Questions and Answers with Cynthia Kunze of PsyShrink

What are some of the challenges for a family when preparing for an overseas assignment?

This is really an important point as studies show that the extent to which a family has been prepared for the move directly affects the experience that follows. The most common challenge is managing the logistics of important details from afar such as finding schools for children, gathering information about the area, and acquiring a clear understanding of how life in general will be following the move. Although helpful, browsing schools and homes via the internet simply does not paint a complete picture. Additionally, the extent to which a relocation company or employer communicates and provides information can also be challenging.

Are there recognizable patterns that you have noticed in your practice with regards to how expatriates adapt to a life abroad?

Absolutely. We have found, as is reflected in the literature on the topic, that regardless of how prepared a person/family is, culture shock will always play a role in the expatriate experience. How quickly it emerges, its intensity and duration are always varied, but it does appear to be unavoidable in even the best of circumstances.

Do you find that there is a “breaking-point” so to speak when an expatriate actively seeks out therapy?

Not necessarily a “breaking-point,” though this is sometimes the case, but frequently the motivation to seek therapy comes in-part from the frustration of being isolated as expatriates often are. Whatever the issues that lead to a specific expatriate beginning therapy may be, most often people do not have friends or family nearby in whom they can confide about their current difficulties. As is the case for anyone, the pressure that builds from not being able to share struggles can be maddening. This seems to be intensified for people living abroad.

How can a family prepare itself to cope with the psychological impact of an overseas move?

The best thing an expatriating family can do before their move is to make time to have open conversation routinely as the move approaches. An ideal scenario would be for the family to engage a counselor prior to the move who is versed in the intricacies of living abroad. If this is not an option, a family that is diligent about sharing their fears, excitements, and expectations prior to the move is more likely to do so once abroad which will foster a better experience in general. Additionally, working to address problematic family dynamics/issues that were present even before the prospect of the move is crucial as these will be aggravated once abroad.

What are the most common emotional challenges that people may face when the move is finally made?

In the context of the previous question, the challenges we see most of our clients struggling with were usually present on some level prior to the move. Rarely do we see people presenting for therapy with an issue that was completely foreign to them prior to expatriating. An expatriate client who presents for therapy describing symptoms of depression and/or anxiety is likely to have grappled with both to some extent back home. In the over 3000 hours of sessions we’ve conducted with expatriates, what we know is that whatever emotional challenges that existed prior to moving are likely to be triggered by the culture shock and other pressures that appear to be inherent to the move.

What makes the emotional challenges of expatriates different from those of individuals/families who remain in their home country?

The challenges themselves are not particularly different. Any family can find itself facing, for example, behavioral problems with children or periods of disconnect between spouses—the difference seems to be in how these issues manifest. A child in his home country may act out occasionally in school or at home and may only need a brief intervention to get back on track. An expatriate child, however, may act out more severely or over a longer period of time baffling his/her parents with behavior that seems extreme and new.

It would seem that family status (single, married with no children, family) plays a big role in the different types of problems that an individual may develop. Are there significant differences in the psychological impact of a move depending on family status?

Not necessarily. Understandably, single expatriates with no children are in our experience more likely to describe feelings of loneliness and isolation. With that same token, however, an entire family can find themselves isolated with few opportunities to socialize with other families.

It seems a reasonable summation that relocation from countries such as the States or Britain to Western Europe would not be as great a cultural leap in comparison to expatriating to countries in Asia or Africa for example. Do you find that to be the case?

This is a huge commonly-held misconception. Although living in a third-world country or a country much further around the globe from one’s home country is indeed incredibly challenging, a life away from home will always be an adjustment. Navigating the bureaucracy of a new country, for example, will always be a challenge even if the bureaucracy conducts business in your native language. Differences in weather, local customs, holidays, and so forth can be incredibly difficult to adapt to. The bottom line for any expatriate will always be that s/he is away from home.

Are there cultural-specific challenges that an expatriate living in Germany faces?

Absolutely. The German language itself can be incredibly difficult to learn much less master—this is the case also for Germans themselves. Additionally, ways of doing business, socializing and work ethic are all uniquely German. An expatriate living in Germany, regardless of their country of origin, will be challenged to adjust and will pass through phases of acceptance or rejection of the host culture.

How would you say “culture shock” plays a role in the emotional well-being of expatriates?

