This chapter explores barriers and enablers in multilingual counselling for Mainland Chinese Students (MCSs) studying in universities in Hong Kong and who face mental health challenges linked to linguistic and cultural adjustment. The study utilized reflexive thematic analysis to examine data from debriefings of three bilingual counselors and one facilitator who conducted two four-week blocks of counselling sessions for four groups of MCSs. Findings revealed three main barriers, namely linguistic barriers, cultural clashes, and systemic shortcomings, and two enablers, specifically, creative engagement and group cohesion strategies. These insights highlight counselors’ cultural intelligence and strategies for mitigating challenges. Ultimately, the present study proposed empirical strategies for enhancing multilingual counselling services in Hong Kong, and policy implications, including micro (Mandarin proficiency), meso (integrating local training programme), and macro (comprehensive government regulation) levels to enhance multilingual counselling services. It aims to contribute to the global discourse on multicultural counselling, offering replicate strategies for mental health education in multilingual settings.