Editor's Note: This is the second of a five-part series on how people in China are coping with stress in a fast-changing society

Stress management for expatriates barely existed 20 years ago when Danish psychologist Kirsten Hogh Thogersen first moved to China.

Few Westerners lived here, and even fewer foreign psychologists were available to help them cope with the pressures of living and working in the country.

"When I decided to set up a clinic here for foreigners, there was none in China or, to my knowledge, even in the whole of Asia," Thogersen said.

"Now there is a big need. It's incredibly more difficult to live life as an expat than to live in your home environment. The stress of settling down somewhere else can be enormous. I often see people break down with depression as a result of the stress and challenges of an international lifestyle."

Thogersen came to Beijing with her husband, who was posted in the Danish Embassy.

"At that time I was a psychologist working in a university clinic in Denmark," she said. "I could see that back then people who had moved here and needed support had to go back to the States or London, or wherever they were from, even just for an evaluation.

"When I came, I had a good background, so fairly soon I settled down with a private clinic."

Thogersen, now based in Shanghai, is also a professor of clinical psychology at Sun Yat-sen University in Guangzhou, capital of South China's Guangdong Province.

She said that because the number of psychologists working outside their own countries was still small, little work had been done to understand how to help expats thrive in a new environment amid a culture very different from their own.

"But more businesses are now taking globalization seriously and offering coaching for people who move abroad to work," she said.

To prepare foreign workers for life in China, many multinational companies now offer special programmes to help them acclimatize.

US communications giant Motorola is one of them.

"Motorola's expatriate programme has many policy elements that are offered to support the acclimation of employees and families to their new environments, including a pre-departure set of activities and post-arrival support," said Mary Lamb, regional spokeswoman for the company's Asia-Pacific region.

"A few of these items are cultural self-assessment tools. The tools provide an employee with an overall evaluation of how perceptions and behaviour will impact their time in the new location, as well how it will affect the family unit.

"The other support Motorola provides is cultural training. This training involves the employee and the spouse and is conducted prior to their going to the new location.

"This training is customized to the employee's needs and business role, and addresses the acculturation curve and other well-known psychological aspects of cultural adjustments.

"The same training team follows up after arrival to assist and remind the employees of the various 'self-help' aspects to assist all in acclimation."

Mark Duval, 37, director of operations for Motorola China, is among the company's workers who benefited from the programme.

He moved from the United States to the North China port city of Tianjin in 1996 and is now based in Beijing.

"I did the cultural awareness programme in the US before I came to China," he said.

"It looked at your potential abilities at dealing with international assignments and at your personality as well.

"There were specific training sessions as well on the difficulties you might come across and psychology tests.

"It was a very intensive three-day course. It helps people understand that they are going to encounter certain difficulties and shows how you can react and deal with them."

He said the programme helped to give an early indication about individuals who were likely to encounter difficulties in adjusting to life in China.

"On a couple of occasions, I have been told by the human resources department that I should work closely with people, as the results in their tests suggested they might have difficulties at some point.

"And they were right, but because we were aware these people might experience problems, we were able to support them and help them through it."

Duval's wife, Ginger, and two children, Josh, now 15, and Amanda, now 14, joined him in China about nine months after his arrival.

He said it was often the partners of people who moved to China to work who had the most difficulty in acclimatizing.

"I think for the working individual, like myself, it is challenging to adjust, but I think a big issue is the pressure on the spouses.

"Kids can acclimatize and adjust quite easily once they get settled into a school.

"The working spouse can just dive into the work, but I think the weak link, in a way, can be the partner who doesn't work and has to acclimatize to a different daily routine, which my wife had to do."

He added that the main difficulties he experienced were from a business perspective.

"I did find it frustrating to adjust at first," he said.

"Of course there were the initial language problems. But also in the US things tend to be done more directly; it's about getting from A to B in the shortest possible time span.

"Here, however, a more cautious approach is taken, and there is a more group-oriented way of doing things.

"Adjusting to these kinds of things can be frustrating, and it is tough learning how to still be aggressive but in a more appropriate manner to the Chinese way of doing things."

For Vesa Kalenius, 41, from Finland, cultural differences and daily life in China presented the most problems.

He lived in Beijing for three years, before moving in 2002 to Shanghai, where he works as a representative for the city's HSH Nordbank office.

"The traffic in China is something that I have never got used to. It is so bad," he said.

"The air quality is also very poor and is something that may lead to moving eventually.

"Culturally, things such as the volume that people speak at in China and meal times are also very different from Scandinavia.

"But I do like Asia, and workwise it has been good.

"It can be a difficult working environment, but it's also fun. There is never a single day at work that is the same as the last one."

Aside from companies' own support programmes, with larger numbers of Western psychologists now in China, additional private support is also at hand for those who believe they need it.

Thogersen said she had seen a range of patients over the years from different backgrounds, and one of the most common times that people encounter problems was after around four to five months of living in their new countries.

People's identities are structured by well-known surroundings, she said.

"At home, as you walk down the street, with the things you see in shop windows, you always have some level of recognition, of things you have seen in the last 10 years, and that is like feedback on your identity," Thogersen said.

"You are helped by things that you recognize, and a familiar environment sends signals back to your brain all the time without your realizing it.

"For instance, you could take a walk in the park and see a couple talking together on a bench. Even if you can't hear exactly what they're saying, you can recognize the pattern of their speech, you can tell their age, and you can work out what kind of job they do by their clothes.

"But when you move away, you miss all of that subconscious recognition of your identity, and that can be very hard. I think it is often underestimated how important that is.

"In the first couple of months it's all fun. It's like an interesting event box in your brain, but when you have been here for a few months, things can start to startle you."

After the initial excitement at being in a new environment has passed, Thogersen said, expats needed to find connectedness in their new homeland to make them feel "real."

It's not just a decision to learn the language that helps the acclimatization. Often, she said, it's little things that can make the biggest difference.

"For people I see, I recommend that they do things regularly such as have a cup of tea in one of the old traditional places, of which there are so many in China," Thogersen said.

"It is something that is fairly unique to China - and helps you to connect."

Connecting with China is one thing, but an often-overlooked aspect of living overseas for several years comes when it's time to return home.

"You find that it can be more difficult sometimes for people to become repatriated when they return back home after three or four years away than when they moved away in the first place," said Duval, the Motorola executive from the United States.

"When people first come to China, they are prepared for the fact that things could be a lot different.

"People don't expect to have problems when they go back, so it's unexpected when they find out they have to get used to a different way of life again and readjust."

(China Daily 08/30/2006 page1)