Starting Therapy in Your Mother Tongue: A Step-by-Step Guide From Abroad

A step-by-step guide to starting therapy in your mother tongue from abroad: initial chat, time difference, booking, payment and tech set-up. Be ready.

For a while now you have been thinking, "Maybe I should talk to someone." But you don't know where to start. You have tried to find a therapist in the country where you live; perhaps the waiting lists were long, or describing your feelings in a second language felt hard. The idea of an online session with a Turkish-speaking psychologist appeals to you; yet questions such as the time difference, payment, connection and privacy are confusing you. Starting therapy is a process in which the hardest part is often taking the first step. In this article we explain, step by step, how you can start online therapy in your mother tongue as someone living abroad: from the initial conversation to booking, from payment to technical preparation and the first session.

Why Might Starting Therapy in Your Mother Tongue Matter?

Feelings, memories and family relationships are to a large extent encoded in the language we first learn. A remark your mother made to you as a child, an argument with your father or the memory of a morning on a religious holiday are held in your memory in Turkish. It is possible to describe these memories in another language; but sometimes something is left missing. It is not easy to translate fully the meaning carried by expressions such as "içim daraldı" (my chest tightened), "gönlüm kırıldı" (my heart was hurt) or "elâlem ne der" (what will people say).

Therapy in your mother tongue can make things easier in the following ways:

• Expressing yourself: Being able to describe your feelings in their finest shades without searching for words.
• Cultural context: Not having to explain topics such as family structure, hospitality, the concepts of shame and propriety, and the longing of "gurbet" (life far from home) and "sıla" (the homeland one longs for).
• Less fatigue: For someone who speaks a second language all day, returning to the mother tongue during the therapy hour can be mentally restful.
• Family work: If there is a language difference between parents, grandparents or spouses, sessions in Turkish can make it easier for everyone to take part.

This does not mean that mental health services in the country where you live are inadequate. Many people also benefit greatly from local services. Online therapy in your mother tongue is one of the options that can be chosen alongside or instead of them. For detailed information you can look at our page on Turks living abroad.

When Should You Seek Professional Support?

You do not need to wait until you are doing "really badly" to start therapy. Sometimes support can be sought to understand an issue, to clarify a decision or to get through a period in a more balanced way. Even so, the following situations can be important signs that you should consider talking to a specialist:

• Unhappiness, listlessness or hopelessness lasting several weeks
• Constant anxiety, panic attacks or intense worry
• Marked changes in sleep and appetite
• Ongoing conflicts in relationships or within the family
• Difficulty recovering after a hard life event such as migration, loss, divorce or illness
• A marked decrease in functioning at work or school
• Turning more and more to alcohol, betting or other behaviours
• Changes in your child's or teenager's behaviour that worry you

An important reminder: Online therapy is not an emergency intervention service. If you have thoughts of harming yourself or ending your life, or if you are in a crisis, call the emergency number of the country you are in immediately: 112 in EU countries, 911 in the US and Canada, 999 or 112 in the UK, and 000 in Australia. In situations of severe risk, local emergency services and local psychiatric services are necessary; online sessions do not replace these services.

Barriers That Make Starting Therapy Difficult

Many people feel they need therapy but put off this step for months, even years. The barriers commonly encountered are these:

• Worry about "shame" and stigma: Thoughts such as "If I'm going to a psychologist, it means something is wrong with me" and "What will people say if they hear?" Yet starting therapy is not a weakness but a way of investing in yourself and your relationships.
• The belief "I should sort it out myself": This is common especially in people who are used to being strong and keeping their problems inside.
• Uncertainty: Not knowing how therapy works, what will be talked about and how long it will last.
• Practical worries: The time difference, payment, technical problems, not being able to find privacy at home.
• A previous negative experience: Having seen a therapist you did not get on with before.

Most of these barriers lessen once you learn how the process works. The steps below are prepared for exactly that.

Starting Therapy in Your Mother Tongue Step by Step: From the Initial Chat to Booking

Step 1: Roughly work out what you want support for

You don't need to know everything; but preparing a short note will make things easier. For example: "Since we moved I've been constantly anxious and can't sleep", "My partner and I argue all the time", "My son doesn't want to go to school". Write this note so that it also includes who the support is for (yourself, as a couple, your child or teenager).

Step 2: Research the specialist

When choosing a specialist, look at their training, the age groups and subjects they work with and the therapy approach they use (for example Cognitive Behavioural Therapy). To assess whether they suit you, you can read the information and service pages on their website. You can find detailed information about how sessions are held on our online therapy service page.

Step 3: The initial chat or first contact

Many specialists offer the chance of a short initial contact before the first session. At this stage the following are generally discussed:

• What you want support with
• Which country you live in and your time zone
• Which kind of session is suitable, such as individual, couples, child or teenager sessions
• General information about the frequency and length of sessions
• Payment and cancellation terms

The initial chat is also your chance to ask the specialist questions. You can feel free to ask things like "Have you worked on this before?", "How do the sessions go?" and "How is confidentiality ensured?"

Step 4: Work out the time difference and book your appointment

The confusion most often experienced in sessions from abroad is the time difference. While Turkey uses the same time zone all year round, many places, such as most of Europe, North America and Australia, switch between summer and winter time. For this reason, the difference between you and Turkey can change during the year.

