Unpacking Your Emotional Suitcase: Therapy for the Globally Mobile

In this episode, host Doreen Cumberford chats with Dr. Sally McGregor, a licensed clinical psychologist and adult third culture kid, about the mental health challenges faced by expatriates and globally mobile individuals. 

Dr. McGregor is the founder of Wanderwell Psychology, focusing on the well-being of expatriates, third culture kids, global nomads, and more. They discuss the unique psychological pressures of expat life, the importance of finding the right psychotherapist, and the difference between therapy and coaching. They also explore how cultural identity affects mental health and the significance of maintaining meaningful relationships.

• The conversation highlights the stigma around psychotherapy and how cultural norms influence mental health perceptions;
• This episode encourages expats to find support and maintain balance in their personal and professional lives;
• We remind listeners that choices are available and can have a significant impact on our relocation experiences.

Key Topics:

• Reasons expats might seek psychotherapy and the unique challenges they face
• Cultural adjustment and its impact on mental health
• The importance of belonging and identity in the expat experience
• Coping strategies for trailing spouses
• The evolution of therapy for globally mobile individuals
• How to find and choose the right therapist
• Differences between therapy and coaching

Resources Mentioned:

• Wanderwell Psychology (Dr. Sally McGregor's practice)
• Email: wanderwellpsychology@gmail.com
  Website: www.wanderwellpsychology.com
• LinkedIn: https://www.linkedin.com/in/dr-sally-mcgregor-3ba96887/
• Truman Group
• International Therapists Directory
• Location Independent Therapists

Additional Notes:

• The conversation highlights the stigma around psychotherapy and how cultural norms influence mental health perceptions.
• The episode encourages expats to find support and maintain balance in their personal and professional lives.
• We remind listeners of the significant impact choice has on the psychological experience of relocating.

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Thanks for lending us your ears!

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www.doreenmcumberford.com

Transcript

Hi there. 

Welcome to Nomadic Diaries. We're the podcast that takes you on journeys through the lives of those who have already embraced the international lifestyles. Whether you're an expat, a digital nomad, or someone who's dreaming of those lifestyles, this is your passport to world of insight. We dive deep into the hearts and minds of the overseas lifestyle professionals. The authors and researchers join us on this fun adventure as we deconstruct all the elements of expat and nomadic lifestyles one captivating story at a time. Hello and welcome to Nomadic Diaries. My name is Doreen Cumberford. 

Today's guest is Sally McGregor. Dr. Sally McGregor is a licensed clinical psychologist and an adult third culture kid. She is the founder and the owner of Wanderwell Psychology, which is a private practice dedicated to the well being of expatriates, third culture kids, adult third culture kids, global nomads, digital nomads, military families, veterans, trauma survivors and emerging adults. Dr. Sally McGregor, here you are. Thanks for joining us today, Sally.

Of course, anytime. I think this is just such a fabulous topic, the one that we don't dig into enough. I think that we all have some vague ideas about what therapy or coaching or mental health even is. Let's start today and talk about what are some of the reasons that expats should seek or might seek psychotherapy? Yes, good question. I think the first most important thing to know is that expats seek therapy for the same reason that the non expat population seeks psychotherapy. Huge range of presenting problems, problems and diagnoses in this population. So, and then of course we know that there's issues that are unique to expats. You know, as you know, the upheaval of moving regularly, this constant revolving door of folks in and out of your life, even if you're a, what we call a stayer, someone who's stationary in one place for a long time, that doesn't help you escape the constant revolving door of folks around you. 

This can lead to issues with grief and loss. Really challenging to constantly have people coming in and out of your life and to be transitioning into new places. I think there's also cultural norms within the expat community and outside of the expat community that can demand a lot of adaptability or you can even resist a bit like sort of you need to show up in a certain way or you need to adjust to where you are and that can be kind of frustrating or lonely or isolating. I wonder what you, if you have any thoughts on that. Yeah, well, I'M wondering if you have an example of that. Good question. 

