰個係佢兩個孫。佢嘅仔仔娶咗外國太太，佢冇見過兩 and he/she never saw the 2 grandchildren…what was seen was the 2 個孫…見到嘅咁佢兩個孫真係企喺個床尾度同佢打招呼. 呢 grandchildren were standing by the bed to greet him/her. We got to know this 個我哋事後咪知道其實係咁樣。但係我哋都唔撇除曾經有 afterwards. However we do not rule out some patients did see “those things”.’ 啲病人係真係遇過呢啲嘢…’ (Q21) 22 1 ‘可能外國唔係嘅，就算一個年紀大嘅佢都可以去聽個年紀 ‘Perhaps its different in the West, even an older person can listen to the 輕嘅人嘅說話，但係喺香港人中國人嘅社會我係咁大嘅我 younger, but (in) Hong Kong-ese Chinese’s society I have this certain age, I 有番咁大個年紀，我咁多嘅經歷我點解要聽你講。’ (1, have so much ‘life-experience’(,) why do I have to listen to you.’ (1, Q22) Q22) 23 3 ‘我問過一D外國處理過家暴既人，性別對作為對counselor ‘I asked some foreign domestic abuse practitioners, whether gender makes a 有冇分別？外國人就認為冇乜分別. 雖然我唔係問好多國， difference to counselor? Foreigners think there is no difference. Although I 但佢覺得冇問題。但係可能呢個同傳統有關。(3) haven’t asked many, but they do not see a problem. And yet this may be related to tradition.’ (3, Q23) 24 1 ‘(我聽聞就係)…但係香港就唔係咁樣，外國可能就個心理 ‘So I heard…but Hong Kong is not like this, in overseas perhaps a 學家會跟曬小朋友所有嘢，咁就變咗其實個資源畀佢好好 psychologist follows up with the whole child case, then it turns out that the …心理學家同我哋小朋友做咗評估，返落嚟開咗會，呀小 provided resources are good…(Hong Kong) psychologists provide assessment for our children, return for meeting, “hey this child has this problem”, but 朋友有啲咩問題，但可能都係我哋做番…但係我哋冇佢咁 perhaps we have to take it (the case) back…but then we do not have their 專業去幫到個小朋友，同埋可能我哋做嗰啲嘢真係好好好 (clinical psychology) expertise to support the children, and we really do the 表面…香港我諗資源真係冇咁多，資源真係少好多…’ (1) superficial things…I think there aren’t many resources in Hong Kong, really too few resources…’ (1, Q24)

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25 10 ‘同外國好唔同. 外國就好清晰Chaplain喺醫院個位置,佢哋 ‘(it’s) different from the overseas. The overseas has clear indication of 嘅專業、功能. 但係香港嚟講未去到呢個階段, 仍然都係好 Chaplain’s positioning in the hospital, their professionalism, functionality. 初步…我哋係一個宗教團體。佢哋唔覺得醫療同佢哋嘅專 However Hong Kong is not at that stage yet, it is still preliminary…we are a religious organization. They do not see any linkage between this and medicine, 業有咩掛鉤.所以變咗我哋就唔會喺醫院裏面有一個所謂嘅 so it turns out that we do not have an independent professional job positioning 專業職级去分別出嚟。所以我哋話我哋係醫院嘅大義工！ in the hospital. Therefore we say we are a big volunteer in the hospital! It is a 係醫院honour畀我哋喺度工作…就同外國唔同，外國 honorary job that the hospital gives…not like the overseas, the overseas Chaplain 喺醫院嘅員工…等同係醫院嘅醫生，嗰個位份係 chaplain is a medical staff…equal to the medical doctor, the position even 高過醫生. 但香港未去到呢度，香港仍然都係好遙遠. 因為 higher than a doctor…but Hong Kong is not yet that stage, Hong Kong is still 佢哋未有嗰個視野覺得呢個係重要.’ (10, Q25) far (from it), because they do not have the insight that this is important.’ (10, Q25) 26 4 ‘輔導原來可能係好labeling，姐我有問題，唔掂當。佢唔會 ‘”Actually Fu-do” can be very labelling, meaning I have a problem, not ok. 好似我唔舒服感冒睇醫生，咁樣平常去睇呢樣野。所以有 They are not like “I am not well/have a cold and go see a doctor”, this way of 時我都未必用話我要比輔導你，有時會講上堂，咁真係好 seeing it (counseling). Therefore I sometimes do not say “I provide Fu-do to you”, sometimes say “taking class”, this really gets better, (as) it is like D，好似佢黎學野，唔係痴線，要有人幫佢輔導或者改變 coming for learning, not “being-crazy/痴線”, so requires Fu-do or change. I 。咁有一D字詞我會調整，咁但係內容其實一樣。咁我都 alter some wordings, but the content is the same. I do not fixate on what so- 唔執着所謂咩叫輔導 …’ (4, Q26) called Fu-do is…’ (4, Q26) 27 3 ‘我冇思考過係唔同既東西，姐係等如apple係蘋果一樣… ‘I do not ever think they are different things, like apple means “蘋果”…(I) 巳經習慣左。從小到大我地，呢個都係獨特既地方，我地 already got used to it. Since small till now we, this is a unique place, we read 睇既語言係英文為主. 我以前係讀英文中學，睇英文為主， dominantly in English. I used to go to English medium school, read in English, 係學業上面可能係英文，但係生活上面甚至乎工作上面係 studies are mainly in English, but in living even at work, Cantonese Chinese is dominantly used. (I) can freely change in between, (there is) not much 廣東話為主。好自由既切換冇乜大問題…我都要熟習一D problem…I have to be familiarized with some vocabulary, to express in 詞彙要用廣東話去表達當然盡力希望避免同講英文 , . client Cantonese Chinese. Therefore (I) devote to avoid speaking in English with the …但係我覺得自己都可以係大部份情況下唔講英文。因為 clients…but I think I can try not speaking English at most circumstances. 好奇怪架確實係，好多香港人傾計係夾雜住英文.’ (3, Q27) Because its actually weird, many Hong Kongese speak with the fused English language,’ (3, Q27) 28 4 ‘好間唔中，你話成日都令到你寫唔到就唔會…所以我估個 ‘(it happens) quite often, (yet) not to the level as you cannot write out (the difficulty有時係係個reflection上面, 果個language係會有唔 translation)…so I think the difficulty is on the reflection level, the languages 同。但係其實medium of learning我地睇英文既野，學得到 are different. However, actually (our) medium of learning (the learnt things) is English, then I do not really think it has affected the learning efficiency.’ (4) 既野，咁我又未係好覺得會影響左學習果個efficiency。’ (4)

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29 1 ‘Student Guidance佢冇用到Counselling呢個咁professional… ‘Student Guidance it does not reach counseling such professional level…so I 所以我都係講緊我自己係做緊一個Guidance…英文就真係 call myself doing guidance…English language really distinguishes guidance 分得好清guidance 同counselling係兩樣嘢。但中文嚟講就 and counseling as 2 separate things. However in Chinese it is psychological 係心理輔導員，輔導員都會叫輔導。如果你話中文嚟講， Fu-do worker. Fu-do worker as in Fu-do. If you say in Chinese, Fu-do, I think I think it is more similar to this, because if reaching counseling…it is already, 做輔導，我會覺得係似呢個多啲，因為如果去到 ah! It is also called sum-lei-Fu-do, perhaps more as sum-lei-Fu-do…sum-lei- counselling…係咪已經係，呀唔係喎都係叫心理輔導，可 Fu-do means psychologist.’ (Q29) 能叫心理輔導多啲…心理輔導應該就係心理學家。’ 30 4 本土都會有教，但係聽就一回事，你做到落去，應該 ‘there is local teaching, but learning is one thing, doing practice that therapy skills就唔係果種文字上既learning，有時係果個 therapeutic skills are not language based learning, sometimes it is the experiential process learning。你地有果下經驗然後, 陏到小 experiential process learning. You have that experience, and then develop your framework, (and) you have to seek some system to explain the unfit 小你自己既framework, 你要再搵一D system去explain返唔fit areas. The first layer is taught in learning…he (professor) taught us similar 既地方。聽既時候第一層就實有教佢敎我地既過程都係 … things in process, not only just the therapy, but also assessment itself cannot 講緊呢樣野，not only係個therapy既野，係assessment本身 simply be a duplicate, so we initially attend to concepts as what is indigenous, 都係一D唔可以就 duplicate過黎既野，所以我地一開頭去 though there is textbook (knowledge), but you have to gradually mold via 接觸乜野係indigenous等等果個概念，書本上係有既，但係 daily practice. Therefore I think it is not just simply language on the 有時你係daily practice入面都要自己慢慢磨返黎。所以我覺 documentation, that was actually the easiest, so what, (I) don’ t write it if (I) 得唔係淨係documentation既language咁簡單，果到反而係最 don’t know. The most important (thing) is the process itself, we have to be 容易，有咩所謂姐，唔知咪避左佢唔好寫。姐最緊要係個 aware, some words are not learnt via English (language), and is important in therapy, and thereby we develop a set of vocabulary on our own.’ (4, Q30) process本身，我地要aware，有D字你英文學唔到，而係個 therapy裏面好重要，果D要自己再develop一套vocab出黎。’ (4, Q30) 31 3 ‘我係一路學習過程其實都放開左一D我自己既包袱，我覺 ‘I have via learning let go some of my baggage, I think the so called (question) 得對於所謂係咪西方影響我呢個唔係好大。反而我自己既 “if the West influences me” does not impact me that much. Nonetheless my 價值觀，我對於佢地既睇法，我接唔接受，同唔同意 client values, my views of them (clients), my acceptance or not, agreeing or not to client’s behaviour, stance, ways of the expressed emotions, that affects (me) 既行為,立場，表達情緒既方式，果個可能會影響多D. 因為 more. It is because the so-called satir model or counseling is only a tool, it has 所謂我地用或者只係一個工具，佢黎 satir model counseling (when coming to me), actually at certain level reflected my projected values 到我身上其實某程度反映住我一D價值觀到client身上。我 onto the clients. I think I have (via the recent learning), initially noted what is 諗我近年學習一開始巳經講所謂叫value-free，但係係頭 value-free, yet cognitive and subconscious/unconscious levels, all my 腦認知既層面同埋我地唔知道底下, 所有我既反應某程度 responses reflect at certain level, that I was taking side. Therefore these 1/2 上可能反映我 take緊side。所以我呢一兩年好努力學習緊 years (I) effortfully learn how, regardless of clients’ backgrounds, I would 點樣係無論client黎自咩背景，我都可以避免比佢事衝擊到 avoid their impact on me, that balanced state…exactly how to have

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我，果個平穩既狀況…正正就係點樣去有個彈性…輔導係 flexibility…Fu-do is about understanding the self and change, not letting some 認識自己同埋改變，唔好比一D框框或者固有諗法去限制 framework or fixated thought to restrict our interpersonal interactions, even 我地同人相處，甚至自己既行動.’ (3) our own behaviour.’ (3, Q31)

32 10 ‘從文化角度，其實我哋喺醫院嘅角色普遍已經被接受…已 ‘from the cultural perspective, actually our role in the hospital is generally 經發展咗成差不多廿幾年, 而家香港每一間公立醫院都有 accepted…there has been more than 20 years of development, that there is a Chaplain. 但係過去香港嘅醫院淨係得一間天主教同埋基 chaplain in every public hospital in Hong Kong. However there (were 2) chaplains in a Catholic and Protestant hospital in the past. Therefore inview of 督教醫院先有Chaplain. 所以如果睇返香港整體個公立醫院 the overall Hong Kong public hospital on the level of functionality or roles 嗰個功能上面又好，角色扮演上面其實係已經走前咗一大 taking, there has been a big step forward. At least acceptance…means all 步. 起碼我哋嘅認受性…就係而家香港嘅政府醫院已經全 Hong Kong public hospitals consist of a Chaplian, the level of staff members’ 部有Chaplain喺裏面, 同事接納我哋嘅程度亦都好好。同埋 acceptance is good. Also they know we do not just religious work, rather 佢哋知道我哋唔係淨係做宗教工作，而係進入咗人心靈裏 entering one’s inner spirit/soul via counseling, and provide spiritual care.’ (10, 面去提供輔導，同埋提供靈性關懷.’ (10) Q32) 33 3 ‘應用既時候其實都會有一D 微調或者調整。我覺得個問題 ‘The application will actually have some tweak or adjustment. I think that the 係，我地用既時候係咪有足夠既了解究竟本身果個theory既 problem is, whether I have sufficiently understood the essence of the 精髓係乜野…我覺得係香港人既特性，拿香港人係…我冇 theory...this is Hong Kong people’s characteristic, Hong Kong people are… I do not know other countries’ ways of survival, but comparatively Hong Kong 去認識其他國家既生存，但我認為比起上黎香港人既彈性 people’s flexibility is high, means in changes, that adaptability, different 係高，姐變化上面，果個適應，唔同既轉變。所以我覺得 changes. Therefore I do not feel there will be too many difficulties, or our 唔會有太大既困難，或許本身我地學習唔會有所謂我地讀 learning itself does not has circumstances in which, we learn Chinese 開中醫，要學西醫就哇… 唔同既所有野，就冇呢個衝擊。 medicine, and then go “wah!” when asked to learn Western medicine…(we) 一學就巳經係學緊所有西方過黎，咁好自然係理所當然D do not have this shock (in) all these different things. As soon as (you) learn, 野.’ (you) already learn all the incoming Western things, and they becomes things taken for granted.’ (Q33) 34 3 ‘可能都受惠於…唔敢斷定係咪同我地係英國殖民地既身份有關，但係以前我地既規劃…我地香港所謂機制等等本身原住都係英國黎，而家我覺得如果你將中國擺落黎我就反而覺得唔習慣…’ (Q34) 35 4 ‘Counseling render，句號。有時都費是寫咁多野，skip左佢 ‘Counseling render, full-stop. Sometimes (I) rather not write so much, skip it. 。對我黎講，有時你睇餸食飯，你情願多D時間去做case多 Sometimes you eat whatever is brought to you, you would rather have more 過 documentation，所以見到D煩既野咪唔好寫。有D都會 time to work on case(s) more than documentation, so (you) do not write those

