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Mental health in Singapore: Counselling tips for stressed-out expats

By: Verne Maree

Verne Maree asked three psychologists and a life coach what their advice would be for unhappy expats caught up in any of the following four fictional but only-too-common scenarios

Single and lonely – Florence (41), Dutch

The Scenario:
Florence was excited by the opportunity to head up the Singapore branch of the shipping company she works for. But she’s finding it hard, despite her best efforts. As the only woman at the office, and the boss at that, she is surrounded by men who hardly bother to pass the time of day with her. Outside of work, she is finding it difficult to make friends, partly because her English is not very fluent. She finds herself unexpectedly bursting into tears at odd moment, spending the weekends at home watching television TV in her condo and Skypeing her old friends in the wee hours of the morning.

The Psychologist:
Dr Shrimathi Swaminathan runs her practice, Psynaptica, at Body with Soul Total Healthcare Network. As a clinical psychologist who often helps people who are under stress from multiple changes happening all at once – divorce, change of job, relocation and so on – here’s her advice for someone in Florence’s position.

The Questions:

Florence chose to move. Why, then, is she unhappy?
It is not uncommon for a new job to cause stress, even though it’s what we want. Even if stressors are limited to one area of life, the problems spill over into other areas too. Problems or challenges at work can make a person angry, intolerant or withdrawn socially or at home, while problems at home can affect concentration, problem-solving and resilience at the workplace.

Is she depressed?
Florence certainly sounds like she could be depressed; and, perhaps due to low self-esteem or anxiety about her worth and capabilities, her efforts to connect are probably not effective at this time. If Florence can be helped to break the cycle of negative thoughts and feelings and ineffective coping behaviours, she can slowly begin to take charge of her life and her wellbeing and begin a positive cycle of experiences.

What should she do?
There are many things Florence could try. Different things work for different people. She could start by consulting a psychologist, who will help her articulate her problems, change negative thinking habits and enhance positive feelings and behaviours.

Physical exercise is an important way to relieve stress, enhance positive mood and regulate sleep. If Florence doesn’t feel like doing any exercise, she could motivate and reward herself for short workouts – perhaps at the condo pool or gym, or in a fitness group. She could even just switch on music and dance!

Social interactions are as important to our wellbeing as nutrition and exercise. Late-night Skypeing is messing up her sleep cycle, and is less rewarding than actual social interaction.

I’d suggest she explore an interest or hobby through a class or activity group. This brings many benefits, from the pleasure and pride in learning something new to the fulfilment of meeting likeminded people. In fact, Florence should consider taking up English classes: language classes are often fun and bring together people from diverse cultures and backgrounds.

Keeping a journal of her thoughts and feelings would help pinpoint negative thoughts with a view to challenging and changing them. What’s more, writing can be therapeutic in itself, allowing us to articulate our experiences just like talking to a friend would. Also, this material can be extremely useful for therapy sessions.

Could medication help Florence?
If her depressed mood and poor sleep patterns continue, she could talk to her general practitioner or a psychiatrist, who might prescribe medication. Medicines do not teach new behaviours or skills, but they can be useful to provide quick relief, boost energy and mood to enable her to do the necessary psychological work. Furthermore, her doctor would be able to check for hormonal imbalances or nutritional deficiencies that may be contributing to her low mood and irregular emotions.


The Couple – Malcolm (38) and Susie (36), Zimbabwean

The Scenario:
Brought here by his job in the tobacco industry, Zimbabweans Malcolm and Susie are into their third year in Singapore. All was fine until Susie found herself pregnant with a third and unplanned baby, right around the time Malcolm was given more regional responsibility. Susie is now struggling with a croupy infant and postpartum depression, and feeling inadequate because her helper seems better at calming her baby. Malcolm spends more than half the month travelling for work, and when he’s home, she finds him distant, pre-occupied and unloving. She’s terrified that he’s having an affair. He, on the other hand, feels overwhelmed by responsibilities and expenses.

The Psychologist:
To Ho Shee Wai, registered psychologist and the director of The Counselling Place, this is a familiar scenario: the expat couple with a newborn baby, without the support of the extended family.

The Questions:

Why can’t Susie cope? After all, this is her third baby.
No, but it’s her first experience of mothering a baby in a foreign country without the normal support networks. Like many expat wives, she feels uncomfortable about her helper taking on a parenting role, although she might happily have accepted the same sort of help from family and friends.

From the baby’s perspective, the helper is family, just another adult person who cares for them. What’s more, the helper may genuinely love and care for the baby and have childcare excellent skills. It would be far better for Susie to accept and utilise this precious resource, one of the few that she and her family have here.

What’s going wrong with Malcolm and Susie’s relationship?
Many expat breadwinners take on a regional role when they come to Singapore, putting a strain on the family and leaving the stay-at-home partner – usually but not always the mother – to fulfil a dual parenting role while they are away.

Some at-homers try to cope by run the household with a system that doesn’t include the travelling spouse. As a result, the spouse at home might resent the disruption caused when the traveller comes home; he, then, feels left out and isolated, as if his only function was to be a bank.

Add to this the additional stress of a newborn baby – difficult enough with two fully co-parenting parents! – and there’s every potential for disaster.

This couple are clearly having issues with intimacy and trust. Many couples fall into the roles of mum and dad, forgetting that they are a couple first. Some women struggle with self-esteem and body image issues after giving birth, and this is further exacerbated when their husband seems not to be attracted to them and the couple are not having sex.

