And Then She Laughed: Counseling Women

By Sylvia Estrada Claudio

More than a clinical book, And Then She Laughed is an attempt to reach out to those who may be grappling with problems related to violence against women, but have no access to a good counselor. Claudio covers the most common cases she has handled in her years as a counselor for abused women, which include healing from rape, sexual harassment, violence in intimate relationships, and depression. In the process she also points out valuable life lessons learned from those who have overcome the violence and healed.

• Language: English
• Publisher: Anvil Publishing, Inc.
• Release date: Oct 19, 2017
• ISBN: 9789712732003

Book preview

PROLOGUE

AND THEN SHE LAUGHED

She was 60 years old when she came to see me. She had been experiencing all sorts of violence from her spouse to whom she had been married for 30 years. Aside from physical abuse and his perpetual infidelity, he had taken all her income through the years. He gave her a very small allowance that hardly covered the household expenses and certainly left very little for her personal expenses. This, despite the fact that for long periods of time she had been earning more.

All her attempts at self-improvement, such as her desire to take higher studies, had been derided and stopped. She was socially isolated from friends and family and co-workers. Once, he agreed she could take a gym class. But he accompanied her to every class and was offensive to everyone there. So she stopped going.

Today, she was late for her appointment. We had been counseling for months and she had been gaining courage. Today, since her daughter could not accompany her (the only reason she could come to my clinic was that they pretended to go out together to shop or have lunch), she had decided she would come alone.

Her lateness was worrisome. But she finally came in, hot and flustered. It was a summer’s day. She said she had taken public transportation and it was very hot and she got lost. She took several minutes to tell me the story of her getting lost. AND THEN SHE LAUGHED. For the first time in our months of counseling, she laughed fully and long and until she was doubled over in glee.

How happy she was to have gotten lost. Because she had not gone on an adventure in decades. To go on an adventure, to plan her route, the bus she had to take, the bus stop to get on and off, the walk to my clinic in the sweltering heat—these things were possible only because she had decided to regain her freedom. And freedom involves risk, and getting lost and being found. It means making decisions for oneself and taking the consequences and learning a new route.

And so she laughed from the joy of being free.

CHAPTER 1

HOW IT ALL BEGAN

I did not choose to do counseling; counseling chose me. At some point in my medical education I discovered that I did not want to deal with patients in a clinic or hospital. It was not that I hated clinical work, but I realized that I had a far better appreciation of the theory of medicine than I had of its actual practice.

Not that I was all that enamored of theory. After medical school I was an activist in the struggle against the Marcos dictatorship. I spent a number of years doctoring in remote rural areas, at detention centers, at picket lines, at violent rallies and demonstrations. During the tumultuous years that eventually led to the downfall of the Marcos dictatorship, I worked in the rehabilitation of those who were tortured by military and paramilitary forces. After the fall of the Marcos dictatorship, I began to work with women and health groups. One of these was a crisis center for raped and battered women.

Clinical practice, however, was often incompatible with my need for theoretical clarity. To me, the gap between my understanding of theory and my encounters with reality was disconcerting. I consider a particularly insightful joke I heard in medical school. The joke says that diagnosing a patient’s illness is difficult because diseases never read books. So, a disease never presents itself to the physician the way the book describes it. Another frustration was that whatever theoretical insights I could come up with (e.g. that social injustice was the real cause of malnutrition), I could not translate into better patient care.

This is not a put-down of medical practitioners or their scholarship. I am just trying to explain why I never thought myself cut out for clinical work.

So, when by both force and circumstance I had to go back to school, I decided not to go into residency training for a medical specialty. Instead I chose to pursue doctoral studies in psychology. Of course psychology itself has a clinical aspect, but I did not choose to specialize in clinical psychology.

Yet even before I began my doctoral studies I already had counselees. They came to me for various reasons. In this country, there has always been a lack of mental health personnel, and my pre-medical degree was in psychology. I was one of a few doctors whose background made me particularly suited for people who were comrades in the anti-Marcos underground. After all, who better to assess whether a counselee’s claim that the military is after me, is a sign of paranoia or the truth? Who else could put into better perspective a counselee’s regret over leaving her children in order to go underground?

Other counselees were referred to me by colleagues in the women’s movement. When I started my PhD, the Philippine women’s movement was just beginning its organized response to the issue of violence against women. Like other women in other cultures and countries, we developed a distrust for counselors, psychologists and psychiatrists who, because they were unaware of the realities of women’s oppression, ended up doing more harm than good to women who were being battered or harassed or had been raped.

Yet another reason was that I was a doctor working in what has been called, at various times, non-governmental organizations (NGOs), cause-oriented groups, civil society or the social movements. While the people who work in such groups are as diverse as any other group of people, they have some commonalities. My bonds are even stronger with those who work in what is broadly and loosely called the women’s movement. Many women, who see their lifestyles as intimately linked with social transformation, also feel more comfortable with a counselor who has similar advocacies.