Practical suggestions about the time difference:

• Always note the appointment time stating which country's time it is in.
• When adding the appointment to your phone's calendar app, check the time zone.
• In the weeks when the summer and winter time changes occur, confirm the appointment time again.
• If you are in a place with a big difference, such as North America or Australia, assess together the suitable times in the day for both you and the specialist; early morning or late evening hours can be a suitable option.

You can send your appointment request from the appointment page. Stating the country you live in and the time ranges that suit you in your request makes it easier to find a suitable time.

Payment and Technical Preparation: What You Need to Know Before the Session

Step 5: Clarify the payment process

For online sessions from abroad, payment is generally made online. Pricing can be in Turkish lira and payment with an international bank or credit card is possible. It is useful to check beforehand whether your card is enabled for overseas transactions and to find out about your bank's currency conversion fees. You can find out the current fees and payment terms directly at the contact stage.

Insurance reimbursement, on the other hand, varies greatly from country to country and from policy to policy. To find out whether online sessions with a specialist abroad are covered by your insurance, check the insurance terms in the country where you live with your own insurer. If you need an invoice or documentation, say so from the start.

Step 6: Make the technical preparations

A good online session does not require complicated equipment; but a few basic preparations are important:

• Device: A laptop, tablet or smartphone can be used. If you are using a phone, place it somewhere stable instead of holding it.
• Internet connection: If possible, prefer a wired or strong Wi-Fi connection. Check your connection speed before the session.
• Headphones: Headphones make the sound clearer and also keep what is said from being heard by others.
• Application: Download the secure platform on which the session will be held in advance, log in and check the camera and microphone permissions.
• Charge: Make sure your device is fully charged or plugged in.
• Backup plan: Talk beforehand about what to do if the connection drops; for example trying to reconnect or switching to a voice call.

Step 7: Prepare a private and quiet setting

Confidentiality is one of the cornerstones of therapy. To be able to express yourself freely, a setting in which nobody can hear you is important:

• Choose a room with a door that closes; if the house is crowded, schedule the session for a time when the household is out.
• If necessary, tell family members beforehand, "I have an hour-long session, I shouldn't be disturbed."
• Turn off notifications and silence your phone.
• If privacy at home is not possible, you can consider alternatives such as a parked car or a quiet study room.
• Keep a glass of water and a piece of paper on which you can take notes beside you.

For a more detailed checklist, you can look at our article on preparing for online therapy.

What Happens in the First Session?

The first session is generally an introductory and assessment meeting. In this meeting the specialist tries to understand you and the difficulty you are facing. The commonly asked topics are these:

• The issue that brings you to therapy and how long it has been going on
• Your daily life, work, family and relationships
• Your migration story: when, why and how you went abroad
• Any psychological or psychiatric support you have received before
• Your expectations and goals for therapy

You don't have to tell everything in the first session. You can leave subjects you are not ready for until later. At the end of the session, how to proceed, the frequency of sessions and the goals are generally discussed together. It is perfectly natural to feel a little tense in the first session, to cry or not to know what to say.

Step 8: Give yourself time after the session

One disadvantage of online sessions is that the moment the screen goes off you may find yourself suddenly in the kitchen, with the children or on the verge of a work meeting. Because emotional subjects are discussed in therapy, it does you good to leave yourself a fifteen- to twenty-minute transition time straight after the session. A short walk, a glass of tea or noting down what stayed with you in a few sentences helps you both digest the session and return to daily life more gently. These notes also make it easier to remember what you want to talk about in the next session.

Starting therapy does not require you to have worked everything out; it only requires being ready to talk.

How Do We Work in Online Therapy in Your Mother Tongue?

Online therapy in your mother tongue is carried out within the same framework as the principles of face-to-face therapy: confidentiality, regular sessions, shared goals and a therapeutic relationship based on trust. In work based on Cognitive Behavioural Therapy (CBT), the process generally runs as follows:

• Assessment: What the problem is, when it started and what maintains it are understood together.
• Goal setting: Concrete and measurable goals are set; for example "Sleeping regularly at least three nights a week" or "Being able to talk about arguments with my partner calmly."
• Skills work: Techniques such as noticing and testing thoughts, coping with anxiety, problem-solving and communication skills are learnt.
• Homework: Short tasks to be carried out between sessions help carry what is learnt into daily life.
• Review and closure: Progress is reviewed together at set intervals; when the goals are reached, the process is brought to a planned close.

The content of the work is shaped according to the person. Parent counselling and age-appropriate activities can be planned for children, separate sessions for teenagers and joint sessions for couples. In some cases an assessment by a psychiatrist may be needed; when there is such a need, it is recommended that you consult your doctor in the country where you live.

Frequently Asked Questions

Is online therapy as effective as face-to-face therapy?

It is known that for many issues online therapy can be helpful in a similar way to face-to-face sessions. However, it may not be suitable for every situation; local services are necessary especially in urgent risk situations and in cases requiring intensive medical follow-up. Suitability is assessed together in the first sessions.

How often are sessions held?

Generally we start with a weekly or fortnightly session. The frequency is determined together according to your needs, your goals and the course of the process, and may change over time.

What happens if I miss appointments because of the time difference?

Always noting the appointment in both time zones and setting a calendar reminder reduces this risk. Finding out the cancellation and rescheduling terms at the first contact lets you know what to do in the event of a mishap.

Can I have therapy in my mother tongue while continuing to see my therapist in the country where I live?

Working with two different therapists at the same time on the same issue can confuse the process. In such a case it is recommended that you inform both specialists and clarify what support is being received for what purpose.

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• #therapy in your mother tongue
• #preparing for online therapy
• #psychologist abroad

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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