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問，其實大家遇到咁既情況會點寫呢. 有陣時慢慢，原來可 ‘annoying’ things. (I) sometimes do enquiry, how to write this when everyone 以咁樣寫，有D就諗左好多年 …好多時practical裹面都係懶 faces such situation. Sometimes (I) do it slowly, so it can be written this way; ，都係藉口…當然有D key fact 我地要寫清楚…有D佢好懶 some is dealt for years…Mostly (we) are just lazy in the practical, they are just excuses (not to write)…certainly there are key facts we have to write ，唔comply to 做運動，果D會blame個病人，果D我地搵個 clearly...like he/she (patient) was too lazy, did not comply to doing exercise, 其實就唔係特登唔做果咪 formulation . D communicative psy those (writing) which cause blaming at the patient, we do not record that in the 。但係underlying 果個issue其實大家唔care。佢中間唔需要 formulation. That is communicative psychology. However, no one cares about 知道佢經過好糾結.’ (Q35) the underlying issue. They do not need to know (patient) entangled process.’ (Q35) 36 4 ‘我估你大約講到你用緊咩approach，大家都ok，你唔係用 ‘I reckon you roughly note your adopted approach, everyone is ok (as long as) D好怪既野。你做既野都係evidence base，咁你有個 you are not adopting abnormal practice. Your practice is evidence based, then formulation informed 既 direction，其實pretty much大家都覺 you have a formulation informed direction, in fact pretty much everyone feels ok (with it). It is because we do all our printing, (like) some notes, some self- 得ok 。因為我地自己print哂，都有D notes，一D self- internal auditing criteria. What we write/not, stays within our rules.’ (Q36) internal audit既criteria. 我地要寫D咩唔好寫D咩，咁大約我地within個rules.’ (Q36) 37 17 係一個中間但係又唔係中間，只不過係即係嚟到咁就掂一 ‘at the middle and not at the middle, (it is) just arrived, touched briefly and 掂跟住就走.’ (17, Q37) then going already.’ (17, Q37) 38 5 ‘佢哋文化意識上，呢啲搵社署即係家庭服務中心…可能打 ‘according to their cultural awareness, looking for SWD means the Integrative 社會福利署電話，社署都會check返個住址，教佢地去返我 Family service center…(they) may call SWD, then SWD checks the 哋中心. 所以佢地會有咁既意識。’ (5, Q 39) accordingly regional (center) location, and teaches them to look for us. Therefore they have such awareness.’ (5, Q38) 39 2 ‘我覺得香港就算其他輔導提供者都係同我地有D似，譬如 I think that in Hong Kong, even other counseling providers are similar to us, 我地係做埋褔利或者其他工作再加埋輔導. 假設CP佢可能 for example, we provide social welfare and other work and then Fu-do. 有輔導，但亦都有包含其他野，可能要係評估既工作，或 Assumingly clinical psychology proides Fu-do, but it also incorporates other things, perhaps assessment or other therapeutic work, not real pure Fu-do, 者其他治療既工作,未必真係純綷輔導，而係用果D工具去 rather using those tools to achieve certain goals. School Fu-do perhaps 達到某既目標。到學校輔導可能包括一教學或者其他工 D D includes some teaching or other work. Therefore there is no much pure (Fu- 作。所以都真係冇乜好純綷，除非有D真係佢自己去 do), unless the practitioner provides independent practice and claims the pure practice真係話齋輔導。但係有一D中心就算係私人都係一D Fu-do provided. However, some centers even in private practice are integrated 類似綜合服務. 佢地都會做某D類型既評估，譬如評估有冇 services, They do certain evaluations, such as ADHD assessments or other adhd或者其他狀況…然後過程有需要輔導先至係提供輔導 conditions… Then Fu-do service is only provided if it is required in the 既服務。所以我既理解就算唔同field都係，撈左其他野…’ process. Therefore in my understanding, different fields’ Fu-do is infused with (2) other things.’ (2, Q39)

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40 3 ‘我諗社工係香港讓我可以專業地行駕. 我counseling work ‘I think social work in Hong Kong allows me to ‘drive’ (work) professionally. 既一個銜頭。我既職業係社工, post係社工，不過當我做 (It is) a title for my counseling work. I am a professional social worker, my counseling果陣我就係一個counselor.’ post is social worker, but when I do counseling, then I am a counselor.’ (Q40) 41 1 ‘我以一個老師我會比較明白到老師個方便嘅困難, 或者老 ‘As I am a teacher, I understand more a teacher’s difficulies, or teachers’ 師嘅要求. 咁變咗我就會喺處理嘅時候有個好嘅優勢就係 needs. In this case there is an advantage as I deal with things, that is that I am 我本身係老師、我知道老師嗰方面嘅困難或者需要，咁就 myself a teacher, I understand teachers’ difficulties or needs, and thus coordination can be better.’ (Q41) 可以協調比較好啲.’ (Q41) 42 11 ‘就算你好想去輔導佢, 人哋未必畀到咁多時間, 或者可能本 Even you want to provide Fu-do for them, people do not necessarily give that 身佢哋係有啲目的, 你又知道佢有呢啲目的, 你就唔會咁花 much time, or perhaps they have an agenda, and you know they have such 咁多時間喺佢哋身上! 始終我哋而家做社會福利署, 帶住一 agenda, you would not want to spend that much time on them! Afterall we are working in the SWD, (this) brings some benefits. Many citizens then feel that 啲利益. 好多市民就會覺得我只要喺個社工面前講到我好 “I just have to talk about so much of my bear suffering to the social worker, 慘佢就會幫我申請屋感覺好似我哋幫到佢佢就攞到間 , ... , then he/she would help me apply for housing benefits... It feels like if I help 屋, 或者透過我哋可以攞到更加多嘅福利…’ (11) them, they would get the house, or through us they can get more benefits...' (11, Q42) 43 11 ‘可能我本身自己讀社工, 我知道其實我好難叫一個社工坐 ‘Perhaps I study social work myself, I know actually it is difficult for a social 低畀四節counselling 我, 佢可能都係畀頭兩節, 已經好唔 worker to sit down and give 4 sessions of counseling to me, he/she would give regular 嘅counselling, 但其實感覺上係似係 tangible多啲…’ 2 initial sessions, which are already not regular counseling, but it would feel more like a tangible (service)…’ (Q43) 44 5 ‘做中心果個特別之處就係因為同政府或者社署有一D扣連 The special thing about working in (this) center is its linkage with the ，關連. 譬如有一D既referral或者有一D既服務既申請排位 government or SWD. For instance, queues for some referrals or service ，一定要經我地去評估去做. 咁所以呢個都係其中一D特別 requests, are mandatorily assessed via us. Therefore this is a special position, only I can or am needed in order to do this.’ (Q44) 我個位先做到或者需要做既野…’ (Q44)

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45 10 ‘我覺得我喺醫院嗰個身份好特別. 我哋嘅對象唔係淨係醫 ‘I think my identity in the hospital is very special. Our targets are not just the 院病人. 家屬同埋員工都係我哋要care, 提供一啲唔係 patients. Family and staff members are also those we care for, (as we) provide Spiritual care 嘅service，而係 counselling service。因為有啲 those not spiritual care services, but counselling service. It is because some colleagues choose to look for us for Fu-do more than clinical psychologists. 同事，佢哋選擇會搵我哋接受輔導多過CP。原因係因為可 The reason is our roles are bit special! As to them, we are religious staff 能我哋嗰個角色係有啲特別！因為我哋係畀佢哋叫做神職 members, religious staff members, within the Chinese’s concepts/beliefs, have 人員，神職人員喺中國人嘅觀念裏面係有一個好特別嘅位 a special position. They think you have a religion, especially Christianity, we 。佢哋覺得你有一個信仰，特別係基督教，我哋會幫佢哋 would help them keep secrets, not publicize their things. Certianly in Fu-do, 保守秘密，唔會事先將佢啲嘢張揚出去。咁但係當然輔導 (we) know we would not tell anyone anything of what was brought to us. 裏面好知道我哋唔會將任何人嚟到我哋面前講嘅嘢同人講 However this is the Chinese’s distinction, they think that talking to a pastor 。咁但係呢個就係中國人嘅分別，佢哋覺得同牧師講自己 would rather be better than to the hospital staff, because (they are) the 嘅嘢，係總好過同醫院嘅同事，因為醫院嘅臨床心理學家. hospital’s clinical psychologists. They think “I only see clinical psychologists 佢哋認為我有病我先至去見臨床心理學家，所以其實去見 if I am ill”, so actually to see the so-called Fu-do, they are wary.’ (Q45) 所謂輔導, 佢哋會有一個戒心。’ 46 4 ‘我估psychologist比一般counselor或者therapist多既，我地 ‘I reckon what psychologist has more than a general counselor or therapist, is assessment果part就會多好多，因為我地面對既可能逢一D our much larger part in assessment, as we are faced with perhaps some IQ IQ request或者report， court report，或者child abuse，我地 request or report, court report or child abuse, we often have much (time) on report. (This) is unique to psychologist, this is perhaps also, in disciplinary 成日都會好多攞左個report。都幾unique to psychologist， orientation, how we are unique compared with the other counseling 呢個亦都可能定位上我地比其他，叫住先， counseling professions. For my personal view, actually the other parts we do by nature are profession，一個比較unique既位。我自己個人睇法就?果 not much different (from each other).’ (4, Q46) part，其實其他我地做既野by nature係冇乜分別.’ (4) 47 1 ‘可能就係心理學家同我哋小朋友做咗評估，但係佢畀返落 ‘Perhaps the psychologist conducts assessment for our children/students, but 嚟開會，小朋友有啲咩問題，但可能都係我哋做番呢，點 then coming back to the meeting, (regarding) what problems children face, 樣去幫個小朋友。但係可能我哋冇佢咁專業去幫個小朋友 actually are mostly taken over back from us (on) how to help that ，即係同埋可能我哋做啲嘢真係好表面，可能就係話功課 child/student. However, perhaps I do not have (clinical psychologist)’s expertise to help that child, and also perhaps our work is very superficial, such 抄寫嗰度抄少啲，教佢嘅時候可能分啲淺啲嘅工作紙畀佢 as less copy-writing homework, (or) when teaching (we) assign easier ，即係將啲工作紙調校. 教佢嘅內容可能就縮窄少少，或者 worksheets for him/her, meaning alter the worksheets, (or) narrowing down 係畀啲小組佢去train返佢嗰個讀寫障礙嗰個問題.’ (1, Q47) the own taught content, or provide training in groups regarding the own learning difficulty.’ (1, Q47)

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48 17 ‘做完assessment然後可能就會pass去其他啲例如社工或者學 ‘(the case) is perhaps passed to the others after (my) conducted assessment, 校去跟，咁就未必可以長遠睇到client個進展各樣…跟一個 like social workers or school, and this may allow (my) long-term review of the treatment manual 真係去run一個program,我覺得喺香港有時 client’s progress or other things…I think it is difficult (for one) to follow a treatment manual (or) really run a program. In particular there is only one 比較難去做到。特別係個community setting因為始終得一個 clinical psychologist in the community setting, and no other colleagues to 又未必有其他同事一齊去協助其他範疇亦都係個 cp, … Self- collaboratively support other aspects…also the self-finance setting does not Finance setting未必可以有個case worker做case manager, 例 allow (the capacity) of a case worker as a case manager, (therefore) for 如醫院嗰度可能同醫生個處理都係大家分開做。就變咗有 example work and hospital doctors are separately done. (Therefore) on the 時嗰個治療上就未必可以統合得非常之好.’ (Q48) therapy level coordination is not done well.’ (Q48) 49 17 ‘但係我同另外個system就未必好容易有個交流,就會變咗 ‘but it is not easy to have exchange/communication with another system, and 可能大家跟嘅方式都未必好一致,或者係中間處理手法都會 so everyone’s approaches cannot be unified, or interventions are all somewhat 有啲唔同,咁就變咗未必係可以做到服務collaborate得好好 different, and so (one) cannot collaborate the service well…everyone cannot really generate the service direction, and perhaps either are there many …大家又未必會好傾得到個服務方向，又未必一定會好多 opportunities.’ (Q49) 機會做到。’ (Q49) 50 3 ‘你見所謂培訓都好5花百門，可以好深入，好醉心去推廣. You see that these so-called training are so diverse/5花百門, in-depth, (one) 但係咪純綷係一個培訓，大家果個專業認可，或者業界果 can immerse in the promotion. However is it merely a training…(regarding) 個監測，果個質素其實我覺得係唔夠. 同埋冇人去規劃…果 everyone’s professional recognition, or the professional regulation, I think (the 個發展係好冇規劃. 所謂既發展係…見行內既人係點樣， current) quality is insufficient. Furthermore, no one does the structural planning…the development is without planning. The so-called development 大家有一D共通平台去為香港輔導推行一D長遠既規劃…可 is…(one) sees how others in the field do, everyone’s got a common platform 能唔同派別既人，可能輔導大家特性都係，專注返係自己 to deliver some long term planning. Perhaps everyone in Fu-do (despite the 個派別果個推廣. 當然大家會有交流會有傾，但唔似譬如我 different disciplines) by nature only focuses the own disciplinary promotion. 有一個平台真係傾下專業化既事情，係無…似乎多D係留 Certainly everyone interacts in exchange events, but not in ways like a 係學術果個交流.’ platform to discuss the professional issues. No there isn’t. Perhaps only limited to the academic exchange.' (Q50)

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51 17 ‘出面supervision可能都要自己畀錢,機構又未必一定 ‘(I) have to self-finance for external supervision, (my) organization does not support…因為NGO可能有啲得一兩個CP，咁就未必會有個 necessarily support…as there is only 1/2 clinical psychologists, and so there is supervisor，咁就變咗真係需要多少少支援…其實有 no (clinical) supervisor, in this case (I) really need more support…actually there is a supervisor, but my supervisor is not a clinical psychologist. In this supervisor，但係我嘅supervisor就唔係CP。變咗未必係啲專 case the professional aspect is not really supported. Conditions in bigger 業範疇嗰度可以得到如果喺啲大機構就好啲，因為 support . organizations are better, as there are really more psychologist supervisor(s), 真係會有比較多PS同埋有supervisor即係CP…即係可能係 and supervisor(s) which means clinical psychologist(s)…meaning (here) admin上support比較多. 一般NGO都係咁樣，所以反而係呢 consists of administrative support. It happens in the most NGO, so I think 個範疇我覺得都需要有啲支援.’ (Q51) there should be more support in this aspect.’ (Q51)

