Expat therapy: setting affecting outcomes

Expat therapy: setting affecting outcomes

Living away from your country of origin can be enriching and incredibly satisfying. It can also bring challenges that would not have been faced if you had stayed at home.

Unfamiliarity with your surroundings, mastering a foreign language, the need to build up a supportive social network and understanding a different bureaucratic system are just some of these.

Throw in dealing with intimate relationships (or the lack thereof), finding work and perhaps having children without having the immediate support of your family, then things can get complicated. You might then consider discussing your difficulties with a psychologist.

CBT in its traditional setting

When we consider the psychological therapy setting, most think of the standard face-to-face discussions in a small office, where the professional and client sit across from each other discussing and working through issues.

This is a well-known approach with well-documented benefits. One of the most widely researched forms of therapy is cognitive behavioural approach.

Cognitive Behavioural Therapy (CBT) involves talking about your issues, examining your behaviour and thought processes in relation to these issues, understanding their relationship to aspects of your life and learning new ways of facing your problems to make them easier to cope with.

CBT has helped thousands of people across the world who have suffered from mental health problems over the last decades. Yet, does the therapy setting affect the desired results? Can, and should, we start using other innovative methods to make psychological therapy more accessible, and maybe more appealing, to some who find the office setting dated and stigmatised?

Walking therapy: CBT in a natural setting

Walking therapy (referred to as Walk and Talk Therapy in the US) takes the cognitive behavioural approach into a natural setting, for example the local park or along one of the Amsterdam canals.

The location may have significance to the client or they may just find the area relaxing. Also, regardless of the location, the route is predetermined so that attention can be paid to the matter at hand rather than the direction you are taking.

The structure of CBT used during the walk essentially stays the same. Each walking therapy session has an agenda, a set focus to be discussed during the allotted time, but the session is managed in a slightly more informal way. Client and professional walk side-by-side and the necessary processes and theories can be explained via diagrams and appropriate metaphors.

Activity as the added benefit

The added benefit of walking therapy is the activity itself. To start with, the behavioural aspect of many CBT therapies promotes an improvement in the activity level of the client.

Sufferers of some of the most common mental health problems report a reduction of physical activity due to the onset of their condition or repeated failed attempts to get active, but few consider walking as an exercise alternative.

Regular activity has been frequently shown to aid in the improvement of these common problems. Walking during CBT also provides the perfect metaphor for improvement; walking forwards, away from your problems and towards a solution.

Walking therapy therefore not only offers professional psychological help in a natural setting, but it also gives you the feeling that you are actively in pursuit of improvement in your life while making a positive impact upon one of the fundamental building blocks of psychological help: becoming active again.

CBT in the electronic age

In the last few years there has been a growing trend in the use of E-Health forms of healthcare, and psychological or counselling services have also stepped into the electronic age.

CBT has also been adapted into an effective online therapy form. Sessions can be conducted through the use of e-mail, Messenger services, Skype and other webcam facilities. In some practices it is backed up with internet facilities, providing the client with access to information relating to their sessions and online modules that can guide the treatment along.

These services can be very appealing to parents with children at home and little time to spare, the professional who is busy with work commitments, or as a starting point for those who have difficulty leaving the house due to anxiety or sadness.

Building trust with a therapist

Regardless of the form of therapy that appeals to you, "clicking" with your therapist and being able to trust him or her fully is one of the most important aspects of any psychological support process.

There are practices that will offer a brief consultation or perhaps even a free first appointment to allow you to see if you feel comfortable discussing your issues with the therapiest.

You should also feel free to ask about their education, experience and professional affiliations when making your choice. Good mental health is vital for your daily functioning, so it should be given the priority it deserves.

Do you believe that therapy should remain in the therapist’s office or does the idea of walking and talking appeal to you? Should the use of technology in therapy be encouraged?

I am always interested in hearing other people’s points of view so please share your thoughts in the comments.

Stephen Davies


Stephen Davies

I am an expat living in the Netherlands since 2000. I am a qualified psychologist and running therapist and have completed the majority of my studies here in the Netherlands....

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