Dutch mental health care explained

Dutch mental health care (GGZ) explained

 Even though the Dutch health care system is rated as one of the best in Europe (EHCI 2018), navigating through the different institutions, doctors and clinics can be challenging. Especially when you’re struggling with mental health problems, it can be difficult to find the right person to help you.

In order to get your therapy covered by your insurance, you need a referral letter from your GP. The role of the GP in the Dutch (mental) health system is that of a doorman: he or she is the one that assesses your complaints and tries to match it with the right health care provider. Sometimes this means that –similar to a general doorman- sometimes you have to ring the bell twice or thrice to get in.

Another important thing about the Dutch mental health care system is that it’s a stepped care system. This means that different health care providers offer different levels (or intensities) of care. Within the Dutch mental health care system, there are 4 steps:

1.       Anonymous e-health
For some people, making an appointment with the GP and talking about mental health problems is simply too difficult or embarrassing. The Ministry of Health, Welfare and Sport (VWS) still wants to offer these people some form of care or guide them to regular care. Various easily accessible tests and treatments via the internet (anonymous e-mental health)  can provide this kind of help. E-mental health helps to recognize and prevent psychological problems in time, and aims to improve self-management of patients.

 2.       Short-term psychological treatment with POH-GGZ
The GP treats minor psychological complaints him/herself, in collaboration with a so called ‘practice assistant mental health care’ (POH-GGZ). These treatments are usually short-term and last up to about seven sessions.

 3.       Referral to basic mental healthcare (BGGZ)

If your symptoms can’t be treated within the limited timeframe of the POH-GGZ, the GP can refer you to a healthcare provider within the BGGZ. Treatment of mild to moderate mental health problems occurs in BGGZ. Here you can get up to 750 minutes of psychological treatment.

4.       Referral to specialized mental healthcare (SGGZ)
In case of more severe or chronical psychological problems, the GP will refer to the specialized mental healthcare (SGGZ). There are numerous clinics, some offer therapy sessions with psychologists or a combination with a psychiatrist. This more intensive treatment can last up to a year, and has a possibility of extension.

 At Kühler & Trooster, we offer treatment in the Specialized Mental Healthcare. Our services are aimed primarily at internationals, offering treatment in English, Dutch, French, German, Spanish, Chinese, Italian and Japanese. If you are interested in starting treatment here, please contact us or ask your GP about a referral. 



How to beat your post-vacation blues

Do you know that gloomy feeling after a great vacation, where you return home and everything seems so incredibly normal? That your usual life suddenly feels boring and you lack energy to go out and make something of your time? If you do, you’re not alone! Many people who travel find themselves experiencing post-vacation blues. Having to get back into the routine of work, studies and daily life can be a source of discomfort, distress and disorientation. But however unpleasant it may be, the post-vacation blues can be overcome with a couple of tips and tricks.

1.       Adjust your sleep schedule ahead of time
If your holiday destination is in a different time zone, chances are that you’ll suffer from jet lag when you return. With sleep deprivation, chances are that you’ll be less able to handle the transition to home life. If you can adjust your sleep schedule already while on vacation, you’ll make the transition easier for yourself. There even are apps to help you adjust to your specific time difference (for example time shifter and jet lag rooster).

2.       Stick to your healthy habits while on vacation
It might be tempting to stop your workout routine, eat everything you want and end each day with a couple of sundowners during your vacation, but you’re actually doing yourself favor by minding your health on vacation as well. Exercise helps to reduce stress and release endorphins. Going for healthy food options and having a couple of alcohol-free days will prevent unnecessary weight gain and  fatigue.

3.       Schedule your return trip a couple of days ahead to acclimatize
When planning your vacation, you might feel like you want to use every minute of your time. But since getting back into your normal routine can be quite stressful, it helps to give yourself a couple of days before returning to work or school.

4.       Practicing gratitude: actively enjoy the memories you made
Some people say: buy experiences, not souvenirs. Some people use their vacation to do things they usually don’t do. These experiences and the memories usually last longer than the average souvenir from the gift shop. You can print some of the photographs you have taken and hang them at home or at work, so that you get reminded from time to time.

5.       Implement something from your vacation into your daily life
With these experiences, such as activities, sports, food or rituals, you have a chance to incorporate something from your vacation into your daily life. While on vacation, try to be mindful of the things you find pleasant and think of ways how to bring a bit of that pleasantness to your normal life.

6.       Know what to expect when you return
For many people, part of the discomfort of returning to work is the stress that comes back after being away. Help yourself adjust to your work by scheduling ‘admin-time’ the first hours upon returning, so you can catch up on your e-mails. Another option is to call or e-mail a colleague before returning to work, so that you’re informed on the important developments at the office.



Befriending the Dutch

When moving countries, one of the most important (but also trickiest) aspects of feeling a sense of home is creating a social circle. For most people, having friends and sharing experiences is a very important part of life. Unfortunately, the Dutch are not well known for their openness to new friendships.

In fact, according to research the Netherlands is one of the most difficult countries in the world to make friends. This is apparent from a large international survey among expats. Of the 68 countries included in the survey, the Netherlands is in 56th place when it comes to 'finding friends'. That is striking, since the the country is doing better in other areas such as quality of life, leisure and travel.

On average, the Netherlands is in 16th place in the list of 'best countries for expats'. This is mainly due to a good score for our quality of life, the work that can be found here and the ease of living with children.