And I would give an example of, for instance, when I lived in Saudi Arabia, which I'm sure all you listeners are tired of hearing, but we had to. I. I wasn't allowed to drive at that time. Now, women may drive there, but I love to drive. And so I was allowed to drive on the compound, which resulted in a few speeding incidents because we could only go, like, I think, 45 miles an hour. And that was a huge behavior change. And really, I felt extremely disempowered by that. Would that be an example? That sounds like a lovely example. Yeah. A major adjustment for you. Something you were very used to that was very different where you were. Absolutely. And so these adjust. These cultural adjustments can blindside us. Even although we know they're coming and even. Although we've supposedly prepared for them, it can still make a huge difference. Is that correct? Absolutely. And even if perhaps initially it doesn't. It's something you feel like you can adjust to, or it doesn't seem like that much of an issue over time, it may drain you or. Great. You may become increasingly frustrated. Right. Yes. Yeah. Yeah. The other example I have on that, of course, was dress, because. And that changes, I think, in response to geopolitical situations. Like we had nine, 11. And that was a geopolitical trauma, and it resulted in us starting to wear abayas more frequently, more commonly, and more of us wore them, and then we had to adapt from that into becoming fashionable. How do you make an abaya fashionable? How do you make it colorful? Do you add glitter down the front or down the back or across the bottom? So that led to creative responses. Yeah. Right. Sort of making it your own a bit as well. Yeah. And also I'm thinking about how that's quite symbolic. Each time you were putting that on, if it weren't something, it wasn't something you were doing before. You're aware of exactly why it's happening and what has happened in the world. A reminder. Absolutely. The other thing I wanted to make sure I touched on, and perhaps you have thoughts about this as well, is which shows up for me a ton with expat clients, is that belonging becomes a more complicated concept. You know, our identity is challenged in beautiful ways and also really difficult ways. And it's hard. There's a lovely quote I'm blanking on about sort of seeing the moon on the other side of the world and I'll never be the same again. I totally butchered that quote. But, you know, it's I know it. We know it. Yeah. It changes us from the inside. And I don't think that we are very necessarily conscious of the subconscious rearrangement of our psyche and maybe even our personalities. Is that true? Totally. And I think we can have different. If you're, you know, navigating language barriers is difficult, and if you do navigate, if you do speak several languages, you can often feel like you have a different personality in each language or each accent. Right? Yes. Yes. Yeah. And even when you have children that are being raised in your host country, they can frequently speak the language way better. Yes. And can then act as I've seen the children, a five year old act, as the translator for the parents. Yes, yes. Yeah. And I think if your children grow up quite differently from the way you grow up, there is an opportunity to feel a little bit of a divide, a little bit of a misunderstanding or misalignment. Yes. I was very curious to ask someone about generational belonging because I've recently been recording a series on that. A lot of our interviewees have been in a different generation and their conception and struggles with it are way different from the ones that I experience. Can you speak to that a little bit? Oh, that's a lovely question. It seems to me that when we have huge major changes or events that happen, the generational divide seems more stark. You know, for example, in a country like China that went through just incredible growth. Yes. Very quickly there was a generation who had a life that was unrecognizable from their parents. And I can see how it would be confusing to try to understand each other or have a shorthand for that. So it'll be interesting given. Given the state of the world for the last five years, there's a lot that's happened that has impacted kids differently than it's impacted their parents. So. But I think, you know, a lot of opportunities to be compassionate and to listen to each other, you know, to communicate more. I think something we don't do well in the west is honor our elders and listen to their stories and their wisdom. And I. I mean that so genuinely. It's. It's important. We all have a lot to learn from each other and to offer each other. And I think, you know, in true expat fashion, instead of meeting somebody different and assuming you'll never get along with them, think about the ways that you can connect and what you have in common. Yeah. Focus on the commonalities. I mean, I think that that is one of the greatest expat superpowers that I learned very early on and have been able to carry with me. That has helped me as an elder expat now is really to find. Find the places that we over. You know, like a Zen diagram. It's like, it's like, where do we overlap? What do we have in common and zone in on those with intense focus? That has been an absolute gift of the expat life for me is meeting. When I meet people and they are different, my immediate thought is not, oh, no, this is not someone I will connect with. With. I think about. I first go to, well, what can I talk to? What's interesting about them? How can I connect with them? You know, not with perceptions, of course. Right. But. Right. I think I'm more oriented that way because you are connecting with so many different people that are unlike you in this life. Right. So maybe this is a question more for a neuroscientist than a therapist, but by making these changes, are we actually changing the nature and the chemistry of our brain and developing not only new behaviors, but a new pattern? Is that what happens? That's an excellent question. I am not a neuroscientist, but I, I hope you ask one. I'd love to know more about that. It would be really interesting to read research about that. Perhaps there's already research out there about that. I know speaking multiple languages we know has huge, you know, brain benefits. Yes, but that, that's a separate question and it's a good one. Yes. Well, I will save it up for my next neuroscientist that I talk to. Perfect. Yeah. Yeah. So what are the reasons? Could expats seek psychotherapy? Might they seek it for a support and assistance with their children and in the family situation, do you, do you see a lot of families? I see primarily adults. What I do hear very often from parents, I see a lot of parents are concerns about shall I raise my child in this lifestyle or shall I be concerned about raising my child in this lifestyle style? And I, you know, I will speak with folks about the pros and cons. I think there's pros and cons to every way that you choose to do it. I think that's the truth. I don't think there is a hard answer. Hard yes or no. And every, you know, as we know, every kid is different. Right. Every family. And so there's huge benefits. And also. Definitely downsides. Yeah, definitely. And so, you know, we, you and I have had some conversations about, you know, why we're quite nervous. I mean, just humans in general, sometimes we're nervous about getting into psychotherapy or avoiding it. Personally, I've always found it to be positive experience when I've chosen the right person and at the end of the journey. Yeah, but not. It has not necessarily been an invited in kind of experience. So why are we nervous about entering therapy? Oh, God, that's such a good question. 