For many foreigners living in Taiwan, the excitement and novelty of learning about a new country is often tempered by feelings of isolation and bouts of culture shock, which are often made worse by a language barrier. Loneliness and stress can sometimes morph into depression or at the very least cast a pall over the experience of living abroad.
Sometimes talking to friends and family is not enough — especially when those friends and family are living across the world. Counselors at the Community Services Center, a Taipei-based non-profit organization that provides support services to foreigners, can offer professional insight into how to identify and manage sources of stress.
The Community Services Center’s counselors each hold a master’s degree or doctorate in counseling, social work or psychology, and have at least five years of experience counseling patients. Therapy is available in either English or Mandarin.
People seeking therapy first speak to a counselor on the phone, who will gather basic background information about the client and ask what they are looking for in a therapist. The fee is based on a sliding scale depending on the patient’s monthly income (for couples or family therapy, monthly household income is taken into consideration). “We have never turned away anyone for lack of ability to pay,” says Perry Malcolm, a counselor at the Center.
Individual therapy, family therapy and couples therapy are offered at the Center. Therapy clients run the gamut from people living abroad alone to children of expatriates, cross-cultural couples and spouses who followed when their husband or wife was relocated.
They seek counseling for a wide scope of reasons, including difficulty adjusting to life in a new country, work and relationship issues, substance abuse, or depression and other mental health issues. Therapy can last for as short as one session or can go on for longer stretches of time. Sessions can take place once a week or less frequently, depending on each individual’s circumstances.
“People come here for a variety of reasons and there are a variety of causes. Everybody is an individual and we definitely respect that,” says Malcolm, “There is not one solution that fits everyone and we try to be very creative and adapt to the individual. We don’t ask them to adapt to us.”
While the Center’s patients seek treatment for a wide variety of reasons, the challenge of adapting to life in Taipei is what prompts many newcomers to call the Center. Cumulatively, the day-to-day stresses of living and working in a new country can add up.
“You have an English teacher who is basically struggling to get by and the school won’t even help buy supplies like markers, or they live far away from their buxibans [cram schools], so they can’t go home and take a break. They may be strained in many ways and sometimes they are ill-prepared,” says Malcolm. Having a supportive workplace or social network can help soothe and alleviate stress, but that is not something that all foreigners can count on, especially if they have only just arrived.
Even mundane tasks like buying groceries, reading street signs or plotting their daily commute can be difficult for newcomers. Malcolm compares having a daily routine to the programs running in the background of a computer that ensure it functions smoothly; having to build a routine from scratch in a new country can take up an enormous amount of emotional energy. “We now have to consciously think about things which we had previously taken for granted, and things like work, love and relationships that we would like to think about are all more crowded in our mind,” says Malcolm.
Culture shock can also hit foreigners who have been living in Taipei for several months. “There is a honeymoon period where you are charged up,” says Malcolm, but the worst of culture shock often strikes around the third or fourth month of a person’s time in a new place, before gradually improving. Getting and staying connected with other people can make the adjustment phase go more smoothly, says Malcolm, while isolating yourself or abusing substances will make it worse.
For people who come to the city to teach or study and arrive at the beginning of the school year, that means the worst of culture shock can hit them in the middle of winter, when shortened days and unpleasant weather can exacerbate depression and tempt people to withdraw from social interactions. Malcolm suggests that newcomers make an effort to meet people as soon as possible and continue to keep up with those fledging relationships. The Center, which in addition to support services also offers social gatherings, workshops and classes that are open to the public, can serve as a jumping-off point. In addition, finding Taiwanese friends or a host family can ease the strain of adapting to a new culture and ward off feelings of alienation.
The process of acclimating to life in Taipei can also start long before people step on an airplane. For people who are coping with mental illnesses like depression or bipolar disorder, preparation is especially key. “If you know up-front that you have a certain condition, you need to find help for that as soon as possible. We’ve had people e-mail us six or seven months in advance, wanting to schedule an appointment and making sure that there is somebody here who can help them,” says Malcolm.
If a patient decides that they want to see a psychiatrist, either to start a new course of medication or maintain their ongoing prescriptions, the Community Services Center can provide referrals to doctors who are fluent in English at hospitals and private clinics. Counselors will also help monitor the patient’s reaction to new medication.
An initial intake appointment at Taipei Veterans General Hospital’s (台北榮民總醫院) department of psychiatry, one of the hospitals that the Center refers patients to, usually last about 15 to 20 minutes, says psychiatrist Tsai Shih-Jen (蔡世仁). Intake sessions at private clinics, which charge more, can take up to an hour. Doctors will first ask patients what symptoms they have been experiencing and then prescribe them medication if necessary. If a patient appears to be responding well to medication, then Tsai advises them to come back for follow-up appointments about once a month; if they need more care, their psychiatrist will see them once or twice a week. The same psychiatric medications that are available abroad can also be found in Taiwan, though brand names may vary.
For people who have not seen a therapist before and are apprehensive about counseling or wondering how it will benefit them, Malcolm encourages them to give the Center a call. “You don’t have anything to lose,” says Malcolm, “Just come and talk to us. If you are already asking yourself that question, then maybe that’s a sign you need to come in.”
How to get in touch: The Community Services Center is located at 25, Ln 290, Zhongshan N Rd Sec 6, Taipei City (台北市中山北路六段290巷25號). To set up an appointment with a counselor, call (02) 2836-8134. Regular office hours are Monday to Friday, 9am to 5pm.
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