During the early stages of an assignment expats may need some extra help when adjusting to their new life. Here are the signs to watch out for.

Whether you are a globetrotting pro or a beginner expat, living overseas can be an unsettling experience. For those just arriving, setting up a new house, settling in the kids, refitting a marriage into a new culture, and starting new work can all add pressure to an already confusing
situation.

Even for those who have spent years abroad, feelings of inadequacy, marital problems and depression are common issues which are difficult to face alone. Mental imbalance compounded by culture shock at any stage of the expat experience is a common and serious problem, according to Carmen Guanipa of the Department of Counselling and School Psychology of the San Diego State University. "If you feel stressed out, look for help. There is always someone or some service available to you."
 
Many international firms who move their employees around offer counselling services as part of the relocation support. But often the counsellor is also a colleague in a small office or the service is superficial at best, and many expats feel awkward or embarrassed to ask for help from someone they also socialize with in a small expat circle. Many expats opt instead for local counsellors -- either expats who have set up a practice or those native to the area. 
 
As with any health care service professional, finding a local counsellor requires diligent research. Across the board, experts agree that a counsellor should speak the patient's mother tongue (or a language the patient is extremely fluent in). Searching for words in a foreign language or struggling to explain or describe an emotion will hinder the healing process and add to the frustration of culture shock, which may be at the base of the problem in the first place.

If you need to see a marriage counsellor, the search may be more complex. "Most couples simply don't consider that their relationship is also being shipped to a new country where the impact of a variety of pressures and shocks can take a heavy toll, often leading to a divorce court," according to Robin Pascoe, author of several expat books including, A Moveable Marriage. Finding an appropriate marriage counsellor is tricky anywhere, but a local counsellor may also carry foreign attitudes and cultural preconceptions that do not jibe with your own goals or ideals for your marriage.

What ever type of counsellor you seek, start by querying your local embassy or consular office for a list of accredited, recommended counsellors who speak your native language. Many offer this service online or will provide a written list of recommended professionals. But don't just call the first name on the list, or settle on the one closest to you. It is important to interview a potential counsellor to determine not only if you share his or her philosophy, but also to find out the approach to your specific problem.

Ask if they have published articles or if they have given seminars relating to your specific problem. Make sure they understand where you are coming from, both figuratively and culturally, advises Pascoe. If they are also expats, chances are they have a keen understanding of your circumstances. A local counsellor who happens to speak your language may draw a blank as you describe your cross-cultural issues.
 
If the counsellor you find is an expat, it is fair to ask why he or she is living abroad. Make sure you see a diploma or other certification. It is acceptable to ask to see a current license, especially if the counsellor is also a medical doctor. Make sure you feel comfortable talking to him or her. Take a cue from the office environment and how they answer the telephone. Is there a receptionist? Is the office legitimate or just a make-shift studio?

Keep in mind that some of the best counsellors are spouses of other expats who are stationed in your city and who are offering certified counselling services from their homes, but you should expect a professional atmosphere and not have to trip over children's toys or be interrupted by the babysitter during a counselling session. 
 
Ask questions about payment before your first session. Can you pay with a credit card or a check? Be leery of anyone who requires "cash only" or who says you don't need a receipt. They should also have a valid local business license even if they are providing counselling services "freelance". They should have a tax code and give you a receipt for the service. Before you engage in long-term counselling, make sure it qualifies under your health insurance plan. Some counsellors need a local practice license or to also be medical doctors to be covered under major insurance policies.

Finally, search their names on the Internet to see if anyone has posted or logged a complaint about them, either abroad or in their home country. And don't be afraid to switch counsellors if you aren't happy with the service you are getting. Don't get drawn into a situation that is unhealthy or one that makes you feel insecure or additionally burdened just because the counsellor speaks your language.

Some signs to watch for:

* Fits of anger over minor inconveniences
* Irritability
* Extreme homesickness
* Withdrawal from people who are different from you
* A new and intense feeling of loyalty to your own culture
* Compulsive eating or a loss of appetite
* Boredom
* A need for excessive periods of sleep
* Headaches
* Upset stomach
* Excessive concern over minor pains
* Depression
* Loss of ability to work effectively
* Unexplainable fits of crying
* Marital stress
* Exaggerated cleanliness
* Feeling sick much of the time
* Difficulty concentrating

Source: San Diego State University, 2005
Reprinted with the permission of Abroad magazine
Subject: Expatriate health, workplace stress