Thursday, June 20, 2013

Holistic Health: One Psychologist’s View

Holistic Health: One Psychologist’s View

A  Guide to Holistic Health providers is now available. You may be wondering what Holistic Health is all about. Somehow, the phrase leaves one with the idea that there is something like ‘partial health’ in contrast to ‘whole health.’ The difference is really one more of emphasis and perspective.

So what is “Holistic Health?” It is a notion in healthcare that all aspects of people's needs including psychological, physical, and social are important and a person is seen as whole, and not just a collection of individual parts. Psychological services are part of such a package. A person’s ability to heal and recover from an unusual (i.e., abnormal) physical condition or symptom is affected by that person’s attitudes and expectations.

 I had the opportunity to see this truth play out early on in my career as a psychologist.
In the early 1970’s I was working my way through graduate school in psychology. My first such job was to be a research assistant on a large project investigating natural childbirth. That concept was new then. The professor leading the research was the national research director of what was then called the “Childbirth Without Pain Preparation League.” The name was later changed to ‘Childbirth With Preparation.’ This research used many questionnaires over the course of many pregnancies. At one point in time, we taped a print-out on an office wall with 40,000 correlation coefficients, used to determine what characteristics were related to what other characteristics, and started looking for trends.

I had a debate going with the professor. She thought that the most important factor to reduce reported pain during labor and delivery was continued practice of special breathing techniques and other psychophysical preparation. On the other hand, I thought the pregnant woman’s attitudes and expectations beforehand would be the best predictor of pain during childbirth and delivery. In the end, I won. It turned out that that the biological father’s participation in preparation for the birth was critical to how much pain was reported by the mother.

Unfortunately, there were not any prizes (for me)! But it was a good adventure and a chance to learn early on the importance of social support and psychological factors in achieving good outcomes in labor and delivery. That was new information at the time.

Today, caregivers of all kinds are tuned in to the importance of a patient’s state of mind for the best possible outcomes. In addition, we are still learning new things about this. For instance, the “placebo effect” used to be considered a nuisance variable in research. Now some researchers are wondering how and why this effect, which is an improved result when a patient takes a pill that should not have any effect at all, occurs in the first place.

As a practicing clinical psychologist, I attempt to help my patients build the mindset to achieve better health outcomes. I am able to use a variety of tools and approaches to do so, including, for example, visualization exercises, behavioral action plans, structured journaling, psychotherapy, hypnosis, EMDR (a special technique developed to be used with persons suffering from posttraumatic stress disorders), couple and/or family therapy, and so on. My basic philosophy is to stay in the present when possible – although discussing how a person got to their present state can also be quite important to help people get ‘unstuck’ from their past, and focus on current goals. Contrary to cartoon characters, psychologists do not have their patients lay down on couches and discuss their dreams. (Dreams can sometimes be important, but that is beside the point here.)

It is my belief that a person should use whatever works for them, so I am not critical of alternative approaches to health unless I believe that a person is being exploited.

The path to better health can be complicated and no one has all the answers. So if you have not yet found healthcare that works for you, try another approach. Some health approaches that are “new age” in the western world have been used for thousands of years in the eastern world. Who knows, perhaps an old “new” approach will work for you. And certainly talking your issues out with a psychologist may help as well.

Fred J. Klopfer is a practicing clinical psychologist, certified in Ecuador and licensed in the USA. He is currently accepting new patients. Appointments can be made or questions answered by calling 099-428.0580. Further information can be found at

Monday, June 17, 2013

Six Reasons Some Expats Feel "Forced" to Leave Ecuador and Return 'Home," and How to Avoid These Problems

Six Reasons Some Expats Feel “Forced” to Leave Ecuador and Return ‘Home,’ and How to Avoid Those Problems

Whenever someone comes to my office, and says they are packing up and going home, I tend to feel sorry for them and think that perhaps this conclusion could have been avoided. Here are some reasons why people get themselves to this place.

1.   Paperwork

Some expats come to Ecuador, intending to stay, and either do not know what paperwork they need to have to obtain a residential visa, or intend to have the paperwork mailed to them in Ecuador. This seems to be a particularly difficult problem for persons who cannot document events that lead to their current name being different from that on their birth certificate. The solution is simple. First, work with the designated Ecuadorian consulate to determine what paperwork is needed, and second, have it all before getting on the plane.

2.   Family Problems

One characteristic of families is that all members of a family get used to treating each other in a particular way. When a family member disrupts the system (by, for instance, leaving) other family members often work to undue that change and return the system to ‘normal.’ Even if that ‘normal’ is dysfunctional, it is still what family members are used to and want to see again.