1. I love what you said about kind of the experiences you've had in therapy. Some folks have had bad experiences in therapy, as we've talked about in the past too. One of the most consistent findings is that the quality of the therapeutic relationship is the number one predictor of whether someone gets better. And this is above and beyond whatever modality or technique is used in the therapeutic space. Interesting. It's basically whether you and your therapist are a fit and like each other. So that being said, I, you know, if you're finding that you don't feel like the therapist is fit or you're having a difficult time or perhaps they've said something that has been sort of upsetting, I think a good therapist will be able to hear what you don't like about therapy. What's not working for you, Receive feedback. It's important also for you to notice their response. How do they receive critical feedback from me? Because I do believe that a good relationship improve after a rupture and repair. That being said, if you try that and it doesn't work, don't be afraid to fire your therapist. Not all of us are fit to be in a therapeutic relationship the same way. Not all of us are fit to be friends. So I would say try to work through any feeling of being misunderstood or slighted by communicating that. And if it still doesn't feel right, there's other folks out there, and I think you can be direct and honest about that. The therapist should be able to handle that conversation. You asked a separate question about what keeps people out of therapy. I think one big thing for a long time has been stigma. There's all sorts of stigma about mental health. Cultural. For example, you know, the parts of Asia and the Middle east seeking help outside the family can be shameful or dishonorable. Or there's communities where these are questions you bring to spiritual leaders, not to a mental health professional. There's also a long history of marginalized groups being discriminated against by medicine and by mental health. Huge lots of data to point to misdiagnosis and over diagnosis of people of color and lots of psychological research to, you know, to show that we have, we've, we've treated People very poorly in medicine. And it makes sense to be fearful of getting into a relationship with somebody that may represent a larger system. That has been scary. Those are some of the thoughts that I have about that. I, I wonder if you have any other. Well, that's, that's a lot to dig into right there because I think that we all bring our culture perceptions to the idea of therapy. Yes, totally. Yeah. So do you notice when you're, when you're with clients, do you, obviously you're aware and trained enough to observe the patterns and you're aware of cultural norms. I'm very curious as to how much influence cultural norms have on our mental health. Part of my initial intake does involve asking for some demographic information rather than assuming. And I'll also ask people how important is there anything, any parts of your identity that I haven't asked about or that are important to how you see yourself or, you know, sort of the level of importance because that also really varies for folks and they're to feel understood or not understood by you. And, and that's particularly important when you're in a cross cultural relationship with your therapist. Right? Yes, of course. Yes, yes, definitely. We, you know, I think all of us, we walk into a room and we represent a lot for other people, you know, based on our identities. We look how we show up and you know, the trend has been to talk about those things more directly. And I mean, I tend to be quite a direct person, so I'm, I'm into it. I think it's helpful rather than having an elephant in the room. And, and wouldn't that lend to more itself, to more authenticity and having a better result? Totally. Well, and I, I wonder, I don't know if you can identify with this, but having, you know, if you've had the experience of feeling quite misunderstood, it's very important to me that if my client feels misunderstood by me, that I know about it. Yes, yes, I hear about it. Yeah. So, and it's, so it's, I should say it's also likely to happen. It's likely that there will be something that I misunderstand or get wrong. Definitely. And I think the only way we can kind of improve from that is by talking about it like. No, no, no, that's not quite right. You didn't, you didn't quite get that. Okay, good, tell me, I want to know. So when you're in, when someone comes to you for psychotherapy, it's a question of like, no topics are off limits, is that correct? Yeah, I would say so, yeah, I'm trying to think of a topic that would be off limits. I don't think so. Okay. Now, in your practice, you know, expats, we can be very dynamic people with or we bring our own ideas of success and achievement on this journey, and many of us are motivated by adventure. How do you address that level of seeking, that level of maybe sometimes even perfectionism? Yes. Oh, I love the idea of putting perfectionism and adventure together because they seem like they would be different things. But it's so interesting to think about the blend of those. The first thing I will say is that people who tend to be perfectionistic in other areas of their life often show up in therapy as perfectionists. They want to do therapy. Right. They want to be the perfect patient. Where's my homework? Look, I've done it. You know, that sort of thing. And there's also this pressure, I think, as an expat, to be very hearty and bold and adventurous and not be impacted by difficulties. Right. So it is interesting how those two things go together in that way. I think important things around that are to know yourself and set realistic goals for yourself. You know, you create your own measuring stick for what is success and be proud of yourself for what you're doing, not just what you're not doing or not able to do. Like, look at everything you're doing. If you pause for a minute and go, oh, my God, look at everything I'm doing. Yeah. Look how adventurous I'm being just sitting here. Right? Yes. And so that's part of looking at the complexity that you are because of the life that you have chosen. Right. Many of us choose this lifestyle and then get into it and go, oh, there's a heck of a lot more to juggle than we ever imagined. Right? Absolutely. And perfect us don't want those plates to drop. We want to keep them spinning. No. And the issue with perfectionism is often the standard you're setting itself is completely unrealistic. You're expecting yourself. Let's give a really simple example. I want to get in shape. I'm going to set the. I need to exercise seven days a week for an hour. That's not going to happen. That's not a realistic