Can’t afford therapy? Start with this.

Before you go on to read this, I should tell you that mental health issues are complex and what I’m suggesting is too simple for some concerns. Another aspect I would like to stress is that it is always best to work with a mental health professional as it kind of gives an outsider perspective, and expertise, among other things.

Now, if you are someone who cannot afford a therapist or who is contemplating what happens in it, you can try what I’m suggesting next.

Step 1: Describe your problem. This could be in a written format or as a tape/audio or a drawing. Look for these things: What are the most obvious effects of the problem on your life? How long has it happened? What are some of the things that led to it or added to it? Are there people who are responsible for this? Who gets affected by this apart from you?

Step 2: Give your problem a name. Anything that suits it best. A client of mine would call their anxiety “the big giant head” – a reference to a controlling character from the series, 3rd rock from the sun as their anxiety would consume them as if it were the voice of God. Now, ask yourself, what influence do I have on the problem? – Now, this question is weird for a lot of people. It sounds absurd. Can I ever have any influence on my anxiety or depression or mood disorder? Turns out you do. This is how a client of mine put. “I influence my anger such that I don’t let it make me hit people. No matter how angry I get, I stop it at yelling max”. So this is the influence that the person has on their anger.

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Step 3: Find out times when, despite the problem being there, you have not behaved in the way the problem would like you to. For example, if you gave a speech despite your anxiety killing you, that was an alternate behavior. That was an exception. Ask yourself, what made me do that? What was I thinking? What was I feeling? Quite often, exceptions are the key too change but we are so caught up with the problem, that we forget to pay attention to the exceptions.

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Step 4: Find out the kind of thoughts you have about yourself and the problem. This can be done with an exercise called the downward arrow. Here’s an example. Neeta feels that “I must comply with others wishes if I want them to like me” – Then she asks herself and that means? – That others must like me – And that means? – If they don’t like me, I’m worthless – And that means? – i’m worthless. So, to make sure that “I’m worthless” does not surface, neeta compensates with pleasing behaviour. Now, some sort of pleasing behaviour is socially required, we are only talking of extreme ones which come at the price of our self-esteem. So, this is a good way of the kind of thoughts you’re having about yourself and the problem. Some thoughts are not helpful, they are called cognitive distortions. They make you see the world through a coloured glass. Here’s a list of common cognitive distortions. And here’s how you fight them.

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Step 5: Once we identify our thought patterns, it may feel like “I’m such a loser to think like that” or “will I have to always fight my thoughts?”

Here’s the good news, along with naming the problem (which helps you to see the problem outside of you, something which is not your personal fault), finding your influence on it (gives you a sense of control), finding out exceptions (what you’re already doing right and which can be done more often), finding out cognitive distortions and fighting them (helps to change your thought process), there’s one more thing we can do : not think of “my thoughts = me”. Just like wearing a blue shirt does not make you blue, some of your thoughts don’t make you who you are. When we start thinking of thoughts as facts that need to be believed or commands that need to be followed, we do things that we do not like. For example the thought “I must go check that lock” – even when we have checked that lock many times before, becomes a compulsion and reinforces the OCD. Therefore, we have taken our thoughts as facts/instructions that are right and need to be acted upon. This is called “Cognitive Fusion” which literally means, fusing with your thoughts.

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So, now that we know that our thoughts are not true, not real instructions and not helpful, how do we get unstuck? We do so by recognizing them but letting them come and go.  There are many ways of doing this. You could do mindfulness meditation. Or you could do thought-distancing. An example of thought distancing:

“I’m an idiot” 

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“I’m thinking that I’m an idiot”

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“My mind is telling me that I’m an idiot and I’m noticing that”

This helps to ensure that you distance from your thoughts in a way that you’re looking at it as an outsider as a process of the mind rather than something to believe in. Another way of accepting your thoughts and let it come and go is to visualize your thoughts floating away like clouds, or like leaves on a stream.

