Mental Health: How counselling works, be it face-to-face or long distance

If VERNE MAREE hadn’t been so bad at maths, she wouldn’t be writing this month’s Health Matters column on psychotherapeutic counselling. Instead, she’d have a doctorate in clinical psychology and be doing far more listening and a lot less talking than she does right now.

Ishould have been a psychologist. In fact, I probably would have been a psychologist if I’d had slightly more aptitude for maths. (All right, a lot more.) As it was, I miserably failed the Research Methods module of my undergraduate psychology degree, particularly the statistics component – I’m not sure I even turned up for the exam – and you had to have passed that module in order to carry on to masters.

So began a sort of love-hate relationship with psychology – unlike my relationship with maths, which was strictly hate-hate from the start.

For one thing, I’ve always been a sucker for any sort of pop psychology. If you don’t remember those compulsive quizzes in Cosmopolitan magazine in the nineties – “Are You a Team Player?”, “How Good Are You in Bed?” or the classic “How Much Do You Really Know About Vaginas?” – not to worry, they’re still churning them out.

I’ve wallowed in favourites such as Spencer Johnson’s Who Moved My Cheese?, Allan Pease and Barbara Pease’s Why Men Don’t Listen & Women Can’t Read Maps and Steven D Levitt’s Freakonomics. Everyone should read the great standards, including Dale Carnegie’s How to Win Friends and Influence People and Susan Jeffers’ Feel the Fear … and Do It Anyway. I also really like the sound of The F*ck It List! – All the Things You Can Skip Before You Die (Kevin Pryslak).

A Fragile Thing

More seriously, I’m bothered by the terrible fragility of the mind, how it seems to be so readily disturbed by so many different things that can so easily happen to any of us. From childhood trauma or the death of a loved one, to sometimes unexplained chemical imbalances, little-understood genetic factors and the ravages of dementia, we seem so horribly vulnerable.

In a bipolar speechwriter that I used to work with, I’ve witnessed brilliantly joyful creativity alternating with debilitating paranoia and misery. I’ve seen a friend’s personality completely altered by grief caused by the traumatic death of her son. As a twenty-something, I watched Alzheimer’s disease slowly and inexorably taking my grandmother away from us. No doubt you can recall similar events; they’re all around us, part of our world.

How Not to Lose Your Mind

In many of the above cases, medical intervention – be it lithium or shock treatment for bipolar disorder, anti-depressants for symptoms of posttraumatic shock disorder, or ACHE inhibitors in certain cases of dementia – is at least helpful and sometimes essential.

Concerning the psychologist’s counselling role, as a first-year psychology student learning basic theory for the first time I was mystified to discover that it didn’t appear to matter whether one followed Freudian psychodynamic theory, or another approach – behavioural, cognitive or humanistic, for example. They were so different, I reasoned: how could they all be true?

Then it struck me. Whatever the modality, there was one common denominator – a living, breathing, caring and above all listening human being, like the ones who talked to me for this article.

COUNSELLING FOR EXPATS

As an expatriate, you may be more likely to need counselling than someone who stays put in their home town, surrounded by the support of long- time friends and family, confirms MARIA LUEDEKE of Aspire Counselling. She herself uses a collaborative approach, she says, to help her clients develop self-efficacy, resilience and self-empowerment through their innate strength and abilities.

“Expats are in a constant state of transition and adaptation as we are continually moving in and out of each other’s lives, changing social groups and establishing different norms,” she says. While this can be exciting, continuous change in the absence of traditional support structures can make expats more vulnerable to loneliness and isolation, creating distressful situations and triggering mental issues.

Some Danger Areas

Worries about ageing parents are intensified when thousands of miles separate us from them; the same goes for our own adult children who may be going through difficult times. A sense of impermanence and instability can arise from the unpredictability of expat assignments. “Expecting to stay only for two or three years, they simply exist in their adopted home, instead of fully investing in it and creating meaningful connections,” explains Maria. Anxiety about the future can make us reluctant to engage with others, so we end up isolated and depressed. Pressure to perform can lead to excessive stress, especially for high-achieving expats whose companies have brought them here for their valuable skills. As a result, they sometimes neglect themselves and their families, or turn to problematic coping mechanisms such as drinking, drugs or unhealthy relationships. “People may act in ways they would never consider acting in their home country, as they feel a sense of anonymity and entitlement.” Family structures can be strained by school changes, work changes, social changes and extended separations between parents and children and spouses, be they for work or leisure. Be aware, too, of the possible consequence of replacing parental supervision with that of domestic helpers.

Marital issues can develop or worsen as you adapt to new environments, new roles and different cultural expectations. Long hours, excessive travel, the frustrations inherent in setting up life in a new country, and perhaps the loss of a former career, can lead to loneliness, to temptation, to anger and to resentment.

Seeking Help

It’s commonplace for expats to ask one another for referrals to dentists, hairdressers, tutors and such – “but there is still a degree of taboo when it comes to asking for the name of a good mental health practitioner,” says Maria.

“Don’t be afraid to talk about mental health and share information and knowledge,” she urges, and don’t suffer in silence. “Reaching out for help – be it face-to-face counselling or video-conference-based online counselling – can make all the difference in successfully navigating the challenges of expat life.”

“People may act in ways they would never consider acting in their home country, as they feel a sense of anonymity and entitlement”