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.


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.

help through computer

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.



11 thoughts on “A Series on Expat Depression #7 – Seeking professional help

  1. I´m so grateful that you wrote this series on Expat depression and you´ve certainly nailed some of the feelings that I have. Even in this latest post, feeling that just getting out of bed and washed/dressed is like a monumental effort and certainly, if it weren´t for my 4yr old I wouldn´t be getting out of bed at all on most days. 😦

    I´ve been in Holland ( I´m British ) for 3yrs now and unable to work due to not being able to speak Dutch. I don´t have the transferable skills from my profession back home to just come and work in one of the big companies here, where my husband works. The loss of identity, lack of purpose, unfullfilment in life, isolation, lack of adult contact and meaningful conversation of what you speak….I totally get that and it´s no surprise that depression results. How can someone NOT feel depressed living somewhere where they have no prospects? I´ve tried learning Dutch too, but it´s gonna be a looong time before I´ll be ready to compete in the jobs market. All the while I´m on the scrap heap, insignificant, invisable, worthless, unable to contribute or feel a part of society. My life that I enjoyed back home ( interesting, fulfilling profession I loved ) and my existance here is like night and day in it´s contrast. It´s easy to feel hopeless. I comfort eat ( and feel worse obv! ) too, another point you made which I can totally identify with!

    However, there is hope on the horizon. There´s a new group here called the Expat Spouses Initiative, and I´m going to one of their community evenings this week. I´m really hoping I can learn that I DO in fact have opportunities and prospects to use my brain again and have a future here. Possibly retrain seeing as my sector is a no go. They also run life coaching sessions with psychologists so I´m hoping to embark on a course of these as it can only be of benefit. So I have a glimmer of hope that there is something positive which may help me in my predicament.

    Thankyou for your writings. It feels really good knowing someone out there in the ether is empathysing and acknowledging how I am feeling, and the struggles that a lot of expat accompanying partners are faced with.

    Liked by 1 person

    • Hi Karen. Thank you so much for your comments. It makes writing the series worthwhile knowing that it is helping even just one single person. I’m sorry you have been having such a tough time. It sounds like you have been experiencing what so many of us go through and are just not prepared for. So glad you are doing something positive though, it really sounds like you are taking steps in the right direction. I would love to hear how you get on – I don’t know if you enjoy writing but I would be honoured if you ever wanted to write me a guest post about your situation and what you are doing about it. If you do drop me a line clara@expatpartnersurvival.com. The more we share the more we can help others 🙂 In the meantime good luck with the new initiatives, it sounds like a really good project.


  2. Hey Clara, thanks for responding so promptly 🙂 The meet up is on Thurs eve and ( fingers crossed ) I only hope I come away from it with an idea of what I can possibly do with myself in the future. I´m interested to see what they can maybe do to help me. I feel I really need some outside guidance as I feel so directionless, lost, unemployable and useless. But I´m not ready to just give up totally yet, even when my motivation and energy to do even the simplest task is in my boots.

    I think if I can have an idea of a real possibility, training and work-wise, and set my sights on something that is actually doable, this will surely galvanize me into putting my energies into focusing on the end goal. And I am badly in need of a goal right now! Everybody needs something to aim and strive for in life. I was a nurse in the UK, and I think I´ve been mourning the loss of my career and all of the positive aspects it brought to my life. I doubt anything will bring me the same job satisfaction as my role as a nurse brought me, and I probably didn´t fully appreciate that until I had to leave it behind. I also turned 40yrs this month, and with such a milestone age there´s been reflection and trying to look to the future. I think this has made me feel even more melancholy as I´m certainly not in a place in my life that I envisioned I´d be in when embarking on a new decade.

    But hopefully I will learn of some potential prospects this week and a degree of optimism will be instilled in me! I will certainly let you know how it goes. Thank you for the kind offer to write a guest post. That´s such a compliment and you made my day : – ) Maybe if there´s a happy ending to my plight once I´ve been to the ESI evening and once my Life Coaching starts next month, then I would feel more comfortable writing about the ¨bad times¨ cos I will have overcome them. So possibly I will get back to you on that and take up your generous offer. I really hope I´ve reached a corner now and things are going to be looking up for me here.

