My work in Shanghai with clients from all over the world

Eight years ago this month, I moved to Shanghai for a 2.5 year assignment.  I have been meaning to share my reflections.  Here they are:image description: Lauren Muhlheim with coworkers in Parkway Health poster

I had been working at Los Angeles County Jail for nearly 10 years when my husband’s business plan for a site-based English Language Learning Children’s business in China got funded by the Walt Disney Company. I was by then more than a little “burned out” and ready for a change.

I know my jail co-workers questioned the legitimacy of my excuse for finally “getting out of jail.” “Really, you’re going to China?” they asked incredulously, as if I were just naming the furthest place I could think of from Los Angeles County Jail. I left my job in November 2007 and became wistful. I wondered if my kids would ever be able to remember having a working mother (they were 10, 8, and almost 6 when we left).

And so, in January 2008, my husband and I packed up our house, 3 kids and a dog, and said goodbye to our family and life in Los Angeles. We arrived in Shanghai during its coldest winter in 20 years.

Within 2 weeks of my arrival, I had coffee with a Dutch psychologist who lived in my compound and supervised the counseling program through the expatriate community center. Knowing of my expertise in eating disorders from my CV, she immediately handed me 2 cases. A friend encouraged me to apply for a job with the Singapore-based Parkway Health, which ran clinics throughout Shanghai staffed by Western-trained doctors, serving a predominantly expatriate clientele. Parkway Health promptly hired me, and within 4 months of my arrival in China I was working two jobs.

My clients were anyone who could speak English. This included clients from every continent with the exception of Antarctica (I never got to treat any penguins!). They ranged in age from children to adults in their 60s. The majority were on expatriate assignments or had children with foreign passports attending international schools. Some were Chinese who had lived abroad and were now living in China while their children attended international school. Others were American-born Chinese who had come to work in China and faced significant cultural issues. Other clients came from the UK, Germany, Brazil, Argentina, Sweden, Canada, Israel, India, South Africa, and Australia.

Map in my office in Shanghai with pins representing hometowns of patients.

Map in my office in Shanghai with pins representing hometowns of patients.

I learned that clients around the world experience very similar problems. Due to my specialty, a significant portion of my clients was seeking treatment for eating disorders. But with a short supply of therapists to treat the large and diverse population of expats in Shanghai, I also saw clients with anxiety, mood disorders, and marital problems.

I found that the stress of being an expat away from one’s family and home, and the clash of living in a foreign culture, added overlays of additional stress to whatever other disorder or issues were already there. I also found that there were a certain number of individuals who had fled their location of origin (sometimes a series of locations) in an attempt to run away from a problem; unfortunately, in these circumstances the problems had merely followed them to China.

A Cognitive Behavior Therapy (CBT) approach provided benefits for clients of diverse ethnic backgrounds. I sought additional training in Emotionally-Focused Therapy for couples and Family-Based Treatment for adolescent eating disorders to enhance my skills.

One of the most exciting aspects of living and working in Shanghai was spearheading the establishment of the Shanghai International Mental Health Association (SIMHA), an organization for therapists serving the international community of Shanghai. Over time, I proactively cultivated relationships with anyone who had been a therapist. This aided me when I needed to consult or refer to another therapist. Unfortunately, although various international schools and organizations serving expatriates retained lists of expatriate therapists, whichever list I consulted of therapists practicing in Shanghai was outdated (and the turnover was relatively rapid). Thus, I reached out to the International Mental Health Practitioners of Japan and sought their advice on forming a similar organization in Shanghai. I then banded together the various and diverse therapists I had identified in Shanghai and together we formed a professional organization of mental health professionals (also from all around the world), adopted an ethics code, and built a website and a community of therapists who could support each other. I am proud that SIMHA still thrives.

Living and working in Shanghai gave me an amazing training in cultural awareness and sensitivity. I love learning about clients’ unique backgrounds and experiencing their worldviews. I particularly enjoy working with clients of diverse backgrounds. I am sensitive to the issues of expatriation and acculturation and generational conflicts around culture. I am also comfortable and enthusiastic about engaging with people from different backgrounds, whether cultural, religious, gender orientation, sexual orientation, or lifestyle.  It is this diversity that makes the texture of life so interesting and my work so rewarding.

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