When You Need Help Abroad: Finding A Good Counselor When You Live Overseas

by Lisa McKay on September 3, 2014

One of the first questions people often ask me when they learn that I’m a psychologist is, “are you practicing?” They are invariably disappointed when I tell them “no, I’m still busy with our young children, and I’m trying to start a business on the side.” Here, like many other places I’ve lived abroad, there is a shortage of trained mental health professionals who are well equipped to help the expatriate population.

And, boy, a significant chunk of the expatriate population needs some helping.

That’s not surprising, really.

Moving abroad pushes you out of all sorts of comfort zones. Pretty much everything in life – from grocery shopping to figuring out the point of life – gets more complicated. The level of challenge in your life goes way up, right when you lose a lot of your normal support and coping mechanisms.

Yes, this can be a recipe for great personal growth. It is also, often, a recipe for great personal struggle and pain.

Coping with sudden and extreme change gets exhausting. Living far from family and friends gets lonely. Witnessing the impact of your choices on your family members – particularly your children – can breed guilt and insecurity right alongside gratitude. Having the familiar social and cultural scaffolding of your life ripped away can force you to confront core identity questions around yourself, privilege, meaning, purpose, and the existence and nature of God. The pathways to answering these questions often lead through dark valleys.

I would guess that those who live overseas entertain a higher chance of experiencing significant mental health problems, marital challenges, or substance abuse issues than those who remain on home soil. I’ve seen numerous marriages hit the rocks and other important personal and team relationships become hopelessly mired in miscommunications and conflict. I’ve seen people skid into alcohol and porn addictions. I’ve seen parents feel guilty and helpless as they watch their children implode (or explode). I’ve frequently seen more people who cannot shake anxiety, grief, bone-deep exhaustion, or the grey, soul-sucking fog of depression.

When these things happen (and they happen more often than you might think) expatriates can find it very difficult to get help.

There are all sorts of reasons why this is so, but one of those reasons is a shortage of qualified mental health professionals who themselves live abroad. So today, we’re going to talk about how to find some help when you find yourself struggling with a dark, difficult chapter in your story.

Keyboard_Help

When you’re trying to find a counselor locally, ask around

If you’re looking for a psychologist or counselor, start by asking others in town about the options. You don’t have to go into details, just ask if anyone knows of any psychologist, counselors, or social workers living in town.

You might want to start with your embassy. Talk to the doctor on staff at the embassy clinic, if there is one. Ask them whether they know of any psychologists or counselors practicing locally and, if not, what they recommend when people contact them asking for mental health or family counseling referrals.

If you live near an international school, you can approach them for information, too. The international schools may know of skilled expats in town, especially those who work with children.

You can also ask other expatriates, particularly doctors, nurses, midwives, doulas, and pastors.

Search online

world magnifyingWhen you live anywhere outside the major city centers, word of mouth is your best bet when it comes to finding mental health professionals who live nearby. However, you might get lucky with an internet search. Here are three things to try…

Check out International Therapists Directory. It provides an online global listing of professional mental health therapists who are familiar with the TCK and international expatriate experiences.

Use Google. I’m in Laos, so I would try searches like “mental health Laos” “mental health Vientiane” “psychologist Laos” “counselor Laos” “family therapy Laos” etc and see what comes up. I’d also search LinkedIn with those same search phrases.

When it comes to choosing a counselor, be picky

Don’t work with someone just because they live nearby. Yes, there are some benefits to sitting down with someone face to face, but a significant proportion of the mental health professionals I’ve met abroad are… well… to be honest… strange.

Be picky. You will be far better off talking to someone you trust and like via Skype than sitting with someone locally who isn’t qualified or able to help you.

Selecting a counselor is an important and individual process. Remember that a counselor who works well with one person may not be the best choice for another person. Also, when you live overseas, it can be helpful if your counselor has lived abroad themselves or has previous experience working with expatriates.

When you’re considering working with someone, you might want to let the counselor know you’re thinking of making an appointment and ask if they have a couple of minutes to talk with you before you make a decision.

Don’t use this time to explain at length why you want to make an appointment. Instead, ask some questions that can help you get a better feel for this counselor and whether you feel comfortable talking to him/her.

Here are some questions you could ask:

  • Can you tell me a bit more about your training and experience? Are you a licensed mental health professional?
  • Can you tell me a bit more about your general approach to counseling?
  • What do you enjoy about counseling?
  • If you feel comfortable naming the issue that you want to work on in general terms (e.g., “issues related to humanitarian field work,” “child-rearing problems,” “marital issues”), you might ask, “How much experience do you have working with people with this concern?”
  • How long (over time) do you generally like to see clients?
  • Can you tell me more about your fee structure/how you handle billing? (Either on the phone or in your first meeting, the counselor should provide information about procedural matters – fees, meeting times, availability, confidentiality, etc.).

When you meet with a counselor, ask yourself whether this is a person with whom you feel comfortable talking. You may need to talk with the counselor more than once to know the answer to that question. Do you feel the counselor is listening to you? Does the counselor treat you with respect? Does the counselor respond to your questions constructively?

