Healing Room: The Need for Psychotherapy

By Reena Nath

'Psychotherapy is the art of finding the angel of hope in the midst of terror, despair and madness' - CLOE MADANES Problems happen to all of us at some time or another. It can happen to people who are strong, capable, successful and normal. Emotional difficulties can cause pain that affect rational thoughts and decision-making, leading to conflicts in relationships and in the capacity to work and enjoy life. But while pain might be inevitable, suffering need not be. This book is about hope, the hope that we can live without the sadness of depression, the fear of anxiety, the pain of fractured relationships. Psychotherapy can heal these and other challenging situations that can wreck a person's life. But how does one find a psychotherapist? What does a therapist do? And, very importantly, what type of psychotherapy should one choose that best suits one's needs? THE HEALING ROOM is a collection of essays put together by noted psychotherapist and systemic family therapist Reena Nath that sets out to act as a bridge between the person seeking help and professionals from various branches of psychotherapy. Nine eminent practitioners share their experiences and insights into their fields of expertise. Psychoanalysis, Cognitive Behaviour Therapy, Systemic Family Therapy, Jungian Psychology, Couple Therapy, Mindfulness-Based Therapy, Person-Centred Therapy, Psychotherapy for Children, Therapy for Adolescents Remember, the choice lies with us. The therapist does not direct those who seek help; they facilitate dialogue so each one of us can find our own answers. A must read for anyone interested in understanding how the human mind works.

• Language: English
• Publisher: Element
• Release date: Jan 20, 2017
• ISBN: 9789351365310

Reena Nath

Reena Nath is a psychotherapist and systemic family therapist in private practice in Delhi. She is an MSc in child development, Delhi University, and an MA in systemic psychotherapy from the Tavistock Clinic, U.K. She has worked for seventeen years at Sanjivini Mental Health Society, India's first suicide helpline and crisis intervention centre. She set up and was director of Sampark, a walk-in therapy centre at Modi Hospital. She also started and was the director of the Family Resource Centre offering therapy and training in Delhi and under-resourced rural areas in Haryana. She has worked at the Marlborough Family Services centre, the Anna Freud centre, and the London Marriage Guidance Council, U.K. She has offered group therapy in crisis situations in Punjab, Kashmir and Afghanistan, the latter under the U.N. She has been secretary of the Indian Association of Family Therapy, a board member of the International Family Therapy Association and is currently on the board of the Journal of Family Therapy.

Book preview

INTRODUCTION

People I meet outside the therapy room sometimes get nervous around me. ‘Am I being analysed right now?’ they will ask, before taking a step back. What they really mean is – ‘Are you reading my mind?’

No. That would be telepathy.

It has been well over a hundred years since psychology was widely accepted as a scientific discipline and yet mental health professionals are still regarded with suspicion. Shamanism is in the mix. Quackery, head-shrinking, countless jokes involving a couch, dream interpretation, penis envy, Oedipal complexes and madness. We don’t trust what we don’t understand.

And that is alright. This book will tell you what therapists do.

Trust takes time. It is a two-way street and it has to be earned. Sure, it is always a little act of faith to trust someone, whether it is your cardiac surgeon or the mechanic you leave your car with, but transparency goes a long way in establishing that trust. In moving past the doubts, the fears, and encouraging us to use those four words that all healing begins with: I need your help. Because to reach out is to be human.

This book’s purpose is three-fold. Firstly, it provides information for any reader who wants to make an informed choice before starting therapy. Secondly, it is a reader for persons interested in psychotherapy that is available in India. Lastly, it serves as documentation of the work and practise of Indian psychotherapists for a wider audience.

Interest in psychological issues is not a recent phenomenon in India (Neki, 1975). Academic writing, as in the Indian Journal of Psychiatry, has also been consistently growing since the middle of the last century. Outside the small community of mental health professionals, however, interest in psychological health has been miniscule.

The subject of mental illness has been taboo and mentally ill people have been routinely discriminated against. This attitude has been observed in families and communities, and mirrored in public policies. Allocation of state resources has not been reflected in the large number of people needing psychiatric or psychological help. Even if a person did not have a major mental illness, but showed emotional vulnerabilities, there was very little understanding and support available, let alone treatment.

