The Move Did Not Cause the Problem. It Removed What Was Hiding It.

Published September 2026

Living in another country changes you in ways that are hard to explain to people who haven't done it. I have. The initial excitement fades. What replaces it is often more tangled than homesickness. It's a slow reshaping of identity. Slow enough that you miss it happening.

Many expats I work with aren't in crisis. They're functional. But "functional" has started to feel like the ceiling rather than the floor. They want to understand why they feel stuck, disconnected, or not quite themselves, despite having built a good life abroad. I work online, in English, with individuals and couples who live abroad.

When you're abroad and something feels off

People often reach out when life looks stable on paper but their inner experience has shifted.

• You feel lonely even when you're surrounded by people.
• You're functioning (work is fine) but you feel flat, detached, or unreal.
• You don't recognize yourself in this version of your life.
• Your relationship is under strain after the move.
• You're stuck in the same loops and don't know what keeps recreating them.

Why expats look for an English-speaking therapist

Therapy works through language. Through the specific words you use to describe your experience, and the nuances a therapist picks up on. Working in your second or third language adds a barrier that most people underrate. You can still communicate in another language. What goes missing is the emotional texture. And texture is what therapy runs on. The difference between "I'm frustrated" and "I feel like I'm losing myself" is the difference between surface reporting and actual therapeutic work.

Beyond language, there's the question of cultural context. A therapist who doesn't understand what it means to be a foreigner. To deal with bureaucracies in another language. To raise children between cultures. To feel like a permanent guest. That therapist will spend valuable session time on explanations rather than exploration. I understand these dynamics from the inside. I have lived abroad for years and I am raising children between cultures, so you will not spend session time explaining what that is like. What matters is working with someone who already gets it.

What expats typically bring to therapy

A few themes come up again and again. The first is not quite belonging anywhere. Not in the new country, and increasingly not in the home country either. Home gets blurry. Relationships strain under the asymmetry of who gave up more to move. Identity questions that stayed dormant for years surface once the familiar scaffolding is gone. Deep friendships are hard to build in adulthood and in a foreign culture. The weight of being the foreigner in every interaction adds up. The high performers who tend to get posted abroad often bring perfectionism with them, and the exposure of expat life sharpens it. Some people describe a flatness or unease that has no obvious cause and will not lift. In cross-cultural marriages, expectations clash. About who does what. About how you are supposed to argue.

In session it sounds like this: "We went home for three weeks last summer, and I spent the whole trip feeling like a guest in my own family. Then we flew back, and the airport here felt more familiar than my parents' kitchen. I don't know what that makes me now."

How I work with expats

I don't treat being an expat as the problem to solve. The move abroad is the context, but the work is about you. The patterns you brought with you. The ones that developed in response to the move. And the ways they interact. Sometimes the expat experience has amplified something that was already there. Sometimes it's created something new. Either way, understanding the pattern is what makes change possible.

One example: someone who always kept the peace at home becomes the one who handles everything abroad. The visas, the landlord, the school forms, all in a language they barely speak. The old pattern did not change. The move just tripled its workload.

Sessions are virtual and run over secure video call. Your therapy doesn't depend on where you live, or how often you move. I work with clients across every time zone, and scheduling is flexible. If you relocate (which many of my clients do) you keep your therapist.

What the research says about expat mental health

The story everyone knows is the U-curve: honeymoon first, then the crash, then slow adjustment. It is in every relocation briefing, and the best longitudinal research rejected it. Ward and colleagues measured newly arrived sojourners from within twenty-four hours of landing through the first year and found no honeymoon and no U. Adjustment problems were greatest at the entry point and decreased over time (Ward, Okura, Kennedy and Kojima, 1998). The same research group later rendered the formal verdict that the model should be retired (Ward, Bochner and Furnham, 2001). This matters clinically. If you are struggling in week two, you are not off schedule. There is no guaranteed honeymoon, and for many people the beginning is the hardest part. What I do see in practice, and this is a clinical observation rather than a research finding, is the delayed hit: people brace for the stress of the move itself and are blindsided when the real difficulty arrives later, once the new life has turned ordinary and everyone back home has stopped checking in.

The prevalence numbers circulating on expat blogs are mostly untraceable, so let me tell you what the evidence actually is. The most cited comparison study (Truman, Sharar and Pompe, 2011) screened expatriate employees against US-based workers and found more than half the expatriate sample at high risk for anxiety and depression, roughly two and a half times the domestic comparison. It is a convenience sample drawn from different employers, using a screening tool rather than diagnostic interviews, so treat it as a strong signal rather than a precise rate. The signal is consistent, though: across independent surveys, distress and disconnection run substantially higher among people living abroad, and the drivers that keep showing up are stress and isolation rather than cultural distance itself.

The finding with the most direct bearing on choosing a therapist comes from the cultural-adaptation literature. Across 78 studies and nearly 14,000 participants, therapy adapted to the client's cultural frame outperformed unadapted therapy by a moderate margin (Hall and colleagues, 2016; the effect shrinks somewhat once publication bias is accounted for, per Soto and colleagues, 2018). The more interesting result is why. In the most rigorous head-to-head comparison, the ingredient that mattered was not surface features but the explanatory framework: therapy worked better when the therapist's understanding of what the problem is matched the client's world (Benish, Quintana and Wampold, 2011). For expats, that is the whole argument for a specialist. The value is not a technique. It is a shared model of what living between cultures does to a person.

The language question has a physiological answer. Bilingualism research finds that the first language carries more emotional charge than languages learned later: skin-conductance studies show measurably weaker bodily responses to emotional words presented in a second language (Pavlenko, 2005; Caldwell-Harris, 2014; Dewaele's work on taboo words). A second language can create useful distance for some kinds of talk. For grief, shame, resentment, and identity (the material expats actually carry), that distance is a cost. This is the evidence underneath the thing this practice is built on: the work goes deeper in the language your inner life runs in.

One more pattern matters for timing, and it shows up most clearly among trailing partners. Expats tend to underreport distress for a long time before they ask for help, partly because of the pressure to have made the right decision and partly because the local network is thin enough that no one outside the marriage notices what is happening. By the time people reach out, the patterns are usually months or years into calcification. That is the argument for starting earlier rather than waiting until something breaks.

This essay began life on my therapy for expats page, which now carries the practical version: who the work is for, how it runs, and what it costs.

Common questions about therapy for expats