If you can’t find someone local who you like and trust, find someone back home and work with them using Skype, Facetime, or other video-chat options. Nowadays, many counselors are happy to take on long-distance clients.

Find and read resources online

Articles, online training modules, and podcasts are not an adequate substitute for talking to someone, but they can help along the way. Here are a couple of websites that you might find useful.

The Headington Institute: Provides psychological and spiritual support services for aid and development personnel worldwide. Check out their free online training center covering topics related to resilience, stress, trauma, relationships, spirituality and more.

Member Care Associates: Provides and develops supportive resources for workers and sending groups within the mission/humanitarian sectors. Click on their Articles/Books tab to find a long list of resources for those on the mission field. Click here to read about their latest book in the Member Care series.

The American Psychological Associations Online Help Center: This is a good source for general articles and tips sheets about health, emotional wellness, families, relationships, and children.

Please chime in and add to this list!
Feel free to ask questions, share your experiences, or add useful links.

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About Lisa McKay

Lisa McKay is a psychologist and the award-winning author of the memoir Love At The Speed Of Email, the novel My Hands Came Away Red, and several books on long distance relationships. She lives in Laos with her husband and their two sons.
  • KB

    In my perfect world, overseas workers would establish a relationship with a therapist in their home country before they ever go overseas. They’d do real, serious work with that therapist for a while. Then they’d check in with that person on a regular basis via email, Skype, etc. And they’d go see that person when they were back in their home country again. Here’s a link to the International Therapist Directory: http://internationaltherapistdirectory.com/ (“professional mental health therapists who are familiar with the TCK and international expatriate experiences.”) Because yes. It’s going to be hard, and you’re going to need help.

    • Yes, that is a great model, indeed! Much, much better than waiting until you’re deep into dark times to first make that contact.

  • Dalaina May

    Oh this is wonderful! I went through BRUTAL post pardum depression overseas and just never thought about these possibilities. Will be sharing this in my expat circles!

    • I’m so glad you found it helpful. Hope the PPD has lifted!!

  • Marilyn Gardner

    So good and so practical Lisa. A critical resource!

    • Great, that’s what I was hoping… Practical. Useful.

  • This is a great post with some really helpful tips, thank you! I have found that this is one of the most pressing needs for my organisation… finding competent counsellors in various fields of expertise (ie. marriage, depression issues, etc). There are so many missionaries that are fully aware they are in need of a good counsellor or therapist but it can take months upon months to find someone. Thanks for highlighting this issue and giving such practical suggestions!

    • Yes, it’s a really tough one, and even if a counselor is technically qualified and understands the field well, there’s no guarantee it’ll be a good fit anyway. Humanitarian workers have the same issue. It’s getting a bit better, I think. But sloooooowwwwwlllly,

  • Tara Porter-Livesay

    well researched and CRAZY GOOD INFORMATIVE post. The Oaks Counseling out of Austin, TX send counselors abroad and do Skype sessions … I have only ever heard really great references for them. They specialize in caring for those living cross-culturally.

  • Richelle Wright

    for those in Africa – can’t speak highly enough of these folks: http://www.mmct.org/

    • Yes!! I know and love several members of MMCT and have co-trained with them before. Wonderful resource. Thanks for adding, Richelle.

  • Rachel ‘Pieh’ Jones

    This is so good and helpful Lisa. Thank you!

    • Pleasure. Read your article on boarding school yesterday. Such a good one.

  • Brilliant, Lisa! This needs to be shared everywhere. People back “home” need to understand this. Overseas workers need to understand this to help themselves and to be compassionate towards the other workers alongside them. Kids of overseas workers need to hear this message. Help is not bad. We used to not understand that, thinking that we all had to have this martyr-savior complex. Now times are changing and getting help is viewed not as a weakness, but as a smart way to stay strong.

    • Yes, times are changing around this, thankfully. But although the stigma is lifting it’s still not easy to find a counselor who’s a great fit. And that “fit” – which can be so hard to define – does make a real difference.

  • Sorry – reposting earlier comment (now deleted) that was done using my husband’s disqus account by accident. 🙂
    In my perfect world, overseas workers would establish a relationship with a therapist in their home country before they ever go overseas. They’d do real, serious work with that therapist for a while. Then they’d check in with that person on a regular basis via email, Skype, etc. And they’d go see that person when they were back in their home country again. Here’s a link to the International Therapist Directory:http://internationaltherapistd… (“professional mental health therapists who are familiar with the TCK and international expatriate experiences.”) Because yes. It’s going to be hard, and you’re going to need help.

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  • Mary L

    Great article! The problem I have is not find a counselor, but paying for one. We have sort of been left stranded living on the field and there is barely money for food, let alone anything else. It seems those who want to help want to make money from that help. (that may just be my cynical depression talking but at the moment I do not have 10gs for Marble retreat) The other problem is my husband is a trained psychologist, so all of our “friends” are friends because they want help. They could careless whats happening with us. Just let us show a bit of reality and they run a mile. 🙁 Sadly we are both totally wiped out and in need of help ourselves.

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