The good news is this condition of neglect seems to be changing. For instance, the incidents of suicide among students, abused women, impoverished farmers and other vulnerable groups have been repeatedly highlighted in the media over the last few decades. Not being able to cope is less of a reason to feel ashamed and more of a reason to find a solution. The idea of over-stress as the cause of ill-health, physical and emotional, has been taken on board by doctors, teachers, yoga instructors, gurus, corporate trainers, personnel managers and everyone’s aunt. The demand for well-functioning people is greater than it has ever been in human history.

There is also a growing understanding that relational health impacts people, that the presence of loving and nurturing people in one’s life cannot be taken for granted. It was believed that having a family was a sufficient guarantee for an individual to flourish at work and at home. This belief, this certainty, is being questioned by the number of lives shattered by the trauma caused by sexual abuse committed by family members, the stress of conflict-ridden relationships within the family, by domestic violence against women, children and the elderly.

In India, there is a new demand for understanding psychological processes, for explanations of how a person comes to have problems and, more importantly, how to get well again. Who does one go to when troubled? What can psychotherapy offer? How does one find a therapist? What type of therapy should one choose? These are the questions that this book can answer.

The First Question Is: What Is Psychotherapy?

Psychotherapy is a service for people to help them resolve their emotional, psychological and relationship issues. It tries to understand the problem, its causes and its impact on the person and on their life. A person’s problems can range from situational difficulties that require short-term therapy to relationship breakdowns that require longer periods of therapy. Whatever the length of the treatment, the goal is alleviation of pain and sorrow, and beyond that is self-growth, the ability to choose one’s path in life with greater clarity and acquiring the confidence to cope with future problems.

Psychotherapy is referred to as the ‘talking cure’ as it is through a dialogue between the psychotherapist and the seeker of help, called the client, that positive change is made. The main form of communication is talking together about the client’s life, including all parts of the client’s lived experience. The psychotherapist uses evidence-based interventions to foster long-term recovery, increased resilience and well-being.

Psychotherapy is sometimes called counselling or simply therapy, and the psychotherapist can be referred to as a counsellor or a therapist. The therapist does not direct the seeker of help; instead they facilitate dialogue so that the person can find their own answers. The therapist uses their training in psychological processes, knowledge and experience to do this.

‘In my early professional years I was asking the question: how can I treat, or cure, or change this person? Now I would phrase the question in this way: how can I provide a relationship which this person may use for their own personal growth?’ said the American psychologist, Carl Rogers.

Healing in psychotherapy happens in the context of a trusting relationship with the psychotherapist. The quality of attention, the close listening to the speaker for what is being said and what is left unsaid, the acceptance of the person as they are, the respect offered – these are the building blocks of the therapeutic experience. Through this relationship, the person in distress begins to open up to all the aspects of their experience, to understand themselves better, gain insight into their own emotional reactions, thought processes and belief systems. The clients capacity to live as they wish increases through changes they bring about in themselves and in the circumstances of their lives.

The most important aspect of therapy is confidentiality. The therapist ensures that whatever is spoken about remains confidential between them and the client, and never revealed to an outsider. The client is free to disclose the conversation with whomsoever they wish, but the therapist is ethically bound to keep it confidential.

The Next Question That Arises Is: Do We Need Psychotherapy?

Psychotherapy is a modern term, but the need for assuaging human grief, unhappiness and fear has existed as long as humans have walked the earth. The human mind has always been prey to external and internal trauma, causing emotional suffering and mental illness. Healers and healing have existed as long as has human misery, evolving in understanding over the ages as civilization evolved. Before modernity created a split between spiritual healing and bodily healing, resulting in the separate institutions of religion and medicine, healers worked with the body, mind and spirit in multiple ways. An important part of the work of ancient healing practitioners was to listen, see, touch, recognize and feel with the person seeking help. The healer would create a safe place for the healing to happen and give the sufferer the dignity and respect that comes with being given special care. These traditional practices still exist in parts of India and the world. This is not to say that there wasn’t cruel treatment for people suffering from mental illness by groups of people.

