Tricky task of choosing a therapist by Sharon Reier
March 22, 2003
Tricky task of choosing a therapist   Sharon Reier International Herald Tribune March 22, 2003 Call it globalization and its discontents. The assignment abroad was a fantasy come true. An expatriate package, a stimulating work environment and the anticipation of exotic weekend excursions. But combine the pressures of cultural adaptation with a major misfortune like losing a child, divorce, or dealing with a disabling illness, and the rosy scenario may become one marked by bitter frustration and anxiety or even depression. Extended suffering of this sort may prompt a person to seek the help of an expert, a delicate matter in your native country, let alone one where techniques and attitudes toward psychology differ. Whatever the problem, it can be aggravated by living abroad. ''There is a feeling of helplessness, even if you have gone out of your way to go to a radically new setting and are enjoying most of it,'' said Juris Draguns, professor emeritus of psychology at Pennsylvania State University. ''The rule of thumb,'' said Draguns, ''is that all kinds of serious cases would be harder to handle in a new and unfamiliar environment. They are traumatic events to begin with. Being away from your network and your familiar surroundings exacerbates the symptoms.'' Psychological pressures can also provoke greater sensitivity to cultural differences and isolation and vice-versa. A person may get incensed by subtle or not-so-subtle discrimination from the surrounding society. An American in Japan may feel lost in a society where emotional control and minimal display of negative emotion is valued. Once a decision is made to seek therapy in a foreign country, it presents a dual problem. Choosing an appropriate therapist in your own culture can be knotty enough. Choosing a therapist from another culture opens a myriad of questions about technique, language and value systems, some of which a troubled person may find difficult to sort out. In Western countries, a prospective patient must sort through half a dozen psychological theories. They include Freudian theory, which underlies most psychiatry and psychoanalysis; Lacanian analysis, a French specialty that adheres to the deconstruction of the use of language as a key to the unconscious; cognitive therapy, which features short-term practical decision-making focusing on current problems and is popular in the United States, or past-life regression therapy, which has gained popularity in the Netherlands. Although studies have shown that technique is not highly correlated to a treatment's success, it will probably be easier for all parties if the patient is aware of the theory his therapist uses — and values it. He should also know whether the therapist has a specialty like grief counseling or marriage counseling, and discuss whether he thinks the therapy will be effective in his case. Catherine Grandsard, a psychologist and researcher specializing in ethnopsychiatry at Centre Georges Devereux at the University of Paris 8, noted, ''The way psychology works is that the therapist is always an expert and the patient a novice. It is not a democratic space.'' ''In the one-on-one setting,'' she added, ''the psychologist or therapist is always the most powerful. Because the patient is alone and has no group to defend his ideas.'' What's more, most people typically seek therapy when they feel weak in the first place. That helplessness may prevent them from asking the right questions. One of the most important tasks for expats in choosing the right therapist is to find out if he or she is familiar with your native culture and your society's values. For the native culture can influence both the symptoms and the cures. Take depression. Most depressed people raised in Western cultures describe themselves as sad, lonely and indecisive. This is sometimes coupled with guilt and feelings of not being ''good enough.'' . In non-Western cultures, depression might evoke physical complaints such as fatigue, weakness, and sleep disturbance. A study carried out by Arthur Kleinman at Harvard University in 1982 looked at about 100 Chinese patients suffering from a condition called shenjing shuairo, or neurasthenia. It concluded that they were actually suffering from what Western psychologists would diagnose as depression. However, instead of reporting sadness or loneliness, they reported headaches, sleeping problems and dizziness. Cultural differences can also create misunderstandings. One 42-year-old American patient complained to her Dutch 60-year-old psychologist that she was having difficulty making friends. Instead of offering concrete suggestions like joining a sports club or making contact with other foreigners, the therapist stated categorically that people just did not make friends any longer in middle age. That advice, suggested Draguns, reflects cultural traditions in Germany and the Netherlands, where people tend to limit their friends to those they made in school and to keep the same friends through old age. Not fitting in socially may seem like a small thing. But it can lead to severe difficulties. The Japanese psychologist Junko Tanaka-Matsumi, who worked with the 50,000-member Japanese community in the New York, New Jersey and Connecticut region, noted that a foreign transfer could commonly spell depression for so-called trailing spouses. ''The wives suddenly find themselves in a foreign country. Their children are adapting. Their husbands are very busy. The wives are left at home, often in the suburbs. Loneliness can be a precipitating factor in depression,'' she said. ''Suddenly they have no role to play. No social network to get into. Back in Japan, you speak the language and you have a sense of who you are in the society at large.'' One solution is to search for a therapist from your own culture. But Tanaka-Matsuma said it is not really necessary. ''Ethnicity matching is not the only answer to cross-cultural problems,'' she said. ''The client should be looking for someone who understands his culture. Someone who is specifically trained in clinical cross-cultural psychology and has an in-depth awareness of cultural differences and value differences. Problems cannot be understood without context. These are not side issues.'' As frustrating as it seems, patients must also be prepared to do more explaining than they might at home. ''Things have to be spelled out more explicitly,'' said Fons Van de Vijver, professor of cultural psychology at University of Tilberg in the Netherlands. And if language is a barrier, it may help to bring in a good translator who knows the cultural differences. Sharon Reier
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