Mental Health Problems: What To Expect When You See A Therapist
Ali Madeeh Hashmi advises on how to find the best therapist for your mental illness and what to expect during the therapy.
Once you decide to consult a professional for anxiety or any other mental health needs, the first thing that needs to be done is to find someone appropriately qualified and, more importantly, someone who is a ‘good fit’ for you. In the US and other Western countries, there is a wide range of qualifications that enable a person to practice as a psychotherapist. This can include people who have training in psychology, social work, counseling, rehabilitation, marriage and family therapy and other disciplines.
Like most professions in the West, the practice of psychotherapy is licensed and tightly regulated. One has to have the requisite years of education followed by supervised work which ultimately leads to a license to practice independently (and supervise others).
In Pakistan, as with most professions, regulation and oversight is minimal or non-existent. And in a country where untrained (and often uneducated) people can practice medicine and even surgery, it is not surprising that there are any number of people claiming to be ‘therapists’.
Finding A Therapist
The first step towards finding someone reliable is to reach out to family and friends who have been in therapy themselves or may know someone who has experience with it. Most large cities in Pakistan have networks of trained mental health professionals who can be found by word of mouth or by reaching out to someone who may be connected to them. Online directories are also available and occasionally, a simple Google search may yield some helpful results. As with all things in Pakistan, buyer beware!
Make sure you ask any therapist you are planning to see what their educational qualifications and/work experience is. A Masters or PhD in Psychology is essential. People who are teaching or supervising psychology students in public or private colleges or universities are usually a safe bet. Social work and other mental health disciplines do not exist in Pakistan yet.
Beware of people who claim to have done brief ‘Diplomas’ from private organisations while having no mental health education or training otherwise. If in doubt, reach out to reputable public institutions for recommendations. Big public institutions like The Aga Khan University in Karachi, King Edward Medical University or Punjab University in Lahore can help.
Online ‘Helplines’, a good idea in theory, are beset by problems. They are unregulated and unsupervised and may be staffed by people with little or no training in mental health. Avoid them if possible. A well trained, ethical psychiatrist who does not jump to medications as a first option can also provide referrals for therapy but is often hard to find. Again, a well reputed teaching institution can probably help.
What To Expect In Therapy
The first question I get asked when I recommend that someone go to therapy is ‘How will talking help?’ followed by ‘I can talk to my family’ and ‘I can do my own counseling’. At the root of these responses lies a fundamental misunderstanding of the process of psychotherapy. While it is true that psychotherapy is ‘talk therapy’, it’s important not to confuse it with talking to a friend, a family member or even your family doctor.
Psychotherapy does NOT involve the therapist providing sympathy or random suggestions that they think will be helpful in your particular situations (something that friends and family can provide, for free). A psychotherapist is a trained mental health professional whose task is to first analyse both the problems you bring to them as well as your own particular personality, coping style and your way of thinking, feeling and behaving.
This may involve several initial sessions where the therapist offers no suggestions at all, just listening to what you are describing and how you are describing it. I see one or two patients for psychotherapy a week (yes, psychiatrists can also do therapy if they have the appropriate training although the vast majority now only do ‘medication management’) and the commonest complaint from people that I see is that I never tell them what to do! It takes some effort to help them understand that my task is not to offer simplistic solutions to complex, often intractable problems but to help them formulate their own, lasting solutions over time.
How your therapist does this will vary depending on what problem you bring to the table and how deeply you want to explore it. If you simply want relief from periodic anxiety attacks or mild depression, they may choose to do therapy that involves very concrete analysis of your thoughts and feelings and how you can practice changing them over time.
On the other hand, if you bring in a question such as ‘Why do I keep getting into relationships with the wrong people?’ or ‘Why am I unhappy with my life?’, it may involve more than a few sessions in which you and your therapist ‘dive deep’ into your feelings, your past, your family and personal relationships in a quest to bring about a basic change in your outlook, a process that can take several months or longer.
No matter what approach your therapist takes, you can expect to see them in therapy at least once a week (occasionally more often) for at least several weeks or, if you decide, for longer. Each session usually last between 40-50 minutes. People often find that they start therapy in order to find relief from a specific symptom but then, as they talk, other deeper issues come up which they had never thought about.
You and your therapist can then decide if you want to explore these further or if you want to stop once your initial symptoms are relieved.
As you start and then proceed through therapy, depending on the severity of your symptoms and degree of your distress, occasionally your therapist may decide that perhaps a referral to a psychiatrist is warranted to see if medication can ‘accelerate’ your symptom relief. If your therapist wants you to see a psychiatrist, what can you expect? More on that next time.
The writer is a psychiatrist practicing in Lahore. He taught and practiced Psychiatry in the United States for 16 years. He tweets @Ali_Madeeh