Expat Life

Mental Health Challenges for Expats

Interview with Vivian Chiona, Psychologist and Director of Expat Nest, online counselling service for expats.

Vivian Chiona, Director of Expat Nest, talks about the most common mental health challenges that expats seek counselling for– relationship issues, anxiety and parenting abroad. She gives some tips on how to handle these common challenges and shares her insights on online counselling.

 Why do expats come for counselling?

According to Vivian, expats seek counselling especially for relationship, anxiety and parenting issues.

          1. Relationship issues

Vivian:  “Common relationship challenges include managing a long-distance relationship, single expats struggling to find a partner abroad, and difficulties in reaching a common understanding in a cross-cultural relationship or marriage.”


“If you are in a cross-cultural relationship, it is important to realize that there are always 2  people going out for a coffee – never 2 cultures going out for a coffee,” says Vivian with a smile. “Start from the universal needs that you both have, like your need for love, for trust, and build your relationship on that. When you’re going out with someone with a different cultural background, spend time and effort getting to know the other as a person with their particular context.” 

             2.  Anxiety

Vivian: “Anxiety can be related to many different factors, such as the relocation or to adjusting to the new work culture, which can be very different from what you knew before,” says Vivian.

“The good news is that there are many stress management techniques that you can easily apply when you are ready to do the work. It is about learning and practising the skills to manage difficult emotions.”


“As a starting point, it is always best to identify what is really stressing you. Because once you identify it, you can rectify it. I say this because many people come to counselling not knowing the main stress factor(s) in their life; “stress” is an unknown general feeling they experience. Part of our job is to work with them to find the root of the problem and then the right approach to solve it.” 

           3. Parenting abroad

Vivian: “Parenting abroad is about maximizing the blessings and minimizing the challenges. Parenting abroad is very different to parenting in the relative comfort of your home country and with family support. We work a lot with global teens, but we also help parents with kids of all ages, and with different types of requests.”


Vivian advises: “Be open and understanding about what your child is going through. As a parent, you do not necessarily need to immediately ‘fix’ their problems, and how you communicate will be key. Of course, you need a solution in time, but above all your child needs compassion and understanding. Because it is hard to leave everything behind.”

“With one plane ride, the whole world as you know it in one country dies and there is no funeral, is one of the images that stayed with me. I think it may have been Third Culture Kid expert Ruth van Reken who said it.” Vivian continues: “Your children need space and time to reflect on what’s going on and they need understanding as a starting point before they are ready for solutions.”

Vivian continues: “As a parent, you know your children best and you have to trust that you are the expert when it comes to your child. So, when you feel that something is not right, do not be afraid to ask for help – seek out a counsellor, or talk to other parents who may have tips that will help you.”    

When should you seek mental health support?

Vivian: “It is not really possible to give a fixed rule for this. Something like anxiety can be very acute and go from 0 to 10 in a short time, even manifesting for some in a panic attack. In that case it is better to ask for help immediately. For others, their discomfort has become a chronic situation. 

Everyone’s circumstances are different and you know yourself best. When something is not right, it is better to make a change sooner rather than later. This could be counselling and/or making changes in your lifestyle.

Lifestyle is so important, because if you do not sleep well or drink a lot of alcohol or coffee, or you do not eat healthily, your body cannot help you with the changes you want to make.

Overcoming most common mental health issues is 50% lifestyle, 25% how you set boundaries in situations that are not healthy for you, and 25% how you respond to events. All are skills to learn, and the more you practise, the more you will benefit.”

If we see a fellow expat struggling, what can we do?

Vivian: “Be there for them… this may be as simple as meeting up for a coffee and asking how they are. Be there and see what comes. Lack of connection, with themselves and with others, is one of the bigger struggles for expats, much more so than loneliness. Time and attention can be the biggest gifts you offer.”

When you are one struggling, remember this: Love is never gone. You can still get love and support through online technology. A struggling expat can benefit both from people around them and also from connecting with friends and family at home or in other countries.”    

How is online counselling different from offline counselling?

Vivian: “Online counselling is often more accessible because, unlike regular counselling, you do not have to go to someone’s office. It is ideal for people who move frequently, work long hours, or prefer support in their native language. Our services are expat focused, so clients know they can speak to a professional who understands life as an international, and the unique challenges that brings.”

Another set of skills

“Online counselling requires another set of skills from the counsellor,” says Vivian. “For example, tone of voice, facial expression (if using video), and the (digital) background are even more important than in offline work. For an online counsellor these kinds of details are fundamental to getting a sense of the bigger picture. All Expat Nest counsellors are trained in online counselling skills and work with secure communication platforms.”


“When you work with an online counsellor, make sure they use encrypted platforms to enhance confidentiality. A counsellor also needs to abide by a Code of Ethics. I follow the Dutch Code of Ethics as I’m based in the Netherlands. Another basic is for both counsellor and client to have an antivirus program installed.”

Clients also need to protect themselves in other ways. “We do not want our clients to be exposed and recommend a private space to talk. Do not get counselling at a café, even if you speak a language different to that of the host country. ”


International insurance often covers the costs of online counselling. Says Vivian: “Some insurers do not require details, some want to know a lot. Each country has a different system.”

About Expat Nest

Vivian Chiona established online counselling service Expat Nest in 2013 to support expats worldwide. The team at Expat Nest provides counselling in English, Italian, Spanish, Greek and Chinese. Counselling in Arab is launching at the time of writing. Mental health services in Dutch are expected to be added in 2020. Expat Nest counsellors understand the expat experience and are skilled in finding expat-focused solutions.


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