Psychotherapist specialized in working with expats, with first-hand knowledge of the reality in the field, accumulated through both regular and emergency humanitarian missions in conflict areas and through interventions in cases of critical incident.
Thanks to a great time flexibility and the use of Skype / Whatsapp / other Apps, I can follow you regardless of where you are and adjust the therapeutic setting according to your needs.
Sessions in English, Spanish, Italian, French.
In the further information, you will find:
- A link with my article on the expats’ experience working for NGOs and the uprooting syndrome, in which I also explain the model of intervention I work with;
- The most frequent distress reactions in this lifestyle;
- The definitions of stress, distress, burnout, vicarious trauma, ASD, PTSD, complex PTSD and the most typical changes that take place in the personality
Being an expat means moving abroad with varying frequency, for reasons of work, study, interest. This requires an adaptability of the therapeutic setting different from that applied in traditional psychotherapy. In this context, we have people living in the same time zone, or with no difficulty to come to the cabinet, or, in any case, having a good internet connection and fixed working-hours. This is why the number and setting of the sessions will be adjusted from time to time taking into account your routines.
For expats, the decision to go and live for a more or less long period in another country brings along many feelings and questions, so it is normal to feel excited and intimidated at the same time.
On one hand these questions give a strong sense of adventure, freedom, joy; on the other one, they are combined with the logistical preparation of departure, the separation from the known environment, the discomfort linked to being able to be absent in significant moments for their own family or social network (e.g. births, marriages, religious rites, illnesses, losses / deaths, etc.). This situation creates a certain amount of stress.
It is also important to take into account the unexpected process of re-adaptation upon the return.
It is commonly understood, in fact, that going to an environment in many ways new implies a need for adaptability, while we do not anticipate this need when we return to the place that we have always considered “home”. In this case, we face a process of re-adaptation that is not always easy and a source of stress or distress.
But, what do we mean by stress and distress?
Stress is an adaptive and useful physiological reaction that represents the body’s way of protecting us. It helps us to stay focused, with energy and on alert, increases strength and endurance.
In emergencies, a good level of stress can save our lives.
Despite this, when this natural reaction lasts too long or is too intense, stress stops being adaptive and starts damaging seriously your health, mood, productivity, relationships with others and, ultimately, the quality of life. This is when stress becomes distress or negative stress.
The main reactions in distress situations are:
- Feeling of general malaise
- Emotional instability: frequent crying, irritability or anger outbursts
- Increased alert status (hyper-arousal)
- Fear in the absence of a clear danger
- Nervous tics or unusual movements
- Malaise or physical problems without a clear medical cause. E.g. rashes, muscle-skeletal and joints pain, headache, gastritis, digestive problems, nausea, palpitations, dizziness, hyperventilation, etc.
- Concentration difficulty
- Remembering difficulty or memory loss
- Sleep disorders: insomnia or hypersomnia (excess sleep), nightmares, intermittent sleep
- Disorders in the sexual sphere: loss or excess of desire
- Feeling of a future without expectations regarding work, life in general, relationships
- Feeling useless
- Feeling of shame or excessive or prolonged guilt
- Decrease in interest or participation in activities that were previously pleasing
- Feeling lonely, isolated, being away from others
- Emotional anaesthesia
- Lack of energy, fatigue, sensation of effort
- Difficulty in making decisions or choosing
- Substance abuse / addiction: alcohol, drugs, medicines
- Poor personal care
- Loss of appetite or excess of hunger (hyperphagia)
- Aggressive behaviour
- Suicidal acts or ideas
For those who dedicate themselves to a job that involves frequent moves between one country and another, for example the expats who go on humanitarian or military missions, to the factors listed above is added the whole process, often unexpected and therefore of great impact, of the re-adaptation upon the return.
After work experience in another culture, you can feel a series of sometimes-conflicting feelings. In fact, the joy of returning and the desire to rest may be accompanied by other less pleasant feelings. It is usual to feel confused, disoriented, lost, upset, frustrated with regard to the materialism of Western countries. You may have the feeling that the expectations you had before you left were not fulfilled, or even you may have had to return earlier than expected.
You may feel depressed and constantly remember the experiences you had in the field, or what you lived on a mission may seem unreal and far away.
It is often very difficult to try to communicate the experience you lived to those around you. It may happen, for example, that when you start telling your friends and relatives about your experience, you have a feeling of lack of interest from them side.
Another important change that you may feel is to go back to being “one of many” and find yourself more alone. In the field, you most probably lived 24/7 with other people, while the return to your usual place of residence can mean not always having someone next to you, having to find a specific moment during the week to meet with friends or do activities with other people, and this can make you feel alone.
All this requires a process of re-adaptation to your environment that may cause feelings of sadness and loss.
