Heeding those inner voices

Therapy. Safe spaces. Healing. Self-reflective practices. These are words that a growing section of Indians are getting familiar with today more than ever before. While this is a welcome change, there is another aspect to this deepening awareness that remains mostly hidden. We are talking, of course, about the mental health of therapists. 

Bengaluru-based Vanaja Ammanath, senior mental health counsellor and founder of the Institute of Relational Therapy, in her recently published book Relational Gestalt Therapy in India, has tried to decode the needs and challenges of being and becoming a relational therapist. Her book, the only one of its kind in the field of Gestalt Therapy in India, highlights how personal development, self-analysis, self-awareness, and actualisation are dire requirements for practising therapists; the lack of which can be a pitfall for the current, toddling mental health system in India. 

In the book that was launched at the Bangalore International Centre earlier this year, she remarks, “Trainees (those learning to offer relational therapy to clients) must learn to distinguish their emotions and be aware of their beliefs, values, moral principles, sociocultural and political identities, and their reactions to various stressful situations… However, if we do not invest in our own atmagyan — at an individual level — our fluidity and growth become stuck. At a larger relational level, there is a risk of not being fully present for our clients because we have shied away from being fully present for ourselves.”

Know thyself 

Not many are aware that in order to practise counselling as a mental health professional, therapists need to themselves be in personal therapy sessions. While individual therapy is very important and non-negotiable, group therapy can be at the discretion of the therapist. This is different from supervisory sessions with a mentor, which are crucial for professional growth. 

Garima Khanter, mental health advocate and Gestalt Therapy practitioner, concurs with this ideology in theory and practice. 

“You can meet your clients only as deeply as you have met yourself. Therapists are people themselves, living their own full lives outside the therapy room. Whatever happens to a client, happens just as much to a therapist in general… It (continued therapy) is an ongoing commitment: like investing in learning, being ethical, and competent,” she shares, hinting that personal therapy sessions for therapists can prove to be a safe space to process their own dilemmas in order to avoid spillovers in professional sessions.

While it is not a mandate yet in India unlike certain other countries in the world, it is a healthy way of practising as a mental health professional.

Parul Soni, a mental health professional and Relational Gestalt Therapy practitioner, shares that she has been in individual therapy ever since she chose the field as her purpose in life and enrolled for group therapy around 2019. 

“It is not a mandate but a choice for therapists to be in therapy themselves, at least in the early years of their practice… a norm across the world. However, for healthy practitioners, for healthy dynamics and your own healthy practice, it is a requirement,” she says, adding, “One may have completed higher-level education or major work in psychology but one may not have been in real-time therapy before seeing a client, which makes a real and crucial difference.”

Discontentments surface

With increasing demand for mental health practitioners and a mismatch in supply due to a lack of sufficiently trained therapists, incidents of discontentment have begun to surface. Certainly, the pitfalls of not caring enough for one’s own mental health are pretty evident. 

Ammanath, who also teaches at Psychology institutes in the city, shares, “We are churning out so many psychologists. Corporates have come up with their own mental health platforms, a lot of them being online apps. It is not uncommon anymore to come across horrific tales of therapy sessions gone wrong.”

While many youngsters find the field lucrative and pursue it academically, few are ready to commit to prolonged periods of training, constant learning and supervision that are requisites of a healthy practice. There is also a huge gender gap with more women professionals than men. Add to this the societal bias that blankets all mental conditions as disorders and not a state of being, and we are looking at a gaping abyss. 

For many years, therapy or counselling sessions meant seeking comfort in a physical space with a one-on-one interaction. In layman or organic terms, it meant finding someone safe to talk to without the fear of judgement or receiving unsolicited advice. During the pandemic, mental healthcare saw a shift in how help was offered and serviced. From confined physical spaces, these conversations had to move to a virtual room or a video call. With threads around generational stigma associated with mental health loosening a bit and with rising demand, workplaces began to offer mental health services, sometimes even free of charge or at discounted prices. 