goal, at least in my life. Right. Looking at the standards you're setting, I think is important. Oh, the plate spinning made me think of Melissa Parks, who's with Location Independent Therapists. I met with her once, and she gave me this lovely analogy. I don't know where she got it, but I can attribute it to her because she shared it with me. She said, you know, being. She would use the example of working parent. Being a working parent is like juggling a million balls at once. And she said, some of those balls are glass and some of those balls are rubber. If you drop the rubber ones, they'll bounce back up and come back into the rotation later and the glass and drop because they're too important. Too important. I don't know if I've shared this before, but I thought that was a really neat analogy of, like, you're going. The idea that you're going to drop. Some balls and that's okay. Totally. You can do everything, but you can't do everything all at once. Right. You can't do it all perfectly. Exactly. Oh, that's interesting. And so how do you also address the subject? You know, we're talking about the why right now, as Simon Sinek would say, the why of psychotherapy for the expats or the nomadic population. What about the pressure that many expatriates feel? Because I know that especially in the corporate world or the diplomatic world and the military world, those worlds can be extreme pressure cookers. I've been part of that world. I have been accompanying spouse, witnessing that world, living in it 247 in a compound. Talk to me about the sorts of pressures that expats can be subject to that when we stay in one place, just don't exist. Yes. One thing I think you're speaking to is work. Identity becomes super salient as an expat because it's the reason you're there. It's often a huge part of your social circle. The personal and professional are often very blended. And so that can be a lot of pressure in itself. Because let's say you're tempted to be really frank with friends about what you're struggling with. You may worry that this friend is also a colleague. And so what implications does that have? I think that can be really challenging. That's where therapists can be helpful, I think as well, because you can share things that maybe you don't feel terribly comfortable sharing in your expat community. That's also connected with work. You know, in order to prevent burnout. We do not want to keep doing more of the thing that's burning us out. You want to balance. You want to find other interests, other activities, other parts of your identity. Really challenging with time, you know, having good boundaries around time with work, I realize that feels pie in the sky for some people. They're like, my work is overwhelming. I cannot set Boundaries. But I think it's important to. And it's important, especially in a leadership role in an organization, to do that so you can model that for your colleagues. Some of these communities are communities of overachievers. So everybody is sort of just trying to get an A. And then if everyone else around you is doing that, you pick up on that energy and do it too. So I think as you move up, it's especially important to set a nice example around, hey, I'm leaving at 5 because that's important for my family. You know, if that's reasonable in your workplace, that sets a lovely example for everyone else who may be staying till 8 because you're staying till late. Yeah, I think that's. That's a wonderful way to encapsulate that topic because it can be very, very pressurized. And we are. I was part of an organization where everybody had to have an A. That's right. So can you discuss the specific psychological pressures faced by people like the role I had for 15 years of a trailing spouse or partner? Well, I would love to hear your experience, if you're open to it. And I mean, I'm happy to share a few thoughts. I would love to hear if there's anything you would add. I often think about how each person in the partnership can have a really different experience and reaction to the adjustment. Like we spoke about, sometimes the trailing spouse will have difficulty transporting their job and then sort of feel like they're lacking work identity. And that can be hard when the question in a social setting is often, what do you do? Yes. Oh, as if the most important thing. About you justify yourself and your beingness on this planet to me right now in this cocktail party. Exactly 100%. 100%. The suggestion I'll give that I personally think is one of the most important for couples. There are probably a lot of different thoughts on this, but is that you both have to agree to the move together as a joint project and discuss how you will support each other. What do you need from me? What do I need from you? We are acknowledging that it is your job, literally, logistically, bringing us here. But your wellbeing is important to me, and we are a team and we decide together. And I think that's important. Yeah, I think that's. That's really important. I noticed that when I was a single professional living and working overseas, first in diplomacy and then in corporate America as a single woman, I managed. I thrived, and then I made some decisions and got married, went back to live in the States My husband left because of repatriation challenges for him. Remarrying and going back overseas as a trailing spouse completely did not pay any attention to the difference that I would process between being a single professional female overseas and then the accompanying spouse. Right. Oh, and it was really different, I imagine. Felt really different. It felt really different. Yeah. And I was not prepared for that. I was like, what's my purpose here? What's my role? What am I supposed to be doing? Yes. How, how have you managed that? I imagine you feel really differently now than you did then. Oh, yes, yes. Well, I think, number one, I learned from it. My daughter said that I became one of the most studious studier of art because I took every different kind of art class I could get my hands on. I wasn't particularly good at any of them. And I was a serious. I became a serial hobbyist, but then I had a part time job. I mean, I felt like every year I had to reinvent myself. Yeah, right. So we would come, we would leave for the summer holidays and we come home and then we go back and it's like, okay, what is my role going to be this year? Number one, as the mother of a first, second, third, fourth grade grade or whatever grade she was in. And then I adjusted from that and I grew my network and grew my interests around that and ultimately became the publisher of things like the, the yearbook in the, in the middle school and the yearbook advisor and, and the photographer. I was a school photographer, so I was able to sort. Which I think eventually turned into becoming a podcaster. Actually, as you're talking, I'm thinking about how women are sort of incredible in their ability to reinvent themselves. Right. I mean, through these different stages. It's pretty amazing. Yes. So, well, thank you for that acknowledgment because I think women are amazing. I also think that there are some very subtle expectations that women will naturally do that. There's a lot of subtle messages that are