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An extract from my PsyD Thesis: “Art therapy as a Tool for Treatment of Couples’ Dynamics in Relocation” 2018



Relocation is a common phenomenon in the global world of the 21st century (Ornoy, 2009). The term relocation translates literally in English as “repositioning” and is used in the social context of stationing an employee or a student in a country that is not his country of origin for a specified period (Cambridge dictionary, 2018). Scholarly literature sometimes makes use of the term "uprooting" to describe relocation (Baldridge, Eddelston & Veiga, 2006), a term that emphasizes the severity of the event despite it being temporary. A person who is the subject of relocation is referred to by the term expatriate or, in short, expat. A relocated employee often relocates with their spouse and children.

The term relocation differs substantially from immigration, in both the motives for the move and the mechanism of moving, as well as its transitory nature, as compared to the intent to end the relationship with the country of origin, which characterizes immigration (Merriam-Webster dictionary, 2018). From a psychological standpoint, relocation creates what is considered a crisis event (Lavee, Mccubbin & Patterson, 1985). A crisis is seen to be a traumatic event, regardless of the relocation’s ultimate success (Hausman & Reed, 1991). The crisis in the context of relocation is time-limited when the individual and the family face social and psychological changes where their adjustment skills are challenged. The individuals find themselves in a new set of circumstances undergoing the negative psychological symptoms of culture shock (Oberg, 1960), where they lose all or most familiar cultural cues and social rules and would find themselves often insecure, vulnerable, and frustrated.  The family members leave their relatives and friends behind and establish a new social network (Ali, van der Zee & Sanders, 2003).

Relocation is unique in the sense that psychological distress may escalate in severity due to the extreme change of conditions and increased level of stress, even more so when a couple or family relocate altogether (Minter, 2008). When a family relocates, one’s crisis risks cascading to others and unbalancing different equilibriums in the family. It is also common that extreme change causes the exacerbation of other conditions. In such cases, existing conditions that have been dormant or not critical before the relocation worsen and trigger a crisis (Ruszczynski, 1993).

I found that when treating mature family members in relocation, the role of the couple as the significant core of the family unit played a major role in distorting a balanced lifestyle for the expatriates. Therefore, I focused my research on the treatment of couples.


Psychological challenges of relocation

Globalization, an important phenomenon in international business in the 20th and the 21st century, has influenced organizations to search for competitive advantages, opportunities and possibilities by expanding their business and business activities to other countries, leading to the existence of multinational corporations (MNCs). As a result, there were 850,000 subsidiaries of MNCs operating globally in 2008 (Colakoglu & Caligiuri, 2008). One of the consequences of operating internationally is the increasing need for employees who are able and willing to work on international assignments with the requirement of relocation for a specific period of time. These employees, called expatriates, are internationally deployed by MNCs (Deen, 2011).

In 2017 there were 56.8M expatriates in relocation (defined as employees in 6 months to 5 years of temporary assignment), with an anticipated annual growth of 2-3% (Finaccord, 2017), and an estimated between 60-80% of such documented expatriate workers reporting having family members that relocate along with them (Haslberger & Brewster, 2008).

The complexity and potentially severe impact of relocation on individuals and families is demonstrated by the abundance of articles dedicated to the legal aspects of relocation, mainly when children are involved. Two examples of publications that cover such topics are: The Psychological Effects of Relocation for Children of Divorce (Gindes, 1998), Relocation of Children after Divorce and Children’s Best Interests, New Evidence and Legal Considerations (Ellman, 2003), and Relocation Following Parental Separation, The Welfare and Best Interests of Children (Taylor, Gollop & Henaghan, 2010). Expatriates are considered a primary stakeholder in determining the achievement of organizational goals, (Takeuchi, 2010) hence the need to motivate them to relocate. Their employment budget is significantly higher compared to that of an employee serving same function in the firms’ headquarters. Expats sometimes earn the highest salaries in their company outside of the fact that employers commonly pay well beyond wages, usually for the move itself, and some costs of living (schools, housing, transportation, and home visits).

An MNC must deal with the potential risks of failure of the expat’s assignment in the form of premature termination and compromised productivity. The success of an expat’s assignment is, therefore, an area of increasing interest for the employer. Albeit this, relocation is mainly dealt with in publications dedicated to human resources management, business management and others, which are focused on the organizational concerns and interests (Rawls, 2016) rather than the point of view of the relocated individual.