Expats new to Ecuador who decide they must go home to fix a family problem are not likely to return. This problem tends to affect daughters of aging parents the most, since they usually get the role of being their parents’ caretakers. This attribution from other family members is unfair, but still exists. The solution is to have those ‘What if’ conversations with family members before leaving for Ecuador, and then resolutely sticking to those decisions. If such discussions did not happen before you left, quietly figure out what you want to do. Write down those intentions and stick to them.

3.   No Experience Moving

Some expats move here and it is the first major move of their life. The problem is that there are many things different when one moves. Changes might include, for example,

  • ·        how people talk,
  • ·        what they talk about,
  • ·        foods available,
  • ·        recreation available,
  • ·        jobs available and how to apply for them,
  • ·        how to find favorite foods in the grocery store,
  • ·        how to make new friends,
  • ·        how to stay in touch with old friends,
  • ·        how phones and phone numbers work,
  • ·        how the bus system works
  • ·        how taxis and cars travel,
  • ·        how to find new doctors and hospitals,
  • ·        how to start a new business,
  • ·        the new look of some currency,
  • ·        how addresses are written,
  • ·        how to send and receive mail,
  • ·        and many other things. 

Change is generally tough for people, and a lot of change is sometimes too much. A successful move to Ecuador is more likely if someone has moved before, even if only a small move. It may help to write down things that have not changed since your move – like how you do laundry.

4.   All Push – No Pull

If someone is moving to Ecuador because they say they don’t like XXXX (whatever “XXXX” is) and that is the only reason, they are going to have trouble with the move. [In my opinion, the most ironic are the people who move to Ecuador, a country with a three-term successful socialist President, because they say they do not like “socialism” in the US.] You should have some things to look forward to doing, not just things you are leaving. Generally speaking, people who move to leave problems, find the same problems are in their new location when they arrive. 

5.   Feeling Lonely

Making new friends takes work, no doubt about it. A reasonable goal might be spending ten to twenty hours per week meeting new people, or spending time with new friends you have met. A person can meet new people in Ecuador by going to places where other new people spend time. Since you are reading this article, you are able to access the Internet. So read the,  and, every day, 9there are other sites also) and attend some of the events suggested. Be assertive. Introduce yourself to people you overhear who sound interesting. After a few weeks, you will have friends; but it takes work to get there.
So consider these concerns in your move, and enjoy the adventure of moving to Ecuador!

Fred J. Klopfer, Ph.D. is a practicing clinical psychologist with 40 years’ experience who is accepting new clients. Read more about his practice at He can be reached on his cell phone at 099-428-0580.

Saturday, June 8, 2013

26 Tips for Successfully Moving to Ecuador

26 Tips for Successfully Moving to Ecuador

As a psychologist, I am used to seeing people make changes, some voluntary and some not. For those of you who are considering a move to Ecuador, I’d like to suggest the following actions:

1.    Make sure you know the requirements for your visa. The best source of information is the closest Ecuadorian Consulate, or the Ecuadorian embassy in your originating country. Arrange a visit or a phone call. Find out what is required for documents and fees. Send them back email with your understanding and ask them to verify what you understand. Then, get the documents. Don’t plan to get them mailed to you in Ecuador. Have them in hand before you leave. Even if you are told by an individual this is not necessary to physically have these documents, it is.

2.    For people coming from the USA “Estados unidos” [States United] is abbreviated “EEUU” in Ecuador) your documents need to be either certified (for marriages, births, divorces and other public records) or notarized (for diplomas, transcripts, background checks, income verification or other non-public information.) Then the documents need to be “apostilled.” The secretary of State’s office in whatever state the documents came from has a process for doing this. Contact that office and check on the internet. Doing this will take some time and cost some money, so don’t plan to move until it is done. If coming from Canada, documents are “legalized” rather than “apostilled,” but the process is similar. If your country is other than the USA ir Canada, check to see what the process is in your country. It will be one of these two. tThen, if applying first for a “consular visa,” obtained from the consulate and good for six months, have the visa in hand before you leave.

3.    Set up an ability to communicate back to your home country before you leave. I am a fan of MagicJack Plus and Skype services. They work in Ecuador.

4.    Arrange a temporary place for stay for a month or two when you get to Ecuador while you look for a more permanent place to stay. Do not buy a house or apartment right away. The standard recommendation is to rent for at least a year. Also buying a place definitely requires a lawyer in Ecuador, no matter what anyone tells you. The law is different here. Title insurance is virtually nil, and uninformed buyers have been stuck in odd situations (such as buying an apartment but not being able to obtain a title.) Also do not buy a house or an apartment that is under construction, period. You could end up with no legal documents showing ownership.