52 5 ‘我覺得果個means可以係用唔同既方法carry out，就唔係 ‘I think (Fu-do) means can be carried out via the different methods, and not 純綷同佢係個counseling room到傾…有一D活動，或者有一 just talking in the counseling room…(it) can consist some activities, or D野幫到佢咁樣…我覺得係多過一個輔導員。同埋我覺得 something which supports him…I think (I am) more than a counsellor. Also I think this approach can bring a more dimensional ‘Fu-do’, or multi-faceted.’ 亦都係如果咁樣既模式去做會令到果個輔導立體D，或者 (5, Q52) 多元化D.’ (5, Q52) 53 15 ‘最好既院牧， social worker，even (43:03) counselor都可能 ‘the best pastor, social worker, even counsellor would not this (evidence 唔會做D咁既野，或者你想做你老闆都唔會support你. 因為 based), or your boss would not support even you do. It is because the game 個遊戲規則唔同，你福機構果個係講個交個數呀嘛，人次 rules are different, you report by statistics in your organization, number of attendance, satisfaction rate…they use service evaluation on conceptualizing 有幾多，服務滿意度…佢係識service個evaluation去 this event, but they do not use advocacy perspective. Therefore people do the 果件事，但佢地唔會係用個角度去睇 conceptualize advocacy same thing, everyone does counseling, but the index I see behind the 件事。所以做既野大家都可能一樣，大家都可能做 performance is different.’ (4, Q 53) counseling，但我背後去睇果個performance，果個index就睇唔同既野。’ (4) 54 15 ‘職業架構的確都影曫左佢個mindset …我自己唔係social ‘Career structure does affect ones mindset…I do not come from social work, work出身，所以好難comment，但係從同學畢業生嘅反映 so it is hard (for me) to comment, but graduates reflect that often (social 就係好多時會跟番regulation 或者個工作routine要行先, 即 worker) follow regulations or work routine is prioritized, meaning he/she is required to maintain efficiency, or quickly handle the case and report the 係佢要maintain 個 efficiency，要快啲處理到個案同埋要交 number. Hong Kong is always constrained by such thing, so it turns out that 到數香港成日都會受制於呢樣，所以變咗就算你想提供或 . even you want to provide, or you realize this case is more than this, you would 者你發覺呢個case唔係剩係咁樣，但係佢都要按住一個 have to follow the regulation first.’ (15, Q54) regulation 行先.’ (15)

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55 6 ‘等如醫管局或者醫生，醫生唔係U黎管，應該有第三班人 ‘like Hospital Authority or doctors, doctors are not regulated by University, it 黎管。香港唔係囉，香港自己管自己, 姐係圍威喂…’ (6) should be regulated by the third group. Its not like this in Hong Kong, Hong Kong rules itself, everyone圍威喂 (gather and bluff loudly)…’ (6, Q55) 56 17 ‘每個system裏面個話事人唔同，例如學校就係教育局去睇 ‘The head in each system is different, for instance schools are under ，醫院就醫管局，咁再細個啲嘅小朋可能係衛生署去跟， Educational Bureau, Hospitals are under Hospital Authority, and so the 咁變咗大家係唔同範疇. 有時見到一啲唔係咁好嘅狀況，可 younger children are under Department of Health, and it turns out that everyone has different approaches. Often bad things occur, as everyone pushes 能大家會推來推去 case. 可能明明喺嗰度開咗case但係佢覺 the case to each other. Perhaps a case is generated at one place, which then 得呢度我哋都未必幫到你，咁又推佢去另外一個系統再去 said “I cannot help you”, then pushes the case to another system to follow. 睇. 咁就變咗有時呢啲位可能喺seek help嘅過程中對client都 Therefore it turns out that this point, the help seeking process can bring 有啲困擾.’ (17) distress to the clients.’ (17) 57 17 ‘一般真係入到學校或者係同佢去醫院覆診一般都好少CP ‘clinical psychologists seldom really enter the school or accompany clients to 去做。但有時呢啲位我覺得都幾緊要，即係要有啲 the hospital follow-up. However I think these tasks are also important, collaboration先至可以一次咁樣去處理.’ (17) meaning (we) need collaboration such that we can handle (it) at once.’ (17) 58 11 ‘有啲學校會有社工, 有啲就淨係請輔導員, 其實你問我, 佢 ‘有啲學校會有社工, 有啲就淨係請輔導員, 其實你問我, 佢哋做嘅嘢其實哋做嘅嘢其實我覺得係一樣, 但係只不過係佢哋title唔同 ! 我覺得係一樣, 但係只不過係佢哋title唔同 ! …做嘅嘢唔同? 但係頭先我 …做嘅嘢唔同? 但係頭先我… 我都唔知有乜嘢分別, 我唔 … 我都唔知有乜嘢分別, 我唔知點答呢條問題!... 唔通佢title係輔導員, 如知點答呢條問題!... 唔通佢title係輔導員, 如果個client叫佢, 果個client叫佢, 我想你refer我去一啲food bank , 唔通佢唔幫佢做咩, 其實我想你refer我去一啲food bank , 唔通佢唔幫佢做咩, 其實我我覺得佢哋都會幫佢做.’ (11, Q58) 覺得佢哋都會幫佢做.’ (11)

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59 2 ‘我地同小學輔導主任合作時候，有時就會有小小含糊. 大 ‘When we work with student’s guidance teacher, sometimes there is 家講既野點解對方好似唔係好明白既？有時慢慢知道就呀 ambiguity. Why does one not understand each other when discussing things? 原來佢唔係社工出身，所以D人可能又唔清晰，咁岩係另 (We) gradually learn that, ah he/she does not come from social work (background), and so he can’t be clear (about the role). Coincidentally we 一間學校合作既時候，一講又好清晰. 大家目標，傾既野， work with another school, (and) things are clear since the beginning. Our 個過程又好，好明點樣去幫個小朋友，原來佢係社工出身 goals, discussed items, the process, (they) really understand how to help the ，於是大家有D共通，或者佢係讀過輔導出身，咁變左呢 children. Actually he comes from social work, such that everyone has a 個係一個小小既問題…果個角色，原來佢係唔同既人做， common ground. Or he/she studies Fu-do, and so it turns out to be a small 咁我地合作起上黎，點樣去幫個小朋友，原來個影響好大 issue…if the role is carried out by the different people, the impact is huge on ，或者點樣睇果個問題或者嚴重性，或者幾時需要介入？ how we collaborate to support the children, how to see such problem or the 果個角度都好唔同。因為頭先講話輔導老師果個角色又要 severity level, or when to intervene? (Ones) perspective taking can be very 好睇果個輔導老師本身佢既輔導經驗同埋輔導training係點 different. As said Student’s Guidance Teacher’s Fu-do role depends greatly on 。姐變左好多因素會出現，於是係咪真係發揮到果個角色 the own Fu-do experiences and training. It turns out that lot of factors emerge, and whether the role is really carried out depends on individual differences and ，就真係好因人而異，同埋間學校係點樣搵到果個人係做 the school’s recruitment process.’ (Q59) 呢個角色。’ (2, Q59) 60 2 ‘CP其實好小會形容自己做緊輔導. 可能唔係用緊呢個term ‘Clinical psychologists seldom say they provide Fu-do. perhaps (they do) not ，但係可能用治療，甚至用一D治療方法. 其實我地都唔太 use this term, rather the ‘therapy’ (terminology), or even use some therapeutic 知道係點樣亦都係治療方法。同時係譬如我地去一D approaches. Actually we do not really know what they are…the therapeutic approaches. At same time we all go for some training together (for) one training，都要一齊上堂，某一種therapy，就變左可能有社 therapy. It means social workers, clinical psychologists, educational 工去上，有或者一輔導員，甚至醫生，即大家會 CP, EP, D psychologists, or some Fu-do workers, even doctors, everyone learn the same 學埋同一套野，但可能出黎有一D therapy 冇話要點樣特別 thing. However outside (the training) there is no indication of examination or 考試或者點樣攞個資力，純綷你學左你就可以應用，其實 how to acquire the qualification. You simply apply what you have learnt. So it 大家係應用緊果D野，變左果D都係好似共同但當然我地 turns out that everyone seemingly share the same thing, but certainly we don’t 唔會知道…’ (2, Q60) really know that…’ (2, Q60) 61 2 ‘尤其是講緊黎緊要同唔同既人合作，我地如果都唔知對方 ‘especially when talking about collabrating with different people, if we do not 既範疇係點，或者冇咩共通語言既時候，又或者唔知係點 know the other party’s (work/professional) aspects, or there is no common ，就變左有D含糊. 因為我唔肯定外國係咪有呢D制度係要 language, or not sure how things are, ambiguity occurs. As I am not certain if 註冊定點樣，如果有既時候當然係會清淅到，或者大家都 the overseas has a registration system or not, if yes then this clarifies things, or everyone knows if one is a registered Fu-do worker, this then people are clear 會知道呀果個係註冊既輔導員，咁樣大家都好清晰咩為之 what makes a Fu-do worker. As mentioned the ambiguity means the public is 一個輔導員. 因為頭先講果到含糊就會可能市民都未必好清 not clear about it either.’ (17, Q61) 楚。’ (17)

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62 9 ‘好多人就會睇呢啲咁嘅銜頭收錢。即係佢哋話 PHD就收 ‘many people would regard such “titles” as ways of charging. It means, they 千八蚊一個鐘；Masters就千二蚊；學士學位就八百蚊…香 say, PhD (qualification) means charging HKD 1,800 per hour; Masters 港有個現像好得意，你越收得貴，佢會覺得你越有料.’ (9, (qualification) equals to HKD 1,200 per hour; Bachelor’s qualification equals Q62) to HKD 800…Such phenomenon is interesting in Hong Kong, that the more you charge, the more qualified people believe you have.’ (9, Q62)

63 18 ‘其實呢個院士點攞返嚟，我哋都唔會問. 只係信原來佢係 ‘(we do not ask) actually how this bachelor’s degree is obtained. (We) only Hong Kong U, 佢係Chinese U, 所以我哋都唔會識得去問, 就 trust he/she is from Hong Kong University, he/she’s from Chinese University 信呢啲頒授學位嘅學院，但跟住話乜嘢嘅係乜院士，冇人 (of Hong Kong), and so we do not know how to enquiry, and already trust the training institutes’ provided programs. However then no one know what it is, 知道。’ (18, Q63) what a bachelors’ program is.’ (18, Q63) 64 3 ‘不過就算講專業既訓練，都唔一定係專業. 都睇院校個自 ‘Even talking about professional training does not make it (training) 律性，因為而家所謂果個課程, 以社工為例，係經過社工註 professional. This depends the school’s self-discipline, as the current so-called 冊局批核。但係你點樣去教, 去收生，你點樣利用你既評核 training, in case of social workers, is after approval by Social Workers Registration Board. However how do you teach (students), to recruit students, 基準去將D唔合格既人去讓佢不能夠畢業？呢個係學院做 how do you utilize your evaluative criteria to guard unqualified trainees such 架。係咪大家都去到果個足夠既標準呢？唔係，有係好 D they should not graduate? This is done by the academic institutes. Is everyone 求奇，好容易都可以畢到業. 所以呢個把關，如果係香港機 (academic institutes) up to the sufficient standard? No, some are loose, that 制真係靠學院去做，因為佢地可能係自己去評核自己，姐 (one) can easily graduate. Therefore this gate-keeping, in Hong Kong system 唔會有third parties既。咁當然講，一個有認可既註冊制度 relies on academic institutes’ work, as they can self-evaluate, meaning there is 係需要，但係究竟邊個去做？有冇人去做呢？咁似乎將來 no third parties. Certainly a recognized registration system is important, yet 係冇.’ (3, Q64) who does it? Is anyone doing it? It’s like to be no in the future.’ (3, Q64)

65 3 ‘社工既training三年乜都要學D…一個fresh grad既社工其實 ‘social work’s three years of training involves learning a bit of everything…a 係唔足以有能力去做一個稱職既counselor。坊間咁多機構 fresh graduate actually is incapable to be a qualified counsellor. There are 可以搞training實踐，我地繼續比錢出去，讓自己變成一個 many organizations out there to provide training, so we continue to pay, to let ourselves be a more qualified counsellor.’ (3, Q65) 稱職D既counselor。’ (3, Q65) 66 18 ‘又好得意, 好多人又好鍾意做輔導, 因為覺得咁先可以係更 ‘and it is interesting, many people would love to do Fu-do, as (this) makes 加好似professional. 但如果你睇番, 其實社工個訓練其實唔 them more professional. Yet in view of the social work training, the training is 係做呢啲嘢.’ (18) not about that (Fu-do).’ (18)

