Counselling & Psychotherapy

[rogerthedodger]

This is perhaps a bit obscure, but any info would be very welcome.

We are hoping to move somewhere between Angouleme and Limoges, as soon as we sell our house. I need to work as a self-employed counsellor/psychotherapist in order to pay into the system because I am insulin-dependant diabetic-I am 4 years away from retirement age.

My question concerns the attitude in France towards counselling/psychotherapy-whether it is seen as the treatment of choice for anxiety and depression or whether medication is preferred-in other words is there potential? Our choice of home is based on loving the area & choosing to be within travelling distance of a good-sized city for potential clients. I don't need to work financially but need to have some work so as to be seen to be 'legitimately' paying my dues, and so be able to live in France as our permanent home.

As I said, a bit obscure, but if anyone could shed some light on the potential this would be very much appreciated.

Thanks,

Roger

PS I would be looking for English-speaking clients.

[5-element]

You could contact these people

http://www.counsellinginfrance.com/

I understand that some of them are well-established - and they surely would be able to answer your queries, since your clients would have to be English-speaking - in which case, it hardly matters what the attitude is in France towards counselling/psychotherapy?

What might be more tricky, is how to do it legally - they should be able to help with that too.

 

[P-D de Rouffignac]

Hallo. You could start by looking at the website www.counsellinginfrance.com which lists English speaking counsellors by region, with a short presentation if you click on a name. The site also offers a number of other resources. I use it myself (I am an English trained counsellor and also work in the property business to pay the bills!) but have not had a single referral from it - yet.

Regarding controls on psychotherapy in France, as in Britain the situation is very fluid and the word 'counsellor' which I prefer is simply not known here. I operate through a charity (association loi 1901) but starting in January 2009 you may know there will be a new simplified form of self-employment, which will include 'professions libérales'. Basically it is designed for small, part-time entrepreneurs and goes under the name of the 'auto-entrepreneur' regime.

The main advantages include payment of tax and social contributions ('cotisations') based on a fixed percentage of turnover - around 23% in the case of services - and this is only payable as and when you earn. Up till now, even the smallest enterprise has had to pay high social costs, even if you earned any money or not. If you are retired you need to reduce these as much as possible, as what you get back from the French State is minimal (if you are retired and receiving a British pension).

Regarding therapeutic choices, the profession is dominated by psychiatrists, psychologists and psycho-analysts brought up in the Freudian tradition (cf Lacan and others) who are trying to persuade the government to reserve the word 'psychotherapist' to their members only. A number of other professionals are opposing this, including the AFP-ACP (person centered counseling association) to which I belong. Regarding medicinal cures, the French are the world's largest pill poppers and I think the bigger problem is educating them generally about the advantages of the 'talking therapies' as opposed to taking drugs. It's an uphill battle.

Hope this info helps.

P-D de Rouffignac

[rogerthedodger]

Thanks for your quick reply. I do know of that site. However, they specifically exclude your contacting those listed about client numbers, distance would-be clients will travel etc.. I have done a lot of research into how to practice legally so I'm OK with that side of things.

My query about 'attitudes' towards counselling & psychotherapy of English-speakers stems from the fact that most people are guided by their doctors. In UK there is something of a swing away from medication towards psychological therapies which may not be the case in France-hence the question.

Thanks,

Roger

[rogerthedodger]

Thanks, P-D, that's very helpful.

Sounds like there's some potential for growth in our field & maybe to challenge the status quo (from my doctoral thesis relationship & not pills made the difference!). The 'auto-entrepreneur' system sounds like it would be great for me. My reason for wishing to continue my practice in France and pay cotisations is because I would never get health insurance with my diabetes & will need regular prescriptions. I could not be resident unless I work & pay into the system, which I'm happy to do. I am 60 & my wife is 57 & both of us are fortunate enough to have private pensions that are enough to live comfortably on. I also enoy what I do!

Thanks again,

Roger

[merle]

Hi Roger

Like P-D, I'm a person-centred therapist and a member of the AFP-ACP. I have a small practice here which is part of an Association Loi 1901, which works fine for me as my health contributions are covered elsewhere. Up until now, I wouldn't have found it viable to register as a profession libérale because of both the phenomenally high cotisations and the very sporadic nature of the work, but as P-D says the new auto-entrepreneur system is going to change all that (at least until someone realises just how much of a good thing it is ...).

If you're looking to work exclusively with English speaking people I think the primary attitude that you're going to come up with is whatever attitude to therapy your clients have brought with them. You won't get referrals from doctors; I'd be very surprised if any médécin traitant even broached the subject with their patients (and if they did, it would be for what I call 'medical' psychotherapy, which is a whole other ball-game here and has a big bias towards pychopathology). Basically, your clients will be self-referred, which means you've got to have a good network. You've also got to face the fact that le pouvoir d'achat is a huge issue for many expats here at the moment, especially those with fixed sterling incomes, and that, frankly, counselling and psychotherapy is often seen as a luxury that's amongst the first things to be shelved when times get difficult. (I offer some sessions as part of an 'energy exchange' or barter system - bit like a LETS scheme - but that wouldn't work for you as a way of getting into the system). What I haven't caught up with yet is whether under the auto-entrepreneur system there will be a minimum amount of cotisations that have to be paid in a year to ensure health cover. I can't believe that there won't, otherwise it seems too good to be true.

Feel free to email or pm me if you want to talk some more.

