About the Author Robin Pascoe is the author of numerous books for the expat family and is internationally known as the Expat Expert at www.expatexpert.com

During the many years that I traveled globally to lecture to expatriate clubs and international schools, I would always try to make time to sit down with mental health practitioners working with expatriates.

These informal sessions - where I could put on my journalist’s cap and ask a lot of questions - would include school guidance counselors as well the many qualified therapists living abroad. They all recognized the urgent need for expatriate families to be aware of trained professionals in their communities who understood the unique needs of the expatriate family.

Now, Josh Sandoz, a Seattle-based therapist, well-versed in the issues of the expat family and in particular third culture kids through his work with Interaction (the organization started by the late Dave Pollock), has put together a tremendous gift to the expat world at large.

He has set up a website called the International Therapist Directory at www.internationaltherapistdirectory.com where professionals can list their services, and those in need of that assistance, can find them.

I ‘chatted’ with him recently via e-mail about the directory in general and the challenges of finding the right therapist far from home:

Robin Pascoe: How difficult is it for expats and their families to find therapists abroad?

Josh Sandoz: One of the main reasons I started the International Therapist Directory was to help ease the difficulty that so many expats have had in trying to find an understanding therapist. Many internationally mobile adults, families, children, and adolescents desire therapeutic supports in their locations abroad or once back in their country of passport.

My primary goal in developing this resource has been to create a comprehensive well-maintained online listing of mental health therapists around the world who self-identify as having experience working with TCKs and the internationally mobile community. Hopefully, because of this directory, the answer to this first question is: much less difficult.

RP: Besides the obvious challenge of finding the right person, are there other obstacles facing expats?

JS: Health care in general carries many various stigmas, depending on the culture of a particular community. Unfortunately, some attitudes are quite discouraging.

If someone I care about, however, experiences a broken leg, I would encourage him or her to seek health care from a professional who can facilitate a healing process. In my way of thinking, the same principle applies to mental health.

If you find yourself in a situation where you are concerned about community attitudes as you begin therapy, I would recommend talking about that dynamic with your therapist directly. Deciding how you will navigate those realities early on in your process will serve you well over time. After all, no matter your age, for better and for worse, peer pressure never really does go away.

RP: Given how people feel about therapists at the best of times (and not living in fish bowl communities) what is the difference for an expat seeking help rather than a stay-at-home?

JS: Two primary components of the expat lifestyle are high mobility and cross-cultural living. With those realities come an elevated concentration of opportunity to experience grief, loss, and questions around cultural identity.

When an expat repatriates or a TCK makes the move to her or his passport country, it is not uncommon to go through an extended period of adjustment. Experiences such as “reverse culture shock” can be quite overwhelming, even for the highly adaptable. Often, major life transitions can involve seasons of isolation and complex grief, unearthing intense feelings that require significant care and thoughtfulness. Those things in mind, it becomes increasingly important for an internationally mobile person seeking mental health services to work with someone who has a good enough understanding of these common expat dynamics.

RP: Can you give us some signs that families should watch out for...and if they see them, to seek help?

JS: There are many excellent reasons to meet with a therapist. Some enter therapy to have a completely confidential space in which to be curious about self, explore deeper questions, and pursue personal growth. Major times of transition often spark intense feelings, questions, and concerns, and meeting with a therapist while making significant adjustments can be quite helpful.

However, many people seek out a therapist when certain life struggles become simply unbearable. These struggles can be interpersonal (relationships with others) or intrapersonal (relationship with self).

In terms of warning signs, if someone you know well begins to act markedly different from how they usually behave, it is likely that they are experiencing some kind of stress in life with which they are having real difficulty coping.

To be specific, for parents wondering if a child may need therapy, http://www.everydayhealth.com/emotional-health/when-children-need-therapy.aspx contains a helpful list of concerning symptoms. The most serious warning signs include experiences of incessant ideation about or gestures toward harming self or others, and in those instances, professional help should be sought out immediately.

RP: Specifically about your directory: I know you are offering a disclaimer but how else can you reassure people who turn to your resource that they are finding a qualified person?

JS: Nothing beats a personal recommendation from someone you trust. If you are considering contacting someone listed in the International Therapist Directory, and you feel comfortable asking around, it might be helpful to inquire locally to see what kind of reputation the therapist already has in your community. Since the International Therapist Directory is not designed to facilitate specific referrals, it can also be helpful to learn what you can about an individual’s training and experience.

While each country has its own specific set of requirements for those who work as professional therapists, it is a good idea to seek out someone who has had at least the equivalent of a master’s degree in the area of counseling psychology or a closely related field. For licensed therapists, many countries also require an extensive process that includes thousands of hours of supervised practice. So, if your potential therapist is both degreed and licensed, you’ll know that they have had some solid training and experience under their belt.

For an expat, knowing something about a therapist’s cross-cultural background may also be appropriate when making a decision. Still, when it comes right down to it, it is important to involve your intuition when selecting a therapist. When you first meet with someone, it is natural to feel somewhat nervous. However, if your gut is sending you all kinds of red flags, and you weren’t eating something unusually spicy the night before, it is wise to listen and move on in your search.

RP: Related to that, what are some good questions people can ask a potential therapist to ensure they are the right person for them.

JS: Along with wondering about a potential therapist’s credentials and experience, it can also be helpful to ask about a clinician’s areas of specialty, basic approach to counseling, and personal belief system. While the bulk of your work together will be slanted toward what is going on for you during your meetings, it is important to ask of your therapist whatever questions seem genuinely important to you.

On a practical note, it is always good to learn up front what the expectations are in terms of payment, communication outside of sessions, confidentiality, cancellation policies, and what to do in case of an emergency.

RP: Finally, what is the difference between a therapist and an expat coach?

JS: One of the biggest differences I am aware of between therapists and expat coaches has to do with underlying theoretical framework. Therapists have been through a clinically minded education process and various training requirements specific to the field of psychology and tend to operate out of a theoretical framework that is grounded in a history of psychological perspectives.

While coaches typically draw some inspiration from the counseling field, coaches do not have a standardized training process and are not qualified for psychological intervention. Since coaches do not treat clinical disorders such as anxiety, depression, addiction, or PTSD, it is important for expat coaches to have a good referral system in place should a client wish to address any of these kinds of issues with a qualified mental health therapist.

Josh Sandoz can be contacted through www.internationaltherapistdirectory.com

Robin Pascoe is the author of numerous books for the expat family and can be found at her website www.expatexpert.com

Watch Robin's "Successful Living Abroad" lecture tour at www.expatexpert.com/video_lectures