The best country for expats is oil state Bahrain. An Indian expat says in the research: "I don't feel like an expat here. I feel at home here." 53 percent of all residents of Bahrain come from abroad, which probably contributes to the pleasant business climate. The worst performing country this year is Kuwait, where expats report unpleasant experience in almost all areas of living.

The survey, the 'Expat Insider', is held every year among thousands of expats. In the last survey (2018), Sweden is one of the big droppers. The country plunges 24 places in the list. "It is very difficult for non-Swedes to fit in. They are not as social here as in other countries, and less inclined to connect to people they don't know well," one writes.

Chances are that this is also the reason that expats find it hard to befriend Dutch people as well. The Dutch culture resembles that of Scandinavian countries in certain respects.

Source :



4 tips for intercultural relationships

Any relationship takes work, but when you are merging two cultures, navigating new customs and norms, all while trying to stay connected and in love with your partner, the stress can be daunting. But the trick here is to pinpoint and remember just exactly what each of you need and want from one another. In an intercultural relationship, you are bound to meet a few of these challenges, but if you keep your head up and face them as a couple, you can avoid creating a barrier between you and your love.

1. Norms – Remember that dating and relationship norms differ

Different cultures can mean completely different dating and relationship habits. This can range from casual dating and multiple sex-partners, to chaperoned dates and arranged marriages. And of course, these habits are bound to clash when you have an intercultural relationship. While one partner could be used to dating a different person each month, the other partner could have never experienced a relationship more serious than a middle school romance, and could quite possibly still be a virgin. These differing habits can lead to pressure very early in the relationship. To avoid a lot of stress early on, be honest with each other. As a couple, you need to carve out what works for both of you, and what doesn’t. The sooner you tackle the basic dating and relationship sphere that you will be working within, the better!

2. Family and friends – Doubts and expectations

The doubts and expectations of your partner’s family and friends,  as well as your own, can weigh heavily on your relationship. Outside influence impacts all relationships, but it can be particularly overwhelming when you’re trying to merge two cultures. The diversity of values, priorities and attitudes can cause additional stress as you try to maneuver around doubts and expectations. The doubts can start flooding in very early in a relationship when your family and friends reveal their first impressions. They may announce the eminent failure of your love, or rave about how cute your mixed babies will be.

They may even drop suggestions such as, “As long as you are happy”, and then further down the road, “Are you sure this is what you want?” And all this may lead to an information overload that will end with you questioning different parts of your own relationship.
To make it harder, there are also family expectations, such as whether both of you plan to get married or not, and if so, in which country? How many children will you have? Will you live abroad? What side of the family will you live closest to?

In order to steer clear of any major disagreements with your partner’s family and friends, and with your own, learn to communicate quickly. Of course, if you’re truly happy, and if your family and friends are genuinely supportive, they will recognize that you are just fine with your mix of cultures, and should let you go on your way.

3.  Balance – Perfecting the balance of each other’s food and traditions

This seems like a superficial stress but you will encounter completely different traditions, especially when it comes to food. Food fuels us, and each culture has perfected their own balance of flavors, aromas and textures. You might be faced with particularly potent dishes, or extremely spicy sauces. But whatever your preference, and level of adventurism, you need to connect with your partner (and their family) over food. You try theirs, and they try yours.

While you’re trying a few new dishes, why not check out the arts scene, listen to a new artist, and try to learn a traditional dance? Not only does it show interest and commitment, you also get to learn some neat and unique stuff, and make your partner feel special for being the one to show you!


4.  The future – planning for the years ahead

What comes next? Most couples fear this question but as an intercultural couple, you have a few additional things to think about. The cultural expectations and doubts of family and friends, who hold varying opinions of your love, could impact the discussions and decisions about your future. You will have to face particularly difficult choices such as where to live, how to communicate all of your goals and dreams to each other and your families, and how to plan basic necessities such as careers and money. Money is approached in different ways in many cultural circumstances. As for careers in different cultures, there are a variety of expectations for each partner. This can easily place pressure on your relationship and your future together if you’re not working as a team. You should prioritize your goals and dreams as individuals, and as a couple, and strive to meet them together.

The most important piece of advice for intercultural relationships

The bottom line in any relationship is that you will face obstacles, whether from external or personal pressures. Yet, when you are navigating through two completely different cultures, the challenges can often be harder to understand, and seem near impossible to overcome.
But, before you become overwhelmed by it all, be truly honest about what each person needs and wants from the beginning. If you can, you will be able to build a relationship that is especially your own, each need and want determined by your partnership, regardless of any additional pressures. You can stumble through the cultural differences together, and strengthen your relationship along the way!


Original article :



Mindfulness course starting September 17: limited spots available

We live in an incredibly busy world. The pace of life for most people is frantic, keeping up with work, social life, health and family – and at the same time keeping track of everything that happens in our digital world. Our brain is doing overtime to keep up with all these developments, not getting any rest until we crash into our cushion late at night. And even then, most of us have a hard time falling asleep because we still need to process all the things we were exposed to during the day.

So ask yourself this: when was the last time you did nothing? And by nothing, I mean: no-thing. No TV, no book, no phone. No eating or drinking. No worrying, reminiscing about the past or making plans for the future. Simply doing nothing. Just 10 minutes of giving that busy mind of yours a break.