As reported in the Harvard Business Review (Black & Gregersen, 1999), between 10% and 20% of managers sent abroad returned early because of job dissatisfaction or difficulties in adjusting to a foreign country. There is, therefore, a growing interest in recent years in the root reasons for relocation assignment failure which in turn widens the related research. Companies that were interested in the past interested in the selection and assessment of the international assignee realize that there is a need to explore the failures and successes of the assignment more broadly (Global Relocation Trends Survey Report, 2011).  The imported role that the employer takes in the expat’s life is unique compared to the position of an employer towards its domestic employees. The employer is rightly regarded by the employee as the cause and drive for his or her life-changing experience. As such, the employer potentially has a significant role in the relocated employee’s wellbeing, both by selecting candidates that are well-fitted to adjust to the relocation conditions and to cope with the challenges of relocation, as well as by providing them with adequate support.

Adjustment is defined as the degree of physical or psychological comfort and familiarity that individuals feel concerning a specific context, such as a new living environment, culture, work environment or interaction (Deen, 2011), these different aspects refer to the work and the non-work domain. International adjustment is considered a multi-dimensional concept (Black, Mendenhall, & Oddou, 1991), consisting of psychological, sociocultural and professional adjustment. The first two aspects are relevant to the assignee as well as to their trailing spouse. Psychological adjustment refers to internal psychological outcomes such as mental health and personal satisfaction. Sociocultural adjustment refers to external psychological outcomes that link the individual to the new environment, such as the ability to deal with daily problems in the host country (Ali, van der Zee, & Sanders, 2003; van der Zee & van Oudenhoven, 2007).

An understanding of expatriate psychographics is an important area in expatriate adjustment because personal psychological factors such as motivation, relational skills, flexibility/adaptability, and extra-cultural openness have a direct impact on expatriate adjustment (Mol, Born, Willemsen & van Der Molen, 2005).  In their model of expatriate adjustment, Naithanki and Jha (2009) added that “Psychological factors such as individual’s personality, emotional maturity, and adaptability help cope up with work and performance related pressures in a new country, and extra-cultural openness helps an expatriate to adjust socially and culturally” (p. 38).

Stress Factors in Relocation

Expatriates leave behind family members and friends, familiar activities, religious centers, jobs and schools. These losses can be ambiguous and difficult to express, leaving individuals confused and unable to fully identify the sources of their grief (Boss, 1999). The geographic distance can add stress: time differences can minimize the window of availability of the support network in the home country, for example, or even the very thought of physical difference. Home visits, which are often done yearly, and friends’ and families’ visiting the hosting country can add stress. In isolation and absence of a support network, what may start as minor issues in daily life (e.g., trouble with school, transportation, language) may altogether evolve into anxiety, irritability and a feeling of helplessness. An expat tends to depend on other long-termers from the same country (Hånberg & Österdahl, 2009) rather than integrate into the new social environment. Emotional ambiguity can also be triggered by job ambiguity; expatriates commonly face entirely new job roles, which might come with the need for a new set of job knowledge and technical skills (Mol et al., 2005).  When job roles are ambiguous, role ambiguity adds on to the negative impact on work adjustment (Beauchamp & Bray, 2001). Results from several studies show that expatriate adjustment can influence organizational commitment, performance and lead to withdrawal (Deen, 2011).

Couples conflicts in relocation were described by Waldron and Kelley (2009). In a chapter headed “Understanding the relocation experience,” in which they state, “relocation can be taxing at any life stage. It is considered by social workers and health professionals to be one of the most taxing events in a person’s life, potentially as stressful as the death of a parent or a divorce” (p. 180). While the expat’s adjustment process takes place in a more familiar organizational context in which the employee usually arrives with a predefined role, a set of responsibilities inherent in the job (Eriksson & Lindström, 2013), and a present organizational support system, the trailing spouse‘s adjustment process takes place in a new context (Shaffer & Harrison, 2001). The trailing spouse often gives up their studies, job or career, and are placed in a completely new social environment. As a result, the trailing spouse has no access to support systems in the new country at the entry point of the assignment (Takeuchi, Yun & Tesluk, 2002).

Expat spouses, 84% of whom are women, find problems obtaining work abroad, despite most of them being highly educated, with about half holding a post-graduate degree. Only 24% of trailing spouses have jobs in the host country, mainly because of many countries' restrictive rules on work visas for family members who are accompanying the primary wage earner in a family. 20% of trailing spouses were looking for work with another 20% already working part-time. Almost two-thirds of the spouses said they found relocating abroad and having to give up previous careers to be "very hard" (Von Plato & Zeeck, 2017).