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67 18 ‘無論大學好或者神學院，就好想收到生，所以係個門檻, ‘whether it’s the University, or Seminary, would really want to recruit 我哋會set 得比較低…政府唔係咁重視，大學嘅收生門楷就 students, and so we would set the lower entrance requirement…the 會降低然後先可以維持到嗰個生源. 你冇人嚟讀就死梗，係 government does not take much concern, and so the University’s recruitment would be lower to maintain the student pool. It would be over if you do not 咪? 你就降低自己嘅門檻 , 咁你可能收埋啲唔係話真係好有 have students coming, right? So you would lower our entry requirement, and 心或者係好好成績嘅人入嚟讀 .’ (Q67) what you recruit would not be really passionate or academically excellent students.’ (Q67) 68 18 ‘就唔係單只係我meet到呢一個學院嘅 minimum requirement ‘not just me meeting the institute’s minimum requirement, how can it be ，如果你要畢業，又何其難呢!你唔畢到業學院都要求你畢 difficult if you want to graduate! (The institute) would require you to graduate 業…你攞到個C, 可能已經係畢業,但係我諗當然學院亦都喺 even if you cannot…you can already can graduate if you got a C, but then I think academic institutes should take extra concern, if (we) would increase the 呢一方面要三思，其實係咪要將嗰個entry requirement提 entry requirement, or graduation requirement, meaning if you cannot get a B, 升番多啲，或者係畢業嗰個要求即係如果你攞唔到個， , B you cannot graduate.’ (Q68) 或者你根本畢唔到業。’ (Q68) 69 14 ‘輔導唔係真係咁重視，即遠比醫人…呢個都係大家對呢一 ‘Fu-do is not really well considered, way compared with medical 個profession 個尊重程度有幾多? 呢個嘅係彼此嘅一個骨牌 treatment…This is about how much everyone’s respect is there towards the 效應，或者係一個連鎖效憑.’ (14, Q69) profession? This is a domino effect, or chain effect.’ (14, Q69) 70 18 ‘如果你個gate keeping唔夠, 出到去你就係更加難去收科( ‘If your gate-keeping is insufficient, it is harder for you to control/handle out 控制/處理) ，因為佢畢咗業，出面嘅人只知道呢個人原來 there (in public), as once they graduate, the public only know this person has 有碩士資歷, 就以為碩士就好巴閉.’ (18, Q70) Masters qualification, and think that its extraordinary.’ (18, Q70) 71 2 ‘總之任何人，你讀左一D course，你都可以開一間公司或 ‘Everyone who has studied some courses, can open a company or a Fu-do 者一個輔導中心話做 private practice。差在人地信唔信佢 center and claim yourself doing private practice. It is only a matter of whether 。’ (2, Q71) one believes it or not.’ (2, Q71) 72 9 ‘而家都幾混亂…我覺得各自開花. 譬如你個網頁做得好好 ‘this is so chaotic…I think everyone blossoms separately. If your website is 哋靚靚哋；佢哋睇網頁就去見人…所以有啲輔導員，如果 done well and pretty, they (the public) would look at the website and see 佢識得宣傳，佢又會有好多生意，譬如Google，即係將履 you…so some Fu-do worker, if they know marketing, they get lots of business, such as google, meaning (you) put CV out there, HKD 3,000 each month, and 歷擺上去，每個月三千蚊，啲人上Google就搵到…’ (9, so people can find (you) once they go to google…’ (9, Q72) Q72)

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73 9 ‘有一個OCD，佢嚟見我之前已經見咗一個Clin Psy ，每一 ‘one OCD (client), saw a clinical psychologist already before seeing me, each 次收二千四蚊，佢見咗24次，差唔多所有錢都擺咗喺嗰度. session was charged HKD 2,400, he/she had 24 sessions and put most of his 嬲尾, 嗰個Clin Psy 同佢講，我唔再見你, 因為呢都幫唔到 money there. 嬲尾/it got bad at the end, that clinical psychologist told him, “I 你，咁佢嬲尾呢就走咗嚟我, 因為我喺個輔導中心(神學院) would not see you anymore…because this does not help you.” (Client) then 做義工嘅幫佢，佢就走嚟呢度，因為呢度唔使畀錢，係一 came to me, as I helped him as a volunteer in the Fu-do center. This place does not charge, only one voluntarily donates in the seminary. When he first saw 間神學院裏面，佢就係自由奉獻。佢第一次見我，佢就咁 me, he/she told me, “the clinical psychologist said its been 24 sessions, I had 樣同我講，佢話我已經見咗廿四次，我好似冇得救，所以 no hope, so he/she would not see me anymore. Would you not see me?” I said 佢唔見我。佢就話你會唔會又唔見我，我話唔會，除非你 I would not stop, unless he/she left himself/herself…I think he/she really 自己離開…我覺得佢好需要一份接納同安全感…’ (9, Q74) needed acceptance and security…’ (9, Q74) 74 3 ‘如果係政府資助底下既社會服務，係社工做主導。但如果 ‘If under governmental funded social services, social workers take the lead. 係私人既層面，其實就會由可能係唔同既CP或者counselor However on the private setting level, actually perhaps different clinical 主導。呢個好得意，形式幾極端, 就係經濟上面可能真係唔 psychologists or counselors take the lead. Such polarized phenomenon is 足夠人，就只能接受社工或者其他。如果我要搵專業既 interesting, that money does not support the sufficient labor, and so (NGOs) only accept social workers or others. If I look for a professional counselor I 就要比錢。呢個唔知係咪如果你係社會福利署或 counselor have to pay. Not sure if it’s true or not, you do not have space for a job 者NGO 你作為counselor你係冇乜職位或者上流既空間。如 position or promotion in SWD or NGO if you are a counselor. If you do not 果你唔係入去所謂private clinic 或者你自己去開，其實係冇 enter the so-called private clinic nor open it yourself, you do not have any 乜機會係NGO到做,除非你係CP。可能會形成兩條路既情 chance in the NGO, unless you are a clinical psychologist. Perhaps this is how 況.’ (3, Q74) the 2 paths are generated.’ (3, Q74) 75 15 ‘我俾一筆錢你，你自己機構自己攪掂佢，咁你點樣去營運 ‘I give you money at once, you the organizations deal with it all. You take care 你自己睇. 大家都知道其實人工係最多，最貴. 有啲機構維 of the operation yourself. Everyone knows actually the salary occupies the 皮唔住(維持唔到), 佢咪就係嗰個薪酬度削減，咁所以有啲 most, the most expensive (expense). Some organizations cannot maintain operation, and they cut the salary expenditure, so some give entrance salary 係個entrance咪比萬七你，咁你做唔做, 嘻嘻…, 你搵唔到 fee HKD 1.7K, then you do it or not, haha… you have to temporarily take it if 其他野做你都暫時要入去做㗎，係咪咁但係講真你 ? Ha! you cannot find anything else, right? Ha! Yet honestly, you work for 1-2 years, 做多一兩年，如果你有一啲嘅筍工，呢啲同事都會走. 你走 if you have a better job offer, these staff would leave. Your departure actually 嗰時其實都影嚮，即你嘅人唔可以有 stability，咁你一定影 would affect, meaning there is no consistent staff, so it inevitably affects the 嚮到個service quality，有啲機構事實上係留唔到人. 不斷 service quality. Some organizations actually cannot keep the staff. The turnover 好勁.’ (Q75) turnover rate is high.’ (15, Q75)

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76 15 ‘政府冇錢，就係會one-line budget. 好多機構會請你，係大 ‘The government has no money, hence the one-line budget. Many 學畢業嘅人，但可能你嗰個post就叫做Social Work organizations employ fresh graduates, but your post would be social work Assistant，咁就降左一個等級，而所做嘅野嚟講, 其實都唔 assistant, means one grade down, and so the involved work is not as so-called professional. Therefore so many fresh graduates only engage in tangible 係so called咁professional. 所以有好多大學畢業嘅同學, 可 services in the first few years of career. Then you judge if Fu-do is a big 能有好幾年，其實都係做緊一啲比較嘅野 tangible services . concern to them, as their job roles do not involve much Fu-do.’ (15, Q76) 咁你話呀輔導其實對佢嚟講即係咪咁重視，因為根本佢自己工作裡面都唔需要太多輔導.’ (15, Q76) 77 4 ‘香港而家比輔導最多既錢比哂SEN學生，一來每年既 ‘Hong Kong currently give most Fu-do funding to SEN students. The absolute absolute number其實就跳升緊，你小學中學個landscape都定 number increases in every year, your primary and secondary school landscape . 大家都係收到有錢然後就外購服務. 8成都係 NGO 自己包 is consolidated. Everyone receives money and then refer to outsource services, in which 80% is covered by the NGOs. There is no role to play (for 辦哂. 其實又冇乜role to play, 姐係話counselor 又好， counsellors and counseling psychologists). These children grow up, after 又好呢班仔會大佢考完次後，因為種種 counseling psy , . dse taking DSE (Hong Kong public examination), due to different reasons they 原因，佢地入唔到U既機會好大，我估就8成都入哂ive…教 mostly cannot get into the University, I reckon 80% enter IVE…Educational 統局比IVE support 呢班人既錢，其實係大到一個數係好恐 Bureau’s given financial support to IVE, is horribly large, not just about 佈，唔係講緊千萬計。所以點樣去將counseling 同埋 ranges of 10 million. Therefore how to utilize counseling and psychologists psychologist既knowledge去address果個回應係最大呢？我諗 knowledge to address this? I guess this area will be focused these 5-10 years. 近5, 10年應該都係呢個area...岩岩林鄭又撥左三十幾億去再 Recently Lam Cheng (Hong Kong Chief Executive) has granted HKD 30 expand coordinate 既service...我覺得最大值得去發展, 因為 billion to expand service coordination…I think (this is) the biggest development area, and your service would fulfil your requirement, so you look 都幾大既area，咁中間你服務都係fulfill到你requirement， for space to conduct counseling service. You can image whatever studies for 咁中間你咪再去搵去空間去做。咁你想像 counseling service those students would be valid, meaning they have high rate of depression, 果班仔其實你做咩study都valid，姐佢有high rate of anxiety. You can do whatever prediction, adjustment need, big parental stress, depression, anxiety, 你predict , adjustment need 你做乜都得， so often this can help this population.’ parent既stress係大既，實中架，果到可以再幫到呢一班人.’ (4, Q77)

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78 4 ‘SEN Education其實唔係clinical psy 既定位…姐係果D地方 ‘SEN Education is not clinical psychology’s orientation…means you do not 唔會見到好多CP. CP去哂邊？去哂醫院，衛生署，社署， see many clinical psychologists in this area. Where have all clinical 姐係果D absorb哂D人. 係一個psychologist既角度黎講，我 psychologists gone? To hospitals, Hospital Authority, SWD, meaning most of them are absorbed in these places. From a psychologist’s perspective, I think 諗我地面對既未必係一般public見到既, 就係我地永遠條隊 what we face is not just what the public see, which is that the queue never 都係唔完。我地請幾多人都好，一路都好，我 queue referral disappears. Whether we employ the staff, referrals are done, we know that the 地知政府唔會去相應地加返資源，有咩既時候條隊咪愈黎 government would not by proportion enhance staff capacity, and the queue 愈長。呢個係傳統上manual model比人丙. 係丙得岩，因為 would be longer and longer especially at critical times. Traditionally (this 你唔係係個源頭去做事，我地?加嘛，姐死啦，急症室入黎 service) manual model is condemned. It is right it is condemned, as you do not ，咁就搵我地。咁cp有時定左位就係我地框左係到.’ (Q78) work from the root source. So ah la, (they) come via A&E, and look for us. Sometimes this is how clinical psychology orientation is restricted.’ (Q78) 79 1 ‘其實我哋邊有咁多心理學家係咪？香港冇咁多心理學家， ‘Actually how do we have so many psychologists right? Hong Kong does not 就算社會福利處啲社工，一個社工都咩七八十個cases. 真 have many psychologists. Even one SWD social worker takes up 70-80 cases. 係好緊急好需要嗰啲可能佢就真係好深入去做，其他理唔 They may do in-depth (counseling) for the most urgent and needed ones, but cannot attend to the rest that much. Actually I think resources would greatly 到咁多。其實我諗個資源都好影響本身輔導個質素同埋 affect Fu-do quality and depth.’ (Q79) 深度.’ (Q79) 80 15 ‘放咗工都係公眾嘅一部份，即係其實佢地點樣思考，大程 ‘(they) are part of the public after work, means they think on the same level as 度同公眾係同步… even政策處理，即policy maker 唔係太 the public…even for strategic intervention, the policy maker do not really 理解其實乜野叫做獨立嘅counselling行業，即係佢會覺得 understand what it means as an independent counseling industry, in other words it thinks it’s an activity that everyone can be part of.’ (15, Q80) 係人人都係可以有份嘅一種activity。’ (15, Q80) 81 14 ‘之前我哋好ridiculous，香港有個debate就係究竟 ‘we were so ridiculous, there was a debate in Hong Kong which is whether Psychologist 或者 Counsellor 屬唔屬於healthcare 嘅 psychologist or counsellor belong to the healthcare professional(s)…I think if professional…呢個我諗喺外國社會真係睇到吓！Psychology the overseas society really sees this! Psychology is not a healthcare profession? Or counseling is not a healthcare! It will make (them) laugh 唔係一個health care professional？或者counsellor 唔係一個 themselves off!’ (14; Q81) health care ，笑死人啦！’ (14, Q81)

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82 15 ‘香港心理學會話要做工，去到依家都26年，係未有任何進 ‘Hong Kong psychological society asked for this (accreditation), and it’s been 展. 因為其實政府一路都話呢個人數唔係咁多，唔需要花咁 26 years and never any development. It is because the government has always 多錢去規管. 佢最多就話政府工嗰度請番你有某啲 training said about the insufficient member number, that not much money is necessary for regulation. They mostly would mention about the governmental job 嘅人就咁樣，但係唔係政府嗰啲就冇得控制，或者甚而佢 positions’ allocation to some certain training, but they can’t control those non- 個人就算做緊佢嘅野佢唔叫自己做心理學家，叫治療師 , . governmental (jobs), or an individual doing. (If) he/she does not identify …輔導師，乜野總之佢任何名,唔係心理學家幾個字就冇辦 himself as a psychologist, perhaps therapist, counsellor, whatever the name is 法理架，’ (15; Q82) other than psychologist would be outside their intervention.’ (15; Q82)

