Expat married to a local, really struggling, seeking help
March 21, 2014 8:40 AM   Subscribe

Finally giving in and looking for a therapist, while permanently living abroad... what 'cultural combination' should one look for? Don't want my current mental state to cloud my thinking. Details inside.

I'm really struggling internally with whether or not to stay in my marriage (about 5 years, together about 7+). He is European, I am American.

I'm very, very confused about where exactly these feelings come from, because a lot of built-up personal crap that I've never fully worked through is cluttering my view. And I still love my husband, despite how it all sounds.
I feel like I'm going insane and have decided that I can't do this on my own anymore.

My question now is: do I look for a therapist who can understand any potential inter-cultural part of this this mess, which I can say at the moment I don't see myself?
Or should I go for a therapist from the States, who may understand my personal context better, since I have a lot of other issues going on that may be at the root of this?

To be completely honest, my gut wants me to go to my own culture. But I feel this could introduce blind spots somehow, especially from a therapist who has never been an expat themselves. Ideally I would find an expat therapist with the same cultural-combo as me (inverted would also be fine). After looking around I don't feel optimistic about finding one though.
About a local therapist - yes, this has crossed my mind, but the language barrier makes me very hesitant, despite speaking the local language well.

At the moment I'm just looking for individual therapy rather than couples counseling; I feel it necessary to work on myself first.

If anyone has personal experience with this, or an anecdote, or a professional opinion, or resources, or even just a fresh view, I would be very grateful for your words. My heart hurts. Thanks for reading.
posted by anonymous to Human Relations (9 answers total) 2 users marked this as a favorite
In my (unprofessional) opinion, being able to establish an honest and trusting rapport with your therapist is one of the single most important things to getting therapy to actually be effective, rather than just showing up to someone's office to have a conversation and your feelings (which may be enough for you, but probably not.)

If you gut feeling says you'd be more comfortable with someone from your culture, then go with someone from your culture. Therapy on its own is uncomfortable enough, the last thing you need to do is set up a hurdle that doesn't need to be there to begin with.

Wanting a therapist who is from the same cultural background as you is analogous to wanting one who is the same gender, or ethnic background, or sexual orientation: to some people it doesn't matter at all, to others it makes or breaks the effectiveness of the therapy. You don't want to be stuck sitting there thinking "this person doesn't understand who I am, how can they possibly help me?" It's not their matching cultural background (or etc.) makes them a more effective therapist, necessarily, it's that their cultural background makes you a more open and receptive client.
posted by griphus at 8:53 AM on March 21, 2014 [2 favorites]

Good luck, and good for you for looking for help. You seem to be thinking that you can only see a local therapist who knows about your country of residence, or an American therapist who doesn't know anything about it. Are you open to Skype/phone calls? I feel confident you could find a therapist who is both American and has experience with multicultural marriages/living abroad. It may take some digging but I'm sure there are some out there. Try the Psychology Today therapist finder. Or, if you've ever sought out care in the States, could you contact your former therapist and ask for recommendations?

Oh, and be cautious about any agencies in your country of residence who advertise "therapy for expats" unless you've thoroughly checked references, accreditation, etc. There can be some great people practicing in your country who are gearing their practices towards expats like you, but it can also be a way for fly-by-night agencies to charge $$ for "care" from untrained and irresponsible folks. [Personal experience living abroad, not in Europe]
posted by rogerrogerwhatsyourrvectorvicto at 8:58 AM on March 21, 2014

Have you looked for resources in English? In France, for example, there are many English-speaking therapists, and even an English-speaking helpline. Something like this could be a good place to start. Maybe even call the one in France if you are in Europe, since they may be able to put you in contact with support for your particular context. Plus they are used to helping expats, and know how very, very hard and lonely it can be.
posted by bwonder2 at 9:01 AM on March 21, 2014 [1 favorite]

I can offer an anecdote: I know someone (American) who has lived abroad for years in various countries/hemispheres -- she works with an American therapist with whom she communicates weekly via Skype. Her process/rationale for finding a therapist while living overseas was that she needed help NOW, and she thought it would be easier/faster to get recs from her therapy-going friends in the States for therapists she thought she might more quickly connect with. Finding someone immediately was her number one priority - she figured she could always use the time she was already working with the American therapist to find someone local if it turned out the current therapist wasn't working out, or, had blind spots as you mentioned.

