A Series on Expat Depression #7 – Seeking professional help

“I found a counsellor who wasn’t particularly helpful and struggled for a year with her. I’ve found another counsellor and my husband and I are doing couples counselling, which has been very helpful for both of us to face the feelings about the move and our separate unhappiness about being here. It’s a long road from here, but it’s improving” – “V”.

In last week’s blog I looked at how people had helped themselves to tackle their depression. Top of the list was the thing that I will look at this week – which is seeking the help of a professional. Which isn’t necessarily all that straightforward when you are living in a foreign location – especially one that is very remote and not necessarily an expat stronghold. So who did people turn to when they needed that help? And what was the general experience of seeking the assistance of a professional?

As always, it was a very mixed bag. The split between those who said yes they did seek professional help and those that said no was roughly about 50/50 – although if you include those who plan to do so at some point the figures go up in favour of the yes’s.

Why did people NOT seek professional help?

To start to look at why people have sought out the help of a specialist and how this has helped them, I wanted to first look at why people haven’t. This gives some idea of the problems faced by expats trying to get help in their overseas locations.

Many of course simply gave a straightforeward answer – no, they didn’t. No explanation given – they just didn’t. And others gave the same sort of reasons that anyone, anywhere might give – reasons not associated with being an expat but with just feeling vulnerable and in a difficult place: “I felt I had it handled”, “I never had the guts to call”, “I couldn’t get an appointment and gave up trying”.

However other reasons were more specific to being an expat – “the only specialist I could find was geographically unavailable”, “in our last place not a single person respects confidentiality”, and a few people mentioned the difficulty of finding someone with enough understanding of the expat experience to really be able to help.

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But for those that did – how helpful was it?

“I went to a counsellor on GP recommendation when in Dublin. First time I had been to a mental health specialist. In 2005 approached a coach in the UK (I was in the Netherlands) by phone and email to help with a decision for a future expat trip and found myself working out things I’d been holding on to for years. It began a process of self-discovery and a new career for me” – Nicola, who went on to train as an expat coach herself.

Almost everyone seemed to think that the professional assistance they did get was helpful – ranging from a simple “it did help” to “it helped immensely”. In between were some of these comments:

“I saw a therapist in the UK for several months and that, paired with being in a familiar environment with friends and family was just what I needed” – Catherine.

“In conjunction with therapy I made a lot of changes to my lifestyle….all of this helped pretty quickly” – Anne.

There were also some, to be fair, who said that seeking help from a specialist didn’t really help them. However, these were definitely outnumbered by those who said it did and it is always worth at least trying this route if you feel you need it.

Who did people seek help from?

“During my first expat experience in Indonesia I reached out for my psychologist in Australia, via email and obtained a certain amount of support that way. I was lucky enough to have a very supportive psychologist who would do that for me although I imagine it is not very common. It certainly helped knowing that she was there and would help if I asked, even if I didn’t use it. it was simply nice to know that someone who knew me very well could make decisions in an emergency that I knew I may not be able to make if my depression worsened to an extent that I was in a dangerous place”. Robyn.

So where did people find this help? What sort of professionals were they – and where or how did they find them?

Again, this was a really mixed result. Here are the words used in my survey to describe the professionals used by respondents: counsellor, therapist, psychiatrist, medical professional, OB-GYN, social worker, psychologist, family doctor, GP, life coach. So quite a range – and this is an area you may need to explore. But certainly counsellor and therapist were the words that came up most often.

Many people simply sought someone out locally, wherever they happened to be (whether in their host country or back home after repatriation). But more and more people are turning to online counselling as a great alternative to seeking face-to-face help. In particular, these therapists often have a first-hand knowledge of expat life and have almost certainly worked with many other expat clients – thus giving them an edge over those who may not have had the same sort of insight into our world. Of course local professionals can also offer an excellent service and it isn’t always necessary that they have this specialist expat knowledge – especially in cases where your depression is not a direct result of your expat experience.

Finally, as was the case of Robyn whose quote starts this section, some people were able to carry on using a therapist they were already in touch with from their home or another expat location. With the availability of the internet, Skype etc these days this is always a solution worth exploring if you do already have someone you have been working with.

