Therapy for expats: why your own language matters and how to choose

You have just hung up the Sunday video call with your family. You told them everything is going well, and in a way it is true: work is fine, the flat gets plenty of light and the city has everything. But once the screen goes dark, the silence at home weighs more than it did before you called. And you are not quite sure who to tell.

Living abroad has an emotional cost that people rarely talk about, even when moving was something you wanted. If you are thinking about therapy for expats, this guide explains what tends to weigh on people living in another country, when it is worth asking for help, why your own language matters, how therapy works at a distance, what to ask when you live abroad and how to choose a professional.

What weighs on you when living abroad

You are far from alone. According to the United Nations, 304 million people were living outside their country of birth in 2024, 3.7% of the world's population. In Spain alone, the National Statistics Institute counted 3,202,002 Spanish nationals living abroad on 1 January 2026.

A review by Bhugra and Becker in the journal World Psychiatry describes the stress that comes with migration: losing the cultural norms and support network you are used to, adjusting to a new culture and watching your sense of who you are change. They call it cultural bereavement and point out that some migrant groups have higher rates of mental health problems. In Spain, the psychiatrist Joseba Achotegui described Ulysses syndrome, the chronic and multiple stress of people who migrate in very harsh conditions. Most expats do not live through anything that extreme, but grieving what you have left behind is real even when leaving was your own choice.

What tends to come up most:

• Loneliness and homesickness. Close friendships take years to build, and special dates feel harder far from home.
• Adjusting to another culture. Different social and workplace norms, a language you use every day that is not yours and the feeling of never quite knowing how things work.
• Identity. Feeling that you no longer fully belong here or there.
• Your relationship. Especially when one partner moved for the other's job, or in couples from different cultures.
• The family left behind. Parents getting older and the guilt of not being there when something happens.
• Going back. Returning home is hard too, because you have changed and so has everything around you.

When to see a psychologist as an expat

The first months in a new country are often strange and tiring, and that is normal. It is worth asking for help if:

• Sadness, anxiety or irritability last for weeks and do not improve.
• You sleep badly, eat worse or have no energy for anything.
• You withdraw: you turn down plans and your phone is your only window home.
• You drink more than you should to get through the evenings.
• Arguments with your partner always end up in the same place: stay or go back.
• You have had anxiety attacks or are struggling to function at work.

If you want to get your bearings before an appointment, the Anxiety Test and the Depression Test take a few minutes, are free and need no sign-up, and you can take them from any country in English, Spanish or Catalan.

And one sign that cannot wait: if thoughts of harming yourself appear, or thoughts that it would be better not to carry on, call the emergency number of the country you are in. In the European Union it is 112, and in Spain you can also call the 024 line, free and available around the clock.

Why therapy in your own language matters

Doing therapy in a language you speak well, but that is not your own, is possible. But it is not the same as therapy in your own language. A meta-analysis by Griner and Smith pooled 76 studies of psychological treatments adapted to the culture of the people receiving them and found a moderate benefit from adapting them. Two findings stand out: interventions aimed at one specific cultural group were four times more effective than those mixing people from different backgrounds, and interventions delivered in clients' native language, when it was not English, were twice as effective as those delivered in English.

Part of the explanation lies in how emotions feel in another language. In a series of experiments by Keysar and colleagues, people made less biased decisions when thinking in a foreign language, and the authors put this down to a foreign language creating more cognitive and emotional distance. A paper by Catherine Caldwell-Harris notes that bilingual people often report that saying I love you, praying or swearing does not feel the same in their native language as in one they learned later, and that measures of skin response point the same way. That distance helps you decide with a cool head. In therapy, where the point is to reach what you feel, it can work against you.

The same author adds that a second language can also come to feel emotional if you use it a lot and learned it by living in it. If you have spent twenty years in Madrid, Spanish may already be one of your languages for feelings too. What matters is being able to choose. And language is only part of it. Context counts too. Not having to explain what Christmas looks like in your family, or why missing a festival back home hurts so much, saves time and leaves more room for what matters.

Does online therapy work for expats?

Yes. A meta-analysis by Fernandez and colleagues pooled dozens of studies of live therapy by video call, 47 of them with a comparison group and more than 3,500 participants. Improvement with video therapy was large and the difference from face-to-face therapy was negligible. Results were especially good with cognitive behavioural therapy and for anxiety, depression and post-traumatic stress.

For people living abroad, online therapy also solves the hardest part: finding a professional who speaks your language in a city where there may be none. In exchange, a few practical details need attention:

• Timing. Find a time that works in both time zones without eating into your sleep.
• Privacy. A room where no one can hear you, and headphones if you share a flat.
• Connection. A cable or a spot close to the router is better, with a plan B if the call drops.

If you have never had therapy by video call, Online psychologist: how to choose well and what to expect from video-call therapy may help.

What to ask if you have therapy from abroad

In 2017 Spain's General Council of Psychology adapted the American Psychological Association's telepsychology guidelines into its own guide. Three of their ideas affect you directly if you live abroad:

1. Credentials. At the start, the psychologist should give you their qualifications, training and registration number, and tell you where you can check them.
2. The law where you are. Each country may have its own rules on remote care. The guidelines point out that the law of the place where the client is located is relevant and may require the professional's qualification to be recognised there. Ask what they have checked for your situation.
3. An emergency plan. It depends on where you are when you receive therapy, so the professional should know the emergency numbers for your area and, where possible, have the contact details of a support person close to you.

If you have health insurance in your country of residence, also ask whether it covers therapy with a professional based in another country.

How to choose a therapist as an expat

These checks help you get it right:

• Registration as a health professional, with a number you can check.
• They speak your language fluently and understand your cultural background.
• Experience with migration: adjustment, grieving what you leave behind, identity and going home.
• Session times that work for your time zone.
• An emergency plan for the country where you live.
• An evidence-based approach and a plan with goals. If the different approaches confuse you, we explain them in Types of psychological therapy: what they are and how to choose.
• A secure platform and clarity about how your data is stored.

A psychologist for expats

At MyPsicoTest we recommend Xènia Capel Salcedo, a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. She sees clients in Igualada and Sant Sadurní d'Anoia and also through online therapy, in English, Spanish and Catalan, and on her blog she has written an article about online therapy for expats. In it she explains how she works: from an intercultural perspective, because life in London is not the same experience as life in Shanghai, supporting migratory grief without asking you to forget what you left behind, helping you build a bicultural identity and working on adjustment and building a social network in your new country. She adapts session times to the time difference and works with people in Europe, North America, Latin America, Asia and Oceania. She also supports parenting across two cultures and the return home. She works from an integrative, evidence-based approach: on her website she explains that she uses tools from cognitive behavioural therapy, EMDR, systemic therapy and person-centred therapy. The first contact is a free, no-commitment information consultation. She herself points out that in a serious crisis or psychiatric emergency, immediate in-person care is what is needed.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: 13 October 2026