If you are like most people, you have to think really hard and even then probably cannot remember 10 minutes of doing nothing. How amazing is that: our mind, which is such an important instrument and that we rely on to make important decisions, never gets a break. After an intensive workout routine we take care of our body: we make sure to stretch, have a healthy meal and go easy on ourselves the next day. But the mind has to perform top-level, every day.

Do you want to learn how to take care of your mind, and therefore yourself, properly? Learn what it means to do nothing: to be mindful of whatever comes into your awareness, look at yourself from a distance and letting go? Then improving your mindfulness-skills might work for you.

Kühler & Trooster is organizing an 8-week mindfulness group course starting September 17. In 8 weeks you will learn how to focus on the present and notice signs of stress earlier. As a result, you will be better able to deal with negative thoughts and emotions, you will be able to focus better and relax more easily. The mind becomes calmer. There is a higher level of awareness and you can better guard your boundaries.  

For more information and registration, please contact us at or 085-0660500



Vacature Office Manager Amsterdam

Kühler en Trooster International Mental Health is een jonge organisatie op het gebied van kleinschalige en persoonlijke specialistische geestelijke gezondheidszorg aan de expat doelgroep in Nederland. Onze cliënten worden behandeld vanuit onze mooie locaties in Amsterdam en Den Haag, Wij bieden op maat gesneden behandelingen, sterk gericht op kwaliteit van leven en doen dit vanuit onze kernwaarden: liefdevol, gedreven en vrij. Wij werken binnen een internationaal team van psychiaters en psychologen met een duidelijke groeiambitie.                                                                                   

Voor onze locatie in Amsterdam zijn wij op zoek naar een:

                                                               Office manager (32 uur)

Over de functie

In deze service- en klantgerichte functie ben je het visitekaartje van de organisatie en tevens de spin in het web. Je bent verantwoordelijk voor de volgende werkzaamheden:

·         Het inplannen van intakes

·         Het beantwoorden van mail en telefoontjes van cliënten en verwijzers

·         Het aanmaken van patiëntendossiers

·         Ontvangen en verwelkomen van cliënten

·         Ondersteunen van behandelaren in administratieve taken/agendabeheer

·         Facilitaire zaken op de locatie(s)

·         Ondersteunen in projecten van de manager bedrijfsvoering

Jouw talenten

Je bent een proactieve, enthousiaste en gedreven doener. Je houdt van aanpakken en staat voor kwaliteit. Je kunt een breed scala van werkzaamheden overzien, neemt je verantwoordelijkheid en werkt accuraat. Je bent toegewijd, flexibel, representatief, stressbestendig  en sterk communicatief vaardig. Naast een afgeronde HBO opleiding beschik je over een uitstekende beheersing van de Nederlandse en Engelse taal, zowel mondeling als schriftelijk. Het werken met office (word, Excel, outlook) kent voor jou geen geheimen en bij voorkeur ben je bekend met Elektronisch Patiënten Dossier software.

Wat wij bieden

Een afwisselende, uitdagende en verantwoordelijke baan binnen een team dat zich kenmerkt door enthousiasme, bevlogenheid en gedrevenheid. Bij deze veelzijdige functie hoort uiteraard een marktconform salaris volgens cao GGZ (functieschaal 35). Wil jij graag werken in een organisatie die volop in beweging is en waarin je een verschil kunt maken, dan nodigen wij je uit te reageren. Graag ontvangen wij je CV en korte motivatiebrief per e-mail: Voor nadere informatie kan je telefonisch contact opnemen met Tjarda Grimbergen (Manager bedrijfsvoering), 06-25159911.




Intercultural communication: the language of love?

Nowadays, the world is more accessible than ever. Endless opportunities for travel, study or work make us feel like we literally have the world at our feet. Lots of people take the opportunity and jump into an adventure abroad. So it’s no surprise that the number of intercultural relationships has risen over the years.

Intercultural relationships face highs and lows of their own, in addition to the usual challenges any couple faces. A big challenge is a difference in communication. Even though intercultural relationships don’t always mean different languages, they very well can. Communicating with someone of another native language can be challenging. Firstly, there is the verbal content of communication. Within different languages, sometimes translations don’t match the meaning or energy behind a word. But different cultures also use non-verbal clues, emotions and body language in different ways in their communication.

A very important error that is frequently made in intercultural communication is forgetting that when you translate a word from your own language to another, it can have a different meaning. Once you make the mistake of not translating well, not just the word itself but the entire energy behind them changes. A word that is neutral in one language, might have a negative undertone in another language. This can lead to an attribution error: you put a negative association to the personality of the person saying the word(s), whereas in fact it’s just a communication mistake.

Some communication styles differ per culture, and they can stem from deep values within a culture. It‘s important to know your own values and those of your partner, and where they come from, to understand why you speak and act the way you do. Once you're conscious of these things it's easier to be flexible about them, in order to deal with conflict.

Aside from differences, there are also some emotions universally recognized in every culture: anger, fear, happiness, sadness, disgust and surprise. Every culture and every language is different, with many aspects that can be perceived as positive and negative – depending who looks at it. That’s why it’s important to avoid the idea that your culture is superior to your partner’s. Always keep in the back of your mind how your communication style can be perceived. Think about your choice of words and gestures and try to avoid slang and expressions, which get lost in translation.

Some personal qualities make for more successful intercultural communication:

Patience : give your partner the time to explain what he/she means, when a communication error arises.

Tolerance : the better you can handle any frustration without verbalizing, the better chances that a miscommunication won’t lead to an argument but that you can talk openly about your differences.