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And what kind of therapy did people get?

“I wasn’t able to dig myself out of this on my own. Healing didn’t begin until I started seeing a therapist who referred me to a psychiatrist who together worked with me for about six years before they found the correct types and dosages of meds, coupled with weekly therapy.” – Anon.

Just like with any kind of counselling help, a variety of assistance was given. Some started on anti-depressant medication, others just used talking therapy. One survey respondent was given the herbal remedy St John’s Wort (“which helped for a while…but not now”), another was emailed a list of coping strategies from her online counsellor. A couple of people said they were introduced to Cognitive Behavioural Therapy (CBT) as the way to help them cope.

Importantly, almost everyone did say that they used professional counselling alongside self-help methods. It seems that it is the combination of the two that has been proved to be most successful – although often what people need is some specialist help to get them started. When you are so low that even getting out of bed is hard, it can seem like too big a mountain to climb to get out and meet people, do some exercise, find a new hobby…..

How to find help

I can’t personally endorse any counsellor as I have not used them. However I would like to mention a few  experts who I have at least been in contact with since I started this blog and can confirm them as empathetic figures and with a good knowledge of expat life. First of all is expat mental health expert Anita Columbara, who has been helping me by overseeing this series. Then there is Vivian Chinoa who featured on this blog last year and who runs the Expat Nest website and counselling service. Finally is Olivia Charlet, who has also been featured on this site and who runs a coaching business. All three offer something very different – a good example of how many different options there are out there.

In addition, here is an interesting article about Finding a Therapist while living abroad written by seasoned expat Robin Pascoe and including an interview with a Seattle-based expat counsellor.

Finally, a very helpful International Therapist Directory which is an “an online listing of professional mental health therapists familiar with the Third Culture Kid and international expatriate experiences.”

Photo credit: Counselling – Cushing Memorial Library

To read all the posts on depression in this series please visit the expat depression section of my blog here.

 

 

Expats and depression: Interview with an expert

The post on my site which gets the most hits is one I wrote about depression back in February. It wasn’t a long post or a particularly informative one – but what it did say was that depression in expats is common, it’s not something to be ashamed of and it’s something that we should all acknowledge as a very real part of expat life. What the reaction to the post – both the immediate reaction at the time of writing, and the amount of hits that post has had since – told me is that this is a subject that needs a lot more attention.

So I extremely grateful when an expert in this area agreed to be interviewed for this blog, and not only to discuss some of the reasons why expats are so vulnerable to depression but also to help with some advice for those who think they may be affected. Anita Colombara is a mental health specialist with a particular interest in the International Community. Her own background and experience, as well as her training, has helped her set up her on-line counselling service and to be in a great position to offer advice to the globally mobile. I hope many people will read her advice – please share this post if you can because I know, from how many people find my blog by typing in the words expat and depression, that this is a topic more people need to be aware of.

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Anita, thank you for agreeing to this interview. First of all could you tell me a bit about yourself, your background.
I grew up in Washington D.C. with Asian parents. I enjoyed both the American and immigrant experience as I felt part of both and neither worlds at the same time. I also had friends who hailed from every corner of the globe. As an adult, I married an Italian/Ecuadorian who spent summers with family on two different continents. You could say that, since childhood, I’ve been embracing the world, determined to be a global nomad when I grow up.

I’ve had the privilege of visiting and living in over a dozen countries. For four years I lived in Cambodia, gave birth to my second child in Malaysia, and later, enrolled my children in public school in Beijing. Throughout these adventures, I’ve experienced both the joys and challenges of being an expat. I love acquiring new languages, assimilating to new cultures, and feasting on new cuisine. However, I have also struggled with adjustment issues – cultural shock, loneliness, and confusion; with mental health issues – post-partum depression, anxiety, and vicarious trauma; and with relational issues – misunderstandings with locals and colleagues, marital strain, and difficulties parenting my two young children. I’m guessing many of your readers can relate.

How did you come to be working in mental health and why do you think it’s important for the ex-pat community?
I started out as a social worker in the States about 20 years ago. I worked in a variety of settings focusing on issues related to domestic violence, sexual assault, human trafficking and refugee resettlement which I then implemented with my work in Cambodia.