To conclude, the trailing spouse may experience difficulties in adjusting to a new living environment, including a new, unfamiliar context and not being able to lean on a social network for support. As a result, several negative issues may arise, such as isolation, insecurity, and stress (Takeuchi et al., 2002), particularly in the early periods of the assignment (Punnett, 1997). In cases where the family has children, additional challenges arise, such as children’s anxiety and decreases in self-confidence, the breaking-up of friendships, and the disruption of schooling (Deen, 2011). The inability of the spouse to adjust is the top reason leading to expats’ assignment failure (Ko, 2014). Thompson (1986) reports that friendships with other expatriate spouses of the same or different nationality make it easier to overcome feelings of boredom and “redundancy” experienced after relocation (Eriksson & Lindström, 2013). The family’s and spouse’s adaptations are highly important as a source of support for the expat. The importance of family adaptability was emphasized by Harvey (1985 & 1998), who suggested that family support is probably the deciding factor behind expat success, and that the expat’s family plays a crucial role of in providing him/her an indispensable source of motivation and mental security (Harvey, 1985).

Wrong expectations.

Expectations of relocation and their effect on the relocation success are scantly researched. Wrong expectations of relocation are a significant cause of stress (Cole, 2011), not only in the context of culture and the workplace but more significantly in relation to a lack of self-fulfillment. Individuals and couples expect relocation to bring about significant positive changes in their life, such as the receiving opportunities for self-fulfillment, improvements in their lifestyle, and the spending of more quality time with the spouse and family. When faced with a different reality, they may experience regret, disappointment and stress.

Exacerbation of conditions.

Some problems that can be attributed to relocation arise from the exacerbation of the individual’s psychological condition and/or conflicts in relationships that had existed before the relocation, both conscious and unconscious (Ruszczynski, 1993). Conditions that may be exacerbated vary from mental health issues, addiction, the tendency to feel stress and anxiety, other conditions that the individual or couple experienced and learned to balance and live with. These might resurface abruptly under stress or the loss of balances in a relationship due to the relocation. An empirical study written by McNulty (2015) attributes the first cause of expat divorce to core issues in the marriage that existed before relocation and have been exacerbated,  such as “mental health problems and alcoholism. The second cause of divorce is related to the negative influence of the expatriate culture that influences one or both spouses to such an extent that results in “behaviors such as infidelity and sexual misconduct” (p. 109).

Disruption of family balance and the need to rebalance.

Issues such as higher demands for commitment of the employee from the employer, along with the nature of work dynamics, often frequent travels, and social events tend to create struggles within families (Rawls, 2016). van Erp (2011) suggests the Role of Justice as an explanation for the shift of balance in relocating couples. She suggests that such shifts have to do with feelings of justice or injustice experienced by those involved. In general, the importance individuals attach to justice can be explained both by concerns about controlling one’s outcomes and from a need for the gratification of important group memberships. The decision of the assignee to relocate usually affects the couple as a whole and may drastically change their prior arrangements such as familial, financial and functional responsibilities.

Consequently, “the personal well-being of the expat and the spouse become increasingly intertwined” (van Erp, 2011, p. 25). Besides proving the existence of spousal influences, other studies focus on how these influences work. For example, Mukanzi and Senaji (2017) demonstrate in their research the links and balances between work-family conflict (WFC), family-work conflicts (FWC) and employee commitment (EC) (Mukanzi & Senaji, 2017).  The research measures such linkages empirically and their influence on the struggle for balance between employees, their families and the employer. They propose ways to moderate such conflicts and ensure better work-life balance among employees. Expatriate stress experienced at work or home influences the stress or strain on the spouse and vice versa (Takeuchi et al., 2002). This means that problems of the spouse cross over to the expatriate. As a consequence, stressful experiences in the family domain may spill over to the work domain (Takeuchi et al., 2002). Thus, the concept of spillover and crossover is a possible factor to explain spousal influences. In the meantime, the expatriate must establish a new balance between the domains of family and work.

The intensity and likelihood of spillover and crossover effects are magnified during an international assignment is magnified. Takeuchi, Yun and Tesluk (2002) found that this comes from "a probable reduction in available psychosocial and physical support systems, resulting in a greater frequency and degree of interaction between partners, and consequently the influence they exert upon one another" (p. 658).

Culture shock.

