Alumna Update: Ritika Chokhani
Ritika Chokhani is a 2014 scholar, currently working as a Clinical Psychology Trainee at NIHMANS in Bangalore.
In this week’s post she analyzes psychotherapy practices in India, what works, what doesn’t and how she believes therapy should be approached.
Where does psychotherapy come from? What is it?
In a country like India, where many lack access to basic necessities such as food, clean water and clean air, it is easy to discount the valence of psychotherapy, or healing through talk, that has historically anyway been considered elitist. However, language and communication as having immense power to change and create has long been the cornerstone of socio-anthropological, as different from molecular-biological, views of the world.
Some of the core assumptions in psychotherapy are that people can change, that this change can be driven by a human relationship and that it can be sustainable. How well does psychotherapy do in all these fields? Most research outcomes in psychotherapy have culminated in what has been called the dodo bird effect, a reference to Carroll’s Alice in Wonderland when after a race, the dodo bird declares that everybody has won and all must have prizes. So too in psychotherapy research, it appears that most therapies work better than no therapy but there are few models of therapy that demonstrate superiority over other models. The implication: it is common factors, such as the therapeutic relationship, that work.
Play, especially with children, is an important way in which we ‘talk’
When I reflect back to my most valuable lessons about psychotherapy, it has been the child who taught me that, by waiting and chasing after her for sessions, I was not endearing myself to her, but I was paradoxically decreasing her trust that I was strong enough to handle her troubles. Similarly, the so-called Rogerian principles are not so easy in practice – a true commitment to being genuine means conveying to a client that I feel uncomfortable when you sit so close to me, rather than subtly pushing the chair away and avoiding the topic, which is easier. Psychotherapy, I believe, is often about putting discomfort into words. Of course, the relational role is also complemented by empirical knowledge about certain phenomena (that is sometimes counter-intuitive), such as the well-known notion that resisting obsessional thoughts only reinforces them or restricting sleep initially works better for insomnia than trying to sleep harder and harder.
Where is (should it be) it going?
A lot of times, people are depressed because their lives are horrible. How is it fair then to try to get them to change their perceptions of the world? One of my clients’ primary problem is that she doesn’t have enough money. This leads to fights between her and her husband and the constant pressure leads her to fall unconscious periodically. What am I supposed to do here? Help her to cope with her financial status, so that she can keep working and suffering, without the inconvenience of falling unconscious? Or when one client read a news article that the government was planning on conducting mandatory physical examination camps for females to detect potential cancers and concluded that the only way to escape this atrocity was to mutilate herself. She was diagnosed with psychosis – a label of biomedical origins that comfortably ignores the sociopolitical and patriarchal roots of her so-called ‘delusions’. Or how is it acceptable to label someone who struggles with a marriage as ‘adjustment disorder’ as if it is their fault they are not adjusting properly to a man who beats them?
I still don’t have a satisfactory answer to this dilemma. One answer revolves around the idea of bidirectionality. It is not only the world that shapes us, but we shape the world as well, or at least, have the burden of doing so. As I understand the process of psychotherapy more deeply, I am beginning to realize that it does not necessarily have to be oppressive. It can be both revolutionary and rejuvenating. And how trainee therapists conceptualize psychotherapy, the extent to which they revolutionize it, is very much dependent on training institutions.
The famed Rorschach: isn’t it a bit rich to think we can access someone else’s inner world better than them?
Image source: Pixabay
Several hallowed mental health institutions within the country, including the one I am currently at, still adhere to a biomedical model of health. In my institution, the complete sidelining and active discouragement of issues of power and politics is conspicuous. In the OPD, clients who speak English and display the signs of dominant caste, class and education hegemonize more of the doctor’s time and get more choice in treatment. After all, all clients are equal, but some clients are more equal than others. Another thing that is discouraged is critique. Critical thinking begets revolution and that is not something the dominant discourses in mental health want. A true stance of collaboration in caring for someone else’s mental health requires acceptance of a more limited role in their life and acceptance of the diversity of solutions people have to their problems. It also requires surrendering the power of expertise – the other person may really know their life better than you.
The problem of psychotherapy being too narrow in focus also arises from it being conceptualized as primarily individualistic. But this need not be so. Community psychology approaches arise from this very need to expand the scope of psychotherapy from treatment of the individual with mental distress to a critique, examination and eventual overhaul of how we care for the mental health of a society. For example, a young person in London who had just got out of prison suggested ‘problem-solving booths’ (simple booths created literally out of pizza-boxes) be set up in the community where anyone can be the ‘helper’ and the ‘helped’. This has actually inspired an organization to implement his idea.
Such a psychotherapy also demands contextualization. Although psychotherapy is not inherently a Western concept (Cartesian mind-body dualism has only ever been a prerogative of the West), the models of psychotherapy we practice often are. We need to not only ‘adapt’ but inherently reexamine our core beliefs and ideologies. In different socio-cultural contexts, definitions of psychotherapy would be different. Western models of psychotherapy often heavily emphasize the process of communication as comforting or facilitative, even if one may not get something tangible from it. But what about the 11 year old child from Mumbai who guilelessly told me ‘Miss, why should I talk about my problems to anyone if they are not going to tell me what to do?’
Why indeed?
In sum, I truly believe that psychotherapy is not limited to a ceilinged room where people of privilege discuss first-world problems with self-aggrandizing mental health professionals. It has the potential to be social rather than individual, revolutionary rather than repressive and contextual rather than colonial. In this potential, lies both the vision as well as the blind spot of the profession.
Cover image: Play, especially with children, is an important way in which we ‘talk’