However, during my years in Cambodia, and later in other settings, I saw that ex-pat and humanitarian worker’s needs were being severely neglected. As I mentioned, I’ve struggled living overseas. And I know I’m not alone. I’ve heard numerous accounts from those experiencing trauma, disillusionment, confusion, compassion fatigue, depression, anxiety, loneliness, etc. I’ve also seen too many marriages broken and families strained due to ignoring conflicts rather than addressing them in a healthy way. I saw the vital need for my peers, who live and work internationally, to have access to quality, professional counseling.

When I returned to the US in 2008, I enrolled in the University of Washington School of Social Work, focusing on trauma intervention and therapy.Since graduation, I’ve have been serving as a mental health therapist at a community based agency in Seattle, WA. However, my heart is still with the international community. That is why I founded Remote Access Mental Health. My vision is to see globally mobile people thrive no matter where they are. My mission is to provide on-line professional mental health counselling for this unique population.

Why remote counselling? How would the globally mobile benefit from it?
When I lived in Cambodia, there were few counselling services for ex-pats. The few professional therapists in town were often booked. Moreover, with the ex-pat community being so tight, there was a high probability that the potential client and therapist already knew one another. This made professional boundaries difficult and therapeutic relationships awkward. This is an issue in many locations, not just Cambodia.

Services offered by host or sending agencies have their own set of potential complications. A typical scenario is that of a field staff person being assigned an agency affiliated counselor when supervisors become concerned regarding mental health or other issues in that individual. Many times, since the counselor is employed by the agency, they give their assessment to the supervisor. This is not always a bad thing. However, more often than not, I’ve heard from field staff who have been hurt by their agencies when they felt that client-therapist confidentiality was violated. In some cases, this resulted in the sudden expulsion from the international arena in order to receive “treatment” for unresolved mental health issues, family conflict, moral failure, etc. Individuals and families are left feeling like they’ve failed, betrayed by their employer, further isolated, and sink deeper into disillusionment, depression, or resentment.

With that said, I know a lot of ex-pat individuals and families who would benefit from an unbiased professional who could provide support where they are. With high speed internet service becoming increasingly available, even in the most remote places, this is becoming a possibility. Although in-person counselling may be preferable, video conferencing is a viable alternative given the hectic travel schedules and lack of local services that many expats experience. Professional counselling is now within reach!

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What kind of mental health services do you provide specifically for the globally mobile?
First off, I realize the term “mental health” often turns people away. They automatically assume I’m talking about crazy people with paranoia or are detached from reality. On the contrary, most of the people I work with are completely normal.
In short, I apply the same evidence-based therapeutic approaches that I use with my clients in my in-person practice. I first perform a thorough assessment to determine what the client’s needs, goals, strengths and natural resources, and desired treatment modality are. I then work together with the client to flesh out a treatment plan accordingly. I provide tools to address struggles as well as help create a plan for long term self-care.

The difference with my remote access clients is that I tailor to the unique needs of those who travel or live internationally. I am particularly interested in supporting the globally mobile population, including TCKs and ATCKs, that want to address trauma, panic attacks, anxiety, depression, and stress due to unresolved issues or culture shock and re-entry (reverse culture-shock) adjustment.

What are the signs that expats need to look out for if they think they might be suffering from depression, PTSD or other mental health issues?
Depression is different than sadness and normal life’s lows. It involves intense feelings of despair with little or no relief. It interrupts one’s life, work, relationships, eating, sleeping, and ability to engage in once enjoyable activities. Typical signs of depression are:

  • Loss of interest in relationships or activities you once enjoyed
  • Loss of energy, feeling tired all the time
  • Sleeping more than normal or inability to sleep
  • Change of appetite, overeating or lack of eating
  • Difficultly concentrating or finishing tasks
  • Lack of motivation
  • Lack of personal hygiene
  • Ruminating on negative thoughts
  • Feelings of hopelessness, helplessness, emptiness, apathy, failure
  • Feeling more irritable, short-tempered, angry, aggressive
  • Loathing – overly critical or self and/or others
  • Consuming more alcohol than normal or increased drinking alone
  • Engaging in reckless or unhealthy behavior

PTSD, or Post-Traumatic Stress Disorder, is a condition following a traumatic event that leaves one with intense feelings of fear, anxiety, or loss of control. One may feel trapped in a constant state of danger or in a painful memory. Others may feel unable to “snap out of it” and feel disconnected from others and present reality.