5.    You and your family need to talk about your ‘stuff.’ It is not unusual for persons to spend ten to twelve thousand, even twenty thousand dollars or more to ship a container of belongings here. You could easily buy new stuff for that amount of money in Ecuador. But you may want your own stuff just to be comfortable. One word of advice – don’t actually ship anything until you have until settled your visa issues. By settled, I mean documents (residential visa and cedula) in hand. It will take anywhere from three to six months or more to get a residency visa here after you arrive on a tourist or consular visa. Don’t ship things without a residency visa and then after you have obtained your “cedula,” a national ID. Without the cedula your container won’t move off the dock, and you will pay large storage fees to keep it on the dock in Guayaquil. In our case, my wife and I gave away most of our stuff, and brought six suitcases of clothes, one suitcase with paperwork, each a carry-on bag with computer stuff and a cat and a dog. We rent a place with furniture (which my wife found on Craig’s List). But that’s us. We have friends who arranged for their crates of furniture to be shipped before they had their cedulas in hand. They ended up paying large fines, after a small problem caused a delay in issuance of the cedulas.

6.    Expect differences in how things are done. Ecuador is an old country by USA standards. You are moving to a place with more civility on the surface. (People won’t tell you that they disagree.), there is more poverty, there is crime (like in the US) so don’t be conspicuous with things (jewelry, watches, purses, smartphones) that are worth money. Also, don’t expect places of business to carry lots of change (more than $5. Get change at the central bank, Banco Central), and know that most people speak Spanish (and there are schools and individuals who provide lessons). Also, things move at a slower pace. Do one thing a day, and you are doing well. Remember that rules and requirements change.  It will not help to get angry. Go with the flow. Once you learn to speak some Spanish, of course it’s far easier to communicate. Until then, carry an English-Spanish dictionary, get a small electronic translator, or get a translation on your smartphone.As for the differences, learn to embrace them. After all, some new ways of doing tings may actually be better!

7.    Speaking of phones, there are basically two cell phones companies in much of Ecuador – Claro and MoviStar. Until you have a national ID card, a cedula, your only option is to buy prepaid time. Make sure your cell phone is unlocked (not jailbroken, there is a difference) and that it will take a SIM card. If not, buy a phone here.

8.    If you have to have live USA television, find a friend or family member with cable TV, and buy two Slingboxes. On the US end, have your friend or family member buy an extension to their cable service, and hook up one of the Slingboxes to that extension. (You should pay for the additional monthly charge they will have for the extension.) On the Ecuador end, attach the other Slingbox to your internet connection. It should be like you are back in the US on the cable service your friend or family member uses, but their use will be unaffected. If the TV doesn’t need to be live, consider Apple TV, and subscribe to the services you want. Netflix is also available (if you use a VPN and appear to have a US server) or Amazon Prime. Of course these services may change over time, but some such service will be available. In our case, we did none of these, and just subscribed to a TV/internet service that has some English channels. By the way, if you buy electronic stuff to bring to Ecuador, take it out of the original boxes and put it in your carry-on luggage.

9.    Communication is important. Plan to take Spanish lessons, or study Spanish on your own. You will probably first make friends with other English-speaking ex-pats (Gringo is not a derogatory term in Ecuador). You can do that at certain restaurants that tend to be hang-outs for ex-pats. Read about them on,,,, or other such sites. Gringo Tree is the largest internet site with about 7,ooo readers.

10. Understand money. Cuenca is on the US dollar, and has been since 1999. Not all coins will look familiar, but you will soon learn which coins represent what denominations. As stated earlier, carry small change – fives, tens, and change. Stores don’t have much change here. Sometimes you may be charged ‘gringo prices.’ Compare notes with other ex-pats if you think you are being ripped off. Currently buses cost 25 cents per ride (12 cents if you have documented that you are 65 or older, and have bus company ID to prove it). Taxis usually cost two or three dollars. The same taxi ride may cost more at night.  Some things are cheaper here, but not everything is cheaper. Electronics, for example, are more expensive.

11. Mail or packages from the US are very expensive to get in Ecuador, and Ecuador has no routine daily mail delivery to houses. There are work-arounds, but basically plan to get most information by email. In the US there are services which will scan your mail and send you the scans by email. But the post office does deliver mail and, in my experience, is under-rated.

12. Make friends. It takes some work to do this, but is important. Spend several hours every week meeting new people or being with those you have met.

13. Have something to do, and plan that before you come to Ecuador. Spend more time on a hobby. Get a job. Volunteer some time. Study Spanish a lot. But do something! My spouse enjoys attending an active writer’s group, for instance.