In many cases, the expat is relocating from one culture to another. This aspect is broadly documented as a psychological phenomenon termed culture shock (Oberg, 1960). Culture shock is a consequence of the strain and anxiety that seems to occur due to contact with a dissimilar culture, and the feelings of loss and confusion resulting from losing most or all familiar cultural cues and social rules (Eriksson & Lindström, 2013). Culture shock occurs when individuals interact with members of a different culture and experience a loss in the understanding of their new social and behavioural environment over a period of time.  Moving into a new culture poses challenges to existing modes of adaptive functioning and often requires several complex adjustments for even simple tasks (O’Keeffe, 2003). Examples include grocery shopping, recycling rules, traffic rules and language.  Culture shock is a normal and common effect that majority of all expatriates’ experience. Even those who have been on many international assignments before continue to experience culture shock upon each assignment (Hånberg & Österdahl, 2009). Cross-cultural adjustment is a prime factor in expatriate adjustment, as success in the host country is often dependent on the expatriate and accompanying family’s cross-cultural adjustment (Caligiuri & Lazarova, 2005). Moving into a new culture can be associated with “greater states of anger, anxiety, acting-out, withdrawal, distress, or other stress-related reactions such as depression, over/under eating, hives, substance abuse and marital and familial conflicts” (Rawls, 2016, p. 8). Expatriate adjustment in a foreign country has a direct psychological impact on personal self-esteem and may also impair personal relationships (Templer, Tay & Chandrasekar, 2006). Relocation may be seen as an extreme case of losing the home, as described by Matri (2005) in his book Psyche's Home, where he emphasizes the mental and behavioural effects that can occur when one loses his/her home. Additionally, members of the family may experience culture shock to different extents and for different durations.

My experience

Being an expatriate mother and wife in the last 16 years, I have experienced, together with my family, the beauties and challenges involved in relocation. Interacting privately and professionally with dozens of relocated expats and families, I became increasingly interested and involved in the subject.

I relocated from Israel to India in 2002 following the placement of my husband in New Delhi as the representative of an Israeli technology company. I was overwhelmed by the intensity of the local culture and how different it was from what I was accustomed to and by the changes in lifestyle that it imposed in almost every aspect of my life, from high-level social differences such as the lack of independence in women, lack of personal security and compromised health services, to essential daily and logistical functions at home such as the challenge to buy sanitary products or obtain necessary services. The increase in income and living in a so-called high standard residence provided only partial remedies. I felt a complete loss of my social support system, being away from friends and family and cut off from my earlier career path after graduating with a bachelor’s degree. I found no options to continue studying within my domain of interest and no employment options. Initially, I tried to socialize with other expats and locals and establish a new social network, but this provided only partial support. Most attempts proved more disappointing than supportive, while very few friendships were even significant. The frequent departure of friends back home or to a different country created an even bigger distress as I experienced a sense of loss and grief at every departure; what would have been an exotic touristic experience turned into a daily challenge. I found myself increasingly depressed, frustrated, and angry.

My husband experienced the relocation differently. He was focused on the new professional opportunity, made new social contacts at work, traveled occasionally and had an overall fulfilling experience. The difference in the way we experienced the relocation caused increasing tensions that eventually led to a decision to leave India after two years. We then relocated to Singapore and stayed there for the next 13 years, during which my husband worked for several firms. Singapore was much more accommodating in comparison to India; it is a highly organized society with values and a culture in which I felt much more comfortable. On the cultural level, Singapore was less discriminatory towards expat women, offering much more development and work options. It was also more efficient and accommodating with regard to daily tasks. During this time, I graduated with a master’s degree in art therapy and developed a fulfilling career. Challenges manifested in different ways during this period. My husband’s lack of stability at work, combined with the extremely high costs of living and the constant threat of termination of his employment contract along with the frequent departure of friends created a strong sense of instability and uncertainty for the family. This was a reason for growing stress and pressure. It led us to decide to move to a more stable environment.

Singapore has the highest rate of expatriate to locals in the world. The department of statistics in Singapore reports that out of a total of about 5.7M, only 3.5M are Citizens (DOS, 2018). In my work as a therapist, and through social encounters, I became increasingly aware of a broad range of challenges that expatriates experience when relocating. These are intense and disruptive in nature, affecting many individuals, couples, and families negatively. I found that across the board, individuals and families enter the process of relocation with no psychological preparation and support, and often with wrong expectations.  

In my practice, I found that art therapy served me well and was an effective vehicle for treating couples in relocation. Art therapy facilitates the bridging over of cultures and language barriers, and provides tools that are dynamic, genuine and spontaneous, creating a fast track to the unconscious mind. Art therapy offers safe, non-judgemental settings for couples to express, explore, and improve their dynamics. I gradually developed the knowledge and sensitivities towards the topic and am pleased to present them here in the form of thematic research based on an in-depth case study that represents well the efficacy and advantages of treating couples in relocation with the use of art therapy….

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