Many of my colleagues engaged in aid and development work experience what is called vicarious or Secondary Traumatic Stress Disorder (STSD). Through repeated or long-term exposure to stories or observations of those suffering from traumatic events, one may develop symptoms similar to PTSD. These symptoms come in three main categories and can arise suddenly, gradually, or re-occur over time:

  1. Re-experiencing the traumatic event:
  • Intrusive, upsetting memories
  • Flashbacks (feeling like the event is happening again)
  • Nightmares
  • Feelings of intense distress
  • Intense physical reactions when reminded of the event (pounding heart, rapid breathing, nausea, vomiting, muscle tension, sweating)

2. Avoidance and numbing:

  • Avoiding activities, places, thoughts, or feelings that remind you of the trauma
  • Inability to remember important aspects of the trauma
  • Loss of interest in activities once enjoyed
  • Feeling detached from others
  • Feeling emotionally numb
  • Lack of motivation
  • Sense of a hopelessness or assuming premature death

3. Increased anxiety and emotional arousal

  • Difficulty falling or staying asleep
  • Irritability or angry outbursts
  • Difficulty concentrating
  • Hypervigilance (on constant “red alert”)
  • Feeling jumpy and easily startled

Before reaching the point of needing to seek help from a counsellor like yourself, what can we do to help ourselves if we do find we are in this situation?
Self-care, self-care, self-care! I know too many good hearted people who are constantly looking out for others but neglecting to take care of themselves. Development workers, missionaries, and those on the front end of disaster relief for sure! The most important thing is to develop healthy habits and a personal Wellness Action Plan (I call these WAP for short). The second most important thing is follow through with your plan.

Your WAP should be comprehensive, including all aspects of your wellbeing – physical, emotional, recreational, relational, financial, spiritual, etc.

Your WAP should also be specific. It’s not enough to say, “I will exercise regularly.” What kind of exercise? How often? What time of the day? Where? This is especially important for the globally mobile since settings change and new locations may not accommodate to previous routines.

Lastly, your WAP should be realistic. For example, there is no point making a plan to exercise everyday if you know you’ll be on a plane two days out of the week. Make your plan attainable. Otherwise, you will find yourself giving up in frustration for not sticking to it.

Oh, and be kind to yourself. I tend to work with a lot of driven folks who are hard on themselves. Give yourself a break once in a while.

At what point would you recommend we need to seek further help from a professional such as yourself?
Negative feelings such as sadness, frustration, or stress are normal. But when they become overwhelming and interrupt daily function or lead to relational problems, it is important to seek professional help.

With that said, many people wait too long. It doesn’t hurt to seek professional help sooner than later. After all, even the healthiest among us receive physical check-ups. That is why I love assisting people in their personal WAPs to promote long-term wellbeing.

How can we support others if we start to recognize some of the symptoms of depression in them? In particular, how can we help our partners?
Often times, when a loved one is struggling, we may feel distraught or frustrated ourselves. It’s easy to go into advice giving mode or to withdraw due to feeling at a loss regarding how to help. However, the most important thing is your presence – being with them even if it just means holding them, crying with them, or sitting beside them in silence. Validate feelings instead of try to reason with them. Watch out for minimizing their pain, blaming and shaming. Educate yourself on the disorder so that you can better understand your partner, but be careful not to lecture them.

If your partner is reluctant to seek professional help, that does not mean you cannot seek help for yourself. A good therapist will be able to guide you through the process of assisting a loved one struggling with mental health.