    Sorry about the essay :-0 Like crying, I find it hard to stop once I start! But this is a great platform for people who ( like myself ) have never said any of this stuff that´s bothering and slowly eroding them, and speaking it to the outside world. A safe place where you won´t feel judged only understood and supported. I think you´ve created a very important place here tbh, kudos to you for that. Maybe you should start a forum? lol ( that was only a half-joke btw! 😉 )

    Best wishes and I´ll update in a while…..

    Liked by 1 person

    • If you are not already a member of the I am A Triangle FB group it is a great forum for expats like yourself – a mix of expats and people who have repatriated but a lot of people in a similar situation, mourning the loss of a career, loss of self. Incidentally when I was around your age I started new training (to be an antenatal teacher) and then wrote my book. I no longer teach but that job led to the job I now have which I was able to bring with me when I moved here as it is a remote working job. It will never be as exiting or as fulfilling as the career I gave up in the Foreign Office but it is interesting, it gives me something to do, brings in some extra cash and gives me some routine to life. As well as the fliexibilty I need with kids the age mine are. Don’t give up – the only way is up 🙂


  3. I have to second Karen on this: you did create a safe place where we can share and it has been really helpful.
    I have been in therapy for anxiety and depression but it has to do more with motherhood than expat life. My therapist is back home and has been really supportive (I send her emails when I feel overwhelmed). But she can’t help me with expat depression although she’s convinced that dealing with post partum anxiety and depression back home would have been a lot easier and the healing faster. The two got somehow entangled together making things worse on both fronts. I didn’t take any medication although sometimes I wonder if it wasn’t necessary at some point… The worst is when you have to deal with a personal ordeal like illness, or the death of a family member or PPD when living abroad. Where I live, professional help can be scarce or poor or both! Add to that the guilt and shame one feels for being so miserable although you seem to have the perfect life!
    One interesting point also is the strain expat depression can have on a marriage. Expat married couples do face a lot of unusual challenges… But like you said once you’ve hit rock bottom the only way is up!

    Liked by 1 person

    • Hi Jana, thank you for your comments, sorry it has taken me so long to respond – we have been away over the Easter holidays. I totally agree with you, something like PPD/PND can really exacerbate your depression when you are away from your usual support networks. And I also agree that the guilt of feeling miserable when you are “meant” to be living this amazing exotic and exciting life can also make things a lot worse. People just don’t talk about this enough so the cycle goes on. But you mustn’t feel guilt or shame – if it makes you feel any better, the place I have probably struggled most was on a beautiful Caribbean island where you were NEVER allowed to say you weren’t happy! And still people go “oh wow, that must have been amazing” every time I told them where I lived. Err no, actually, it was pretty darn hard!
      As for getting help where you live I see you have been in contact with your therapist back home but have you thought about some online counselling with someone who specialises in expat issues? Just a thought.
      Otherwise you are very brave just to come forward and talk about your struggles, this alone will help others to know that others have gone before where they are. Best wishes, Clara


      • Happy Easter 🙂
        I’m also not supposed to be complaining because it’s almost always sunny and never cold where I live! Plus people see my life as a foreign version of the Ladies who lunch! It’s both amusing and annoying how people perceive our lives abroad. We have it all AND in an exotic place so why are we complaining???
        I think the guilt and shame come mainly from the fact that motherhood and expat life are “choices”. We chose to be expats and we chose to become parents, regardless of whether we struggled with these choices or not and regardless of the difficulties we faced. And yes people just don’t talk about all this!
        I’m almost embarrassed to admit that I’ve discovered recently that there are therapists who specialize in expat depression! It just shows how lonely and isolated l have been feeling and what a taboo expat depression is!

        Liked by 1 person

  4. Pingback: A series on expat depression: round-up |

  5. Pingback: My expat depression article in the WSJ |

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s