Objectivity : the more you can see your situation and communication from a distance, the better you can also notice your own difficulties in expressing yourself.

Empathy : if your communication hurts or affects your partner – intentional or unintentional- be mindful of their feelings and acknowledge how they feel.

Respect : respect both cultures and both languages, as each has its good and bad sides and are equally worthy.



Expats: building a social life

Having been an expat myself, the biggest challenge I can remember is setting up a social life away from home. When I had just arrived in India, I was struck by the fact that really everything seemed different than back home: the cars, the streets, the buildings - nothing looked even remotely like the Netherlands. Yet the biggest obstacle was the fact that the people were different. My trusted Dutch friends and my family members were missing in my new life.

Determined as I was to gather new friends around me as quickly as possible, I decided to socialize fanatically: I went to every party I could find, joined several expats meetups and attended every ‘expat ladies coffee mornings’. Immediately upon entering an event I scanned the room: is there a friendly face somewhere? Which ladies and gentlemen would be potential friends, perhaps have the same interests as me? On top of that there was always the pressing question: how long will this person stay in India before he or she is transferred to the next destination?

For many expats this is recognizable: when you start to build up your life in a new country, new friends are also part of it. The first period abroad can be a lonely time due to the lack of friends and family. These feelings of loneliness make you more vulnerable and more insecure when approaching other people. Asking someone to have lunch together can therefore feel as if you are entering the dating market and you are asking a potential lover on a first date.

Social contacts and building a network can make an important contribution to a pleasant time abroad. But how do you do this?

1. Don't think, just do it!
Because you may feel vulnerable when you first talk to a stranger, you may have a tendency to think a lot about yourself, what you’ll say and how you come across. This makes it more difficult to have a relaxed conversation and can even prevent you from going to meetings in the first place. Therefore, try to be aware of the fact that you may be nervous and insecure, but don't let it stop you from talking to that friendly-looking person.
(If you are experiencing a lot of anxiety in social settings, please read our next blog to see if you match the criteria for a social anxiety disorder.)

2. Be active
Instead of meeting up with potential new friends for a cup of coffee, you could also get together for an activity. This eases the pressure to fill the time talking. Explore your new hometown together, take up a language course, engaging in sports or do something together with the children. In this way you get to know each other in a more relaxed way. By undertaking activities in a group you get to know more people in an easily accessible way. For example, you can become a member of a sports club, artistic or excursion group or other expat networks in your host country.

3. Be open, but critical
Many expat communities are close social structures. Expats are often dependent on each other, certainly in countries where there is a big cultural difference with the host country or – like in the Netherlands- the locals aren’t very open to starting new friendships. Therefore, try to be open to others, but also be aware of your preferences: you don't have to become friends and meet up with everyone. Stay in touch with your feelings and put your energy into people and friendships that make you feel good.



7 things you need to know about mindfulness

1.      Mindfulness is not obscure or exotic. 
Even though mindfulness sometimes has a reputation of being either very up in the coulds-y or the new hipster trend, it’s actually very down to earth and has been with us for ages. When reading a clear definition (see our last blog), you might realize how simple it really is. It’s familiar to us because it’s what we already do, how we already are. It takes many shapes and goes by many names, but what it comes down to is: we are already here, but we need to be present in order to be mindful.

2.      Mindfulness is not a special added thing we do. 
We already have the capacity to be present and it doesn’t require us to change who we are. But we can shape and improve these innate qualities with simple, scientifically proved practices to benefit ourselves, our loved ones, our friends, the people we work with and the institutions we take part in.

3.      You don’t need to change. 
Solutions that ask us to change who we are have failed us over and over again. Mindfulness recognizes and cultivates the best of who we are as human beings.

4.      Anyone can do it. 
Mindfulness practice is available to anyone and does not require you to change your beliefs. Everyone can benefit and it’s easy to learn.

5.      It’s a way of living.  
Mindfulness is more than just a practice. It brings awareness and caring into everything we do and it cuts down needless stress. Even a little bit of mindfulness can make our lives better.

6.      It’s evidence-based. 
Various evidence-based studies have demonstrated the positive benefits of mindfulness to our health, happiness, work and relationships.

7.      It sparks innovation. 
As we try to deal with our world’s increasing complexity and uncertainty, mindfulness can lead us to effective, resilient and low-cost responses to problems that seem too hard to handle.


Kühler & Trooster will organize a new mindfulness group course, starting September 17 2019. More information about the course can be found here.



Mindfulness: new course coming up September 2019

Last month Kühler & Trooster’s first mindfulness training finished. During 8 weeks, the participants of the course learned the practical skills of mindfulness. But what exactly is mindfulness and how did the course help them?


What is mindfulness?
Even though mindfulness is a pretty straightforward word, there are plenty of definitions and assumptions going around. Should your mind be blank, or focus on one specific thing? The word ‘mind-ful’ suggests that the mind is fully attending to whatever is happening, to what you’re doing, to the space you’re moving through. That might sound easy, but often our mind takes flight: we lose touch with our body and pretty soon we’re stuck in obsessive thoughts about something that just happened or worrying about the future. And that makes us anxious.

Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us. (


What did participants of the mindfulness course learn?
The participants learned how to focus on the here-and-now and cope with negative thoughts and emotions that might arise. Through different exercises, both meditation and elements of CBT, they learned how to deal with stress. By practicing and sharing as a group as well as daily practice at home, the participants were able to be present and aware, without feeling overwhelmed. One participant described the benefit of the course as follows: ‘ (I learned to) get distance from stimuli, thoughts, so I can see them for what they are instead of being dragged unwillingly into immediate reactions/reactive behaviors. This helps me remain calm, be less anxious and be caring for myself and others.’ Another participant shared that being in a safe, nurturing environment and learning simple and useful tools helps him to integrate the practice of mindfulness into his daily life.


Practical information
Kühler & Trooster will organize a new mindfulness group course, starting September 17 2019. The course will take up 8 sessions in September, October and November (no sessions during school holidays), Tuesdays 5:00-7:00 PM. Location is Koningslaan 35 in Amsterdam.


More information about the course can be found here. To sign up, please send an e-mail to: or call 085-0660500.



Hello, goodbye: expat friendships

Why, why, why, why, why, why, do you
Say "Goodbye, goodbye, bye, bye".
Oh no.
You say "Goodbye" and I say "Hello, hello, hello".
I don't know why you say "Goodbye", I say "Hello, hello, hello".
I don't know why you say "Goodbye", I say "Hello".


For most expats, setting up a social life is an important part of feeling more at home. But at the same time there is a lot of turmoil in expat friendships, with a constant stream of hello’s and goodbye’s due to the nomadic expat lifestyle. It seems to be inherent to life as an expat: you meet lots of new people, but at the same time you are always saying goodbye to friends who are leaving.

Building a social network is not easy, but when you do have a click with someone you share something special together. You are in the same boat: the same foreign country, the same adjustment problems, the same journey of finding your way and new routine (shopping, sports, leisure). But finding the right people can be challenging. Who can I call when I’m down, to drink coffee with and poor my heart out? Who can I ask if I am bored and want to do something fun? With whom can we organize family holidays?

This ever going cycle of building a social network and saying goodbye sooner rather than later is experienced twice in expat families with children. Because not only do you as parents have to say goodbye to your friends, your kids will miss their friends as well. How can you deal with your own feelings of loss when you have to say goodbye? And how do you guide your kids get through the pain of saying goodbye?

1. Allow yourself the feeling of missing
The process of saying goodbye often starts long before the moment of actually saying goodbye. This is part of the process. Do not put these feelings away, but acknowledge and accept that you are preparing for the moment of saying goodbye. Also discuss this with your child: he or she may feel sad about the approaching farewell.

2. What will you miss?
It is often difficult and painful to think about what you are going to miss about the other person. Yet these feelings and thoughts are also real and it is important to reflect on this, also in conversation with your children. What was so nice about this person? What did you share? Knowing what you will miss can help you prepare for the actual miss.

3. Plan a happy farewell
Saying goodbye is not a happy activity, but you could alleviate the goodbye by doing something together that you both enjoy. Did you used to eat out together, or did you practice a sport together? Then let that be a nice ending. Did your child always play a certain game together with a friend? Then let them play that on their last play date.

4. Staying in touch

Perhaps there is a desire to stay in touch in the future. This feeling can become very strong, certainly when the approaching farewell comes closer. Yet it is important to be realistic about how and how intensively you want to keep in touch and to manage expectations, especially with kids. It’s important not to promise anything that you cannot fulfill and to set realistic goals about how to stay in touch.



Does the sun improve your mental health?

Hooray, the sun is finally out! I can’t count the number of times I have heard this phrase – or a variation of it- in the last few days. Even though the weather in the Netherlands can be erratic, this year it has been a long wait for some good sunny weather. Now that the sun is out, the people I see on the street and the friends I meet generally seem happier. But is it really that simple and is the sun our magic medicine for a better mental health?

First of all, let’s look at the benefits of light –both natural and artificial- in general. Research has shown that being exposed to more light during the daytime and less light during nighttime helps our internal clock to regulate our sleep wake rhythm. Especially expose to light in the morning is beneficial to your health, since it improves your mood, alertness and metabolism.

But is there an exclusive benefit to sunlight? According to numerous studies, the appropriate level of vitamin D is a key factor in helping prevent and alleviate depressive symptoms. Even as little as 10-15 minutes of sun exposure per day can give you these positive effects. Sunlight also causes the release of serotonin, a neurotransmitter directly linked with mood and energy. Additionally, UVA rays generate nitric oxide in your skin, increasing blood flow and therefore energy is better absorbed. A helpful side effect here is that better blood flow causes lower blood pressure, which can be linked to reduced stress.

With the change of seasons and longer days, there is a much better chance that we get our necessary dose of sunshine. These are important findings, because they place a component of mental wellness into our own control. We recognize the importance of taking a break from our day to enjoy a walk outside, which benefits both our physical and mental state.  

Researchers believe that the healing, mood-enhancing capabilities of the sun are limited, but can help in the right circumstances. So even though the sun definitely has a positive effect on our mental health, it doesn’t mean that psychological problems can be solved by catching rays.

Source :,



What is a post-traumatic stress disorder?

Living in an unstable country, with risks of violent attacks or natural disasters, can create a sense of unsafety and can lead to anxiety complaints. When you are personally exposed to a seriously stressful situation you may suffer from post-traumatic stress. This can happen when you are exposed to a life-threatening situation, serious physical injury or a threat to your physical integrity. But a post-traumatic stress disorder (PTSD) can also develop from traumatic experiences outside of war zones, such as physical or sexual abuse, being bullied during childhood or being in a car accident.