(On the subject of blind spots: although I think it's wise that you're thinking about this, do remember that a good therapist doesn't really need to know the details of any of their clients' lives to be a transformative force -- if they're good at what they do *you* will be the one doing all the heavy lifting; their job is simply to listen and help facilitate that. YMMV obviously, in terms of what you want from a therapist, and obviously you want someone who has an open mind and the ability to integrate all kinds of perspectives in their practice. My point is just that you shouldn't assume they can't or won't understand how to best help you without having lived in your exact circumstances. I know expat life can be weird - I've been there. But I think you're smart to realize that while that experience may play into some of what you're dealing with you may have other, more foundational issues that may be at the root of things.)
posted by hapax_legomenon at 9:42 AM on March 21, 2014 [1 favorite]

Most therapists' licenses in the US are granted by the state only for working with clients within that state. Exceptions can be made for regular clients who are traveling temporarily, but it is generally against the law for licensed therapists to be providing regular therapy to someone who is not a resident of the geographic area for which they are licensed.

The laws are often a bit murky regarding Skype and other tech solutions, mainly because they're just so new, but I would be extremely concerned about the professionalism of a US-based therapist who agrees to provide help to someone living full-time abroad; that would be a sign of a therapist who either likely doesn't know or doesn't follow legal and ethical procedures.

(It's an ethical concern because what happens if you're in a crisis? Will the US therapist know how to get in touch with the appropriate local agencies to intervene if you need to be hospitalized to prevent a suicide attempt? In the US, if you make credible threats of violence against an identifiable person, it's required that the therapist inform the local police as well as the target -- would the therapist know how to do that in your country from her office in the States? What if you told her about child abuse; who should she inform? I know that these are unlikely scenarios, but they're highly legislated in the US because they're crisis issues, and ethical therapists need to be operating from a place where they have a clear plan in place for dealing with crisis issues.)

All that to say... find a therapist based locally. I know it's difficult. I think the idea of locating English-speaking hotlines or community centers and seeing if they have resources or referrals is a great idea. I also suspect that working with a therapist who is culturally local might be more helpful than you're thinking -- don't let your cultural conflict with your husband generalize out into feeling that you have an intractable cultural clash with all the residents of your current country.
posted by jaguar at 10:11 AM on March 21, 2014 [1 favorite]

2nding jaguar.

The legality of doing overseas therapy is questionable. In addition even video chat has its difficulties. Unless it is a video of your whole body a therapist might not see subtle body language like twitching your foot or fiddling with objects. Also technological problems can interrupt your session during important moments. Also the time difference will really limit when you cam have a session. Also a therapists office is a space does have its own benefits in helping. In addition if you need local resources (even something like a food pantry) they aren't going to be able to help. I'm a case manager studying to be a therapist in the USA. Many people are qualified, bilingual, from other countries , male and female. I'm sure in a large city you can find someone to suit your needs. Of course always try a few people as finding the right therapist is tricky. You also may discover people can relate even if they don't fit all your criteria. Someone who isn't an expat but has spent some time abroad may be able to relate as well as another expat. Or you may find an expat therapist whose background is so different it just doesn't work
posted by AlexiaSky at 11:32 AM on March 21, 2014

The therapist you see is almost certainly better than the therapist you don't see.

When I was ready to work on an issue, it took me a long time to find a therapist who I felt "got it" well enough to help me with it.

I saw several therapists before I found one who was a good fit, beginning with one who was of a gender that I knew for sure I did not want to work with. But I started anyway because I felt strongly that I was ready to get started, and that was the only therapist who had immediate availability in my area. Meanwhile, I kept looking for a therapist who would be a better fit.

The urge to get started on therapy is a gift. Use it. Don't wait.
posted by Bentobox Humperdinck at 12:20 PM on March 21, 2014 [1 favorite]

I live in France and have a French therapist who's never been outside of Europe and doesn't speak English. She's been wonderful.

When I was a kid, I learned something of great value that's served me well around the world: humans are cultures unto themselves. Just because someone has "been overseas" does not make them multicultural; just because someone has lived all their life in a small town (like a great deal of my close friends still in Oregon), does not make them unable to comprehend multicultural concerns. I know a lot of racist expats. And I know a lot of open-minded "countryside hicks". (I am one, as a matter of fact. A countryside hick multilingual Franco-Oregonian.)

The key is being open to other viewpoints. Most therapists, I would say, are, by the very fact that they became therapists. Obviously there are exceptions. Avoid anyone who makes assumptions about you based on, well, anything. Such as, "you're American, so you must be..." or "you're a woman, so you must be..." Look for therapists who ask questions and with whom you feel you have agency. Stick with one.

Remember – your life is unique, not just your culture. You're going to need to explain the particulars of your life no matter who you find.
posted by fraula at 2:36 PM on March 21, 2014 [2 favorites]

Check out Internations. It's a network for expats and they have branches in most major cities and people from all over. They have forums and much like Askmefi you can get all kinds of help. I've used it to find English speaking barbers, to social events, to libraries open to the public to find a quiet place to study. I'm sure somebody could recommend a therapist who meets your needs.
posted by Che boludo! at 10:30 AM on March 23, 2014

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