The trauma nobody moved here to treat
A significant proportion of the expatriates I work with in Thailand are carrying something from long before Thailand.
A childhood. A marriage that ended badly. A bereavement that was never grieved. A career that collapsed. Something that happened once, was never spoken about, and has been quietly organising the shape of a life ever since.
They did not come here for that. They came for work, or for a fresh start, or because the previous arrangement had stopped working. And for a while the move helped, often considerably.
Why leaving works, and why it stops
Leaving a country removes the reminders. The streets, the associations, the people, the routines that carried the material. That is a genuine reduction in daily load and the relief is not imaginary.
But nothing has been processed. The memory is not integrated; it is simply not being triggered as often.
That works well enough, for long enough, that almost nobody connects the two. Which is why the pattern I see so often is a man who has been in Thailand for five or eight years, whose drinking has become structural, whose relationships have become short, and who has no idea that the thing underneath it all happened in 1998.
Where it shows up instead
Trauma that is not processed does not stay quiet. It reappears as something else, and in this population usually as one of four things.
Drinking or using that escalates without an obvious reason. The substance is regulating a nervous system that has never come down.
Relationships that stay short. Not by preference. Closeness is the condition under which the material becomes accessible, so it gets avoided with reasons that sound convincing.
A flatness that arrives after the first few good years, often diagnosed as depression, which is sometimes accurate and sometimes a description of something that has not been named yet.
Rage, or a startle response, or sleep that has never been right, which people frequently describe as simply how they are.
How it is treated
EMDR for single-event trauma, which it resolves faster than talking around it ever will, and which works over secure video. Over a hundred sessions in this practice have been delivered that way.
Depth psychotherapy for complex and childhood trauma, where EMDR is part of the work rather than the whole of it. Trauma that ran through a childhood has no single memory to reprocess; it shaped the architecture, and that takes longer and needs a different approach.
Both, in sequence, alongside the addiction where addiction is present, which in this population it very often is. Treating one and ignoring the other is the usual reason people relapse.
When trauma work should not start yet
If you are drinking or using daily, processing trauma is not where to begin. It tends to destabilise rather than resolve, and the sequencing is part of what the assessment is for.
The same applies where there is an acute medical situation. There is a medical reality that comes first, and Bangkok has excellent international hospitals for it.
When medical treatment comes first
This is psychotherapy, not medical treatment. Withdrawal from alcohol or benzodiazepines can be dangerous and occasionally life threatening, and needs to be managed by a GP, an addiction psychiatrist or a medically supervised detox rather than attempted alone. Where that is what is needed, it is said at the assessment and the referral is made.
The same applies where a psychiatric assessment should come first or run alongside the work, and where the right answer is residential treatment rather than weekly sessions. Therapy does the work that follows stabilisation, and it does that work better once stabilisation is in place.
Practicalities
Sessions are fifty minutes, weekly, by secure video, from anywhere in Thailand. In English or French.
I have practised EMDR for more than twenty years and I am also going to be honest about its limits: it does not resolve complex trauma the way it resolves a single event. When someone has been living inside something for years rather than surviving one thing that happened, EMDR is part of the work rather than the whole of it.
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Doctorate of Professional Practice at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.
Related: addiction · alcohol · midlife crisis · EMDR
In crisis in Thailand: Samaritans of Thailand English line 02 113 6789, press 2. Department of Mental Health hotline 1323. In an emergency, go to the emergency department of an international hospital and ask for the psychiatrist on duty.
Common questions
Does EMDR work online?
Yes. Bilateral stimulation can be delivered remotely and the protocol holds. I have now conducted well over a hundred EMDR sessions by video, and some of the best outcomes in this practice have been with clients I have never met in a room. Randomised trials comparing video-delivered and in-person EMDR have found no statistically significant difference in symptom reduction, and a twelve month service evaluation at Cardiff and Vale University Health Board found online patients finishing with lower PTSD scores than those seen in person.
What is the difference between PTSD and complex trauma?
A single traumatic event has a before and an after, and can often be processed as a discrete memory, sometimes quite quickly. Complex trauma has no interval: it ran through a childhood or a long relationship and shaped emotion regulation, self-worth and the capacity for closeness rather than leaving one memory behind. ICD-11 draws that distinction formally, and it changes what treatment has to do.
I moved abroad and felt better. Was that the trauma resolving?
Almost certainly not, though the improvement is real and worth taking seriously. Leaving removes the reminders, the associations and the people involved, which lowers the daily load considerably. It does not process the material. That is why the relief tends to have a shelf life, and why symptoms often reappear some years later in a form that seems unconnected.
Should trauma be treated before or after the drinking?
Sequencing matters and it is decided at the assessment rather than assumed. Processing trauma while a substance is doing the regulating tends to destabilise rather than resolve. Where daily drinking or using is present, stabilisation comes first, and where withdrawal needs medical supervision that comes first of all.
Is it confidential given how small the expatriate community is?
That is precisely why many people here choose someone outside the country. Sessions are held by secure video from outside Thailand, with the ordinary standards of professional confidentiality, and no overlap with your employer, your friends or your social circle.