Symptoms of PTSD include vivid memories of the event (flashbacks), sleeping problems and nightmares, irritability, problems with concentration and feeling startled easily. Often symptoms of depression (low mood, loss of appetite and social withdrawal) also occur. A diagnosis of PTSD can be set when the symptoms last for 1 month or longer. Most people with PTSD have a series of avoidance behaviors to help them cope with these symptoms (for example, avoiding certain situations that resemble the traumatic event, or avoidance of thinking about the event). Avoidance can also occur through substance abuse, such as drinking or smoking weed to not think of the event and to feel calmer.

Even though most people experience some of these symptoms directly after a traumatic event, not everyone who goes through trauma actually gets PTSD. It is thought that a combination of a traumatic event, inherited mental health risks, your temperament and the way your brain regulates hormones and reacts to stress determines if you actually get PTSD. Also, there are some factors that increase the risk of getting PTSD:

·         Intensity and duration of the trauma

·         Having gone through previous trauma (for example childhood abuse)

·         Having other mental health problems or substance abuse

·         Lacking a good support system

Getting timely support may prevent normal stress reactions from getting worse and developing into PTSD. This may mean turning to family and friends who will listen and offer comfort. They also may help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs. Support could also mean seeking out a mental health professional for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

Do you recognize the symptoms in yourself? Please contact us to see how we can help.




No safe place

While most of us were spending a sunny Easter weekend enjoying long brunches and having an Easter egg hunt, the world was shocked by yet another terrorist attack, this time in Sri Lanka. Having lived in South Asia for a few years, I was shocked to learn that one of the targets was a hotel that I actually stayed at during Easter holidays two years ago. Furthermore: having lived in the region for a while, I immediately could think of five people I know that were actually at the scene when the attack happened. 

The bombing of churches in New Zealand earlier this year, trucks driving into a boulevard in Nice and a Christmas market in Berlin, a shooting in a tram in Utrecht: if you follow the news, it seems that there is no place in the world where you can live safely anymore.  In recent years, it seems like ‘war’ and ‘terrorism’ isn’t something that only happens far away in unstable areas of the world. As a matter of fact, those places that deemed stable and safe seem to be the main targets for attacks nowadays.

You could spend hours every day watching, reading and listening to news related to these events. This level of exposure can significantly influence your worldviews and how you live your life. The aftermath of events like these can make people feel more vulnerable. And as cities go on alert because of the threat of future attacks, fear can color our daily routines and world views.

It is probably not a surprise that a terror attack can have a major impact on people’s mental health. But what sort of effects are common, and how long do they last?

Studies have shown that after a terrorist attack, psychological effects (such as post-traumatic stress disorder) are not only seen in victims and their families, but also in people that are living in a city when it’s attacked. For instance, a survey of Madrid residents one to three months after the attacks on a commuter rail line in 2004 found an increase in post-traumatic stress disorder and depression.

In a 2005 study of London residents conducted a few weeks after the 7/7 attacks, 31% of respondents reported a significant elevation in stress levels and 32% reported an intention to travel less. A follow-up study conducted seven months later found that the elevated stress levels were significantly reduced. But, the study also noted that a residual level of worry remained. Many people reported relatively high levels of perceived threat to self and others, and a more negative world view.

We would expect to see an increase in psychiatric disorders among people who were directly affected, or who lived in the city at the time of the attack. But this can also happen in people who weren’t living in a city when it was attacked. A survey conducted soon after the September 11 attacks found that 17% of the US population living outside of New York City reported symptoms related to post-traumatic stress disorder. Six months later, that had dropped to 5.6%

2005 review of psychological research about the effect of September 11 highlighted the uptick in psychiatric symptoms and disorders immediately after the attacks and the relatively quick normalization in the following 6-12 months. However, people living closer to the area attacked, and thus more directly exposed, were more vulnerable to developing post-traumatic stress disorder, than people living further away.

Why do symptoms of post-traumatic stress disorder increase in people who weren’t directly exposed? The explanation might be the intense media coverage of terror attacks. In the aftermath of September 11, a US study of more than 2,000 adults found that more time spent watching television coverage of the attacks was associated with elevated rates of post-traumatic stress disorder. In essence, a media-related contagion effect is created where people live and relive the attacks when they watch or read stories about them. This overexposure may, as argued by some, produce a subjective response of fear and helplessness about the threat of future attacks in a minority of adults.

Fear is a natural response to events like the attacks in Paris or New York. While everyone feels and reacts to fear differently, it can push people to make different decisions about employment, whom to socialize with, using public transportation such as buses and trains, congregating in public and crowded places, and traveling on airplanes.

Do you notice an increase in anxiety or stress after watching the news, or do you want to know more about PTSD? Read our next blog.




From tourist to global citizen: what kind of expat are you?

People who choose to start up their life in another country come in all shapes and sizes, and relate to their home and adopted countries in different ways. Some of them call their parents every day and connect to friends from home for daily chitchats, and others living abroad only send a message when they need help with taxes or cooking. And we've likely all run across those who have two (or three) world clocks on their phones, or those who couldn't care what time of day it is back home (or anywhere else for that matter).

It has long been recognized that different expats have different needs when it comes to integration in their adopted country and staying in touch with family and friends back home. As an expat you can see for yourself: what kind of expat are you? 