When you are far from the place where you habitually reside and you consider as one of your homes, you preserve a frozen mental image of what your life is like there and, when you return, you face the fact that there have been changes. It may happen that the appearance of the city has changed, or that the life situation of the people you know did. Recovering the social network is a double process of adaptation, by your side and by the one of those who have remained “at home”.
Upon the return it is important that you take care of yourself, of your health on all levels, it is in this moment where you are most exposed and vulnerable.
A psychological accompaniment is indicated when you feel at risk of distress, in order not to arrive at a state of excessive accumulation of distress, which would result in a burnout, with consequent malaise in the whole of life.
If you already feel in a state of burnout, compassion fatigue / vicarious trauma, the psychotherapeutic path will help you to regain confidence in yourself, to feel again capable of love and to grasp the beauty of what surrounds you.
Burnout, compassion fatigue/vicarious trauma, Acute Stress Disorder (ASD), Post-Traumatic Stress Disorder (PTSD), complex PTSD
Burnout is a state resulting from a multifactorial process of a long-lasting exposure, in a professional setting, to continuous stress. It is mainly due to an imbalance between the demands and the means the person has to satisfy them, in other words, to a lack of reciprocity between the expectations and the real possibilities. The state of burnout has three main components:
Exhaustion: a state of being extremely tired
Cynicism: indifference and detachment towards others (beneficiaries and/or colleagues)
Inefficacy: feeling like one is not accomplishing anything worthwhile at work that may can lead to a lack of motivation
Burnout is a state; however, it raises from a long process consisting of 3 stages:
Stress accumulation with consequent long-time lasting hyper-arousal.
Neuropsychology defines the arousal as a temporary condition of the nervous system in response to an external stimulus. It consists in a state of excitement characterised by an increase of attention, awaken and reactivity.
When this condition is intense and it is not temporary anymore but, on the contrary, it chromicises over time, we talk about hyper-arousal, which is one of the requisite to arrive to burnout;
Utilization of maladaptive strategies.
Every person employs strategies to cope with difficult situations. These behaviours are the so-called “coping mechanisms”. There are no right or wrong coping mechanisms, only useful or harmful for the health. The mechanisms mainly employed in this phase are more drinking and smoking, working longer, less engagement in self-care and social activities;
The maladaptive coping mechanisms are no longer sustainable and a total mental and physical collapse is the result
It is essential to realise when this process is starting, as the early psychotherapeutic intervention will help you to focus the situation and redirect your energies in a healthier way.
Vicarious Trauma or Compassion Fatigue, these two terms are almost synonyms, refers to the reactions that people have resulting from listening and watching to events that caused traumas in the people they are listening to or watching (e.g. Videos, television).
Vicarious Trauma is characterized by 3 key elements:
1) Repeated exposure to people’s traumatic experiences;
2) Cumulative effects that this exposure has on the listening/watching person, resulting in a progressive intensification over time;
3) Long lasting changes in the personality that involucrate all the person’s life dimensions
The main change is a progressive decrease of empathy and compassion toward others;
Particularly at risk of Vicarious Traumatization are all professionals working in direct contact with survivors of natural catastrophes, traumas or diseases. The main categories are social workers, psychologists, psychotherapists, nurses and paramedical staff, ER doctors, radiography technicians, protection workers, lawyers, veterinarians and animal protection workers, teachers, journalists, police officers, firefighters, coordinators of medical units, relatives and caregiver of people enduring chronical diseases.
Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) are two syndromes described in the DSM, Diagnostic and Statistical Manual of Mental Disorders. The second one is increasingly becoming a common used term, it is consequently important to clarify it in order to avoid misinterpretations.
According to the DSM, the Acute Stress Disorder and the PTSD have similar symptoms but they differ about length and onset.
However, to diagnose one of them it is essential to have had an exposure to an event that, for its intensity and threat, let to feelings of deep fear, helplessness and horror.
The symptomatology involves three main aspects:
Intrusion: the person relives the event through pervasive and intrusive flashbacks and nightmares
Avoidance: the person avoids the situations that remind him/her of the trauma
Hyper-arousal: the person presents symptoms of increased activation such as sleeping disorders, irritability or anger, hypervigilance, concentration impairment, excessive startle reactions
In the ASD the symptoms appear within 48 hours from the event and may last from 3 days to 1 month (only after that period we may start talking about PTSD). To the reactions described above, shared by both syndromes, the ASD has the specific ones of numbing and dissociation.
To talk about PTSD we need to have the three main symptoms lasting for more than 1 month and an onset within 3/6 months from the event.
Where to find refuge nowadays?
The following link takes you to an article that illustrates a research on the experiences of Humanitarian Field Workers who leave on a mission with NGOs and the model I work with:
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