Like other people in the mental health profession, I’ve had my share of counselees to whom I just could not say no—a friend, the son or daughter of a friend, a relative. I am not foolish enough to be the psychologist of my most intimate family and friends. Yet some members of my large extended family have had occasion to seek my advice. They refuse to go to other counselors despite dire warnings about my inappropriateness.

The most important reason for my counseling was that the majority of the people sent to me could not afford to pay for competent care.

And so my counseling load got heavier and heavier. Soon, counseling was taking over my schedule, forcing me to recognize the reality I had been denying. I set aside two days a week for clinic.

In recent years, I have begun to teach counseling at the university where I work. I have also done a radio program reaching out to young people seeking information on sexuality. I am unable to respond to all the questions listeners send in. I have also had to turn away an increasing number of counselees because they can no longer be accommodated by my schedule. Some of my friends, students and listeners have urged me to write this book, because it may reach more people and may be of some help. This is also my hope.

There is another sense, however, in which counseling chose me. Despite my resistance, I feel counseling is a real gift. Like many of life’s genuine gifts, I neither asked for it, nor do I feel that I did anything to deserve it. As Joan Chittister writes, The spiritual advantages of the healing process in healers are too often overlooked. We assume that healing is gratuitous condescension rather than a spiritual discipline of immense proportion and great reward.

Counseling also allows me to do an exercise that I need very badly in order to grow as a person. It forces me not to think about myself. Counseling breaks my great capacity to put my own ego always front and center, and instead think more about the other person. All of us need to learn to de-center if we are to grow. I am aware that I need it very badly.

But counseling has brought me even more blessings. It is a privilege to be able to look intimately into another person’s life. It is a privilege to see another’s pain or share another’s joy. I have witnessed the raped, the battered, and the broken succeed in ending the violence and pain in their lives. I have seen courage and determination in individuals whom society have labeled weak. I have seen the oppressed achieve personal emancipation. I have witnessed heroism and greatness.

These things happen not because I am any more competent than the thousands of other good doctors out there. My success lies not just in my understanding and skills. It lies in the fact that my counselees accept my efforts at reaching out to them. It is the act of merely trying that helps. And because I do try, my counselees seem somehow to get the good that I have to offer, throw away the trash and forgive me my mistakes. It is obvious therefore that it is neither my expertise, nor my openness, nor my humility nor my generosity that is crucial. Rather, it is the counselee’s.

My theory of counseling is very simple and not very original. Healing lies in the quality of the relationship between the counselor and the counselee. At the worst of times I have nothing to offer except the capacity to run around like a headless chicken in behalf of the person who is seeking my wisdom. Yet, because that individual sees me reaching out to them nonetheless, even these stupid moments can become therapeutic. There are of course, better moments, when I am not so stupid. The best times are when we achieve breakthroughs. In such moments, the counselee seems to be able to see her situation with intense clarity and this often brings great hope about what can be done. The best times are also when the counselee and I laugh the laugh of the righteous and the joyous—for a while amidst the tears, or at the moment when she decides she no longer needs me. I feel at these times that my attempts at professional rigor and continuous studying are more than repaid.

I have also experienced my own failure to help and witnessed the tragedy of other people’s lives. But even in this, I have learned.

There are many truths in life. Counseling allows me to see a few great truths. These truths come to me not because I am brilliant in figuring things out. These truths come to me because I see what comfort these bring to my counselees. With each individual that comes my way, I see which truths can change lives for the better.

When I counsel, someone allows me to travel along his or her path for a short while. In that little while, I learn more of life’s trivialities and immensities than I would have if I were not sharing their road. I am allowed to see more of life’s contradictions and diversity. I am constantly reminded how passionately beautiful life is. To say that I owe much to my counselees is an understatement.

This book is my way of paying back a debt I owe my counselees and to whoever or whatever it is that brought me to counseling.

CHAPTER 2

THE SETTING

I began my clinic with a women’s health and reproductive rights organization that is alive and well up to this day. What we try to do is give comprehensive reproductive health care to urban poor communities. Because we work with poor women, our services are free. This also means that we integrate services for women that were previously ignored by older primary health care programs. This includes, among other things, services for women who are survivors of violence. Such services demand a counseling component.

I used to do all my counseling with this organization. When I became an academic however, I began to do counseling work at the university where I teach and particularly its women’s centers. Among other things, we task ourselves with helping to implement the university’s policies against sexual harassment.

Women survivors of violence however, are not the only women who need mental health services. Women have other psychological needs even if they are not survivors of abuse. Counselees have come to work out problems about love, romance and sexuality; adolescence and menopause; work and family. In the Philippines as in other countries and cultures, depression is more common among women than men.