The Master Planner
We all know the type: organized, well prepared, maybe a tad compulsive. Master Planners see the world as their home – and need every detail of it in place. In the same way they plan out every trip, they also plan their life abroad thoroughly. Before moving countries, the Master Planner will have read up on the history of his new country, has a detailed knowledge of social norms and knows the fastest way to the nearest Starbucks in his new hometown.

The Lifer
The Lifer isn't really an expat. Not anymore. She’s gone native, is fully integrated in her new environment and is happy to never go ‘home’ again. Home? This is home! The downside of course is that, with friends and family still far away, there can be a struggle with expectations from family and friends.

The Tourist
The Tourist may be living abroad, but she’s not planning on staying forever. Her current home will always be a foreign country. You can spot The Tourist by the way she is always converting currencies and comparing habits and prices with those from back home.

The Free Spirit
The Free Spirit hasn't really decided why he’s in a new country, or how long he’s staying. It’s all about exploring, wandering and enjoying life - no strings attached. He might be a progressive parent, a happy-go-lucky student, or simply an eternal optimist always in search of new adventures.

The Global Citizen
The Global Citizen is constantly on the go, but not necessarily for business – mostly just because. Global Citizens love eating breakfast in one place and having dinner in another, and dashing from one activity – and country – to the next. They enjoy being on the move, diving in novelty. With contacts all over the world and a life full of fun, they are all about smooth transitions.

Original article:



Tips for raising Third Culture Kids

If you are moving countries with your family, it’s important to think about what your children need for a smooth transition. Whether your child is an easy-adapting Third Culture Kid or has a bit more difficulty with the transition, fact remains that you as parents play a significant role in managing the transition for your child. Here are some tips on how you can help your TCK during the transition phase:

  • Read young children stories about emigration or about their new country. Let your adolescent read books or watch documentaries on these subjects. Some book tips for TCK’s to read:
                                  - Pixies new home (for young children)
                                  - Slurping soup and other confusions (4-12 years old)
                                  - Expat teens talk (teenagers)

  • Make a treasury box with your child’s favorite things and give it a prominent place in your new home.

  • Keep communicating with your child, don’t judge and listen carefully. All children have to go through the process of saying goodbye to their old home and get used to their new environment. Younger children often express themselves indirectly, for example through play or creativity. For adolescents it is important to genuinely listen to your children and refrain from giving clear-cut and practical solutions to their emotional problems.

  • Let your children play an active part in making plans for the new country and let them have a sense of autonomy, within boundaries. Discuss with your family what sort of hobbies they’d like to engage in, how they would like to see their room and what sort of family activities you can do.

On a final note: whatever culture your child grows up in or identifies with, being a Third Culture Kid will probably make your child identify most with other Third Culture Kids. Even though having multiple homes can feel enriching, it can also make your child feel lost whenever you return to your ‘home country’. After all: your home is not their home. Unless you’ve been a TCK yourself, it is very difficult to grasp this feeling of non-belonging. Acknowledging your child’s feelings and communicating about them is a very important part of being an expat-parent.

Raising a Third Culture Kid can be very demanding for parents as well. The stress of building a life both for yourself and your kids and getting the help you need can lead to anxiety, feelings of depression and other complaints. Are struggling with parenting a Third Culture Kid and looking for psychological support? Feel free to contact us.




Benefits and challenges of growing up abroad

Growing up in a foreign country (or countries) can have a positive effect on a child’s personal and cognitive development. TCK’s are thought to have specific qualities and skills due to their upbringing, for example increased tolerance for other cultures, high interpersonal sensitivity, good adjustment skills and increased cultural intelligence. On average, Third Culture Kids have a higher education than non-TCK’s, are less likely to get divorced and are linguistically more adept. Most Third Culture Kids learn to live comfortably in their world and can adapt and adjust easily from one situation to the next, growing up to be open-minded and culturally sensitive adults.

Third Culture Kids also face some challenges growing up in their neither/nor world. They can experience confusion with politics, patriotism and values. This is especially the case when moving from collectivist to individualist cultures, or vice versa, as the values within each culture are different from the other. Secondly, there is a need for special attention of young TCK’s in educational settings to make sure they are supported when and if entering a new school. TCK’s can also face difficulties with adjusting to adult life: the mixture of influences from the various cultures can create challenges in developing an identity as well as with a sense of belonging. Feelings of rootlessness and restlessness can make the transition to adulthood a challenging period for TCK’s.

Another area of life that is greatly affected by a TCK-experience is forming relationships. On the one hand, being in an ever-changing social environment with friends coming and going makes TCK’s very sociable and they tend to make friends easily. On the other hand, the cycles of frequent goodbyes can lead Third Culture Kids to develop patterns of self-protection against further pain of separation, which can also affect relationships later in their lives.

In a 1986 survey of 300 Adult Third Culture Kids, 40 percent of the respondents said they struggled with a fear of intimacy because of the fear of loss. Although this means that the majority of TCK’s will be able to form safely attached relationships, here are some signals for a protective response:

Refusing to care.
Some people try to limit vulnerability by not forming friendships and rather staying ‘independent’.

Quick release.
This is a form of ‘leaning away’ when a possible (temporary) separation is expected. When friends are planning to move, this quick release response means that people tend to already let each other go: stop meeting, stop calling and terminating friendships in order to prevent the upcoming pain of separation. Adult TCK’s sometimes notice that they get in arguments with their spouses much more easily on nights before upcoming business trips – an unconscious attempt to protect against loss.

