Third Culture Kids and Therapy: The Survey

by | Mar 30, 2017 | Blog | 2 comments

Thank you so much to all who took part in this survey about Third Culture Kid experiences of therapy. I received 161 responses in a matter of days. This is part of the wonder that is the Third Culture Kid community, you are all so generous with your stories and your time. I promised I’d honour your stories by relaying the survey results back to you – so here we go!

There was a dramatic male (16%) – female (83%) split in responses, more than in a previous survey of mine on social media use. I wonder if this reflects the received wisdom that more women than men seek out professional therapeutic support. Someone suggested I should extend a survey towards those who never made it to therapy – and exploring the reasons for this. It would be interesting to see if this received more male contributions.

Regarding age, there was a fairly broad age range – 28% of respondents were aged between 36 and 45, 24% were aged 18-25, and 20% were between 26-35 years of age.

Respondents represented 32 countries, 19% of responses indicating dual-citizenship or residency. 53% of respondents were American (or if dual, American was one of their nationalities). The next most common nationalities were British, Canadian, Australian and Dutch.

I asked respondents why they’d initially sought out therapeutic support, and I left this an open question – so people filled in answers using their own words rather than pre-set categories. Collating the responses, the top five ‘presenting issues‘ were depression, marriage or relationship challenges, experiences of trauma (physical and sexual abuse, rape and I also included PTSD in this category), identity difficulties, and issues of belonging. Other issues mentioned included family stressors, eating disorders and grief.

While 27% of respondents had engaged in therapy once in their lifetimes, 70% had sought therapeutic support on multiple occasions. 32% of Third Culture Kids found their therapists through local listings, whereas 23% found their therapists through friends’ recommendations. Only 8% got their recommendations from family. The ‘Other’ option listed was used by 40% of respondents, with common qualifiers being school or university counsellors or therapists used by their workplaces or mission organisations. Several respondents found their therapists online. I was surprised however that only 1% found their therapists through international directories of TCK specialists. This low figure suggests that there is work to be done to publicize these excellent therapist directories. With a heavy reliance on local listings, it was unsurprising perhaps that only 19% of therapists used by respondents were aware of the Third Culture Kid experience.

In terms of what kind of therapeutic support Third Culture Kids reported receiving, this was pretty evenly spread. Counselling was most reported at 33%, psychologists at 22%, psychotherapists at 17%, with life coaches at 3%. ‘Other’ was selected by 25% of respondents, to indicate multiple kinds of therapy received. Encouragingly 80% of respondents reported very positive relationships with their therapists. There was a broad range of time spent in therapy; with 22% spending one year or less in therapy, and 21% spending more than 3 years in therapy.

Third Culture Kids mostly met with their therapists in person (81%), but 4% did use Skype with their therapists. Common challenges cited with Skype work were around discomfort with cameras, technical difficulties, time zone conflicts and the lack of social cues. Common benefits cited for Skype were that people felt more comfortable, liked meeting in the comfort of their own homes and enjoyed the flexibility of meeting times that Skype work brought. Respondents also liked that Skype allowed for continuity of care; they could continue with the same therapist no matter what country changes either party went through. 30% of respondents that had not used Skype would have appreciated that as an option in their therapeutic work.

The last questions of this survey are the most difficult to collate. Respondents were open and beautifully expressed many challenges shared by many Third Culture Kids. Because of the sensitivity of this survey however, I’m not going to publish any quotations. Instead, I’ll summarise the five major observations made by respondents about what therapists should be aware of when working with Third Culture Kids.

  1. Therapists need an awareness that they will have different ‘normals’ from their Third Culture Kid clients. Working assumptions about individual identity, family dynamics, and mental health will differ between therapists and clients of different cultures and different life experiences. Spending time gaining an understanding of the client’s ‘normal’ was seen as crucial to building a good working relationship.
  2. Therapists need to have an understanding that a client may be grieving an invisible loss or, as one respondent put it, experiencing bereavement without a corpse. The losses experienced by Third Culture Kids range from the tangible to the intangible, but the intangible are especially hard to grieve without support.
  3. Therapists need to understand the ‘privilege problem’ or ‘positivity narrative’, as I’ve come to call it. Acknowledging challenges arising from childhood experiences could be especially hard for Third Culture Kids who are accustomed to seeing their upbringing as overwhelmingly ‘blessed’, ‘privileged’ and ‘full of opportunity’. This can be a barrier to receiving therapeutic support and gentle encouragement by a therapist who understands this is necessary to make a safe space to share openly and honestly without guilt.
  4. Therapists need to be aware of the contradicting identities that Third Culture Kids can display in rapid succession, being the cultural chameleons that they so often feel themselves to be. Understanding that cultural identities can be multiple and unexpected will help therapists support Third Culture Kids exploring complex identity issues.
  5. This one is my favourite. And one that I hold dear in my own work with Third Culture Kids. It is crucial that therapists treat their Third Culture Kid clients as people first, and TCKs second. Not all issues presented by TCKs in the therapy room will be directly related to their TCK experiences. An awareness of TCK challenges is needed to inform, not dictate, therapeutic work. For all the fact that TCKs share common stressors, these will not impact TCKs in the same ways, nor should the supportive solutions we suggest be the same for all TCKs. For we are people first, and TCKs second. At the risk of labouring the point, Third Culture Kid is a term describing a shared experience, not a shared personality.

Thank you for bearing with me. This has been a post full of numbers and lists… but also stories. And these stories have helped me to better understand the needs of Third Culture Kids myself, and will inform my work with counsellors and other therapists as I pass on your stories to them. So thank you for your time, your generosity, and your stories.

Oh, and in an attempt to increase the chances of Third Culture Kids accessing specialist and Third Culture Kid aware therapists, here are five international directories of therapists to start with. Please share these as widely as possible – I’d love to see them used more widely!

International Therapist Directory

TCK Academy

Expat Business Directory

International Directory for Repatriates







  1. Dan

    A goodly number of responses indeed, Dr. Rachel.

    Oddly, my first reaction on seeing the basic topic was that I haven’t received any counseling, and that I had nothing to contribute. Upon reflecting more carefully, I do recall several instances of counseling over the years. None related directly to TCK issues, as far as I can perceive. More like family and marital issues. But I did have some informal counseling that did relate to my TCK experience, and it was somewhat helpful, as well.

    Thank you for sorting out the data and posting it for us.

    • Dr. Rachel Cason

      Thank you Dan! You raise a good point… not all counselling TCKs receive will be for obviously TCK ‘issues’… but a therapists knowledge of TCK experiences will inform their treatment and approach. Thanks again for reading!


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