Costs to Psychologists and Clients as Barriers of Quality Gap

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Adult clinical psychologist profession in Indonesia

Information regarding the adult clinical psychologist profession in Indonesia is rare. So I want to share some information regarding the topic, as well as my personal view.

Unlike in the United States and Germany, psychotherapy is not covered by insurance in Indonesia. This is an arguable statement as the current BPJS insurance system does cover psychotherapy in its document, but I have yet to witness it in practice. Anyway, this is not very surprising since perhaps the majority of Indonesians are not covered by a medical insurance. Most middle class families use private health care and self-pay. Although to be fair to the Indonesian government, there are many medical expenses under general subsidy, such as vaccines and many types of medicines. This lack of insurance coverage in psychotherapy, to my opinion, has greatly hindered the growth of clinical psychology as a profession in Indonesia.

In Indonesia a typical counseling session begins by making an appointment. The client visits an office that provides various psychology services, describes his/her problems briefly, and then sets up an appointment. At the counseling session, the client consults his or her problem to the clinical psychologist. The typical client usually only come for 1 or 2 counseling sessions from what I have heard and experienced. Most of the time, the client is not given a psychiatric diagnosis (Axis 1 in the DSM diagnostic guideline) and instead, an Axis 3 diagnosis (social situation problem). Besides counseling for personal problems, the two most typical services asked by clients are IQ test and career counseling.

The small number of therapy sessions makes it difficult to deliver evidence based psychotherapy. Most evidence based psychotherapies depend on the existence of a psychiatric diagnosis and require at least 8 sessions. At the current practice, in which psychiatric diagnosis is seldom given and clients usually only come for 1 or 2 sessions, providing evidence based mental health care is close to impossible.

This situation is not without reason and one important contributing factor is that psychotherapy is expensive. For each counseling session (50 minutes), the client typically has to pay around 300,000 rupiah (equivalent to around 30 USD) and around 80% of that will go to the psychologist. This will, of course, depend on the office and the credential of the psychologist. I have heard of a psychologist with a rate of 700,000 rupiah (equivalent to around 70 USD) per session in her private practice. This estimation is based on what I have heard in Jakarta (capital city of Indonesia), it can be very different in other cities. All in all, this rate is not affordable for most people, to put it into context: the minimum monthly wage in Jakarta is at around 2.4 million rupiah (equivalent to 240 USD).

Therefore, I do not have any colleagues who only work as a clinical psychologist and earn enough for a living. Colleagues who practice psychotherapy often earn most of their living from other part time jobs, such as teaching classes at universities and work in projects. Many of my friends from my master degree class work as a staff in a human resource management department. Many also become part-time workers who work in different projects, in which a large part of it will be from businesses. They provide services such as assessment, training, interviews, and others. A smaller proportion of them works in universities and become an academic.

What does the word “psychologist” (psikolog) mean in Indonesia? How does it compare to the US or Germany?

The word “psychologist” conveys different professional meaning in different countries. To many, the word “psychologist” triggers a picture of a person talking to clients to help them with their problems. However, this is not always correct and that mind picture mostly relates to a more specific form: “clinical psychologist”. So, is “psychologist” equals to “clinical psychologist”? It all depends on the regulation and system of the particularly country. I will first try to briefly describe the system in United States and Germany, so that I can contrast it with the Indonesian system.

Now from what I have read in various sources, in the US, the exact word “psychologist” just means anyone with a degree in psychology. However, to deliver psychotherapy and give clinical diagnosis, a special degree and license is required. This is usually achieved by completing a doctoral degree in clinical psychology (PhD.Clin. or Psy.D.) and then, a person can apply for a license to practice. This profession is called clinical psychologist.

In a somewhat similar situation, “psychologist” in Germany is an open profession and is not a protected professional word (unlike medical doctor). Sometimes one does not even need to have a degree in psychology! Still similar with the US system, delivering psychotherapy and giving clinical diagnosis require a special degree and license. Now, unlike the US system, this profession is called psychotherapeut (psychotherapist), not clinical psychologist. To enter this profession, one has to finish a master degree in psychology and then, finish an Ausbildung (training program) for specific psychotherapy format. There are generally two main options: Tiefenpsychotherapeut (literally translated, deep psychotherapy – psychoanalysis) and Verhaltenspsychotherapeut (behavioural psychotherapy – behavioural therapy and cognitive behavioural therapy). The training program can take from three to five years, but some finish it in seven years (for Verhaltenspsychotherapeut). After the training, one still has to apply for license to practice at a certain geographical area (the number of insurance covered practice is limited according to the needs of a geographical area).

Now the Indonesian system is unlike the US and Germany. First, the word “psychologist” is a protected profession in Indonesia. Not everyone can call themselves psychologist without having the proper credential. To become a psychologist there are two requirements: a professional master degree (M.Psi.) and a license from the professional organisation (Himpunan Psikologi Indonesia – HIMPSI – Indonesian Psychology Organisation). Both can usually be obtained in 2 years, but now I hear 2.5 years is the norm for adult clinical psychologist. There are 4 types of professional master degree program: adult clinical psychologist (for clients aged 15 years and above), child clinical psychologist (for clients aged 15 years and below), educational psychologist, and industrial/organizational psychologist.