They’re both struggling with exhaustion and lack of sleep. There also seem to be not enough time in the day for everything they need to do. Malcolm misses Susie’s attention and feels he’s being blamed for his lack of support. Family life is no longer pleasant and enjoyable; he doesn’t look forward to coming home.

Though they feel stressed by finances and responsibilities, men like Malcolm are unwilling to ask for help; instead, they may blame their wives. Often, the outside world seems to offer a lot more fun, excitement and women who appreciate them. If the tendency for infidelity is there, this could be a trigger point.

What sort of counselling is needed here?
For Susie, we would recommend individual counselling for her postnatal depression. We also need to build up her self-esteem, not only as a mother but in her own right. We would support her in being a more effective parent.

Malcolm needs individual counselling for stress and achieving a better work-life balance, and possibly also for depression, which is common for the partner of a mother suffering from that condition. We help him to understand postnatal depression as an illness, and the support he needs to be giving.

We’d also recommend couple counselling for any issues of infidelity, intimacy, co-parenting and communication.




The Relocated Teenager – Jake (13), New Zealander


The Scenario:
Jake came to Singapore with his parents and his younger sister six months ago. He didn’t want to come, and he doesn’t like it here. He used to be the best runner and the best rugby player in his rural primary school; he was popular, top of his class and he even had a girlfriend. From being a big fish in a tiny Kiwi pond, Jake is now one of the youngest and smallest pupils at one of Singapore’s biggest international schools. He misses his friends, his old school and the dog he had to leave behind. Once confident and outgoing, he now shows little interest in schoolwork, making friends or going on family outings. Instead, he spends hours playing video games on Xbox.

The Psychologist:
Clinical psychologist Gisela Guttman and registered psychologist Karolina Isberg of Alliance Professional Counselling feel that Jake would benefit from counselling. Often, in their experience, teenagers feel more comfortable talking to someone neutral rather than to their own parents.

The Questions:

What could Jake’s parents be doing to help him?
It’s important for the family to do things together and to talk about the new situation – both looking for familiar places and activities and discovering the new city together. Instead of avoiding difficult topics, they should talk about what they all miss about New Zealand and be open about how difficult a relocation process can be for everyone.

Why are teenagers sometimes more likely to open up to a third party?
Some don’t want to add more burden and stress to their parents’ own adaptation difficulties. Others feel so angry with their parent that they need an external outlet. If Jake and his parents agree on counselling, however, it’s important that they choose a counsellor that he feels comfortable and safe with.

Are some children less suited to the challenges associated with relocating? What can parents do in advance and during the process to ease the transition?
We are all different when it comes to relocation. But shy children, children with learning disabilities and children from non-English speaking backgrounds tend to have a stronger reaction to the change. That said, outgoing children such as Jake can struggle with it, too.

Though adults of course make the big decisions, it’s a good idea to keep the children feeling involved and to allow them to show any anger, nervousness and insecurity as well as happiness and excitement. Give them the opportunity to say goodbye to friends and relatives before they go. And as soon as possible, try to establish a daily structure that feels familiar and where home feels like a safe place despite the changes.

Should Jake’s parents consider moving him to a smaller school?
After a small local school, a big international one can be daunting. But before considering another school move, his parents should find out from Jake himself what his specific worries are and what he would like to change. Then, for example, they could talk to the school about possible solutions, perhaps extra tuition in a particular subject: this is often necessary when changing from one education system to another. A teacher he has formed a good relationship with might be helpful here.

On the positive side, the transitional difficulties associated with relocation should be seen as an opportunity for personal growth, and the process of adjusting to a new environment, difficult as it may be, encourages the development of flexibility and resilience.



The Trailing Spouse – Hilde (28)


The Scenario:
Hilde was an optician in Norway, and moved to Singapore six months ago for her husband’s career in banking. Her professional qualifications are not accepted here. Deprived of her own career, she feels completely lost as to what to do next.

The Counsellor:
Transformative and transcendental coach Nancy Ho, who is also a clinical hypnotherapist, offers an all-encompassing physical, mental, emotional and spiritual approach.

What options are open to Hilde?
Many options are swirling around her head. Should she redo her medical degree? (That would take years!) Should she retrain for a different career? (What would that be?) Should she write a novel? (She’s always wanted to…) Should she join a club and perfect her tennis? (That wouldn’t help pay the rent, though.) Should she start a family? The options are endless, but it’s up to Hilde to decide her own path.

Do you think hypnotherapy might help?
For someone who feels confused or stuck and unable to move on, hypnosis might help to uncover or recover any rooted subconscious events that may be causing their present inertia or confusion. It can also help to identify any self-limiting beliefs, which can then be addressed accordingly. The most important issue here is to help you to feel good about yourself and have positive thoughts that enable you to move on, regardless of the choice you make.

Would life-coaching be a useful approach for someone in Hilde’s position?
I have spent 25 years using and teaching a system that produces an immediate rise in the confidence, clarity and effectiveness of people just like Hilde. I have no doubt that coaching would help her to clear her thinking and decide on a path forward. Importantly, it would teach her how to rise above obsessive thinking patterns and to stay in the “now”. Feelings of helplessness, uncertainty and stress do not come from outside factors: they generally come from our unconsciously obsessive thinking, and awakening to this truth empowers us to live our lives to the full.


This story first appeared in Expat Living’s June 2015 issue.

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