If you’re too caught up with your thoughts, asking yourself “will thinking this help me?” is a great way of pulling out. However, for you to do this, you need to outline your values. So if your value is to be a person who is helpful, you can ask yourself “Is the thought ‘people are evil and not worth helping’ going to help me achieve my value of being helpful?”

Bringing your values into perspective and pointing out that the current thought pattern is not helping to do so, is powerful to put things in perspective.

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So, what I have tried to show you is – clarity of the problem, looking at it from the outside so as to step away from it and know that you DO have some control, noticing exceptions and making them the norm, knowing the role of your thoughts and beating the unhelpful ones and accepting your thoughts without believing in them. All of this draws from three therapies: narrative therapy, cognitive behaviour therapy and acceptance and commitment therapy. You are welcome to look these up for further help. Some recommended books are Feeling Good by David Burns, Get Out of Your Mind and Into Your Life by Steven Hayes and Step Out of Your Story by Kim Schneiderman.

If you are looking to start therapy in India: Here’s a crowdsourced list of therapists. If you would like phone help, try calling Icall, a helpline run by TISS. For online therapy, you could try out https://www.typeathought.com.

If you have any questions or suggestions, do let me know in the comments. I will try to get back as soon as possible.

Doctor Attacks: Killing the messenger when you do not like the message

In a gruelling incident, our legal authorities have once again shown that the value of human life is less than nil india. Instead of having stronger legislation to save doctors from such attacks, the SC instead told that if doctors are scared, they should sit at home. On the other hand, our health policy is a joke. Our health minister openly says that we cannot ensure health care as a basic right because what if we can’t provide it? Such juveline responses, and they expect to be taken seriously.
Government hospitals all over India are in a bad shape. Eventually, some or the other patient, stressed as he is with the family member’s illness, will want to find some target for his aggression. Then, they end up harming the staff doctors. This is not restricted to the medical sphere. When trains get delayed in Mumbai, there have been many times when the train drivers have got beaten up due to no fault of their own.

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When we are in a state of rage, we do not think rationally and we target our anger on whoever represents the organization we are angry with. Yes, stricter legislation may make us more careful and knock some rationality into us, but that is still a band aid solution.
The fact of the matter is that the Indian public is bursting at the seams and getting buried under huge burdens.

Casteism, sexism, classism and all sorts of limitations stop people from having a good life. We are still struggling with basics of food, clean water and healthcare. Naturally, all this frustration and disappointment is gathering within people, and it will show its ugly face somewhere. That is why, we have such a bad case of mental health, violence, road rage, abuse and suicide.
Agreed, we are a developing country and we are still getting there when it comes to the basics. But that is not what our expenditure reflects.

Was a 3600 crore statue more important than healthcare? Are bullet trains more important than accident safety of our regular trains?

The problem has been the same since independence: uneven development agendas. And this comes from lack of research and empathy from the policy makers. The policies we make are absolutely divorced from the ground reality at the grassroots.
Till we get our priorities sorted and make basic quality of life our main agenda, there’s no point making high rises, statues and fancy bridges. A country is made of people, not structures. And Indians are not happy, and large chunks are also moving towards fits of mental unstability which culminates into mob violence. Till we aknowledge this gap, and treat it, we will keep seeing gruesome attacks on the messenger, just because the message, the organization is not adept.

Exceptions are the key, in therapy and life

A lot of times, in life as well as within therapy, people tend to think that humans are more or less the same as they were before. Yes, people to do come to therapy wanting to change, but they feel that the change is located outside of themselves and they need to be helped to find it by a more enlightened person. But they do not believe that the alternate identity to the one that they currently live, is within them.

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As our basic guiding philosophies have changed to post-structural and post-modern, we are dealing with the idea of fluid idenitites. Some later day therapies also talk about the fact that the “different me” is within me, like narrative therapy, acceptance and commitment therapy and so on. We also believe in this idea in other walks of life, the idea that we create the kind of world we talk about. That is why, instead of cribbing about the bad state of public transport, some people have gone on to make cab-hiring apps which are an integral part of our life right now.