Do you have any particular advice for children who might be showing signs of depression? How would this manifest in them differently than in adults?
The answer to this important question deserves an article itself. In short, children often act out what they cannot put into words. Often times, symptoms of depression, anxiety or PTSD in children are misdiagnosed as ADHD. Children often manifest troubling behavior such as difficulty focusing, defiance, difficultly regulating their emotions, hyperactivity, inability to calm down when aroused, lack of boundaries or risky behavior. They may engage in violent or self-harming behavior such as cutting themselves or hitting their head against a wall. Other children, may retreat, fall silent, even becoming mute. This is often the case for someone with PTSD. Again, disturbing behavior is a sign of a more significant, underlying issue that needs to be addressed.

Anita Colombara MSW, LSWAIC
Anita is a licensed Mental Health Professional by the State of Washington. After spending many years in Asia, she currently resides in Seattle, WA where she lives with her husband and two children and enjoys the natural beauty of the Pacific Northwest. She is the founder of Remote Access Mental Health LCC, providing on-line counseling for the globally mobile. www.remoteaccessmentalhealth.com

If you are or think you may be suffering from depression, or are vulnerable to depression, then please do talk to someone close to you and/or consider seeking help. As well as counsellors like Anita, charities like MIND can also offer online support and advice. I list other forms of support in my book the Expat Partner’s Survival Guide.

Photo credits: woman with key: Mary Lock at https://www.flickr.com/photos/wijen/; woman at table: Adi Sujiwo at https://www.flickr.com/photos/wijen/

Interesting expat: relationship specialist Vivian Chiona

I first came across Vivian when she contacted me via LinkedIn. We had a chat on Skype – her in the Netherlands, me at my kitchen office desk – and I found her to be an incredibly warm and supportive person. An experienced expat herself, Vivian has founded her own counselling service – Expat Nest – to help others transitioning into expat life, with a special emphasis on relationships and a specialism in children and teenagers. The Expat Nest website introduces the service as a “warm, safe and confidential” counselling service and, having spoken in person to Vivian, I am quite sure this is what it would be. I thought it would be interesting to hear a bit more about Vivian, her own background and about the service she provides to help expats with parenting teens, expat life and relationships generally.

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Can you tell me a bit about yourself, how long you have been an expat, where you are from and where you have lived?

I am a bicultural, multilingual expat with family all over the world. I was born and grew up in Greece and have been living and working in the Netherlands for the past eight years. I love travelling, exploring new cultures, trying different food and collecting folktales from all over the world.

I’m also a qualified psychologist and the founder of http://www.ExpatNest.com. Expat Nest provides emotional support to expats and their families by offering telephonic and online counselling services (via Skype and Facetime).

What brought you down the expat road to start with? Was it planned or accidental?
Because of my multicultural background, I’m not really surprised to have expatriated! I feel it’s a big part of who I am. My relocation to the Netherlands to study was planned; however the length of my stay was not. The initial plan of staying for one year in Holland has since become almost a decade!

What has been the most positive thing for you about being an expat?

Celebrating diversity and getting to know people from all over the world… trying their food, listening to their music and just enjoying the blessing of being in a multicultural setting. I simply love it! I also feel at home when I’m around internationals.

And what about the least positive? If you could change one thing about your way of life, what would it be?

The most challenging part of being an expat is that the goodbyes accumulate as friends come and go. Saying goodbye to my family after a visit to Greece is also difficult. No matter how many years I’m away, I still feel the sadness of farewells.

As for what I would change… the weather in the Netherlands! I know it seems trivial, but as someone from a country with 10 months of sunshine a year, I have really struggled to adjust to the climate here.

Tell me about Expat Nest, the online-counselling service you started for expats. Why did you start it, why do you think it’s something that is needed? Who is it aimed at and how do you help them?

It all started with my vision to inspire love and joy in expats everywhere! Founding Expat Nest has therefore been a dream come true for me. I’ve always been really passionate about supporting expatriates and it didn’t take long for me to notice a significant need for counselling services devoted to them.

I know from both my personal and professional experience that expat life can be daunting and lonely at times. This spurred me on to create a comforting, empathetic environment (hence the name ‘Expat Nest’) in which expats could feel heard and understood and deal with the unique challenges they face (like saying all those goodbyes!).