subconscious that, oh yeah, we're going to be the ones to be misflexible and adjust and do a lot of the hard things. Yes. And defined by your roles and relationships to other people, Defined by your role as a mother, relationship to your spouse. Yeah, absolutely. And so that can be another pressure. And do you find that a lot of people are coming to you or are seeking psychotherapy from that silo that we call trailing our accompanying spouses or partners? Yes, absolutely. And I think being in community with other folks, finding what's meaningful to you, I think feeling understood and Respected by your spouse is really important. It's interesting. It would be lovely if we could change the culture around asking people. Having the first question be what do you do? And making you from the outset feel like, oh, now I'm thrown for this loop when there's so many other questions, aren't there? Yeah, yeah, yeah. It's like, where are you from? It's just as loaded. Totally, 100%. That's a really good example. Exactly. And so what are the coping strategies? Do you find yourself most frequently offering to trailing spouses? Oh, good question, good question. Really depends on the situation. But, you know, talking about what does define you, what's important to you, what are your values, what activity, you know, how do you want to spend your time? Yes. What opportunity, what, you know, what are, let's say you, let's say you're a trailing spouse who's very, very unhappy in the place that you're living, which is obviously, you know, happens a lot. What are the few things that you are grateful for? What can you do? And what is this, what is this season for you for? Is this a time to take a class? Is that possible for you? If you're not interested in integrating, finding sort of what you can do, like, you know, sort of if you have to. This is a really stark example that doesn't quite exactly match. But if you have to be in jail, how are you going to use your time? Are you languish in the cell or you're going to. Are you going to read a book or get a degree or, you know, become a lawyer? Right, exactly. Any of these. Yeah. And, and I actually discovered that the, the greatest sort of motivator of creativity in my life was the fact that we had so many limitations in Arabia. And you know, it's, it's like, what can you find in the face of limitations and all of these paradigms that, that we are seeing or experiencing every day, it's what else could I do? And asking those questions, you know, what, what do I want more of, what do I want less of? What's possible here? What's definitely not possible here and what's borderline possible, like ask doing things and then asking for forgiveness instead of permission, which we frequently did. Oh, that's a really nice example. I think about how sometimes the difficult places, the relationships can be deeper and stronger because, you know, difficult periods I've been through in life, I find my relationships are so, it's so clear who's matters and who's there and you build a depth that Maybe you don't if everything's going swimmingly. That's very true because it does give you the time and the space to enter into and really focus on your relationships. So can you tell us what role does cultural identity play just generally in our mental health challenges? What do long term expats have to cope with, particularly those who feel they're no longer fully behold, fully belong in their old home or their new home and they feel like they're living maybe in what sometimes some people call the liminal space. Like the interstitial culture. Yeah. What is that? Tell us about that first. Yeah, well, I think of it probably very similar to interstitial. It's this interstitial culture, neither here nor there. In between this belonging everywhere, but belonging nowhere. I think there's lots of belong after you've been, like you said, long term expat. I know you've spoken a lot about repatriation, so you know a lot about this topic. But lots of folks who have been long time ex ex pats straddle that line or feel like misfits and often connect with other folks that feel like misfits. Whether it's space, you just sort of, you, you don't feel quite like you belong. And I think you can connect with other people who also have that sense. They're also often more open to socializing with you. I've noticed many of the cities that I've lived in have had a high percentage of folks who weren't from there who did not grow up there. And that's been really important to me because sometimes if you move into a community where everyone has lived there and not left, it's. It's harder to break in, right? It's really. It is, yeah. Yeah, it can be harder to break in. How do you help expat clients maintain meaningful relationships? Do you have some recommendations for keeping those ties strong with your friends and family back home? While you're trying to not be the misfit and you're trying to fit into this new perhaps bubble environment of expatriateism, Tell me about how you help people with their relationships. Wonderful question. It's a real balance. I think you want to be where your feet are and also find the method that works for you. In terms of keeping up with folks, there's a huge variety of ways you can leave voice messages. There are apps like Marco Polo that you can leave short videos for folks, you know, texting, calling, do what feels good for you. In terms of keeping up, that is not a choreography it may be a once a month email or it may be more frequent. There's this new trend called Waffle Wednesdays where friends check in with each other and send videos, quick videos to each other. And you can do that, you can do that via text, you can do that on an app, you can do that on WhatsApp and just say, hey, Waffle Wednesday. Just checking in, you know, find a group of friend, a group chat with friends that you do that with. I think that's an amazing trend. Also nice because it's Wednesday, which is kind of a boring day week. We don't give Wednesday a lot of love. Yeah. But I think good to notice if you're spending more time somewhere else mentally than where you are physically, find ways that you can ground and be present, even in small ways. And again, what is one thing you're grateful for where you live? What is one activity that you enjoy that you can do there, that you can sink into, even if it's just one? And that goes back to the interstitial or the liminal place, doesn't it? Yes, because it doesn't happen overnight, does it? Right, right. How much is time a factor in all of this? Can you say more about that? Well, I'm just curious. I've noticed that the longer I'm in a new country, the more comfortable I become, the more me I become in that country. Yeah, totally. So I'm almost noticing when holding on to old relationships is getting in the way of integrating or making new. Yes, I think that's super important. Maybe limit yourself so that, you know, you can settle in. I think, and I think everybody will be different on that sort of checking in with yourself. But if you, certainly, if you notice that engaging with a past, you know, life or part of your life is preventing you from integrating, good to kind of keep tabs on that, right? Yeah. If it's important to you to be there and be