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 am an American who has lived abroad for years and is 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. Many of those moves run through London; therapy in English in the UK has its own page.
Individual and couples therapy for expats
I offer both individual therapy (60 minutes) and couples therapy (60 minutes, with longer sessions available at pro-rated rates) for expats and international couples. Americans abroad often specifically look for an American therapist online or an American couples therapist who understands the cultural frame they grew up in. Before your first session, we have a free 15-minute call to see if this feels like the right fit for you.
How it works
The first step is a free 15-minute call. We talk about what is going on and whether the way I work fits what you need. There is no obligation to continue, and if I am not the right person, I will say so and point you somewhere better.
From there, sessions are weekly and run 60 minutes, by secure video. The work is private-pay, payable in any currency, with no insurance company or diagnosis code involved and no health record created. You can read the current fees on the fees page. Because everything is online, your therapy holds steady if you travel for work or move countries again.
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, and the difference persists even in highly proficient speakers: 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.
Related reading
Frequently asked questions
Why should I see a therapist in English instead of in the local language?
Therapy works through the nuances of language: the specific words you use and the subtleties a therapist picks up on. Working in a second language often flattens emotional texture, which limits the depth of the work. Therapy in your first language lets you access the full range of your experience.
Do you understand what expat life is actually like?
Yes, from my own life. I'm an American living abroad and raising children between cultures. You won't need to spend session time explaining what it's like to be a foreigner.
What if I move to another country during therapy?
You keep your therapist. Because sessions are online, your therapy doesn't depend on where you live. Many of my clients have relocated during our work together without interruption.
Do you work across different time zones?
Yes. I work with clients across every time zone and scheduling is flexible. We'll find a time that works for your location.
Is expat therapy different from regular therapy?
The expat experience 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 how they interact. Sometimes the move amplified something already there; sometimes it created something new. Either way, understanding the pattern is what makes change possible.
When in the posting do expats most often need therapy?
Whenever it hurts. The popular timeline, honeymoon first and crisis later, is not supported by the research: the best longitudinal work found adjustment problems often greatest right at arrival, decreasing over time, with no reliable honeymoon phase. In practice I see two waves. Some people come early, in the first weeks, when the move lands harder than expected. Many others come later, after the logistics are handled and life has turned ordinary, when a flatness or unease sets in with no obvious cause. Both are normal times for it to hurt, which means neither is too early or too late.
Do you work with trailing spouses and partners who moved for someone else?
Yes, often. The trailing-spouse experience is a specific kind of disorientation. Your partner has a job and a built-in reason to be in this country, and you have the country itself and whatever you can make of it. The distress research on this population is unambiguous, and the work often involves separating what belongs to you from what the move has piled onto you. See trailing spouse.
What happens in the first session?
Before we book anything, there is a free 15-minute call. The first full session is mostly you talking and me listening for the shape of the thing: what brought you here and what you keep returning to. You do not need to arrive with it organized. A few sentences is enough to start.
Is online therapy as effective as meeting in person?
For most of the issues people bring to this practice, the research finds no meaningful difference in outcome between video and in-person work. What matters far more is the fit between you and the therapist and the depth of the work itself. I have written more about this on does online therapy work.
Can I have therapy in English if I live somewhere English is not the main language?
Yes. That is most of what I do. Many clients live in countries where the available local therapists work in a language they can manage day to day but not in the language their inner life runs in. Sessions are online, so where you live does not limit access, and we work in the language you think and feel in.
Do you work with digital nomads and people who move often?
Yes, and the continuity is the point. People who relocate every year or two usually have to restart with a new therapist each time and re-explain their whole history. Here the relationship moves with you. You keep the same therapist across borders and time zones, which is part of why people who move a lot tend to stay.