In essence, we are saying that it is not just dominant discourses and hierarchical figures who affect our life, but, by changing the conversation, things can be the other way around.

So, if you have to bring the change from inside of you, and make it a part of your idenitity, you need to start believing in the exceptions. Noticing exceptions makes them more possible to be repeated. For example, if a child is labelled as “naughty” and all of his behaviour that does not match this label goes unnoticed, then what is the dominant idenity that he is going to give himself?

The truth is that we are not simple beings with just one type of motivation. We act in all kinds of behaviours. Some get noticed and some don’t. Sadly, we start to form our idenity based on what gets noticed. However, notcing your exceptions yourself, will make you take a better look at them, at how you made them possible. This makes it easy for you to do it more often, so that others can see it. And that is how the newer behaviour becomes part of who you are.

If you believe in an exception to your social anxiety, and think of all those moments where you managed even to be a little more social, slowly beuilding on that will help you manage the social anxiety. If we want to get somewhere, we need to imagine it. And paying attention to parts of it that you’re already doing, helps you imagine easily and get there faster.

Similarly, believing in and making a “thick description” is what will help teachers manage students and therapists work well with their clients.

When it comes to change, then, God is in the exceptions.

 

The Danger When Only Celebrities talk about Mental Health

Deepika Padukone started it. Then many joined on, including Karan Johar, Hritik Roshan, Illana Dcruz and even Honey Singh. While it is great that India is finally talking about mental health, the aim of bringing normality to the conversation cannot be met if only celebrities are going to carry the torch.

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By default, celebrities have a much more comfortable life, with a lot more reseources. To a common person, if only celebrities are going to talk about mental health issues, then it can seem like the problem is only a first-world one, something that affects only the rich. This is what happened to the LGBT conversation in the beginning. And the effects still last – people tend to think that “its a western product” and “taken seriously on in Bollywood”.

But of course, that is not the reality. Even with genetic predisposition, life circumstances still have an important role in bringing forth the onset of many mental health issues. In fact, poverty and unsafe circumstances contribute to the onset a lot.

By making celebrities to be the only faces of mental health topics, we run a risk of making it an elite problem. Parents may not take their children seriosusly, thinking that he or she is only emulating a rich and famous person.

Therefore, for the Indian scene on mental health, we need the presence of a much more local and well connected entity: the government. It is high time that we took mental health in the country as seriously as sanitation. Findings of how bad things are, are all over the place, right from the report of WHO that we are the most depressed country, to suicide being the leading cause of death among young people.

The government needs to step up its game and not only make laws more friendly and spend more on mental health (compared to the measly 0.6% we do now), but also start awareness programs and find ways of reaching out to all the different people using their own colloquial terms.

Let’s start a conversation. One where celebrities aren’t the only ones speaking.

Whatsapp allowing revoking messages: A world dangerously bent on controlling

Only yesterday, there was this speculation that like Gmail, you can even take back and edit sent whatsapp messages. And that thrilled so many of us. Why? Well, you can take back that sentimental message sent to your ex! Or not say that stupid thing to your boss.

But beneath the layer, what does this inherent urge to control indicate? we want the world to function on our terms, and we are upset when it does not.

At the personal level, trying to exert control and failing leads to anxiety, depression and stress. On a larger level, it leads us to hate minority groups and get angry and violent. It leads us to overcompensate and hoard more and more, because that’s the only way we know to make meaning – do more, gain control.

It made sense to follow this philolosphy when we had little to go on and life was unstable. But now, we are not going extinct. We have more than enough for our needs as a whole, but this very tendency to hoard, capture and control makes us fail at sharing this – leading to disparity, anger, unrest and hatred.

So no, what we need is not better and better technology of controlling. What we need is a philolosphy of acceptance, towards body fat, towards “different” people, towards mistakes and ultimately – towards sent messages. Its alright. That’s how we learn. And grow.

Why Your Friends Can’t Counsel you. 