Sour experience

Rohini N (name changed on request), a senior employee with a real estate company contemplated seeking therapy for a long time. After much courage, the official resource came in handy and she finally blocked a slot for her first-ever therapy-related conversation. However, the experience turned out to be rather sour, pushing her further back in her journey towards dealing with her situation.

She shares, “I never imagined the first conversation to be so conclusive. It felt as if a general physician was asking me for symptoms and then negating that I suffered from anything at all. It took me a lot of courage to book that slot and prepare myself emotionally for it. There was some personal issue with the therapist which made her reschedule the session twice on the same day and finally, when the call happened, it felt like she just wanted to close it soon.” 

Rohini laments that perhaps because it was a free or discounted session, it turned out the way it did. Once ready again, she will only contact someone reliable or referred by a friend or colleague. No telephonic for her at all.

Khanter, who briefly offered her sessions on an online platform, agrees that they (telephonic sessions) may not be as efficient. “In terms of crisis and emergency, in situations when people can’t access anything better, some help is better than no help… nothing replaces the one-on-one, in-person interaction,” she explains adding, “Video calls and Zoom sessions are also doing their job in some way. Since Covid, the video call mode offering therapy has evolved a bit. All of us have picked up a few skills on how to connect effectively with clients online.”

Mental agility, emotional tuning

Unlike a few Western countries where psychotherapy has a strict and structured regulatory framework and mandate, Indian faculty has no such scaffolding to fall back on. In certain European countries, psychotherapy practice involves a minimum of seven to nine years of extensive training along with mandated supervised and personal therapy hours for a therapist, points out Irina Bezic, President of the European Association for Psychotherapy (EAP).

The umbrella organisation, founded in 1991 to support and promote psychotherapy in Europe, unites 120,000 psychotherapists and 128 psychotherapy organisations from more than 40 European countries.

Narrating an experience with an expat client a decade ago, Ammanath highlights how people there have a deep understanding and make informed decisions when it comes to seeking mental health. “In India, we tend to be unsure or hesitant to address authority figures or professionals and ask for information; that’s important when seeking help.”

She also points out that in European countries and the US, to keep one’s licence, one must be in an ongoing accreditation learning space. And only having a PhD or an academic qualification to practice is not sufficient.  

“Consultation and ongoing education and personal therapy keeps us mentally agile and emotionally attuned,” Ammanath asserts.

Sridevi Padmanabhan, another mental health practitioner, sums it up well. “Mere qualifications are not enough. It is important to look for qualities like curiosity, and attentiveness; the therapist must listen actively and ask questions, rather than being prescriptive, or quickly jumping to diagnosis.”

Keep in mind

Here are a list of questions to ask before you decide on a therapist: 

1. Does the therapist have a Master's in Psychology with at least five years of supervised practice?

2. What is her approach to treatment? Does she prefer psychoanalysis, Cognitive Behaviour Therapy (CRT) or Humanistic Existential Therapy (HET)?   

3. Which form of therapy is most suitable to your problems? And why?

4. Has the therapist taken individual therapy? How was the experience? 

5. What kind of client issues has the therapist worked with?

What is Gestalt Therapy? 

In a video interview with DHoS, Bezic spoke about the emergence of Gestalt Therapy as a humanistic form of healing and how it has evolved over the years since its inception after the First World War. 

Gestalt Therapy was founded by German psychiatrist and psychotherapist Friedrich Salomon Perls (Fritz Perls) along with his wife Laura Perls, also a renowned psychologist and psychotherapist in the 1940s after they migrated to the United States. However, the concept remained largely unpopular in America until Europeans embraced it in the 1980s. Predominantly, East Europe was influenced by it. It began to be looked at as a liberal, individualistic, creative, and dialogic form of therapy. Bezic, who hails from Croatia, feels positive about the spread of gestalt therapy in India because of the country's deep connections with Buddhism and the Gandhian philosophy of life. “Human relationships have become more important than ever now. Gestalt Therapy as a humanistic practice is not an attempt to heal one individual of a certain condition but help the society at large find newer possibilities of connecting with the self, with each other and bring a shift in personal structures,” states Bezic.