Living in another country changes you in ways that are hard to explain to people who haven't done it. The initial excitement fades, and what replaces it is often more complicated than homesickness. It's a slow reorganization of identity.
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, and 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 underestimate. You can still communicate in another language. What goes missing is the emotional texture. 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, 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. 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, and the weight of being the foreigner in every interaction adds up. Some people describe a flatness or unease that has no obvious cause and will not lift. In cross-cultural marriages, expectations about who does what, and about how you are supposed to argue, often clash.
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.
Sessions are conducted online via secure video call, which means 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.
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, billed in USD, 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 cross-cultural psychology literature on expatriate adjustment is surprisingly well-developed, and the pattern that emerges is consistent. Longitudinal studies of employed expats typically find that depression and anxiety rates are two to three times higher than for matched non-migrating peers, with the peak around 9 to 18 months into the posting, well past the initial honeymoon but before the person has built enough local roots to feel at home. The classic U-curve of cross-cultural adjustment described by Oberg (1960) and later refined by Black and Mendenhall (1991) matches this: initial excitement, a sharp dip, slow recovery, sometimes a second dip on return.
A second well-replicated finding is that the strongest predictor of expat distress is not the degree of cultural distance between home and host country, but the degree of mismatch between the person's pre-move expectations and the realities they encounter. Couples where one partner moved primarily to support the other's career (the trailing-spouse literature) report the highest distress, with effect sizes larger than any specific cultural or linguistic variable. The psychological problem is rarely adjusting to the new country. It is adjusting to a version of yourself that you did not know you would have to become.
The re-entry literature is the part most people do not see coming. Gullahorn and Gullahorn, working from interview and survey data on 5,300 Americans who had lived abroad, found that returning home is often a harder adjustment than the move out. The pattern they described, a second dip layered on top of the first, became known as the W-curve (Gullahorn and Gullahorn, 1963). People expect to return to an unchanged home as unchanged people, and neither turns out to be true. The home has moved on, and so have they.
One more finding 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?
Research on expatriate adjustment consistently finds the period of greatest distress falls between roughly 9 and 18 months in, past the initial excitement, deep enough into daily life that the gap between expected and actual experience has become concrete, but usually before the person has built a local social network that can hold it. Many of my clients come at that point. Some come earlier, either because they saw it coming or because something broke fast.
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.