These ancient healing rituals may have been unscientific as judged by modern science, but in them lay the roots of modern psychotherapeutic practice, the non-judgemental regard of one human for another that heals the mind and spirit as if by magic.

Progress in modern life, vast advances in knowledge, technology, sophistication of mass-produced goods and services, growth in all aspects has not, and perhaps cannot, remove human suffering completely. People still get sick, they have broken hearts and spirits, still contemplate suicide and many still do kill themselves because living appears to be a more painful option than dying. Leaving people alone in their confusion, fear and despair is not an option in any society.

That human beings benefit from the care and love of other humans is not in question. What people ask is how can a psychotherapist, a professional, offer this care that should come from one’s own family and friends? It appears strangely upsetting and lonely that one has to go to a stranger and pay a fee for being listened to. For some people it is a sign that social life has deteriorated and no person has time for another. While people are still people and have enormous amounts of empathy for each other, it is true that urban living, technology, modern forms of livelihood has distracted people from meaningful person-to-person contact. It could also be that people have lost the confidence and knowledge of how to reach out to each other. Even if people were better oriented towards giving each other personal attention, there would still be the need for the professional who is trained to help people struggling with the distress of mental illness, emotional problems, relationship conflicts, addictions, phobias, neuroses and other forms of human ailments. Like other services, healing has become professionalized too.

This professionalizing can be positive and negative. The positive aspects outweigh the negative ones. Most therapists feel drawn to the field of psychotherapy because of an inner calling. It is not an easy profession to be in; there are very few places to learn the art and craft of psychotherapy in India. They take on the enormous challenge of professionalizing themselves because they make a considered choice born of an inherent empathy for people who are suffering. The ones who find that it is not for them to listen patiently to hours of clients talking drop out. The ones who remain are trained and supervised into practising according to a very high standard of ethics. In this introduction there is a section on ethical practise that therapists follow in order to protect your rights as a client.

The cons of becoming a professional are ones that are shared with other professions, namely losing their sensitive edge. After years of immersing themselves in a model of psychotherapy, the therapist can sometimes forget that each person is a unique individual rather than someone who fits neatly into some model. Costs of studying psychotherapy can make the fees prohibitive. In India, where mental health professionals are miniscule in number when compared to the number of people needing treatment, the power balance is tilted in favour of the psychotherapist. So unethical practices can happen. That brings us back to the need for professionalizing psychotherapy in India and for training and supervision that will offer the best practises to the clients.

When to Start Therapy

The process of deciding that one wants therapy is at times a straight-forward one, decided by consulting a person you trust. It may be a family member, a friend, a relative, a colleague, your doctor telling you to try therapy, or somebody having had a good experience in therapy referring you to a therapist. At other times, this process might be fraught with doubts – doubts about whether one needs or wants to undergo therapy. Does choosing to undergo therapy label one as being ‘mad’ or dysfunctional? Does it mean one is not strong enough to handle what is happening to them? Does it mean one does not know how to solve the problems they are experiencing? What will I say to the therapist? What will therapy be like? Will the therapist or therapy be able to help me? These are some of the questions that arise in the minds of most people who are considering therapy for the first time.

People start therapy when they are unhappy or are unable to function as well as they could earlier. When problems persist over time and attempts to resolve them through tried and tested ways don’t show results, they realize it is time to go to a psychotherapist for consultation. The problems could be in the realm of one’s feelings, thoughts and behaviours. Troubling feelings could be persistent sadness, anger, fear, hate, sense of rejection at unrequited love, despair, shame, jealousy, loneliness, helplessness or envy. Troubling thoughts could be equally persistent and hard to dislodge from one’s mind, such as, ‘I wish I were dead’, ‘What did I do wrong’, ‘Its my fault’, ‘S/he is to blame’, ‘Everything is wrong in my life’, ‘No one can love me’, ‘Everyone wants to hurt me’, ‘My child is a failure’, ‘I could kill someone’, etc. Behavioural indications are sleeplessness or over sleeping, appetite changes, lack of concentration, inability to do one’s work, lack of enjoyment in one’s habitual leisure activities, unfamiliar and sudden shifts of mood and energy levels, obsessive repetitions of the same actions, the sense of being perpetually distracted, fatigue for no apparent reason, lack of sexual interest, substance abuse or violence towards the self or others.