83 14 “而家香港就係一般我唔知道其他西方社會係咪咁，但香港 ‘…I am not certain whether things are like this in the West, but the way that 嗰種做事嘅方法就係有事爆出嚟，我就要去處理。即係好 Hong Kong people deal with things, is that emergency explores, then I handle 多嘢都係add hot add on上去。但係就冇乜人有一個好宏觀 it. However, there is no macro-picture which deals with mental health issue…’ (Q83) 嘅picture其實處理緊mental health 呢個issue。” (Q83) 84 15 ‘就算佢立法都係經過你下面嘅professional組織,即佢當然授 ‘even legislation is processed via the below professional bodies. It would grant 權俾你，但係佢一定要你有一定嘅經濟資本或者點樣先可 authorization to you, but it would require you to have certain economical 以繼續營運到落去.’ (Q84) capital or (knowing) how to operate sustainably.’ (Q84) 85 15 ‘外國已經有成個division，有晒regulation，做得乜野，而 ‘The overseas has already established division, regulation, whatever is done is 且好多係上而下 (佢spot out到有呢個問題，於是佢自己定 via top-down processing (it spots out the certain problem, and it would define 義乜野叫做乜野行業)，通常成個立法一路做晒落去. 香港 the industry itself), and often legislation is carried out throughout. Hong Kong is…you restrictedly wait and wait (the own organization has existed for quite 係你郁一郁 (自己個團體職業存在左一段時間) 下面啲人提 some time) the people below submit a proposal (legislative application), it 交立法註冊佢就玩，唔就算，咁一路就 proposal ( ), buy buy would play along if liking it, would not play along if not, and so this problem 吊住個問題好耐…你想佢變立法規管，掉番轉政府就要求 has been hanging there for so long…you hope it (government) turns to 你大家夾錢，整一個自己營運嘅專業組織，希望每年嘅 legislative regulation, in return the government asks everyone to chip in, create budget唔少過100萬. 咁呢個就係其中一個自願性嘅自我規 a self-regulated professional body, and that budget each year would be no less 管. 咁其實唔係個個profession有咁多member.’ (15, Q85) than HKD 1 million. This is one kind of voluntary society-based registration. Well actually not every profession has so many members.’ (15, Q85)

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86 6 ‘香港係好hierarchical，民主對於我黎講係唔exist. 到到都係 ‘Hong Kong is very hierarchical; democracy to me does not exist. It happens 但香港更極端. psychi係無上，然後先到clinical psychologist everywhere, but its more extreme in Hong Kong. Psychiatrists are limitlessly ，然後跟住底下係乜水，就乜水，姐可能係社工仔又好. 姐 high-up, and then clinical psychologist, and then what’s below would be perhaps social workers. It is very hierarchical, but actually, in Overseas, once 好hierarchical既野，但其實唔係，你係外國既演釋黎講， you have clinical training, even different ones would protect your 只要你有，或者係唔同既都到你 clinical training protect professionalism. There is respect to all training, (the place is) integrative, professional 既野。係好respectful 對所有professional 係一個 everyone has a different perspective to see things.’ (6; Q86) integrate ，大家有唔同既perspective 去睇野…’ (6; Q86) 87 4 ‘咁你周個咁貴人工，我覺得咁先justify到.’ ‘Well your salary is so high, so it can justified (my work)’ (Q87). 88 4 ‘我地就唔會話有幾多病人既感謝信，或者病人既滿意程度 ‘We would not address like how many patients send thank you letters, or 問卷…社會服務單位可能就係停喺嗰個位置; social work唔 patients’ satisfaction survey…social services units are limited to this current 需要，其實佢有D咩好冇咩所謂，因為佢地冇一個medical, position; social work does not acquire…actually it does not matter what they have, as they do not have a medical, clinical guidelines to follow-up.’ (4; clinical既guideline去做.’ (4, Q88) Q88) 89 15 ‘係一個NGO,屬下可能係 social work，你呀頭都係social ‘in a NGO, subordinates are from social work, your head would also be from work，你中間就係psychologist. 於是個定位係點樣做，點 social work, the middle is psychologist. Therefore then there are a lot of 樣滲入個架構度有時侯有好多嘅negotiation…’ (15, Q89) negotiations on how to work out this orientation.’ (15; Q89)

90 3 ‘香港最專業做輔導可能係真係CP， EP都唔係輔導。之後 ‘The most professional Fu-do conductor perhaps really would be clinical 果一層可能係社工，咁輔導員可能變左係最唔專業果D， psychologist, Educational psychology is not Fu-do. Then the next level is 但明明佢地既training係專業。如果聽到輔導員, 社工：哦 perhaps social work, and Fu-do worker would perhaps be the most unprofessional ones, but actually their training is professional. If heard about ，幫人呀嘛，傾下計果D呀！其實係奇怪，社工做左人地 Fu-do worker, social workers “Oh, help people ma, it’s the chatting ah! It is 果，或者香港係以社工為主軸，去做福利服務既一個城 D actually strange, that social workers have done other people’s (work), or Hong 市…所以如果你係讀counseling，你係好多職位你都唔做得. Kong is led by social work, to create a social welfare service led city…so if 我係counselor我可唔可以係機構？唔好意思機構淨係請社 you study counseling, you cannot be qualified in many positions. “I am a 工，唔係就下面果D支援性既野。專業性好彩社工都唔係 counsellor can I (work) in the organization?” Sorry organizations only employ 太差，但係就變左好奇怪，本身counseling係好專既東西。 social workers, if not (one) goes to the lower supportive levelled work. Social 所以我會話我係社工。’ (3) workers are not on the too-bad professional level, but then a strange thing has turned out, that counseling itself is a very professional thing. Therefore I would say I am a social worker.’ (3; Q90)

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91 4 ‘大學counseling center specialist 照計應該係(counsellor)，咁 ‘University counseling center specialist(s) should be (counsellors), but due to 但係有歷屎因素，佢揸旗果D好多都係cp, 因為佢先黎霸左 historical factors, the decision makers are mostly clinical psychologists, as 個山頭. 所以發展空間最大反而係…我覺得就係8大以外既 they firstly dominated the territory. Therefore the biggest potential development actually is…I think they would be outside the big 8 院校…ive其實係一個好大好大既education provider。咁你 Universities…IVE is actually a very very big educational provider. You can 當十萬人畢業其實得兩萬入到但你想像至小冇成都有 U, 7 5 assume only 2,000 out of 10,000 (secondary) graduates enter the Universities, 成掛入左ive. 係ive裹面就好多野冇psychologist，話事既就 but at least 50% if not 70% (people) enter IVE. There are not many 係counselor…佢地真係做counseling…果班我覺得係hk係果 psychologists in IVE, the decision makers are counsellor…they really do 個裂縫之間somehow生存到。同埋因為佢地多錢。’ (Q91) counseling…I think they have somehow survived within the gap in Hong Kong, also because they have much money.’ (Q91) 92 10 ‘唔係話咁明文規定我哋喺醫院個角色都係一個volunteer. ‘there is no such official regulation, our role in the hospital, is only a 我係醫院工作, 但係我唔屬於醫院嘅員工. 醫院招攬我哋喺 volunteer. I work in the hospital, but I do not belong to the hospital staff. The 醫院做呢個Spiritual Care嘅工作、即係佢哋睇係重要…我哋 hospital recruited us to provide spiritual care, which means they regard its importance…we can disappear from the system anytime. However we are also 喺個system裏面係可以隨時消失㗎。但係我哋…又係好重 very important! It is because they think we are important when they need 要囉！因為佢哋需要我哋嘅時候佢哋就覺得我哋重要 , … … us…’ (10; Q92) …’ (Q92) 93 4 ‘Counseling psychologist 係Hong Kong 好論盡, 就係佢claim ‘Counseling psychologists in Hong Kong is in a stumbling status, which is that 係一個specialist. 因為人數上佢冇可能做到primary care，你 it claims itself as a specialist. In terms of number it cannot provide primary 一年出得幾多個，20個，爆喇。你果20個跌左落二萬個就 care, as you only produce 20ish maximum (of practitioners). You don’t exist when your 20 (members) fall into 20,000 (of social workers), but then it does 唔存在，咁但係佢又上唔到去個specialist果到, 因為 not reach the specialist level, as somehow its orientation is, actually how to 佢果個定位就，調返轉問同 somehow counseling psychologist distinguish between counseling psychology and clinical psychology? Both are cp又點分先？咁大家都係psychologist, 咁我冇理由個pay比 psychologists, so I do not have a reason to pay lower salary for you. Then 低D你。咁有冇D野係cp做到但係counseling psy做唔到？舉 would there be things clinical psychologists can do but not the counseling 例可能cp同ep會做iq assessment，咁officially 我估個定位都 psychologists? For instance, clinical and educational psychologists can do IQ 係咁…係admin上，大家又好似會分到清楚，譬如香港己經 assessment, which officially is their orientation I reckon…everyone can 分左係ep cp做，咁我心諗我請佢返黎唔做得IQ，咁咪好蝕 distinguish the administrative division, for instance Hong Kong has already .’ (Q93) allocated (the IQ assessment) for educational and clinical psychology, then I would think it is a waste if I hire someone (counseling psychologist) who cannot conduct IQ (assessment).’ (Q93)

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94 14 ‘即係講白啲就係臨床心理學家會覺得我哋counselling ‘Frankly clinical psychologists would think that we counseling psychologist psychologist好似啲second class嘅psychologist, 好似係一啲唔 like second-class psychologist, like something not scientific. They would name 係好scientific. 佢哋會name我哋唔係一啲對於好challenge嘅 us as those who cannot handle challenging cases, as the current Hong Kong clinical psychologists regardless which University training is provided has case handle唔到,因為而家喺香港嘅clinical psychologist 無論 great emphasis on CDP as more scientific. If you use other approaches, some 係邊間嘅都好其實都側重喺嘅層面 University training , CDP . in the field would even criticize the approaches as not appropriate or 咁因為CDP scientific. 如果你用其他 approach 嘅話,甚至乎 qualified.’ (14; Q94) 有一啲行內嘅人士亦都會話你哋嘅approach其實唔係一啲合適/合資格嘅approach去處理一啲情況。’ (14) 95 15 ‘但係你話去到一啲有international status，social status係比 ‘Yet actually there are very few who are to the international status, social 較權威去代表我哋嗰行業去發聲嘅人，其實暫時係小,。 status and with authority to represent and voice out for our industry. Therefore 所以我覺得我自己有一個諗法其實將來 further study會唔會 I think I have a thought that the future study would help me establish this status, and help the profession’s better development in the future.’ (Q95) 都幫自己可以建立到呢一個 status，日後再幫助業界推動嘅時候有一個更好嘅發展.’ 96 16 ‘心態上我諗即我哋都難免有啲人係老大哥, 你唔好 ‘On the mentality level I think inevitably someone would be the “big brother”: challenge我, 我已經即係上咗神枱. 即係唔能夠大家喺個 “you cannot challenge me, I am already up on the altar”. In that case everyone same level, 都好多人都好驚人哋challenge. 呢個學習氣氛,如 cannot be on the same level, also many are afraid of being challenged. This learning atmosphere, if you are used to it at school, you also have this attitude 果你喺school裏面慣咗,你出嚟practice嘅時候, 你都有呢種 in practice…I follow this teacher, I am this way; another group follows that 我係跟呢個老師我哋係咁另外一批我跟嗰個老 attitude… , , , teacher, they are this way and this affects the whole education…’ (16; Q96) 師, 我哋係咁影響咗成個education…’ (16; Q96) 97 16 ‘香港一粒沙反映緊外面嘅情況, 一樣嘅啫, 係咪呀?喺香港, ‘Hong Kong this piece of one sand reflects the situation out there (overseas), it 有啲都會覺得自己高級啲,呀因為我係AAMMT…佢係繼續 is the same, right? In Hong Kong, some feel themselves as the superior ones, 喺佢自己feel comfortable 個zone度, 不過呢個都冇辦法. 我 “ah as I am AAMMT”…they continue to feel comfortable in their zone, but there is no resolution (to this). I have seen this (problem) remaining the same 睇即係咁多年都係咁, 歷史都係咁…’ (16) for years, so as history…’ (16; Q97)

98 9 ‘大家互相去尊重. 各人嘅需要唔同, 其實幾個field都可以大 ‘Everyone respects each other. Everyone’s needs are different, actually 家一齊提供服務，咁點解係唯我獨尊?’ (9) different fields can provide services together. Why is it ‘I am the unique and only elite?’ (9; Q98) 99 15 ‘其實通常呢啲爭取counselling psychology 規範化或者乜野 ‘Actually such typical counseling psychology standardization or 專業化嘅movement裡面都好少NGO或者係,好少social work professionalization movement lacks support from NGO, or social work…as 嘅 support係裡面…因為佢覺得自己都做緊…’ (15; Q99) they think they are doing it already…’ (15; Q99)

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100 15 ‘我唸training本身會決定左佢睇事物嘅角度, 同一件事有唔 ‘I reckon training itself determines one’s perspective taking, and the different 同切入點. 個拉扯唔係純粹係資源上或者係一個職業嘅板塊 cutting points of one scenario. The struggle is not just about resources or 上面，即係唔係話爭領土咁樣，而係佢睇事物嘅方法唔同.’ disciplinary territory, meaning territorial competition, but also the different (15; Q100) ways of perspective taking.’ (15; Q100) 101 16 ‘佢哋有好清楚嘅guideline. 社工就有社工係需要解決問題 ‘they have very clear guideline. Social workers have social work specific 嘅guideline, 或者要交一啲數字嘅guideline, 所以佢變得呢, guidelines for problems solving , or guidelines for reporting numbers. 好problem solving…’ (16; Q101) Therefore it is becoming a very problem solving (profession)…’ (16; Q101) 102 16 ‘佢哋會分薄咗…之前嗰啲利益得者, 就會覺得佢哋冇咁多 ‘They (new-comers) would thinner the resources…those previous benefits 利益. 之前佢哋已經上曬神枱. 佢哋唔使做乜佢已經收到佢 holders would think they have fewer benefits. They were on the altar already. 哋嘅利益. 咁但係而家變咗佢哋可能仲要做多啲嘢. 另外嗰 They would get their benefits even they need not do much. Yet now this (change) means they would be required to do more. Those new-comers would 啲新嚟嘅又會分薄咗…’ (16) thinner (the resources)…’ (16; Q102)