In a mobile life, technology is often the only constant, so it made sense to offer online counselling so that I could truly serve expats. As a result, Expat Nest’s services are accessible, convenient and flexible for all expats, across all borders and all time zones – this is truly counselling without borders. What also makes us different is that we are expats/internationals and highly qualified – so expats are guaranteed a professional supportive service.

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In my book, the Expat Partner’s Survival Guide, I talk about how hard the expat life can be on relationships. What can people do to try and protect their relationship? Would you recommend counselling even before they move?

I think it helps to understand that relationships exist within an emotional eco-system. When the external variables change – whether a new friend group, job or neighbourhood – the relationship often has to adapt. And of course, it’s also challenging when one partner follows their heart to a new country. Moving for love is one of today’s classic dilemmas and it’s important to recognize that the person moving is not weaker or less-than.

Fortunately there are a number of ways expats can protect and nurture their relationship, including:

• Keeping communication open and honest so that you avoid letting negative feelings build up
• Rediscovering your identity in the new place so that you feel empowered and whole in the relationship
• Setting realistic expectations of your partner so that you don’t expect all your happiness to come from one person
• Meeting other expats (both individually and as a couple) so that you have the space to discuss your unique challenges as an expat. For more pointers, check out this article I recently wrote on moving for love.

And yes, I would highly recommend counselling before moving abroad as it can make a significant difference to the whole relocation experience. (This could be a one-off session or a limited number of sessions – it needn’t be a lengthy process.) Pre-relocation counselling allows you to prepare emotionally and mentally for the move, but it also facilitates a safe space in which to talk about any thoughts and feelings that are not easy to discuss with our partner or children, or those we are leaving behind. That said, if you’re about to move and weren’t aware of the benefits of pre-relocation counselling, or just don’t feel ready for it, that’s okay too. Trust in your wisdom and do what feels right for you.

As well as adults, you also work with children – particularly teens – and in fact one of your specialisations is as a child and adolescent psychologist. I feel this is a hugely important subject and one that perhaps isn’t considered enough before families make the decision to move abroad. What sort of issues do you particularly find yourself dealing with in this area?

There are a number of common challenges faced by expat teens, including:

• Grief at having said many goodbyes
• Feeling disempowered due to lack of preparation or discussion by the parents before the move
• Being reluctant to invest in friendships/relationships as they know they will move again or have already experienced the pain of leaving people behind
• Shutting off emotions to avoid feeling the same pain again
• Feeling confused about their identity or uncertain where “home” is
• Feeling angry without knowing why
• Loneliness as they miss old friends and attempt to make new friends
• Struggles in adjusting to the new culture and way of being

If you’d like more info on helping expat teens and TCKs to thrive in their new country, feel free to read our blog articles, including “10 things you might not have known about TCKs”; “10 ways to improve communication with your child (teens too!)” and “How expat kids can use their difference to make a difference”.

What advice would you give to parents contemplating an overseas move with their children?

It’s essential that parents have in-depth discussions with their teens before moving, so that teens feel empowered (and even excited!) about the move.

After the move:
• Ask your teen to describe his expat experience in three words – this is a great way to lead into an honest discussion about his feelings/thoughts. Above all, listen to your teen… even if what he says is difficult to hear!
• Brainstorm ways to help reduce any painful feelings that have come up. Do this together – the idea is to avoid giving instant solutions and rather help your child to build up his own coping tools. Be sure also to convey the comforting message that any hurtful feelings will lessen in time.
• Focus on the positives of expat life, such as a fresh start, the chance to learn about another culture or learn a new language, and the opportunity to develop an expanded worldview.
• Remind your teen that friendship and love are not gone; all the important people in the previous country/school are still there. Encourage your teen to communicate with those left behind using online technology.
• Put up photos of your previous life to give a sense of stability and continuity (assuming that your teen is ok with this).
• If the painful feelings persist and are affecting your teen’s ability to function (e.g. disturbed sleep, poor academic performance, isolation, high levels of anxiety), seek out professional help.

Thank you Vivian for telling us about yourself and your counselling service. You might want to know that you can get free resources by signing up to Vivian’s website; but in the meantime I would be interested to hear what any expats think of specific counselling aimed at them – do you think it’s necessary? Do you wish you had known about services such as Expat Nest? Would you consider using a service such as this?