14. Have realistic expectations. You will never ‘fit-in’ enough to be considered native. You are likely too tall, perhaps too light-skinned, and have different mannerisms. But you can be considered friendly if you act friendly.  Also many Ecuadorians think all US ex-pats are rich. In fact most US ex-pats who are rich probably live somewhere else. (Remember the Gatlin Brothers song – “All the gold in California is in a bank in the middle of Beverly Hills in somebody else’s name.”) Just be truthful about your circumstances and let people get to know you.

15. Get to know the country. Travel by bus is easy here. Go see things. If you are uncomfortable taking a bus or cab, there are private drivers who have vans and can act as your interpreter. If you stay “holed up” all day in your new house or apartment, you can get very lonely. We brought our pets to keep us company. There are many friendly veterinarians here. However, do some real checking with current expats regarding your particular pets. Some work better here than others. Also, if you bring a pet they must be on their leash at all times. Pet-napping can be a problem here.

16. Many museums are free or very inexpensive to visit. Symphony concerts are free. There are frequent theatrical performances Ecuador has national holidays to enjoy, and other free activities. Participate in them. Enjoy where you are.

17. If you are leaving the US primarily because of something bad in the USA, after you move, leave the problem behind. Coming to Ecuador, and being bitter, is not a way to live. Anger alone is not enough to make a day. By the way, Ecuador is a “developing country” and not a “third world country.” Education is highly valued in Ecuador, and the government is spending a large percentage of its capital on investments to directly help its citizens. While the average income is still low in Ecuador, the middle class is growing.

18. No matter what kind of veteran traveler you are, you will experience some ‘culture shock.’ Just going to a grocery store will do it. You may be upset. There are many fruits and vegetables with which you will be unfamiliar, and the labels will be in Spanish. The items you look for may be located in a different section of the store. Look forward to learning new things.

19. If you have any legal documents done before you moved (such as wills) have them done again in Ecuador. The law may be different. To avoid problems, have them redone here.

20. Medical care is good in Cuenca, but different from care in the USA. In Ecuador, you keep and carry your own medical records. Also, physicians work by themselves, or with very few nurses or other helpers. You will likely get thirty to sixty minutes with your physician, at about the same cost as co-pay in the USA. You can get a home visit for $40,00 (yes, they use commas instead of periods for money).  Some physicians do speak English. Make sure you have the ability to maintain necessary medicines and treatments before coming. Cuenca has a number of good hospitals. They are clean, and largely empty.  You can buy insurance here. Don’t expect your USA health insurance to work here. It might, but you need to check. Medicare and Medicaid do not work outside the USA.

21. Driving issues exist in Ecuador. Pedestrians have few rights. If you, as a pedestrian, cause an accident, you could go to jail. Some drivers seem to aim for pedestrians. Here is where the civility in society breaks down. If you plan on having a car in Ecuador, buy it in Ecuador. You can’t import a used car. You can buy a used car here. Of course, the rules might change – so check. While it apparently isn’t absolutely required to get an Ecuadorian driver’s license, you may want the training. The country seems to have a lot of round-abouts instead of traffic lights, and drivers come within inches of colliding with each other. Go to driving school and learn how they do this. But many, if not most ex-pats, walk a lot. There are trails, and the weather is good enough to do so.

22. There is some prejudice against persons from the USA here. Historically the USA government has been allegedly responsible for toppling freely elected governments here at least twice, and there are still CIA agents in the country. Currently the USA and Ecuador governments are at odds about the Ecuadorian asylum granted to Julian Assange, the founder of Wikileaks.

23. Politeness habits exist here. Learn to lead off conversations with “Buenos Dias” in the morning, “Buenas Tardes” in the afternoon, and “Buenas Noches” in the late evening. Also use “Por Favor” and “Gracias.” Also use “Da Nada.” Conversations here start out with polite small talk to establish rapport, before more serious conversation starts. Beginning a conversation without such rapport is considered rude.

24. Personal Space is different in Ecuador. People stand closer together, and talk with more gestures than is customary in the USA. It is not intrusive. It is how to talk.

25. What we found in Cuenca is nice parks, pretty rivers, and good food. It is customary for new residents from the USA to lose weight here just from walking more and eating better.

26. Finally, a lot of Ecuador is at high elevations. Cuenca, for instance is at 6400 feet above sea level. If you move to a place with higher elevation than what you are used to being, you may be more tired for a month or two while your body adjusts to thinner air. Give yourself time to adjust.

The author of this article is Fred J. Klopfer, Ph.D. He is a clinical psychologist living in Cuenca, Ecuador, and is certified to work as a psychologist in Ecuador. He can be reached on his cell phone – 099-428-0580.