part of this. Interesting. And so how does the psychological impact of living abroad, how is that different between those of us who sort of just launched off and chose to do it and those of us who have relocated for a different reason, which could be an external reason or a partner's career, or it could be a visa reason. What is the psychological impact of having choice or not having choice? Oh, huge. Really good question. Choice or not choice. You know, this comes up so much with children. I think having a good conversation with your children around the decision to move and making them feel a part of it and as if they have some control over the Process, because they are very often don't feel like it's their choice to move or it's an ideal time for them. So I think, you know, this is something we're doing as a family. What do you need? What do you need? You know, how can we support each other as we do this and building each other up in the process? And again, as we spoke about before, there's an opportunity to really build resentment against your, you know, whoever's bringing you there. Yeah, good to notice. What do I have? And then again, if you feel like you have no control, it has to happen. What do I have control over? What do I have control over? I remember we had a neighbor who moved into our cul de sac, and they had come, I think, perhaps from Ireland or the States, via Ireland. And the daughter was in seventh grade. Really a tough situation. She'd already left California behind and had made the adjustments to another new place. And this was yet another on top of that. And I can remember us walking and talking about that because these things become very real. Yes. Oh, so difficult, really, as. As you approach an age where your friends become more and more important. You know, the older you get as a kid, your friends become more important than your family as you move up school. And I think the closer you get to that, the more difficult. Certainly puberty is a really challenging period. Yeah, really hard. So the psychological impact of living abroad and you have gone because you choose to go, or you're just going for the heck of it and for the adventure of it is quite different. So aren't there still problems in either camp? Yeah, of course. Yeah, absolutely. Yeah. That's also challenging too. Right. Let's say you made the big decision. For lack of a better way of saying it. If everyone hates it, it's your fault. Right. It's a lot of pressure. It's a lot of pressure on things to go well, to enjoy it, to feel like, oh, I made the right choice. Yeah, it's a whole nother can of worms. Wow, that's a lot. And I think about that because my partner, my husband and I moved in our elder years. Sure. What difference does that make? Do you get many elder expats in your psychotherapy practice? Oh, great question. Gosh. I feel like I have a lot of folks who are seeking me out at that point because they're navigating, repatriating after a long, long time abroad. So I'm more familiar, I think, with the other end of that. But that's so interesting to think about. I wonder if you'd be comfortable speaking to it, I would be interested in how that feels different on this side of things. I'm not sure I can speak to that. Fair enough. I think I'm still processing it when I reflect upon it. Our decision to move overseas, again, although it's not overseas, we're just over the border to Mexico, was really my. I wanted to go live in Portugal, but we had lived more than 20 years with an ocean between us and our families, and it felt like geography was pushing. Geography was ultimately the pressure factor for us in that it's closer, it's less time consuming, less energetic, less energy consuming in many ways being in Mexico than being in Portugal. And after evaluating all the expat experiences we had had, we made this decision. But I do think also that my husband was very compliant and very willing. He was more willing than I was to cross another ocean. Wow. Wow. And sort of just exciting for the two of you to have it as a project. Oh, yes, it was quite the project. It was a much bigger project than I could have really imagined in front. Because when you're traveling as a corporate expat or diplomatic or military. Military. Or you're with an organization, then it's very different to in your 70s, 60s and 70s, packing up and doing it on your own. Yes, yes. There is some. Certainly some cushioning with the organizations helping you move and getting you set up with an infrastructure instead of doing that on your own. Yeah. Very impressive too, that you've done this. Well, I think there are more and more people who are seeking that. That route out, and I hope they find Nomadic Diaries. I mean, that sounds like a whole separate podcast. Like I'd be so interested in a. Oh, yes, it is. I think so. We've talked about the why of finding a psychotherapist. Is there anything you would like to add to that list? Just to reiterate that there's a huge variety of reasons you might seek therapy, and they may be totally separate from the fact that you're an expat. You may be pregnant, about to have your first child, and decide, I want therapy, and it doesn't matter where you live, that'll be important to you. So it doesn't have to be expat specific. So it's very. It's. It's very individual. And everyone is invited to participate in therapy. And I don't hear those words uttered in that sentence very frequently, do you? That everyone is invited. Everyone's invited, right? Oh, everyone is invited. Yes. I think everyone can benefit from Therapy? Absolutely, absolutely. Definitely. And so what about the how? I know that your profession has shifted a lot, especially since COVID but even before then. So tell us a little bit about the history and providing mental health support to globally mobile communities or people overseas and how has this evolved? Take us back a few years and tell us the story of the evolution of this, please. It's so interesting because I always knew I wanted a career doing telehealth because I knew I would work with globally mobile people. And so I was always sort of advocating for it and getting a bit of pushback. And I remember folks saying things like, well, it has to be good for the client, not just good for you. And I thought, well, you know, yes, I can't connect with my clients unless, you know, we're able to online. So in 2019, I wrote an article for the Colorado Psychologist called Text to Therapist Psychotherapy in the Digital Age. And the whole article was about promoting and advocating for connecting with therapists, connecting with clients virtually. And then six months later, the pandemic happened and I no longer needed to make that argument. I get zero pushback from anyone on virtual therapy anymore. All the research has shown that it is just as effective as in person therapy. There are a number of articles and post pandemic that have shown this. It's more accessible. It has higher completion rates and attendance. There's increased privacy and comfort. There's something really interesting about how obviously if you and I are sitting across from each other in the same room energetically, it is different. We are picking up on different things. I'm getting to know maybe a more