103 15 ‘我覺得成個香港點解變咗個戰爭,就係佢唔係想睇公眾多 ‘(I think) Why the whole Hong Kong has turned into a war, is because they 咗認識. 佢係想喺業界有立足之地. 咁兩樣嘢嘅目標係好唔 (professions) do not want the enhanced public awareness, rather they 同, 例如喺業界保護番自己人. 咁呢個狀況大問題就係只有 themselves want a stepping foot into the industry. These two things’ underlying intentions are very different, for example the discipline wants to 自己人會認同, 但係公眾係冇改變到任何嘢.’ (15; Q103) protect its own people. This situation’s problem is that acknowledgement only reaches the own people, but there are no changes among the public.’ (15; Q103) 104 4 ‘我覺得要明咩係叫ADHD. Social work唔識，social work係 ‘I think (one) needs to know what ADHD is. Social work does not know (this), 唔會識哂咁in-depth, specific既野，原來SPLD就係要用呢一 social work would not know such in-depth, specific things, that actually SPLD 套教材呢就會咁樣教，你呢個就可以有呢套…你suppose requires this educational tool, this tool goes for that…you suppose that general social worker does not know about this. Some social workers have great general social worker係唔識做. 咁有D社工都好fit，再讀多 fitness (in practice), as their studied Masters program is about SEN. Perhaps 個就因為個服務到，可能個又想個 master SEN. NGO provide on the service level, the NGO wants to provide a service. From the business service. 咁business去講都有心既，有錢我地就做。咁 (perspective) this is good passion shown, “I would do it if have money”. The develop既時候個landscape慢慢去轉. 呢個就係cp到唔到既 (service) landscape then gradually changes while in development. This is an area，因為SEN education 其實唔係clinical psy既定位…CP area which clinical psychologists cannot reach, as SEN education is not 去哂邊？去哂醫院，衛生署，社署，果D absorb哂D人…’ clinical psychology’s orientation…where have all clinical psychologists gone? (Q104) Hospitals, Hospital Authority, SWD absorbs all the labor…’ (Q104)

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105 3 ‘我睇(social worker)係一個名。Manager都要洗廁所。但係 ‘I see (social worker) as a name/title. (social work) manager needs to clean the 呢個亦都可能係人地睇社工就係唔專業，譬如CP。佢地係 toilet. However, this is also how people see social workers’ unprofessionalism, 比較單一既工作，或者比較專. 姐CP唔會去做洗廁所，但 such as clinical psychology. Their work is more single tasked, or more focused. In other words clincail psychologists would not clean the toilet, but 社工要。譬如CP唔會需要做我地一D既所謂資源分配工作 social workers have to. For instance, clinical psychologists are not required to 。 ’ (Q105) do our so-called resources allocation work.’ (Q105)

106 2 ‘就唔係純綷頭先講話一D監測或者manage學生既一D事務. ‘as mentioned (it) is not merely about monitoring or managing some student 如果純綷係做果D，而冇包括話要去關心個人，同佢傾下 affairs. If just doing this, and not individual work, like caring for the 或者令佢成長，或者減低佢既困惑，之類呢D人既工作. 咁 individual, having chats or leading to the own growth, or reduce the own worries. This is not Fu-do; rather just management work.’ (Q106) 樣都唔係一個輔導，姐純綷係一個管理既工作.’ (Q106) 107 1 ‘呢個學生輔導老師，我自己感覺我覺得係應該優勝過做老 ‘this student’s guidance teacher (post), I myself think it is better than a teacher, 師，優勝過社工嚟fit呢個位。你話出面嘅即係社區上面嘅 better than social workers to fill in this post. You would say the different target 唔同群組嘅人士，咁可能當然呢啲真係要社工去幫啦. 咁樣 groups in the community may require social workers’ support. School setting is really different.’ (Q107) 學校嘅setting真係唔同嘅.’ (Q107) 108 17 ‘要聯絡其他啲唔同嘅system做cooperation. 咁我覺得呢樣係 ‘have to coordinate with other different systems for cooperation. I would say 成個cp field 可能比較弱小小. 其他 profession嘅人都會覺得 this is a weak point for the whole clinical psychology field. Most people from 可能CP比較自己閂埋門做嘢. 如果係一啲真係入到學校或 the other professions would think that clinical psychologists work behind closed doors. Clinical psychologists rarely enter the schools or accompany 者同佢去醫院覆診一般都好少喺CP去做. 有時呢啲位我覺 clients to the hospital follow-up appointments. I think these are also important 得都幾緊要，即係要有啲先至可以一次咁樣去 collaboration tasks, and collaboration is needed such that (we can) handle (the problem) at 處理. ’ (Q108) once.’ (Q108)

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109 4 ‘我知佢地有教psychological assessment，但係D行家接到既 ‘I know they (counseling psychology) teach psychological assessment, but the 時候就會彈你，話你唔係做counseling既野多D既咩，邊個 experts would criticize you, and said “aren’t you focusing more in counseling? 教你架，係咪qualify架？好正常既問呢D. 因為你train左IQ Who teaches you? (Are you) qualified?” It is normal to ask these questions. Your IQ (assessment) training is not about answering the 11 tests, not just 唔係淨係識問果11個test，唔係淨係計分. 要睇profile呀，要 about calculation. (You) have to read (client) profile, (you) have to 草咁多呀，咁你你邊到會草到？咁你一定要去返 case hk case accumulate cases. Then how can you accumulate cases in Hong Kong? You 個supervision site，咁supervision既時候我地講緊衛生署 have to return to the supervision site. If about supervision, we are then talking child assessment大約一年見幾百個細路既，咁你個place就 about Department of Health child assessment with roughly few hundreds cases 可能見唔好話幾百個，你見住50個. 你大約知道個case係咁 per year. In your position you may see not hundreds (of cases), perhaps 50. 既，adhd係咁既，delay係咁既，speech有問題果D個profile You learn this is how a case unfolds, this is ADHD, delay, speech problems 係咁既. 咁你先叫學左果套technique，姐你識計iq，識分社 and such profile. Then this is how you have learnt this set of technique, 會index。咁counseling psy個disadvantage就係佢蒙糊，我亦 meaning you know how to calculate IQ (assessment), and differentiate social 都唔覺得大家會開放出黎。所以你話理論上呢就可以做既 index. The disadvantage of counseling psychology is its ambiguity, (and) I think nobody would release/open up space for (the assessment conducting ，因為你都係，你知， psychologist psychometric properties authorization). Therefore you may say in theory (counseling psychologists) test administration. 唔係個skills既問題，而次後你地個 can do it, because you are a psychologist. You know about psychometric placement 本身有冇足夠果個profiling，你可唔可以 properties, test administration. (This is) not a matter of skills, rather whether incorporate到果個issue 上，咁所以counseling psy個定位就 your placement itself includes sufficient profiling, and whether you can 難.’ (Q109) incorporate it to the issues. Therefore it is hard to set orientation for counseling psychology.’ (Q109)

110 14 ‘而家counsellor就我覺得如果擺 counselling psychologist嘅 ‘For counsellor, I think if looking from counseling psychology position, (one) 話，就應該要去分開咗去睇,分開咗去做。但係政府嘅 should look at them separately, and they should go separate professional paths. feedback畀我哋一個令到我哋都未係好滿意嘅feedback就係 However, we are dissatisfied by the governmental feedback, which is that it so far regards counsellor and counseling psychologist as from the same field and :佢暫時覺得Counsellor同Counselling Psychologist係同一個 same setting. What is the problem? What problem would be generated? In the 同一個嘅嘢咁有啲乜嘢嘅問題呢容易衍生咗 field setting . ? future, first the existing counselros would ask for a counseling psychologist 嗰個困難？就係如果日後係咁嘅時候，第一就已existing title. However, it is true that counseling psychologists and counsellor have 嘅counsellor就會ask for個title佢哋都要做一個Counselling different training, for instance counselor’ s academic work does not include Psychologist. 咁但係的確Counselling Psychologist同埋 our research requirement. Then is it the best thing provided to the public, if we Counsellor個training不同，例如我哋要一啲research嘅要求 allow fusion of everyone’s professionalism?’ (Q110) 呀等等，可能其實Counsellor嘅Academic冇呢啲嘅. 咁變咗如果我哋去讓大家專業性咁樣混為一談嘅時候，其實係咪對緊公眾畀緊最好嘅嘢佢哋。’

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111 14 ‘係自己行內人士互相嘅Competition. 呢個counselling ‘It is the competition between people in the same field. This is worse for psychologist 仲惨啲，因為佢有半隻腳係counselling界別有 counseling psychology, as it has half foot set on the counseling border, half on 半隻係psychology界別…我諗香港嘅一個社會都係競爭… the psychology border…I reckon its always about competition in the Hong Kong society…it occurs in many industries. Furthermore, the profession’s 好多行業都會發生嘅事情。同埋大家嘅professional spirit/mentality is significantly dependent on how the line of everyone’s 想點畫點界，其實亦都係幾影響到成個行業嘅心 boundaries professional boundaries is drawn. Whether we counseling psychologist’s work 態。究竟我哋Counselling Psychologist 嘅工作點樣同到其他 corresponds to other psychologists like clinical psychologists, or what is the 嘅Psychologist好似Clinical Psychologist, 或者 Psychologist嘅 differentiation between psychologists, it is difficult for one to (respond to this differentiation係點，咁呢個我諗都係難去喺香港existing個 problem) within the existing Hong Kong system.’ (Q111) system入面去做到。’ (Q111) 112 6 ‘如果compare下，啫係orange to apple，咁見 counseling 好 ‘If comparing, like orange to apple, you can see that counseling 過clinical psychology果班人，因為focus係果到。clinical (psychologists) are better than clinical psychologists (in counseling) due to psychology咪assessment，但係counseling psy都做assessment their focus (in counseling). Clinical psychology focuses assessment, but counseling psychology wants to conduct assessment, but only it has no ，之不過佢冇位置之嘛係香港. 而果班clinical psychology都 position in Hong Kong. Those clinical psychologists do not want counselling 唔想比攞佢地位我係 counseling psychology D . clinical psychologists to take away their places. “I am a clinical psychologist, you are psychologist ，你係counseling psychologist 你係乜都唔係。 counseling psychologist you are nothing.” But hey, things are the same from 但係喂，睇下program to program ，training to training，都 program to program, training to training. Then what’s the difference? Nothing 係果炸野黎，有咩分別呢？唔通HKU train人會好D？咁有 is better just because of a different name.’ (6; Q112) 咩分別呢？你唔會因為某個名係好D架.’ (6; Q112) 113 10 ‘其實我覺得前景係好好，會比較我自己覺得係樂觀…所以 ‘Actually I think the prospect is quite good, which is relatively (I think) 其實而家有好多都係透過輔導特別係個人成長裏面，畀自 optimistic…therefore actually there are many (people) who have spiritual 己嗰個心靈成長更加去了解多自己，同埋去明白自己…咁 growth and more self-understanding via Fu-do and personal growth…so in the 變咗香港而家呢十年開始慢慢去講呢啲課題。變咗就多咗 recent 10 years (people) have slowly started to talk about these topics in Hong Kong. It means that more people get to learn and understand this area, and so 人係呢方面多去認識同埋了解，就接納去見輔導佢哋覺 … accept to see Fu-do…they would not see it as an illness. (it) is a good 得唔會再睇為係一種病. 係好嘅一個觀念嘅轉化…’ (10) conceptual change…’ (10, Q113) 114 5 ‘同埋我覺得䢫住香港人D較為知識水平一路上升緊，我覺 ‘and I think as Hong Kong people’s knowledge standard has been increasing, 得佢地都有呢一個concept，慢慢淡化D中國人既文化，姐 they would have a concept, to slowly play down the Chinese culture, meaning 話佢要搵人輔導呀搵人傾呢樣野。’ (5, Q114) they would seek Fu-do, look for people to chat.’ (5, Q114) 115 4 ‘我就positive，社會應該要變好…過幾年我地test run緊個 ‘I am positive, society should change for better…these years we are test model，CP 可唔可以走前小小？我地個 model 就三個party running a model, (so that) clinical psychology could move forward? Our ，ngo, cp同埋一個academic 既psychologist。’ (4; Q115) model has 3 parties, NGO, clinical psychologists and an academic psychologist.’

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116 17 ‘其實就依家都係盡量提高緊啲公眾認識。我都有喺個會度 ‘Actually (we) make an effort to enhance public awareness. I do support in the 幫緊手, 例如整啲leaflet, 或者大家都會post晒喺facebook. 另 association, for instance making leaflet, or people would post on facebook. 外亦都有通知啲機構點樣先係合資格嘅CP.’ (17) (We) would inform organizations what makes a qualified clinical psychologist.’ (17; Q116) 117 6 ‘因為香港係停留左一個好保守既，我係professional 你黎搵 ‘As Hong Kong has stayed at a very conservative (stage), “I am a professional 我。喂大部份外國唔係咁架. 巳經係分左stream…你要走出 you look for me.”. Hey most overseas Universities are not like that. (They) 去，所以先會有community psychologist ，psychiatrist 既存 have set separate streams…you have to go out there, so there would be community psychologist, psychiatrist. Hong Kong remains under the post- 在。香港係停留左係殖民地主義底下既hierarchical system.’ colonial hierarchical system.’ (6, Q117) (6) 118 9 ‘係呀好難，因為佢哋又唔愁冇client，點解我一定要做你 ‘Yes it is difficult, as they (private practitioners) would not worry not having 呢啲低下階層！所以可能嗰度真係要由政府take care番.變 clients, why would I have to serve you the lower class! Therefore this needs 咗大家服務嘅對象唔同,咁都係好，Service如果淨係某一類 the government to take care instead. So everyone’s service targets would be 對象又唔得。即係我覺得可以分散資源去用，邊個可以負 different, which is great, (as) the service cannot be for only one target group. In other words I think resources allocation can be decentralized, those who can 擔多啲，咁咪佢去搵邊一類嘅服務如果有心人，如果可 … afford more could be allocated to a particular services… people with good 以捐啲錢畀呢一私人機構，做一個基金. 如果某一類有受助 intention, if can donate money to the private organizations, set up a funding. 者好需要，會唔會喺嗰度基金可以幫佢pay，咁你嘅私人執 For some target groups with significant needs, such funding can support their 業咪可以都兼顧到嗰啲低下階層. 咁但係真係要有咁嘅體 payment, and so the private practice could incorporate the lower class. 件.’ (9) However this really requires such hardware.’ (9, Q118) 119 9 ‘香港唔係一個福利國家，譬如好似澳洲，佢哋可以 ‘Hong Kong is not a socialist country, like Australia, as people can use Medical Card碌，譬如佢一年可以碌10次，咁變咗低下階 medicare card like 10 times per year, and so lower class could see private 層，可以攞住佢哋嗰個Medicare Card，去見私人執業十次 practice 10 times with the medicare card. I think this is quite good. And yet ，我覺得都係好嘅。但香港唔係一個福利國家，咁就真係 Hong Kong is not a socialist country, and so there is no solution.’ (Q119) 冇辦法。’ (Q119)