Emotional flattening.
Refusing to feel the pain is also a common response to avoid the pain of separation. The flat feeling – neither joy nor pain-  often feels safer that the pain of missing someone.

Source: Third Culture Kids, Growing Up Among Worlds (Pollock & Van Reken, 1999)



Growing up abroad: Third Culture Kids

“Children adapt so easily, don’t they?” Whenever I overhear a conversation between expats in discussing the challenges of moving abroad, there always seems to be one thing more important than their own wellbeing: the happiness of their children. Smoothening the transition for their children is the first priority for most expat parents. But even though it’s true that children can adapt easily to a new environment, it doesn’t always mean that they do.

Children that are raised in a different country than their home country, or in a culture outside of their parents’ culture, are called Third Culture Kids (TCK’s). Growing up in a foreign country means these children are not being brought up in their own culture, but also don’t fully adapt to the host country’s culture.

Instead, they are being brought up in a neither/nor world: it is neither fully the world of their parent’s culture, nor fully the world of the other culture. In this neither/nor world, TCK’s develop a third culture, which is a blend of the parent’s culture and the culture of the country or countries they grow up in.



You know you’re a Third Culture Kid when...

- “Where are you from?” has more than one reasonable answer.
- You flew before you could walk.
- You speak two languages, but can’t spell in either.
- You feel odd being in the ethnic majority.
- You go into culture shock upon returning to your “home” country.
- You can curse convincingly in five different languages
- You think VISA is a document that’s stamped in your passport, not a plastic card you carry in your wallet.

Did you grow up as a Third Culture Kid, or raising kids abroad? Watch out for our next blogs for more information on challenges of growing up abroad and tips for parents of TCK’s.



Trouble in paradise: expats and addiction

The cliché image of life as an expat might sound appealing to a lot of people, but there is a less positive reality behind it. Although some expats do indeed enjoy an exciting life in a new part of the world with lots of social activities, dinners and parties, there are also expats who can’t control their alcohol or drug intake and, after some time, become dependent on them.

What are possible high-risk situations and circumstances that increase the use of alcohol and drugs?


1. Being an expat itself forms a risk
Although living abroad can be an exciting and fun time, it is often also a period of stress. Leaving your old life, friends and family behind can be a great source of tension. Moving abroad can also lead to changes in your relationship and family dynamics. Alcohol then seems to be a means that gives (temporary) relief to this stress, but in the long term it causes more misery.

2. Work pressure
If you have moved abroad for work, the first period will probably be characterized by a high workload: a new job, new colleagues and high expectations. This work pressure, possibly accompanied by the pressure to build a new social network, can lead to more frequent drinking and the use of alcohol and drugs to release some tension.

3. Law and availability
The Netherlands – and Amsterdam in particular- is known for its liberal drug policy (“gedoogbeleid”). This means that the use of soft drugs is socially acceptable and there is a widespread availability. This lowers the threshold to start and continue the use of soft drugs. In addition, Amsterdam has a blossoming nightlife and festival scene where drugs might be illegal, but definitely present and accessible. 

4. An expat partner’s risk
If you have moved abroad because of your partner's work, you may have had to give up your own job. This loss of work, and with it a part of your identity, can cause feelings of sadness, anger and fear. At the same time, a lack of structure in your days may lead to frustration and boredom. To channel these feelings, some people use alcohol to relieve tension and temporarily feel better.

Are you dissatisfied with your alcohol or drug use or do you want to know more about what you can do about addiction? Contact your General Practitioner if you think professional help is needed.



How can I Handle stress?

As explained before, stress is a normal part of life: your body is preparing for a challenge by increasing heart rate and blood flow so that you are ready to perform. These physical reactions are a healthy reaction to your mental preparation for an exciting event: a job interview, performance test or presentation are all events that cause stress for a lot of people.

But what if these mental and physical stress reactions don’t fade over time? Or if there simply are too many things to be stressed about? Longer periods of stress can have negative consequences on both your physical and mental health.

How can you take care of yourself in times of stress?

·  First, make sure you have a good daily structure and rhythm. Go to bed on time and wake up around the same time every morning. Getting enough sleep will help you handle your problems better.

·  Take good care of yourself by eating healthy and limiting alcohol and caffeine intake. The use of alcohol might feel like a relief of stress at first, but in the long term will have a negative effect on stress. Same goes for caffeine: it might feel like your energy increases in short term, but it also has a negative effect on stress and sleep.

·  Get moving! Exercise is a good way to release stress. Find a way of exercise that works for you, such as running, swimming or yoga. Try to make this activity just for you, so make sure you reserve enough time.

·  Get a good overview of your situation by writing down what troubles you. What are in fact the problems that are causing stress? Which ones can you solve yourself and how? For what problems do you need help (practical help or support from friends and family)?

Sometimes problems aren’t easily solved. That’s why it’s important to manage your stress levels even if the stressors are still present in your life. The answer? Relaxation. By relaxing you are helping your body to temporarily stop its stress reaction. Relaxation helps your body to recover. It’s important to build in moments of relaxation on a daily basis, where you give yourself a break from your problems and daily tasks. One way of finding out what relaxes you is the following:

Keep track of your activities throughout the week and make a list: what activities have a positive or relaxing effect and what activities actually increase stress? And do you remember things you used to do for fun, that you don’t do anymore? Make a list of all the possible ways for you to relax and start implementing them into your schedule. Try to make sure there is a good balance between the stressful activities (work, daily tasks, dealing with problems) and relaxing activities.