This list of troubling feelings, thoughts and behaviours is not exhaustive, but indicative. A full list would run into several pages if one had to name all the variety of feelings, thoughts and behaviours that human beings experience. A compounding factor against a fully comprehensive listing is the complexity of language and cultural meanings that are lost in translation. For example, some psychotherapists trained in the western tradition don’t consider shame or loneliness to be a feeling. Both are considered internalized judgements that limit a person from experiencing authentic feelings. However, for many Indians, both of these are experienced as feelings that strongly affect them. Perhaps it is the way that both of these feelings, expressed in Hindi as sharam and akelapan translate into English as shame and loneliness that gives them completely different meanings in different cultural contexts.

Coming back to the indications that one might weigh in order to decide if a consultation with a psychotherapist is required, it would be important to look at the context of one’s life to consider if there have been changes that have added stress to one’s life. The area of one’s relational life is often a key indicator of stress and distress. Changes in one’s close family relationships and conflicts with important work colleagues or business partners could impact one’s emotional and mental health. Such changes affect us at many levels in simple ways like time resources and in more complex ways they impact our identity, our view and regard of ourselves, and the dreams and hopes that we have of our lives.

One has to consider whether we are in a transition stage in our life. At critical junctures, such as, leaving school, choosing careers, choosing life partners, starting a family, raising young children, switching careers, divorce, aging, illness, death of parents, retirement, shrinking and expanding family, all or any of these changes can be hard to cope with. Most people seek therapy during a time of life-changing transition.

Lastly, losses such as those caused by natural disasters, or through tragic accidents, or by physical and mental illness in the self and in relatives are reasons for talking to a psychotherapist.

I have not yet spoken of the difference between mental illness of a chronic nature and everyday problems of living our lives that can be experienced as stress. The range of mental and emotional health problems is large and categories for diagnosis covers the full range. Schizophrenia, bi-polar disorders, depression and anxieties, psychotic breakdowns and neurotic behaviour symptoms are some of the terms used. Each of these and many other terminologies have detailed descriptions that clinicians follow in order to make a diagnosis. The reason for making a diagnosis is to plan a treatment course. Some people fear that diagnosis can be a label that reduces a person to a label of mad or mentally ill. But a diagnosis can be very helpful too in understanding what seemed incomprehensible earlier. It is a relief to understand through a diagnosis why one is feeling and behaving in a certain way. Therapy can heal many levels of mental health problems and in some cases the treatment involves medication for short or long term treatment in addition to therapy.

Not all of the above conditions have to be present in order to consult a therapist; it is sufficient that you have some feelings that are persistently troubling you for several weeks. During the consultation, you and the therapist can decide if therapy is required. Early consultation can prevent future aggravation of a problem.

Process of Selecting a Therapist and Type of Therapy

Sometimes one finds it easier to come to therapy with a ‘just do it’ approach by going to any therapist, starting therapy and then figuring out how one feels about being in therapy, and whether talking to a particular therapist is useful. Often one may start therapy without being aware that there are different psychotherapeutic approaches that can help with different kinds of problems. In this scenario, it is the therapist’s responsibility to empower the client with the knowledge of whether their approach to therapy would be suited for the client’s problems or whether they need to meet a different therapist whose approach and area of expertise may be more appropriate for them.

Some people take greater initiative to understand therapy and its processes. They may talk at length to people who have undergone therapy to learn from their experience or surf the Internet to obtain more information about psychotherapy or about a particular therapist. Having questions and doubts, and desiring to seek more information, are all understandable, normal processes. These help a client gather some sense of familiarity, control and certainty about what to expect, thereby helping them feel more confident about entering therapy and meeting a therapist.

The Steps to Take While Selecting a Therapist:

Ask for recommendations from doctors, health professionals, teachers, people that you know. In the absence of a comprehensive directory of mental health professionals, you can also call up organizations who work in mental health – such as de-addiction centres, crisis help lines, non-profit organizations who work with people with special needs – to recommend psychotherapists in your locality.

