You are performing on two levels at once. Academically, like everyone else. And culturally, pretending the gap between your internal world and the world around you is smaller than it is. You are fluent enough to get through a seminar and not fluent enough to say what you actually mean. The exhaustion you feel at the end of each day is not about the workload. It is about the constant labor of translating yourself into someone who fits.
I am an American therapist who has lived abroad. I work exclusively online in English with clients worldwide. No university records. No visa impact. Completely private.
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You do not have to be ready. You do not have to know what to say. A few sentences is enough.