It’s the internet age and trolls are everywhere. Two troll messages I get as a therapist are:

Our jobs can be performed by the client’s friends and family also 

And 

This should not be a charged service. 

I have a short and long answer to this. 

Short answer: no. 

Long answer:

Troll statement one. People come to us in a state of emotional flux and mental confusion. Now, they have already tried talking to their friends. Either they only got support and more often and likely, they got judgemental attitude and generic advice. 

When you go to a therapist, they do two things:

1. They listen reflectively. This means that they listen without judgement. They gauge your values and beliefs and empathize with you. This is important because being truly listened to, solves half your confusion and heals half your pain.  This listening is a skill and comes with patience and practice. 

2. They use their knowledge of human psychology to find out what is your contribution to the pain points and how to fix those by making changes in yourself. This is something your friends cannot do. 

Image Source – a great article on how to get the most out of therapy 
Now, for the second troll statement. The two functions of therapy as reported above, are a very brief description of what goes on and yet, even they give an idea of the studying and skill development that goes behind it. How could it be free then? 

Besides, how committed would a client be to making changes in themselves if the process they were participating  in was free? Yes, the prices could definitely be subsidized and what not. But apart from crises helplines, if something is free, the commitment may be lower. The therapist also works hard if the process is paid for. 

Oh yes, and then there are those bhakts who will claim this is a western concept. Again no. Through our vedas, bhagavad Gita, and culture of mehfil, we have always believed in the power of talking, reflection and argument to solve problems. If we didn’t, would we pay diplomats high salaries to talk us out of problems? 

Also, that smartphone in your hand is also not Indian. Did not take you so long to adopt to that, did it?

What makes Therapy therapeutic for the therapist?

When thinking of a therapist, people think of posh offices and armchairs, but there’s a lot more to it. In India, many don’t even get to that stage.
Yet, the process is quite rewarding.

When I began working as an online counselor, I did not think that I would enjoy the process much. I felt that only face to face Therapy was ‘real’. But with time, I saw that this was a modality in itself and that it had its own nuances and joys. I met people for therapy who would never have seen a therapist face to face.
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The most fulfilling aspect of being a therapist is that the act of providing therapy is in itself so therapeutic. While you help people see their irrational cognition or repetitive patterns, you come to know some of your own.

When you suggest changes for the particular problem, you realize that the first champion of your techniques should be you. So, you start working on yourself along with the client, and in essence, it’s a joining of two journeys rather than a leader and a follower.
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And of course, the most therapeutic part is when you are able to truly help someone for the better. If someone feels heard or makes positive changes in their life solely due to having a conversation, that is a very powerful motivator for the therapist. Creation is therapeutic and in this way, I can help create little bundles of joy.

Nothing could be more healing.

What is a therapist scared of?

It’s intriguing isn’t it, to know what a therapist would be scared of?

Someone who has all or most answers for client’s problems, an expert who helps people face their deepest anxieties and fears, they also have some fears of their own.

As a therapist, my biggest professional fear is other professionals.

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Wait, before you jump the gun, let me clarify. I don’t hate all other therapists and psychiatrists apart from myself. But the amount of malpractice and sloppy work is so rampant, that it breaks my heart.

There was a time when I used to think this is an Indian phenomenon, what with our archiac mental health act and absolutely no licensing at all, but then I later read of the debacle where APA psychologists were illegally working with the American Defense department to help them with mental torture of the detainees. Then, I was pretty sure that the ‘mad doctors’ are everywhere, but they may just escape better because of our laws.

Right from counselors who think being gay is a sin and people can be cured by converting to their (the counselor’s) religion, to horrible policies of special schools, to suicide helplines who are just downright horrendous, to psychiatrists who give ECTs in a moving van, this therapist’s biggest fears are her colleagues. Some of them.

On reflecting, I think that people who suck at their job everywhere. But the problem here is that in this field, if you are bad, the potential for abuse is high, and you can scar someone forever; because they are the most vulnerable when they come to you for help.