The organizations I work for are dedicated to the idea of giving women, especially poor women, accessible services that does not increase their sense of deprivation and disempowerment. We try to give competent and respectful care to women. We are aware that poor women often have to accept substandard service that is given to them in an insensitive or even an offensive manner. Over-all the capacity to give our services for free has presented many benefits for my work, though it has presented a few challenges.

One minor but rather long-standing challenge has been what to call the people who seek my services. The commonly used term patient, has a lot of connotations which I do not like. For one thing, it is associated with illness. I do not agree with the view that people who have psychological burdens are necessarily ill. Certainly those who are abused, raped or battered are suffering from the effects of someone else’s sickness.

I also dislike the fact that some doctors have given too literal an interpretation to this term. That is, some physicians behave as if their clients should be patient with them. Clients often have to wait for hours for their doctors to show up, even for scheduled appointments. Often the waiting time is far more than the actual time the doctor gives to the patient. There is often not enough time or effort given to explanations and answering other concerns. When clients try to get their doctors to answer to what they need (rather than what the doctor feels are their needs) they are called demanding. Obviously such doctors prefer that people be patient.

Of course, in extreme but not unfortunately, rare cases, patients are expected to bear medical abuse in silence.

Carl Rogers, one of the founders of the humanist movement in Western psychology used the term clients. Rogerians use the term, client for the some of the reasons that I have come to reject the term patient. On the one hand, I agree with the Rogerian belief in a person’s inherent capacity for wellness. But I also have problems with the term client because it implies payment. As I have said, I do not get paid for the counseling.

At some point, a colleague solved the riddle for me. She suggested the term, counselee. For the moment, this is the best term. I shall use it consistently through this book.

Another problem with giving free services is that some of the people we reach do not seem to appreciate our services precisely because they are free. This is a testament to the materialism in which all of us are socialized. Often enough, especially in the Philippine healthcare system, private medical care is of better quality than the care given at government hospitals. A strange logic ensues from this. There is a mistaken notion that the amount of money earned and the capacity to charge large fees is directly proportional to a doctor’s skill and expertise. This stereotypical thinking besets both the health professional and the patient.

Sadly, a number of doctors and patients begin to see the material trappings of their doctors—the luxurious clinic, the designer clothes, the fancy cars—as a gauge of their expertise.

When I am in hospitals I take a morbid interest in this game of medical class politics. Like other disciplines, students are quick to learn not only the content of the discipline but also its subculture. Not a few of us doctors have noted how quickly students learn to flash expensive mobile phones; display expensive pens, jewelry and other accessories; and wear expensive clothes.

Patients too tend to treat their doctors and the hospitals where they seek consultations as status symbols—especially the wealthy.

In this matter I do not intend to be the policewoman for good taste and good values in the medical field—not that there isn’t a crying need for policing our own ranks. Rather, this job falls to each and every doctor. And there are good doctors and bad doctors. Unlike the stereotypes though, the good doctors are not always in fancy dress and the bad doctors are not always in the rural areas and the government hospitals.

To digress further, not all doctors who earn their living from professional fees are mercenaries who fake their concern. In my clinic, I ask some clients to go to other psychologists and psychiatrists if they can pay, unless they are victims of abuse which I feel is an area where I have expertise. Often we also refer for many types of services the women’s center cannot provide. My experience as a woman’s health advocate has shown me that many doctors treat their rich and poor patients with equal concern. They refuse to let the state of a person’s wallet dictate the terms of treatment. Many doctors take care of large numbers of indigent patients along with those who can pay. In a country like ours where social services are horrid, every middle class person is called upon by circumstances to become the social worker for any number of the less fortunate who touch his or her life. Doctors are often called upon more often than others, and many respond magnificently. Thus, when you find a really good doctor, and if you can afford it, please do pay them well. It is a way of socializing medical fees.

However, some good things CAN be had for free. In fact, some of the very best things are free. They come to people unbidden and unearned. The wise person will be able to recognize when this happens and accept it without precondition and without fear.

In my practice, I often see people who are far more able to comprehend the bad things that life brings them rather than the gifts. Many people easily accept their guilt or culpability and tend to treat life’s misfortunes as punishments. Yet when the good things come, they seem unable to appreciate it.

It is ironic, that sometimes the ability to pay gets in the way of the ability to appreciate that which cannot be paid for and for which no payment is expected.

Most of the women I have counseled have been wise enough to benefit from the fact that I do not charge fees. As has been mentioned, the majority of women I work with cannot afford professional fees easily. This is especially true of those who are battered, raped, sexually harassed. But the financial benefit to them seems to me only half of the picture. For all counselees, a giant first step is taken by assuring her of her worthiness in order to re-establish self-esteem. Such a task can be the most difficult for the counselor to accomplish. It cannot be achieved merely by talking about it.