[5-element]

Roger, I didn't realise there were certain questions you were not supposed to ask those listed on the counselling site. It does seem a pity!

As for your question regarding the interest there might be in counselling/psychotherapy for issues such as depression and anxiety, I think you might find that for most "sufferers", the first port of call is their médecin traitant - who might eventually (after trying medication first)! might refer them to a psychiatrist for assessment. Then it might be more medication, and/or a psychologist who will have some sort of training in psychotherapy, but not necessarily. France does not have a culture of humanist psychotherapy/counselling - eventually you might be able to track down someone who practices Cognitive Behavioural Therapy of some kind (EMDR, Ericksson Hypnotherapy) but it is usually with a psychologist - who is often in private practice. I understand that the profession is not as regulated as some would like to see it. For many French people, the crux of the matter is that they are not used to what is essentially private medicine, and they are reluctant to pay for those services. I think the difference with the UK is that so many more people in the UK have been prepared and willing to go to some of the private alternative practitioners of all kinds, including counsellor/psychotherapists.

In France, the culture is such that people feel they should be looked after by their own doctor, and perhaps then referred to other medical practitioners, and that it is all part and parcel of the health service. I don't know much about the frequency of referral between GPs (médecins traitants) and private counsellors/psychotherapists, but it seems that France is way behind the UK around those issues, and still caught up in sometimes antiquated medical models. There is a lot of movement and agitation, but  the medical monopoly has a stronghold.

 

[Pierre ZFP]

I have been reading this thread with interest as although I am not a counseller or anything like, a friend of mine is.  She has been practising in the UK for many years both private and employed by a Health Authority.  When she looked into the possibility of working in France she was told point blank by BACP that she could not as, despite the fact that she has 2 Masters degrees and is going for a Doctorate', that she did not have 'the correct French qualifications' which sounds a bit odd to me.  As I understand it, as was mentioned above, France does not have a culture of humanist psychotherapy/counselling so what qualifications could be gained?  She sort of gave up on the idea as it seemed that the only possible work was through Counselling in France and given what BACP said, even that was a bit dodgy.

If anyone knows different I would be happy to hear and pass the info on.

[rogerthedodger]

Thanks Pierre & '5-Element'.

I'm a UKCP Registered psychotherapist & here in UK would find it well nigh impossible to work in psychiatry 'cos I don't have a qualification recognised in the medical profession-nurse, occ. therapist, psychologist etc.. The status quo suits a number of people despite the research evidence to the contrary! However, I have done considerable research into which if any of the numerous European bodies does one have to be registered with-the answer is none! So despite BACP's advice your friend could work in France. I contacted a French psychotherapist in December 2006 & here's his answer that may prove helpful (I've removed his name & that of a further contact he gave me for reasons of confidentiality), but here's the gist

"At present psychotherapy is not a regulated profession in France. A law was passed four years ago, but was refused by the Conseil constitutionel, and can therefore not be enacted. Even if the title were to be "protected" and reserved for DESS psychologists and psychiatrists, it's most unlikely that there would be much eagerness about enforcing it. In reality a french psychotherapist is in the same fiscal category as, say, a yoga teacher i.e. self-employed, with fairly high social charges and retirement/health provisions. You also have to pay VAT unless you are a medical doctor or a DESS psychologist. You might be interested in getting a brochure which the french psychotherapist union, Syndicat National des Praticiens en Psychothérapie, SNPPsy, edits about getting installed as a therapist."

Sounds like medical referral are unlikely to happen, but I'll continue to use my websites and les Pages Jaunes as I do here!

Thanks again for all the informatio.

Roger

[P-D de Rouffignac]

Just to say how refreshing it is to read this thread - what an articulate bunch we are and ready to help each other out! I have already learnt a lot, so thanks from me also to all the posters so far.

Best wishes, Peter-D de R.

[Boiling a frog]

Everyone so far has concentrated on the high social charges one pays in France and also whether it is legal or not to practice

Can I come at it from a more practical angle.

Your client base will be English speakers I assume

You are going to position yourself somewhere between Limoges and Angouleme.

Do you realise just how many,indeed how few, English speakers there are in this area.

I believe a figure of approx 8000 full time english speakers is quoted for the Charente region.

They are scattered over a huge area.

How many will wish or even need counselling.

I suspect that your potential cusomer base will be in the tens.  

[rogerthedodger]

Hi,

just to echo Peter D's thanks to everyone for your help. BaF (can't call you Boiling!), thanks for the info about potential English-speaking clients or the lack of them! Wherever we settle broadband is a necessity so that I can continue to provide video, telephone or email therapy to anyone anywhere so geographical location will not be limiting. Plus we have some ideas about 5-day 'Growing Old Disgracefully' Workshops with an old mate for anyone in the UK who needs help with that! Should be fun.

Thanks so much to everyone-this forum is great.

All the best,

Roger

[Albert the InfoGipsy]

For many Brits moving here a business based on selling into the UK market has a lot of advantages. This includes anything involving 'residential courses'. My own business model is somewhat different, but still centred on UK clients. The big plus, apart from the lack of a language barrier, is that you probably already have a fairly good idea of where and how to market your services.

Obviously you need to do your homework about organising travel & accommodation, as well as judging whether enough UK-resident punters would be prepared to spend the money. Again, the area you choose can be significant. That said, I'd rather run a one week course once a month than have a weekly commitment of several hours work.