intimate way. But there's an interesting thing where it's almost more intimate in some ways. When I'm sitting and speaking with somebody and I can see the background of the home that they're in and their cat climbs up on their lap and, you know, and they're in a comfortable space with their blanket and their candle. And this is, you know, they haven't gotten to get in a car and commute an hour to come see me or, you know, across the world, which is not possible. So it's, you know, the access is obviously very important for folks that are abroad. People log in from their car, their bed, their closet. You know, I think it's really expanded and I think it's a very good thing. There's some, you know, there's some therapies or there's some folks that it's not terribly appropriate to use virtual therapy with. Certainly if folks are having trouble with psychosis, and reality testing, that can be a little bit challenging online. Children who are very young. Yeah, it can be difficult to keep their attention online. There are folks who work with very young children online who have all sorts of techniques and there is neat technology around that. But. Yeah, so not everyone is appropriate for it, but it's certainly grown. And I think it's been a really good thing. They use it. They've used it in the military for a long time. Yes. And so you've been part of that evolution and you've seen it. And I know that you're also part of a community that offers services that are organized and supported by the health and the Medicaid, Medicare type of thing. Is that correct? Can some people use insurance? Some people can use insurance. I work for a company that has therapists all over the world that connect with folks virtually. They. And they do help support folks with insurance. Excellent. Excellent. Just so that people know, you know, where they stand in terms of access. Yes, yes. Because it's important for people to know that, you know, you can access it from anywhere and be supported by perhaps some of the systems that you've already. That you already have in place. Right. It's so interesting. It's. You know, insurance is such a dynamic space. My recommendation is always for folks to check in with their insurance company about coverage because it very often matters where the client is seated, whether they're seated in the US or they're seated somewhere abroad. And they can check in about which services will be reimbursed. It ultimately does come down to the client. But yes, to receive insurance reimbursement for services is possible for expat virtual therapy. But while we're on this topic and we're talking a little bit about the wear of this, where do you suggest that expats or nomads or people who are traveling or living overseas, where do you suggest that they can find a therapist? Yes. Truman Group is a highly respected company dedicated to psychological treatment for expats globally. Offer a number of different services. Highly recommend. Truman Group International Therapists Directory is another place that folks will find therapists all over the world. Location Independent Therapists is also another organization to reach out to. They have therapists that operate all sorts of places and understand the expat experience. Excellent. So those. We will put those in the show notes. Thank you for sharing those because I think those can be really critical for people in taking the next step. So we talked a little bit about technology and you feel perfectly comfortable. And actually we're eager to get into Using technology, right? Yes. Yes. And what do you recommend that expats or nomads look for when they're wanting a therapeutic relationship? When they're looking for someone. When they're looking for someone. You know, I think good relationships are healing. They bring out the best parts of ourselves. So noticing if you feel connected with a therapist is important. I think looking for, you know, does this person. Is this someone I can talk to? Trust your intuition. Ask the questions that are important to you about a therapist in the first session. Communicate your preferences. Do they specialize in what I'm struggling with? What are their credentials or experience? Do they have education or licensing in, you know, mental health or this area? You know, sort of see if what you're struggling with is a fit with their expertise and check their credentials and ask them any questions. If you have any questions or concerns. Well, I think those are all the nuts and bolts of actually finding and locating and starting the process. So these are excellent advice and listeners. I hope that you will pay attention. You know, one interesting tidbit, if we think about this from the other end of things from the therapist perspective, what therapists are looking for often in a client is someone who is motivated, ready to work, open, you know, meaning flexible, adaptable and introspective, contemplative, curious about themselves. Those things are facilitate. Those are huge markers of ability to change. Right. And get better. Sure. I think that's kind of neat to think about, too. I think that's a fabulous way for us to consider it. So do you have any other recommendations on how to find a good therapist other than. So we've got some resources here. There's also many of the traditional expat employers like the military, the diplomatic service and corporate. Sometimes they have resources. Is that true? Right? Yes, absolutely. Or if you contact the embassies. Yeah, definitely. Excellent. I have two more questions. I'm going to just insert one question here. What is the difference between therapy and coaching? And how do you know when you want one as opposed to the other? Yeah, really good question. There are definitely some similarities. And I can speak to therapy. As a therapist, perhaps you can speak to coaching, given that that's your expertise too. The therapists receive training in specific mental health diagnoses, so we are likely to delve deeply into your life history and to find the root causes for behavior. We receive specialized education and licensure around treating mental health conditions. So, for example, I'm a clinical psychologist. My undergraduate education is in psychology. My master's is in counseling psychology, and my doctorate is in clinical psychology. I'm licensed to practice by two boards in two US States and then also through psypact, which is a compact of several states in the US to practice. So that's sort of what gives me the credentials to, to practice as a therapist. And that's, that's excellent. And when is the best time to find a therapist? If you're, if you're an expat? I mean, what are the clues? What should we be looking for? Is it when we get nervous, anxious? I mean, obviously we don't want to wait till we're in a situation that I call DEFCON 3. Yeah, of course. You know, I think if it's something that you've always contemplated, maybe asking yourself, what's getting in my way? What's stopping me? What is the reason that I'm not reaching out for that, that the answer to that in itself may give you a lot of insight of I'm scared. Am I scared because I know it would be good growth for me, you know, or challenge me? I think that's a good question. If you are anticipating a big