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120 9 ‘其實香港係一個好福地。福地嘅意思，即係輔導理論好強 ‘Actually Hong Kong is a blessed land. The meaning of the blessed land is that ，好多理論大師都會嚟香港教學. 香港好快能夠接觸到好多 (it has) strong Fu-do theory, as many theory masters would come to Hong 新嘅心靈即係輔導理論, 所以我覺得香港畀中國內地, 接觸 Kong to provide training. Hong Kong can connect with many new spiritual/Fu-do theories, and so I think that Hong Kong compared with the 心理學理論係好多機會。而家回歸咗中國, 我諗我哋會一 Mainland China has much more access to psychological theories. At the stage 路去發展但係將來點呢好難講中國大陸佢哋會唔會第 , … , of returning to China, I think we would continue our development, but it is 時有政策轉變、或者私家喺香港…所以我哋本地嘅社工、 hard to say about the future…The Mainland China, whether they would have 輔導員…都想話有啲咩學會、攞咗啲咩治療牌, 希望香港都 policy changes, or the practitioners setting up private practice in Hong 有自己個專業守則、水準, 咁變咗又唔容易畀大陸啲諮商師 Kong…Therefore our local social workers, Fu-do workers…all have noted the , 嚟到香港影響我哋嗰個專業,水平,同埋位置. 咁我睇到佢哋 desire to set up association, therapy licence, (and) hope that Hong Kong has its 而家有呢方面個預備. 所以都係舊年就成立咗個叫家庭同婚 own professional regulation and quality, and so our professional level and 姻治療協會…’ (Q120) position would not be easily affected by the Mainland’s psychological consultants. Hm I notice that they (Hong Kong practitioners) have this preparation, so an association called Family and Marriage Therapy association was established last year…’ (Q120)

121 6 ‘咁其實要，要由上而下郁 (change)係好似你咁講,係好多瓜 ‘actually it requires top-down progressive change, like you said, (which) 葛，係好多糾結係裡面，咁如果係咁可唔可以就係用番依 involves many entanglements (referred to conflicts of interests), in this case, 家呢個system，但係就但係就微調番大家就唔會係一個競 (we) swim with the current (as we) use the existing system, but with slight alternations such that people would not use the competition perspective on 爭嘅角度去唸呢件事…' (6) viewing this (change).’ (6, Q121)

122 18 ‘我自己不斷喺度去即反思，其實佢哋需要啲乜野? Ha ， ‘I repeatedly reflect there, what do they need? Ha! Can my provided program 即我提供嘅program, 係咪都能夠係即能夠meet到佢哋嘅需 meet their requirement, ha, it is because, many subjects are not (directly) 要, Ha，因為點解呢，就係即啲科目好多唔係一定係我教 taught by myself, and so I would also have to (think of), how to teach (the other) teachers, in other words how to express that.’ (18; Q122) ，咁我亦都要去即係, 點樣係即係同番一啲教嘅老師呢，咁去係即表達呢 (18) 123 16 ‘personal growth 囉, 唔係change. Change 佢哋可以change ‘personal growth lor, not change. If talking about change they (trainees) can back. growth, 就一路咁去, 我就強調嗰個growth more than 個 change back. Growth means the continuous journey, (so) I stress the growth change, 因為change始終係有壓力. 你同人講change你要 more than the change, as change involves pressure. You tell others about change, that one has to change, and he/she could change, is changed, and after change, 咁佢可以啦佢就change, change咗,過咗一段時間又 sometime, and (he/she) returns (to the original stage). Dieting is like that, you 返返啦你減肥就係咁最後就返返你最嗰個 . , comfortable eventually return to your most comfortable (stage)...’ (16; Q123) …(16)

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124 16 ‘你如果強調嗰樣, 咁佢哋自然就會咁樣生長, 行界業界, 係 ‘If you highlight that, then they would naturally grow. Industries and 呀, 如果你唔強調嗰樣呢, 你只係強調qualification呀, 或者.. professions. Yes, if you do not stress this, only qualifications, or…what 有咩牌呀, 有咩school 呀, 咁咪會走另外一邊囉…而去整體 license, school, this goes another way (astray)…(it is about) in overall not focusing merely the qualification, meaning the so called reputation or other 唔好淨係focus喺嗰個qualification, 即係所謂, 一啲係 things.’ (16; Q124) reputation嘅或者係東西 (16) 125 2 尤其是香港依家好多時唔同服務都會講collaboration，甚至 Especially many different services talk about collaboration nowadays in Hong 講緊唔係輔導既機構但一齊合作，譬如依家有一個計劃係 Kong, even about working with non-Fu-do organisations. For instance, there is 譬如有醫管局，醫生，精神科醫生，護士，兒科醫生，衛 a scheme which involves Hospital Authority, Doctors, psychiatrists, nurses, paediatricians, staff from Food and Health Bureau, social workers from 生署既姑娘，家庭服務既社工，有D係一D戒毒既服務，或 integrative family services. Others include rehabilitation services, young 者一係年輕媽媽，就一齊去合作，去處理一好複雜好高 D D mothers. [We] then work collaboratively to handle highly complex and risky 危既家庭 (2) families. (2, Q125) 126 14 ‘其實我覺得我哋行業各有各嘅特色，各有各嘅Strengths同 ‘Actually I think our industries are diverse with the respective strengths and 埋weaknesses。我覺得其實如果你話為成個社會同埋 weaknesses. I think if devoted to the society and community, (everyone) does community著想嘅話，其實根本唔需要鬥，大家只要搵返大 not need to compete, only seek for the own survival space, and the role which 家合適自己嘅生存空間，亦都畀到一啲你自己嘅專長去服 can allow our strength provision to the public, which I think that actually is work our very best.’ (14; Q126) 務到大眾嘅一個剛位，其實我就覺得已經係做得最好。” (14) 127 14 ‘乜嘢嘅機構認可, 有啲乜嘢嘅registration 你先去請嘅, 咁我 ‘About organization recognition, the registration system guided employment 諗畀呢啲指引出去, 我諗先由學校入手。因為學校暫時係 criteria, I think these guidelines should be disseminated to the educational counselling呢個行業最大嘅顧主黎嘅…咁我諗可以畀由佢 institutes first. It is because they are the existing biggest customer of the counseling industry…and so I think it (development) can begin from this area 入手再推而廣之到一啲NGO,其他嘅社福機構呀等等。’ and then expanded to some NGOs, and other social welfare organizations, etc.’ (Q126) 128 11 ‘我覺得將來應該實要發牌, 因為作為保障緊呢個 I think that licensing should be done in the future. (This is because) professional嘅嘢… … 有一個制度, 如果輔導員 violate 咗某 professionalism can be protected […]. There is a regulation system, and if a 啲ethical 嘅嘢, 其實係需要呈報番畀個局聽,其實都保障緊 Fu-do worker violates conditions of ethics, actually this needs to be reported to the “bureau”. This protects the people accessing the services. Fu-do touches 接受服務嘅人… … 輔導可能講掂到人一啲好inner嘅嘢, 一 one’s very inner self or trauma. Therefore this service requires some guarantee 啲或者所以亦都需要有呢一啲去保障番個服務 self trauma, for the sake of the service users. (11, Q127) 使用者 (11)

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129 17 我諗而家係規管立法個度其實應該係做佐每一個專業分開 I think that regulation or legislation aspect should be done separately by each 去做先。例如佢係規管有呢個資歷嘅人先至係叫CP, 言語 specialty, for instance, regulation of qualifications of CP [/clinical 治療師. 所以立法規管係會跟專業去做。邊個專業先至可以 psychologists], speech therapist. […] I think the matter of which specialty provides Fu-do would be the next step. (17, Q128) 做某啲輔導呢，我諗呢個係再下一步嘅事.

130 16 ‘我唔知呀,我都係咁走㗎喇. 對我嚟講係就係冇改變過, 不嬲 ‘I don’t know. I have always and will walk this way. To me it has never been 呢(一直)train個人嘅心.’ (16) changed, (it) has been training one’s heart (inner-self).’ (16; Q130) 131 18 ‘我倒一如好好地去留意番我啲學生，係嗰個professional或 ‘I would rather properly attend to my students, that professional or personal 者personal growth…咁可能我會更加focus 俾我知道其實我 growth…perhaps I would focus more on conveying my expectations…(I) hope 期望係啲乜野...希望佢哋可以即係因為有唔少嘅同工喺度 that they (other colleagues) could, I mean because there are currently many colleagues who persistently discuss with the government (on registration). ，不斷喺度同佢哋嗰邊政府官員喺度傾緊. 但呢樣野就唔係 However this thing is not for me to be responsible for. I would only be 我去負責啦，我只能夠審慎樂觀 .’ cautiously optimistic (about it).’ (Q131)

132 14 ‘但係你話而家實質自己可以做到嘅嘢其實老土講句都真係 “However if you say what you can actually do in person, it’s a cliché but it is 做好自己嘅崗位，做好自己嘅本份。特別我諗我哋自己做 about doing our own job, fulfilling our responsibility. In particular we have a tear互相都有一個好清晰嘅目標，其實就係大家要盡量真係 very clear goals for each other when doing (service), actually it is about 唔好行差踏錯，係呀！真係㗎！因為實在有好多人睇緊我 everyone doing the own best not to step out of line. Indeed really! It is because there are so many people watching at our doing, many people would spot our 哋做嘢，好多人亦都會如果發現我哋有呀！有啲 mistake mistakes! (Like) some unethical conduct! This actually really affects our unethical嘅嘢做咗呀！其實會都幾影響到我哋成個行業.” overall profession.’ (Q132) 133 11 對於社工同輔導員嘅觀感都會唔同, 可能client覺得社工就 “Clients have different views of social workers and counsellors, perhaps 好似, 會成日走出 office , 唔會成日淨係識坐喺間房度, 但係 clients think that social workers would often leave the office and do not stay 可能輔導員, client 感覺上, 要上去佢哋office見佢哋, 佢唔會 within the room. However, for counsellors, clients may think that they (counsellors) see them in the office, they do not come out (from the office)…” 出嚟…” Participant 11 Participant 11 134 14 咁我哋一開始喺度幫手做嘢，我哋自己印信件呀，整 We started off to help out (in counselling psychology development). We print leaflet呀，我哋自己甚至乎托啲信落去郵局做posting呀！讓 letters on our own, and design leaflets. We even carried the letters ourselves to 學校知道有我哋嘅存在，我哋可以做啲乜呀！咁我哋經歷 the post office! We want the schools to know our presence and what (services) 咗呢度大概有五年幾嘅時間啦，其實我哋做咗二百幾場嘅 we can provide. We have gone through this (promotion) period for around five years. Actually we have done 200 talks for free, and we do not mind about the ，我哋係真係唔計較地區遠近，我哋試過去離島區 freetalk geographical distance. We have attempted to travel to the island ，貝澳大嶼山貝澳，即係搭完船仲要再搭即係來回起碼成 areas…meaning we have to travel by ferry and then take another transport, 四個鐘咁樣嗰啲嘅去講一場talk呀！都係其實我哋做緊一啲 meaning the whole travel would take four hours (two way) for just a talk!

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Public Education嘅嘢囉。咁而由最初一啲我哋好零碎嘅學 Actually we are doing some public education work. Initially only few schools 校肯同我哋去合作嘅，去到而家其實我哋每年都有十幾間 were willing to work with us, and now we have more than a dozen of schools 嘅學校同我哋合作做輔導呀！做關於下頭先我講嘅 to cooperate with us regarding counselling service, preventive programme and even some group counselling work. Recently we look for connection with a Prevention Program呀! 甚至乎做一啲嘅group counselling嘅 (social) center to perfect our in-school based service. In general there is a 工作係啦咁樣。咁最近亦都有再比個再完善我哋嘅 , center psychologist (from us) per school we cooperate with. So far 7-8 schools have 學校就會開始有駐校服務。咁基本上我哋有一個心理學家 confirmed to use our service. We are waiting to sign the contract (with them) 跟一間學校就全面嘅工作嚟嘅。咁so far我哋而家都有七， and many existing non-governmental organisations. This means social workers 八間學校係mark咗我哋嘅service嘅。即係等準備簽約…咁 are in competition with counsellors or us. However, we have in the five years 所以呢個都係我睇到呀仲有囉有好多existing嘅NGO啦,即 cooperated with many big and small non-governmental organisations, for 係我哋睇到Social Worker同我哋好似或者Counsellor好多 instance the notable 樂善堂, YMCA, 春樂遊樂場協會, 傷健組織.This competition㗎嘛。但係我哋呢五年嘅工作其實大大小小嘅 reflects non-governmental organisations are willing to cooperate with us, and NGO有好多合作嘅，例如果出名嘅有樂善堂啦；有YMCA even ask us to train social workers to enhance their understanding of mental health prevention. This (reputation) is created by us, or (I) shouldn’t use the 啦;有春樂遊樂場協會喇;有傷健組織啦,呢啲其實都係喺 term ‘create’. It is about our reputation built and earned from our work NGO好願意同我哋去合作，甚至乎佢係ask for我哋畀 performance. (14, Q134) training Social Worker, 即係點可以再完善佢哋對一啲Mental health呀 prevention呀呢啲嘅認識嘅，呢個都係我哋自己 create返嚟，或者係唔好用create，係賺到返嚟囉,靠我哋個 reputation，靠我哋真正嘅工作表現賺到返嚟嘅嘢。 135 14 咁我好多時同我嘅學生去講就係其實成個Mental Health呢 I often tell my students that the mental health setting consists of three levels. 個setting呢，我哋講其實係好大嘅。基本上都可以用三個 We speak about taking care of pathological (patients). Indeed everyone may Level去睇嘅。咁我哋話其實照顧Pathological嘅，冇錯大家 have studied psychology, and more or less want to study abnormal psychology. However, pathological problems actually only occupy, according 讀Psychology，Day 1都最嚮往梗係想讀Abnormal to the research, on average 20-30% of the overall population. Majority of the 嘅嘢嘅，但一啲嘅 Psychology Pathological Psychological people do not reach this pathological stage. To be honest it doesn’t matter problem其實佔成個人口比例嚟講，好多research都係講大 actually clinical psychology is specialised in (the) pathological (area).I think 概 20至30 percent，呢個係average！咁majority其實都未去 there is no problem if they concentrate in that territory or specialty. Clinical 到Pathological嘅階段.咁其實冇所謂㗎,我覺得Clinical psychology can continue to do things in that territory, right? Educational Psychology其實佢哋個專長的確係做啲Pathological嘅嘢.其 psychology is also clear about (focusing on) the pathological area. They focus 實嗰個領域 for their concentration, for their specialty,我覺得 on the pathological side of the students, children and youth. We could conduct 冇問題.Clinical Psychology繼續去做緊嗰個area嗰個範疇! 而 intervention while they conduct assessment. Then we have 70-80% (of the population) left. This would be divided into two tears (/levels).One tear does Educational Psychology亦都好清晰咁話畀你聽其實佢哋都 not involve (directly with) the pathological stage, but involves a certain 做緊啲真係嘅嘢。佢哋喺邊啲呢？ Pathological focus Student concern. Yes! Everyone has emotions, and we more or less have frustration. I

