Expatriate Clinical Work: inhabiting elsewhere, inhabiting language, inhabiting oneself
There is, in the experience of expatriation, a subtle vibration that far exceeds the simple fact of moving from one country to another. One believes one is leaving for a job, an opportunity, a love story, a family project. One imagines crossing a border, changing climate, language, time zone. Yet what truly moves is the entire psychic apparatus. Transcultural clinicians have shown this for decades: leaving one’s country, even voluntarily, always means leaving a part of oneself behind. And one never quite knows which part until it is missing.
In my practice, in French and in English, with patients living in Singapore, Canada, Switzerland or Monaco, I encounter the same inner tremor, the same oscillation between momentum and loss, between freedom and uprooting. Expatriation opens a space where landmarks dissolve, where language splits, where identity shifts like a tectonic plate. One becomes slightly foreign to oneself, sometimes in a fertile way, sometimes in a more fragile one. The difficulties encountered are not exotic. They are the same everywhere: anxiety, depression, marital crises, exhaustion, sleep disturbances, parental difficulties. Yet they take on a particular tone when they unfold in a context of displacement. Anxiety becomes solitude, depression becomes isolation, family conflicts become estrangement. Adolescents, caught between several worlds and several languages, often do not know where to place their bodies or their stories.
Some situations are more acute. The transcultural psychiatry teams at Sainte‑Anne Hospital in Paris have described, since the 1990s, cultural decompensations among Japanese expatriates living in France. This is not clinical folklore but a massive cultural shock: the gap between the idealized image of France and daily reality, the radical difference in social codes, the confrontation with an unfamiliar otherness that offers no refuge. The psyche suddenly no longer knows where to settle. It falters. It unravels. It desperately searches for ground.
And then there are families, infants, couples trying to build a family elsewhere. They live in an in‑between space, neither fully here nor fully there. Babies born abroad are sometimes described as rootless, not because they lack roots, but because their roots extend across several soils at once. Their sleep, their language, their attachment bear the imprint of this plurality. Parents oscillate between the freedom to invent and the fatigue of reinventing everything. They carry alone what an extended family would have shared in their country of origin.
Why choose a partner from elsewhere. Why choose to expatriate oneself. Contemporary psychoanalysis, from Dreweski to Kaës, shows that these choices are never trivial. They may respond to a desire for rupture, a quest for otherness, a need to reinvent oneself far from the familial gaze. They may also replay transgenerational dynamics, seek a language that protects or liberates, attempt to repair a story by relocating it elsewhere. Elsewhere becomes a psychic space, a place where one hopes to find oneself by losing oneself a little.
Language plays a central role. Speaking in one’s mother tongue means regaining direct access to emotion, memory, nuance. Speaking in another language sometimes protects, sometimes distances. In my consultations, in French or in English, I see how the language chosen to express suffering is never neutral. It reveals an intimate relationship to identity, to the past, to the country left behind. It shows what can be said, and what remains suspended.
Working with expatriates means welcoming this plurality. It means offering a stable space in a moving world. It means listening to languages, silences, multiple belongings. It means understanding that expatriation is not only a professional project but a profound transformation of the subject. It means supporting families as they attempt to create a home far from their familiar ground. It means helping adolescents inhabit their multiple identities. It means allowing adults to rediscover an inner ground even when the outer ground shifts.
The clinical work with expatriates is neither marginal nor anecdotal. It lies at the heart of contemporary issues of mobility, globalization and family recomposition. It requires fine listening, sensitivity to languages, cultural understanding, and the ability to work at a distance without losing the quality of the therapeutic link. It also requires recognizing that elsewhere is never only geographical: it is psychic, intimate, sometimes painful, sometimes fertile. In this space, therapy becomes a place where one can finally rest, speak what cannot be spoken abroad, and rediscover an inner continuity even when life unfolds across several time zones. A place where one may, perhaps, feel a little less uprooted.
References
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McNulty, Y., & Brewster, C. (2017). Theorizing the meaning(s) of “expatriate”. International Journal of Human Resource Management, 28(1), 27–61.
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Pollock, D. C., & Van Reken, R. E. (2009). Third Culture Kids.
Nicholas Brealey. Sayad, A. (1999). The Double Absence. Seuil.
