Published March 2018 in Catalan by casalcz.cz
Dr. Désirée Gonzalo is a clinical psychologist living in Prague since 2008 and working as a psychotherapist with expats.
Do expat psychotherapy clients in Prague have a typical profile?
One can distinguish various groups of clients according to the reasons why they live here. These reasons could be a determining factor in the integration process. Some come for the ample job opportunities. Most foreigners work for international companies or with an international audience. Those who come with their family tend to integrate to a lesser extent with the Czech population. Those who come alone interact mainly with other foreigners and with Czechs primarily if there are work reasons to do so. There is also a minority working in fields, such as culture, history or diplomacy, which involves relating to local people. Another large group consists of foreigners with a Czech partner. These tend to have more contact with other Czechs, for example with their partner’s family and friends.
However, there is another very distinct group, which I call the “spiritual refugees”. They are those, who came to Prague searching for a “refuge” or “fleeing” from adverse circumstances in their place of origin. We need to take into account that Prague is a fairly liberal city, which has seen a huge rise in diversity since 1989. It is also cheaper and safer than many other Western cities. A combination of these and other circumstances has attracted such “refugees”. This can be the most clinically challenging group, frequently presenting with traumatic backgrounds and more severe symptomatology. Common symptoms in this group are difficulty socialising, panic attacks, paranoia, aggression, and hypervigilance. They tend to settle down here long-term because the prospect of returning to their country of origin is usually terrifying.
Having established these groups gives us a sort of a map. However, mental health is a strictly individual affair. On that individual basis, have you noticed any recurrent mental health complaints in the expat population?
Environmental stress exacerbates problems that expats brought in their luggage, problems that already existed before settling here. Most expats experience difficulty communicating with local people, sometimes needing translators, and embracing a new culture and way of life. Precarious communication generates feelings of personal inefficiency and exaggerates pre-existing insecurities. Common preexisting conditions of those, who do not integrate well, are social anxiety and mistrust.
I often hear complaints about the “Czech ways” (or “Czechness”) along with significant resistance to adapt. There is often the expectation that local people “should” behave according to the customs of their own place of origin. These circumstances compounded can cause dissatisfaction in daily life, a tendency to disengage from the integration process, and progressive isolation towards circles of people that conform to expectations of familiarity, i.e. countrymen or other foreigners. There are thus “islands” of foreigners. The reduction in social circles can generate feelings of uprooting and imbalance of one’s own social identity.
The Czech language comes to mind immediately when it comes to expat life. Well, it is difficult. What role does it play?
Yes, most foreigners are put off by the complexities of the Czech language and the expectation of not staying long enough to “make learning it worth it”. So, very few speak it fluently. Obviously, native speakers of Slavic languages have less difficulty accessing jobs that require Czech and relating to Czechs socially.
Speaking of the meeting of cultures, “mixed” couples is another obvious topic to consider. Are differences in mixed couples a common complaint or trigger of mental symptoms?
I have worked with mixed couples, i.e. one Czech and one non-Czech, who have difficulties in their relationship. There is often a combination of feeling “trapped” and the development of symptoms of anxiety and/or depression. It is precisely in the intimate sphere where people seek to reproduce the relational patterns learned in childhood from interacting with and observing significant others. When these patterns differ significantly between partners, as can be the case of two individuals from disparate cultures, difficulties can be experienced in meeting expectations and needs in terms of communication, fulfilment of emotional needs, and how to raise children. It is possible but effortful to adapt to and integrate cultural differences into an intimate relationship so that it is functional and satisfactory.
On a practical level, the decision to seek professional help and taking the first step might be difficult for the unexperienced. Where do we begin? What psychotherapy services for expats are there in Prague?
First of all, it is important to understand that seeking help when needed is a healthy approach. We all go through crises in life. We have all experienced a range of emotions, sometimes very intense ones that interfere with our daily functioning. We all have had difficult situations when relating to others. If issues are difficult to manage alone, it is wise to seek help. A professional can help you understand yourself and develop effective ways to deal with your problems.
Basically, services available to expats are the same that are available to Czechs, as long as clients speak enough Czech to do therapy. In Prague there are many Czech psychotherapists of different orientations. Some Czech psychotherapists also offer services in other languages. A few of these also charge more to work in a foreign language even if their mastery of the second or third language is not always comparable to their native Czech.
What options are there if you do not speak Czech?
There are foreign psychotherapists in Prague, who offer services in several languages, especially in English. I know colleagues who offer services in Russian, German, Italian, French, and Spanish, but they are few and the demand is great. When looking for a psychotherapist, it is important to understand what training and orientation they have, if their working methods suit your needs, and if they have a professional license to practise in this country. It is also worth comparing prices since they can vary a lot.
When psychiatric medication is needed, it is advisable to see a psychiatrist, since they are licensed to prescribe and have greater expertise in mental health than a GP. There is a variety of Czech psychiatrists offering services in other languages, especially in English.
In case of psychiatric emergencies, the main psychiatric hospital in Prague, Bohnice, has a crisis intervention center (Centrum krizové intervence) where some psychiatrists speak English. You can call in advance to see if the psychiatrist on call speaks English and, if not, look for a translator. Hospital staff, especially nurses, do not usually speak foreign languages.