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！細路仔呀！Youth, Children, 佢哋呢一個範疇入面嘅 believe that actually counselling psychologists could utilise their functions Pathological…我哋亦都可以佢哋去做assessment 去做佢哋 (on) how to do prevention work in this client population/tear. Or we would 嘅intervention。而我哋其實淨低嗰70， 80個percent其實可 deal with people’s developmental crisis. No matter American trained or English trained counselling psychologist, I see they have a principle. I believe 以再分兩個tear。其實有一個tear就係未去到Pathological嘅 we could also accordingly categorize our work. The third tear, meaning the 階段，但佢面對相當嘅困擾嘅。係咪呀！咁我哋講人其實 third level, refers to those without many emotional concerns, nor having any 一定有Emotion，我哋亦都有佢嘅Frustration,咁其實我覺得 problems. We would still prevent rather than solve a problem. In fact social Counselling Psychologist就可以好好發揮佢嘅工作，點樣可 workers could illustrate their functionality even they have (these) three tears 以喺呢個tear 我哋做好我哋個特性就做prevention，我哋亦 (/levels) of client groups. They support patients with external resources. They 都去我哋去幫助解決人嘅Developmental Crisis。呢個我諗 could help allocate funding for those with pathological backgrounds, like 係無論美國train嘅Counseling Psychologist或者英國train嘅 family support. I reckon counsellors could also use (this model) to identify Counseling Psychologist, 其實我都睇到佢哋有呢一個 their strength. (14, Q135) Principle。所以我覺得係 as我哋喺Counseling Psychologist 其實就咁樣分番類。咁至於tear 3即係另一個層面level 就係佢哋真係比較可能而家呢一刻冇乜太大嘅情緒困擾，咁嗰啲亦都冇問題，我哋防患未然。其實Social Worker，基本上 Social worker只得三個tear佢都可以發揮返佢嘅工作，就係佢用一啲External Resources 係咪呀,去幫助一啲patient ， Pathological嘅可以幫佢分申請Funding, 家庭嘅支援！咁 Counsellor其實我覺得亦都係可以喺個field入面睇返佢點樣可以亦都用番佢哋嗰個專長。 136 14 我覺得Counselling Psychologist 其實亦都唔使特登要去做一 I think that counseling psychologists, including me do not necessarily need to 啲嘢好似係interfere咗人哋而家existing做緊嘅嘢.即係早幾 do something to interfere with the existing activities of other parties. A few 年前我記得我自己,我好eager,好insist要爭到做IQ test.我哋 years ago, I was very eager, I insisted to conduct IQ test. Our training actually trains us to do resurrect skills. However, there is a strange phenomenon in 嘅training其實有train我哋做resurrect skill，咁但係香港一個 Hong Kong, different from the US nor England, that is, Hong Kong version 好奇怪嘅現象就唔同美國英國就係因為香港有個 , Hong has its law. (This means) even you receive administration from IQ test on Kong Version， Hong Kong Version 有嗰Hong Kong Law, training, the publisher would not sell the test to you if you are not a clinical even你接受咗IQ test嘅administration去training都好，佢只要 psychologist or educational psychologist. You are not qualified to administer 你唔係Clinical Psychologist或者唔係Educational this test. This involves many underlying issues, such legal procedures, Psychologist, 個出版社就唔會買畀你，你亦都冇呢個資格 monopoly, etc. We take the situation in the US. Once you receive certain 去administer呢個test. 咁呢個我諗呢個其實都好多underlying training, or Pearson training, you can administer the test. However, only 嘅嘢而家發生緊, 包括埋一啲法律行動其實都有處理緊， qualified psychologists are allowed to do interpretation. Administration and interpretation should be separate actions. However, only clinical and

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因為都牽涉壟斷Monopoly! 因為我哋都參考咗譬如美國咁 educational psychologists can only access the test and are allowed to 樣啦,其實美國嗰個做法就係你只要接受咗一啲嘅training， administer and interpret the tests. A few years ago (I) stood out for justice! 即係接受咗Pearson畀佢training，其實你係可以administer個 Monopoly is not right! How can it be fair! We even interrogated the American practice. (Those people) claimed Hong Kong has got its characteristics! This is test。但Interpretation就一定係要registered Psychologist 去做 not a sensible explanation! One excuse after another! In Hong Kong, they 。但同其實可以分 Interpretation Administration Interpretation (Hong Kong publisher) are a manager authorized by Pearson. We enquired 開。咁但係喺香港不論你係Administration同埋 clinical psychology organization. They said ‘we’re not sure! Go and check Interpretation佢都梗行咗只可以係 Clinical Psychologist同埋 with the manager!’ Then the manager would say ‘we are not sure, we actually Educational Psychologist先可以去access。但係幾年前即係 listen to your association – clinical psychology’s indication. They said only 啱啱出嚟覺得即係為公義！即係呢啲monopoly嘅嘢即係唔 their two industries (clinical and educational psychology) can conduct the test. 應該！點解咁唔fair！甚至乎我哋去質問對方美國嘅做法係 Then (we) return to them (clinical psychology) who then said, ‘this decision 咁嘅時候，佢哋會講話香港有香港嘅特色！即係唔make making involves the government too, like Block of the IQ test, Block Register Scale…and so they (the government) would involve who to use the test.’ This sense嘅explanation，咁一個推一個呀! 咁樣喺香港就佢話 is really like playing Tai Chi (/stalling/shirking/). We see a lot of injustice 呀我哋嘅叫做經理，其實嘅一個 publisher Pearson authorize which have lasted for years…five years and still in progress, as everyone publisher。咁我哋問臨床心理學家嗰邊嘅組織,佢就話我哋 pushes this issue towards one other. Therefore we have a lot of underlying 唔清楚呀!你哋問返經理嗰邊係點啦,經理就話唔清楚,其實 issues which are confidential. Therefore I know this discipline (counselling 我哋都係聽即係你哋個會臨床心理學家嗰邊嘅指示.話淨 psychology) is always fighting for more by going against (the mainstream). 係佢哋呢兩個行業做得，去到問返佢哋佢就又話返話，其 Back to what I said I used to be eager to administer the test. However, I 實政府都有份做決定嘅，有個Block of a IQ test，Block realised at the end, that I could actually do much more and not necessarily only Register Scale，咁所以佢哋會有份involve去決定邊啲人用 to fight against another to conduct that IQ test. Perhaps it is because (I) was a fresh graduate and used to believe that that IQ test reflects a person’s 得，咁好似耍太極咁樣。我哋都會睇到係好似唔多公義嘅 professional status and recognition. However, even not doing it, I now find 情況，咁已經last for 好多年…五年啦！其實呢啲嘢都係 that, like what I previously mentioned about, the three layers of client groups under progress，大家推來推去。所以我哋其實都有好多 in the overall mental health setting is something I have gradually developed. underlying嘅嘢,其實都係 confidential! 即係我都知道,呢行會 Via my work I have gradually explored preventive programme. Right now 係有啲嘢做緊。想against要爭取更多! 我可以講返就係我而 neither clinical psychologists nor educational psychologists are involved in 家我自己都我講到頭先以前我好eager想攞呢個Test去做。 this prevention programme. This is something we counselling psychologists 但係我後尾都發現，其實我做嘅嘢可以有好多，亦都唔一 have developed on our own. Therefore, I myself have come to recognise that we can also show our discipline’s strengths and principles. Our developed 定要去同人哋爭去做呢個IQ test。因為啱啱出嚟嗰陣時候 areas are huge. Vocational counselling is another field we have devoted to. US 覺得同一個IQ test即係好似一個都的確係一個professional counselling psychologists have developed in vocational counselling. This work status 嘅 recognition。但做算唔做得都好，我而家發現，好 is dominated by Hong Kong social work field. However, I soon found the 似我頭先老實講我最初都未摸索到自己有呢三個, 頭先一開 difference (between social work and counseling psychology disciplines), and 始講過三個範疇嘅工作嘅，係呀！係through呢幾年我自己 so if counselling psychology develops in this area, we would not face much

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慢慢變develop出嚟。亦都我慢慢入我嘅工作嗰度睇到譬如 competition (as we initially thought). Even social workers mainly conduct job 頭先講嘅 Prevention Program. Existing其實無論係Clinical matching. Therefore, if you return to vocational counselling, you would Psychologist或者Educational Psychologist佢都唔冇做到呢類 understand that (counselling) is not about job matching, but a self- understanding process. This allows us to know how our roles can richen 嘅Prevention Program，係我哋Counselling Psychologist 自己 vocational counselling work. Therefore, we see many development 出嚟。所以我慢慢自己都領悟到更多就係、其實真 develop opportunities, and yet this really requires time until we build our work 係我哋可以發揮，只要我哋明白返自己嗰個行業嘅strength, performance. This means our overall work areas, and others’ recognition of principles 、其實我哋可以develop嘅 area真係有好多! your work. (14, Q136) Vocational Counselling another field 我哋其實係都做咗好多嘢。因為美國其實Traditionally 就係Counselling Psychologist 其實係做啲 Vocational Counselling嘅嘢, 咁喺香港其實係 Social Worker dominate 咗。但係social worker 做緊嗰種類都有去諗下其實如果 Counselling Psychology 做落去，我哋會唔會有好多 competition 等等呢啲嘢。但係發現其實又係可以好唔同，就係譬如我哋可以做啲inventory! 甚至乎因為 Social Worker 做嗰種係比較係多啲其實做 job matching。其實你understand vocational Counselling 成個 picture, 根本佢做嘅嘢唔係 job matching，係一個self- understanding嘅process, 咁呢個又比我哋更加知道，其實我哋嘅角色可以點樣再去豐富番成個Vocational Counselling 嗰個工作。所以我哋自己睇到發展嘅機會好多，不過係要真係讓時間同埋由我哋嘅工作表現 build番呢，即係我哋嘅所有嘅工作嘅範圍. 即係人哋賞識覺得你係做到.

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Appendix 8. Original Interview Questions 1. What is your educational/training background? 2. What is your job like? 2.1. What do you do? What are the duties/functions/responsibilities of your job? 2.2. What percentage of your time is spent on what? 2.3. What work setting are you based in? How is your job related to such setting? 3. What is your counselling work like? 3.1. What is your typical counselling session? 3.2. What theoretical/philosophical models do you adopt? 3.3. What is your client group like? 4. What are your personal philosophies/beliefs/values which have significant impact on your counselling work (on social, cultural, historical, political and ecological perspectives)? 4.1. How do your adopted theoretical paradigms influence on your counselling work? 4.2. How do you think your adopted paradigms can impact on one's psychological well being? 4.3. How do you fit your adopted paradigms within your own beliefs? How do they relate to the strengths and difficulties you face in your counselling practice? 4.4. What are the reasons you believe the client perceives/acts/speaks in that way? 5. What are the different contextual influences (social, cultural, historical, political and ecological influences) on you as a practitioner and your clients? 6. How do you think the different contextual influences have impacted on the clients as being the client? 7. How do you define your counselling work within the Hong Kong context? How does it contribute to/is it related to counselling psychology development? 8. What do you think about counselling development as reflecting the current Hong Kong situation? 9. What is Hong Kong culture? What are the major cultural philosophies/values/beliefs? 10. What do you think are the significant cultural factors on shaping Hong Kong counselling psychology? How has Hong Kong culture impacted on Hong Kong counselling psychology? 11. What do you think are the strengths and limitations of Hong Kong counselling psychology?

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12. How has Hong Kong counselling and counselling psychology informed about Hong Kong culture? 13. What do you think about the future of [your field] and Hong Kong counselling psychology?

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Appendix 9. Interview Schedule (with the improvised questions)

Opening

(Phase 1 and 2)

Hi. (Smile) Thank you for making time to do this interview with me today. As you know, I am doing this interview for my doctoral thesis about counselling in Hong Kong. I am myself a counsellor in Hong Kong, and now a counselling psychologist trainee in the UK. I am hoping to interview different practitioners across Hong Kong to explore about what different professionals think of counselling. The interview will take up to 45 minutes and an hour.

(The additional statatement in the phase 2)

You are invited especially as I am interested in Hong Kong counselling regarding how to mobilise change and action. Therefore, I have a particular interest in the socio-cultural and political perspective of counselling in Hong Kong. In the interview, I may gently bring up the discussion relating to these particular areas.

Informed Consent

Before we begin, let me remind you that I have sent out a set of information sheet and informed consent for your reference. I have a photo copy here now, and may you read again (in case you have not read it already) and sign in the consent form.

Do you have any questions before I start?

Interview Questions First phase:

1) (Personal and professional background) Can you tell me about your work?

2) What does counselling/Fu-do mean in Hong Kong?

Second phase:

1) (Personal and professional background) Can you tell me about your work?

2) What should be considered as action and change in counselling/Fu-do development in Hong Kong (in the future)?

Closing

Thank you for your time. I have personally found this interaction meaningful and benefitical for my understanding. Again I appreciate you give time for this interview. Would it be ok if I contact you further once the interview transcription is done, so you could have a read and see if you are happy for me to have it as my data? Thanks again. I hope you have enjoyed this interview experience.

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