Look up the recommended therapists; many have websites that give information about their training, therapy orientation and experience.

If you want more clarification, ask them about their approach to therapy on the phone or in the first interview. Therapists are, and should be, able to answer your questions to your satisfaction.

Ask them about their experience in dealing with problem areas similar to yours and how successful they have been.

Most importantly, reflect on yourself and see if the therapist has inspired positive feelings within you, such as safety, understanding, acceptance, curiosity, relief and anticipation of the next meeting. Your feelings should be your guide. If you are unsure in the first meeting, you can speak to the therapist about it. A good therapist will be open and accepting of all your feelings.

Take into consideration the distance to the therapist’s office from your home/office. Your ability to reach the therapist every week or fortnight on time should be feasible for you.

Ask for the timings and days that the therapist is available. Sessions are durations of fifty or sixty minutes. If you do not have flexibility from office hours during the week, think about choosing a time slot for Saturday or weekday evenings. Accessibility is important when you have weekly visits over a long duration. Some therapists are available for regular Skype sessions.

Discuss payment. Therapists charge by the hour and convention is that you pay at every session. Most therapists outside hospital settings accept cash and cheques, but do not have credit card facilities. If you find the fee quoted unaffordable, ask if the therapist has a sliding scale. Many therapists have different fee structures for clients, which are dependent on what the client can afford to pay. For example, clients who have special needs or work in the voluntary sector or with grass roots organizations or are not yet established, can ask for a special rate. If you are between jobs, you can negotiate a rate temporarily while committing to a higher rate when you have more monetary fluidity. Most therapists expect to be paid for sessions that you miss as they can take on a limited number of clients. When they commit to a client, that time is reserved for that client solely. This also should be clarified at the first meeting.

While surfing the Internet one comes across a plethora of information about therapy – the types and kinds of therapies and what kind of therapy is helpful for which problems. This mass of information can empower an individual, but can also create confusion about what therapy means, the processes that a person has to undergo during therapy and what kind of therapy will help them.

In order to address this confusion, this book has chapters by eminent psychotherapists from different disciplines who speak

on the specificities of the therapies they practise. The therapies are:

Psychoanalysis

Person-centred therapy

Systemic family therapy

Couple therapy

Cognitive behaviour therapy

Jungian psychotherapy

Therapy based on mindfulness techniques

In addition to these psychotherapies, I have included chapters on two groups that require attention with regard to therapy. These are:

Therapy for children

Therapy for adolescents

I, and other clinicians who work with children and adolescents, notice that young people who are in distress are often not brought in for therapy. Guardians and parents may not have sufficient information on how therapy can help their ward. There may be worries about children being damaged by therapy, or the clinician influencing the impressionable child in ways that may be different from values that the family holds. On the other hand, sometimes young people are brought to therapy by their parents for the wrong reasons or with unreasonable expectations. These chapters are meant to inform parents, families, teachers, school administrators, paediatricians, school nurses, special educators and counsellors about what problems children may experience and how therapy can help. There is no one type of therapy that addresses childhood and adolescent problems – what is important is that the therapist has been trained to work with children. A child psychotherapist is trained to use techniques that are suitable for a child’s developmental stage. For instance, a young child cannot use words to express their experience or feelings, and play therapy would be used by the child-focused therapist to enter the child’s world. Similarly, an adolescent’s problems have to be understood in the context of a growth stage that is turbulent with important identity issues. A therapist not trained to work with teenagers may either get overwhelmed with the material that is presented or may underplay a serious mental health issue as a normal adolescent phase. After the age of sixteen to eighteen years, the young person can talk with a psychotherapist who works with adults.

There are countless types of therapy that are available and new ones are being developed all the time. In this book we have carefully chosen therapies that have stood the test of time and are taught at universities internationally as professional degrees at the graduate or postgraduate level. The only exception I have made is to include mindfulness-based psychotherapy, which is relatively new in the field of modern psychology, but has had a long history in the eastern healing traditions.

Are Psychotherapists Psychiatrists?

There is confusion among many people about the differences between the many professions within psychology, and I will clarify what the main ones are and their job descriptions.

A psychologist is a professional who has studied psychology