We’ve learned through research and experience that it plays a significant role—perhaps the most significant. Culture shock will be a part of any expatriate’s experience to some extent. It is not necessarily an emotional destination but rather a multi-phase process with highs and lows. Unfortunately, the low points are generally when people seek therapy having no awareness of the preventative measures that can be taken to ease their adjustment.

Is the stress on trailing spouses as significant as the stress on the working spouse? Or is it just different?

Yes, just as significant and sometimes to a greater extent. Most commonly, the trailing spouse is, at least for a time, unemployed following the relocation. This is a particularly difficult adjustment for those who have always been employed as they often find themselves unsure of their purpose. The trailing spouse is likely to have feelings of isolation and dependence as they have few options for social and emotional outlets—this can be quite problematic. Additionally, relocation companies and employers tend to be most present prior to and during the move and not necessarily invested in the spouses well-being thereafter.

Aside from expatriates who have been relocated to Germany for business purposes, what other populations would seek out a native English-speaking therapist? Do non-native English-speaking people living in Germany seek out therapy in English?

Anyone living in Germany, who is not a native German speaker, but fluently speaks English might seek out our services. We have clients, for example, from just about every western and eastern European country who are better equipped to describe emotion in English than in German.

Do you see any cultural biases regarding therapy? Do people from many different countries seek help in coping with an overseas work assignment?

There are absolutely cultural biases regarding therapy. This is the case even here in Germany where one can find the roots of psychology as a science. It’s likely, however, that by the time most have found their way to us, the desire for change is greater than the cultural stigma. The range of origins of people who seek therapy while working overseas is quite broad and appears to transcend cultural restrictions.

With the growing popularity of Skype and other online face-to-face technologies it would seem that eTherapy is expanding. What are your thoughts on this?

eTherapy is indeed expanding. It allows people who are remotely located or physically challenged to have access to ongoing therapy with a professional who would otherwise not be available to them. eTherapy has proven invaluable for those who travel frequently or find it difficult to schedule appointments during regular business hours. More and more therapists are utilizing the technology to increase their availability and accessibility.

What makes eTherapy as valuable as face-to-face therapy? Are their differences in length of treatment with regards to success and progress?

To begin with, a therapist brings the same amount of knowledge and experience to an eTherapy session that s/he does to a FtF session. Given there’s a good internet connection and both parties are somewhat comfortable with tele-video, an equally grounded conversation can occur during an eTherapy appointment. That said, ongoing eTherapy (depending on the medium) can progress at the same rate as FtF therapy when there is a good therapist-client pairing and sessions are consistently scheduled/attended.

There are often people who are opposed to therapy or would not reflexively seek out therapy, what are some symptoms specifically related to living abroad that indicate an individual may benefit from therapy?

These would be the symptoms that we associate with culture shock some of which are: feelings of helplessness/frustration/anger; anxiety from loss of social interaction; regression indoors; frequent doctor visits; low mood.

About PsyShrink

Cynthia Kunze (formerly Rankin), owner of PsyShrink, is a registered psychologist in Australia with over 15 years experience in psychological services, including private practice and treatment facilities for children, adolescents and adults. She also has extensive experience teaching psychology at universities in both the United States and Australia and has presented international papers at conferences all over the world. Currently, she works with clients at the private practice in Munich, Germany, as well as online.

How did you come to conceive of Psyshrink?

My husband is German and I relocated from Australia to Germany in 2009. I had a practice in Sydney and was trying to find a way to still see my clients, even though I was living on the other side of the world. Continuity is very important in therapy. That’s when I started to do therapy online via webcam, which actually worked much better than I originally anticipated. I thought that online therapy would be a fantastic service for clients that are highly mobile. It allows for consistency in therapy, independent of your current whereabouts. So, I started my first practice in Munich, specializing in online therapy. I didn’t anticipate that I would have many clients in-office, but I soon started building a good reputation within the Expat community in Munich. We also had many requests from clients living in Frankfurt, that’s when we decided to open our practice up there.

Are most of the PsyShrink therapists expatriates themselves? If so, what role does that play in their work with expatriates?

All of our therapists are themselves native English-speaking expatriates. This plays a huge role in our work as it gives us great insight into the specific challenges of our clientele. The varied individual experiences of our team members also highlight the fact that each expatriate experience is different—so we are always mindful of not assuming that our experiences can be blanketly applied to those of our clients.

PsyShrink has offices in Frankfurt and Munich and offers online therapy