At a near-empty Chinese restaurant on Street 310 on a Monday afternoon, clinical psychologist Richard Jefferson spends far more time flipping through the menu than his colleague Kristina Marshall – a marriage and family therapist – did, but arrives at the same dish that she had chosen at first glance: sweet and sour pork.

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Marshall and Jefferson are partners in Indigo Psychological Services Cambodia, which is the largest private clinic in the country.

The clinic offers  a full spectrum of services for children, adults and couples in Phnom Penh and Siem Reap, for both local and expatriate clientele.

Both are qualified to work in their home countries: Canada and the United States, respectfully, as is their third partner, a neuropsychologist who specialises in assessing and treating developmental disorders in children.

Jefferson uses gestalt techniques to treat the symptoms and disorders his expatriate clients seek help for – primarily depression and anxiety – but is eclectic in his approach, adding cognitive techniques and role play. Marshall says she relies on “narrative therapy”, which she describes as “helping people re-story their lives”.

People with shattered or self-defeating narratives – and those with chapters ripped out or forgotten – are encouraged to reconstruct the stories they tell about themselves in order to make sense of their lives and alleviate distress and negative behaviour that results from unhealthy scripts that have been imposed.    

Both Marshall and Jefferson have been away long enough to know there really isn’t that much of a difference between those who leave and those who stay. “The issues are the same but the stories are different,” Jefferson says.

Marshall is quick to admit that “some people would not end up in therapy at home, but do so here because they lack support systems, like long-term friends and relatives”.

“Sometimes all they need is to be reassured that what they are feeling is natural,” she says in answer to questions about culture shock, which can be triggered by relatively trivial things, like constant bartering and the custom that foreigners should pay a bit extra because they have more money.

“People get infuriated by having to pay more. Then, they freak out at themselves for freaking out,” Marshall explains. Culture shock, however, is usually pretty easy to get over once identified, and most people do so within a few months, both therapists agree.

On the contrary, they don’t ask clients who complain at overcharges whether they also object to being paid far more than their Khmer colleagues.

“That would be antagonistic,” Jefferson explains, adding, that some therapists do use antagonism as a technique to jolt clients.

“Compassion fatigue” and “vicarious trauma” are common among aid workers who seek counseling here.

Working in the aid industry can take its toll on workers due the needs of the people they encounter as well as the institutional systems that sometimes hinder their expectations of what they had hoped they could accomplish.

Moreover, because Cambodia is considered a “soft posting”, aid workers who are transferred here from Darfur or Afghanistan, for example, may unravel due to the pent up stress from previous postings.

Even when they identify experiencing post traumatic stress disorder – nightmares, anxiety and panic attacks – they may need assistance in working through it, Jefferson says..

In Cambodia, vicarious trauma is more common among rights activists. Young volunteers from Western nations advocating for communities involved in land disputes might be the most susceptible.

“You can be traumatised yourself when you are dealing with people who are traumatised,” Jefferson explains. “They can take on the sensations of the community. They can experience anger, sleeplessness, panic attacks and nightmares.” Unlike culture shock, these volunteers, often relatively young, can experience an ethics shock, which can leave them questioning their entire belief system.

Self-medication can also be a problem for expatriates here due to the ease with which Valium and Xanax can be purchased. People who had been on pharmaceutical drugs such as Prozac at home may also decide to buy it over the counter here without seeking advice from a doctor. The dosage might be different and the quality of the drug itself may be dubious, Jefferson warns. Both therapists advise seeking medical advice before taking prescription medications.

They also recommend that those suffering from drug addiction return home for treatment because detox and treatment centres are virtually nonexistent here.

Jefferson and Richards plan to remain in Cambodia for at least another three years, and say they can be more effective here because the lower cost of living allows them to maintain more manageable caseloads. Fees are based on a sliding scale, meaning low-income Khmer clients and foreign volunteers who have no health plans that cover therapy are offered treatment for a nominal fee.

For more information visit www.indigo-cambodia.com