Review Wednesday – Belonging Everywhere and Nowhere

This is a book that spoke to me. It spoke to me because it is a book about people who have had a global childhood, and the impact that can have on them as adults. And, as any regular reader of this blog will know, I certainly had a global childhood.

Belonging Everywhere and Nowhere: Insights into Counselling the Globally Mobile by Lois J Bushong is really a book for counsellors. Lois, a counsellor herself but one with an expat childhood, found a gap in the knowledge of many counsellors when it came to working with Third Culture Kid’s (TCK’s) and Adult Third Culture Kid’s (ATCK’s), and decided to do something about it. So she wrote a book, which is also a guide for therapists, including exercises, activites and discussion points.

However, even as a non-counsellor I found this book fascinating. And eye-opening.

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The book starts by helping the counsellors to identify whether their client is a TCK, and if  the reason they have come for counselling is related to their childhood (I can’t believe it wouldn’t at least come up, in the majority of cases). It then goes on to discuss the different issues that might have affected these clients: depression, adjustment disorder, even post-traumatic stress disorder. And while PTSD may seem extreme, I think about the older expat children of my friends who lived through the 2008 bombing of the Mariott in Islamabad (and subsequent evacuation), and the worry they  had about how to talk to their children about what happened.  If not dealt with there and then, it’s very possible that some of that trauma might surface later on in life – perhaps even at the worst possible time – when those children are at teenagers and at boarding school.

Throughout the book, author Lois uses examples that she has taken from her real-life practice but disguised or amalgamated so there is no breach of confidentiality. However, you can be sure that the examples she gives will be very real, even if they are not each based on one real person.

As an ATCK myself, I found myself nodding along as I read the stories based on the lives of other ATCK’s: Katie, a middle-aged woman who spent a childhood in Asia and struggled with depression at university; Portia, who shied away from getting close to anyone; Rhonda, a teenage client, who asks why her family just can’t be “normal”. And of course, as many of the stories relate to childhood, I also kept the thought in my mind of how living an expat life may affect my own children – and what I can do to try and make things easier for them.

Much of the book is very counsellor-speak, as well as American (although I don’t find it overly touchy-feely in the way American “self-help” books often are; Lois was, of course, an expat child herself so perhaps is less American than some writers of this sort of book!). But because of it being aimed at counsellors, there were parts of the book that I just skipped entirely. The parts that I did read in depth more than made up for the missed bits, although I would still love it if Lois now wrote a book entirely for the “lay ” reader!

There were so many sections of this book that I really liked, and found relevant, that it is hard to pick just one or two out. But to give you a flavour, I have picked out a couple of quotes:

A major reality for those who grow up as TCK’s is that their lives are filled with chronic cycles of separation and loss. Obviously, such cycles are part of the human experience for everyone. Non-globally mobile folks go through this as well. But for the globally mobile, the cycles are chronic and often relatively sudden or severe. They may not lose a friend here or there, but often they lose a whole world when they take an airplane ride away from a place and people they have loved

And

While there may be many TCK’s who struggle for a while with wondering who they are or where they belong, once they understand the reason for their confusion and that these feelings are within a normal range for others of like experiences, most go on  and embrace the various pieces of their life rather than feeling as if they only have an either/or choice to decide who they are.

The last third of the book is taken up with a long bibliography and list of references, two appendices that focus on systems and techniques for counsellors, and finally a TCK Wall of Fame, which gives further details of some of the contributors featured in the book. Finally, it gives a list of useful resources, including books, films, organisations and – helpfully! – a list of suggested counsellors.

I found this book incredibly useful, and made me want to explore my ATCK experience further. But I also think it would be really helpful for parents of current TCK’s, as well as anyone who works with TCK’s – in particular International School teachers and counsellors. If you have already come across it and/or read it, I would be interested to hear your thoughts.

Expat Relationships

The other day I asked for some last-minute help with information about relationships to go into the Survival Guide. I thought I had actually finished the book, I’d read it and re-read it, had it edited and even sent it to the proof-reader for a final going over. I’m still hoping to meet my self-set deadline of April for publication. But out of the blue, whilst out running (which is when most of my revelations come to me) I realised it wasn’t done. I needed more on how couples cope when they move abroad together.

