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Anita Colombara, photographed in studio in Capitol Hill on November 14, 2016

For her day job, Anita Colombara provides counseling to low-income communities throughout greater Seattle, often traveling to her clients’ homes and schools. But with Remote Access Mental Health, her side gig, she travels much farther. Specializing in therapy for expats working abroad, Colombara uses videoconferencing to reach clients in remote regions and urban centers throughout Asia, South America, and Africa—adults mired in the stress of major moves, often left without the professional mental health resources found in the West. Change is almost always hard, she says. But technology (and good, old-fashioned therapy) can help.

Why did you start working with clients abroad?

Living [in Cambodia] for four years, I saw so many expats who were just burnt out, suffering from anxiety, adjustment issues, culture shock. I’ve always had it in the back of my mind: How can these international colleagues be given access to the kind of counseling I now provide in Seattle?

In both rural regions and cosmopolitan cities?

Initially I wanted to gear [Remote Access Mental Health] more toward what the U.S. government would call hardship placements, areas that might have political conflict or poor infrastructure.  But pretty much anyone making a big move and vocational change—to a cosmopolitan European city or a small village in Africa—is going to experience stress.

Can videoconferencing really compare to in-person sessions?

I’ve been really surprised by how much it feels like I’m in the same room as the person. I can still listen to their stories, identify needs and formulate goals, or have the video show my entire body to demonstrate relaxation skills and walk through emotional regulation.

Or maybe they just need someone from the West who speaks English?

I make it clear that I’m not paid to be a friend. There are many other avenues for that. What I do is evidence-based and trauma-informed mental health therapy—the same services I provide in Seattle.

Are there some patients who prefer this type of counseling?

A lot of them like it because they are in enclaves where it’s hard to keep things private. You’re working in a small town in Asia, you’re on a team of 10. You leave for the capital once a month to see a professional, and everyone is going to know about it.

Do you forecast an uptick in clientele with Trump-related anxiety?

I know people are talking about leaving the country, which might be reactionary. But I do know a lot of people already abroad are asking themselves whether they should stay overseas or come back and make a difference in their own country. 

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