change, you know, maybe setting up an appointment in your new time zone, in your new location for shortly after you've settled could be a good idea. Sure, sure. Any other major, you know, major life events or changes, entering parenthood, entering an empty nester phase, a big career shift, repatriation, those are good times to seek therapy. I do think it's important that you want to be there and are not only going because other folks want you to go. Sometimes people in your life will recommend therapy, which is well intentioned and lovely. And I think it's also important that it's something that you want to do because that'll lead to that motivation. Yeah, definitely. And I would say to go back to a little bit about the question about the difference between coaching and therapy is, you know, at the very beginning of one of my coaching trainings, someone explained to me that therapy was like being an archaeologist because you were going to go into your mind and your brain and your past and all of that part of you, and you were going to excavate, ah, you were going to be the dig, you know, this was going to be the architectural dig or the archaeological digit. But coaching is more like being an architect. So you're designing a new skyscraper, so you're designing a new life. It's all forward and forward momentum. And while I think therapy has the benefit of the forward momentum, you also take people back first. And in coaching we don't take People back quite so far, would you say that's pretty accurate. That's a really interesting way to look at it. I have absolutely heard that, that it's more forward momentum, more future focused, and less retrospective than therapy. So, yeah, it's a really interesting way to look at it. Coaching is certainly expanding and, you know, nice also to have referrals from friends. If you have a friend, you know, that can. Can vouch for someone they've worked with, that can be helpful and give you some. Sure, sure, definitely. And so what is the last thing, that last piece of advice or wisdom that you might have to offer people who are in the space of thinking about, oh, perhaps I should get a therapist. Maybe now is the time. What sort of support can we lend to them today, right now? That's such a good question. This Sue Johnson is a therapist I loved, who passed away last year. I think it was last spring. And she has a quote that reads, emotion is like dynamite. If you don't know how to handle it, it's scary. And if you know how to handle it, you can move mountains with it. And I think therapy can be really powerful in terms of leaning into emotion in a safe space. And I think you need to feel in order to heal. And it's this confidential, quiet space where you can connect with somebody and really process and come out on the other side. You learn that if you start crying, you will stop at some point. And, you know, sometimes you think, oh, my God, I can't. You know, you ever have that feeling, you bottle it up, you bottle it up and then someone, you fall apart. And so, you know, it's just that slow release on the bottle cap of a soda bottle, of just letting a little bit out, a little bit out. And I think it's. I think it can be really useful. I think it can be really useful. Well, this is really great wisdom. So I have a couple of questions for you. Just as a fun lightning round. If. If you could transport yourself anywhere in the world Today, just for 24 hours, where would you go? Oh, wow. God, that's a good question. 24 hours. I had a beautiful experience recently in Taiwan. Oh. Which is where I was born. Uhhuh. I spent very little time there as an adult, but it was so powerful to land there and to feel like there was. This was a part of my story and deeply a part of me in many ways. And oh, my gosh, 24 hours there. I think I would love that. Oh, lovely. That's a beautiful, really connected answer. And another question is if you could magically speak another language instantly, which language would you choose? Oh, you know, it would be really nice to have good Spanish. It would be really. Tell me about it. Right. You can relate. So many folks. Have. So many folks speak Spanish in the community I live, there's a lot of Spanish speakers. It would be really nice to have good Spanish. You know, I. I do speak some Chinese and I wish if that. If I had, could have, you know, exceptional, fluent Chinese, that would be absolutely lovely too. So I, you know, I might choose that. That's lovely. And if you were to be transported overseas again as an expat suddenly, what is the one thing you would make sure that you took with you? Oh, like an item. Yes, like an item that was of significance to you. Wow. Boy, these are good questions. Oh, thank you. You're going to ask me them and I'm going to think about them for three days and think, oh, I should have said this. I should have said this. But let me think of what comes to mind first. One item that I would make sure to bring with me. Oh, my gosh. Maybe a journal to remind myself to journal the experience. To remind myself to journal the experience. Because I think I would need a bit of motivation to remember, hey, every day when you wake up, why don't you write a little bit, even if it's just a little bit, and write it on paper. Yes. Yeah. Excellent. That's. That's a. Those are wonderful answers. And do you think that expats have any superpowers? What one superpower would you like to develop? Well, first, do expats have superpowers? Yes. Change is stressful to every system in the body. And expats are so adept at change. Boy. Building relationships and building rapport quickly and being culturally flexible. I mean, I'm naming. I'm naming a few. Being open minded, non judgmental. Think these are huge gifts of the expat life. If I could have any superpower. Oh, I suppose I would have, like, I was about to say power to see into the future, but that might be also kind of difficult. That might be problematic right now. Yes. Oh, gosh, that's such a good question. Let me think. Okay. I could have any superpower. Well, we appreciate the very fact that you are so thoughtful, so intentional with these fun lightning questions. I know I'm not. I'm not at lightning speed, am I? Oh, probably to put people. Put people at ease quickly. To make. To make people not, you know, feel judged and feel comfort in my presence and to feel safe like just sort of a short way to get to that would be important to me and to maintain good relationships with people that are important to me. But that's wonderful. That's a wonderful gift, too, to instantly build connection with other human beings in a supportive environment and feel that you can build on that and carry that forward. That, I agree, is a wonderful gift for Dr. Sally McGregor. You are amazing. And this has been such a a wonderful, practical conversation about, I think, a subject that is often brushed under the carpet and not given enough attention. So thank you so much for coming on today. To Nomadic Diaries and listeners wherever you are, we appreciate a review or a like or sharing this podcast. And today we say thank you goodbye to Dr. Sally McGregor and sayonara pasteluego and Masalama Perfection. I love it. Thank you. Always lovely to sit with you. | 00:00:01.520 - 00:59:01.118