I hadn’t totally ignored this important aspect of expat life. Or at least of expat life for those of you going as a couple or a family. When I talk about relationships in this context, I am really talking about the relationship with your partner – although I do touch on the family dynamic as another feature of life that shifts when you take on an overseas move. The interaction between you and your partner is interwoven right through the book, including making sure it IS a partnership right from the start (eg it should be a joint decision that you go), what happens if you are so bored you want to leave, and how important it is to talk to your partner if you think you are descending into depression.

But there still felt like there was a gap. I think  the affect an overseas move has on your relationship with your partner  is something that doesn’t get discussed enough. Just like a post I did about depression and the expat, this is a topic that can get a bit swept under the carpet. Why? Perhaps because it’s hard to admit that the exciting new life we’re all leading or planning to lead isn’t all sweetness and light. Or maybe because it’s hard to know who to talk to about it. Or perhaps we don’t even want to admit there is a problem to ourselves.

Of course, relationship problems can happen anywhere, to anyone – you don’t have to move half way around the world to start arguing with your husband. But just like with depression, there are things that happen when you do take the leap into expat life that are more likely to put pressure on your partnership. Not least your own loss of identity (if you are the non-working partner), the possible drop in income of only having one wage, the lack of a support network, the new need to be overly-reliant on your partner and just the day-to-day pressures (finding the shops, security fears, worrying about the children etc) that come with moving to another country.

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Luckily the very interesting responses to my survey showed me that it wasn’t by any means all bad news. In fact if anything there was a lot more positive responses than negative – and the clearest message that came out in the answers was that an expat move was likely to make your relationship stronger rather than push you apart. Sharing new experiences, spending more time together as a family, having to turn to each other because there is no-one else – many people told me these brought them closer and made their relationship a more robust one than the opposite. To directly quote one of my respondents: “All the moving around definitely brought us closer together. Even if there were occasional problems, by solving them we grew stronger. He’s my best friend now”. Another one even told me the move had saved her marriage – a planned split was put on hold when they found out he was being posted abroad and now they are not only still together but a lot happier than they had been.

But we can’t ignore the fact that whilst these positive stories are in the majority (or at least they were among those who responded to my request for your experiences), there are still others whose relationship does break down thanks to the particular pressures of moving and living in another place. I have seen first hand a number of couples split up for various reasons. Some I suspect wouldn’t have lasted wherever in the world they lived. But others were caused by bored partners whose spouses worked long hours in the office, affairs made easier due to the particular culture they were living in, the disparity between the two completely different lives being led or just simply an escalation in otherwise endurable problems caused by the massive changes.

So what happens in these circumstances? It’s always sad when a relationship breaks down, but being overseas can cause more complications than normal. What happens if one wants to return but the other doesn’t? Or if the working half of the partnership is tied into a contract which means they have to stay? What about if there are children involved? What are the legal considerations if you are not in your home jurisdiction? What about if one of the couple is from the country where you are living, but the other isn’t?

These are all issues that you might need to think through BEFORE you move, rather than when things start to go wrong. And if you think your relationship could be severely tested by the move, consider counselling either before you go or look for online help (Relate in the UK offers telephone, email and ‘live chat’ counselling) that you can carry on with from your new home.  I know it’s not a pleasant thing to have to plan for, but knowing what I do about the affect an overseas move can have on a couple I still think it’s worth at least considering what you would do if you and your partner did split up.  There is so much more I could say about this subject (and there’s now a whole chapter on it in the Survival Guide) but I don’t want to labour the point. Subjects like this are difficult to talk about and sometimes we just need to open it up as a discussion point just to make people aware of the issues. Hopefully this is not something you will ever need to worry about. But if you think it might be, or if you know it already is,do you know what you would do? It’s better to be prepared for something that may never happen than find yourself floundering when it’s too late.

How has moving abroad affected the relationship with your partner? What advice would you give to others, especially those that might be having problems?

 

photo credit: couple via photopin (license)

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