Structuring Care for the Caregivers

इस ब्लॉग को हिंदी में पढ़ने के लिए, यहाँ क्लिक करें।
हा ब्लॉग मराठी मध्ये वाचण्यासाठी, येथे क्लिक करा.

According to the research published by the Indian Council of Medical Research (ICMR) in Lancet Psychiatry in December 2019 states that one in every seven persons in India is affected by a mental disorder. (Source: DECCAN CHRONICLE). Mental health problems were already a major contributor to the burden of illness in India but it goes unnoticed. The invisibility of psychosocial distress that one experiences makes it harder for us to acknowledge the importance it needs to be given. And now, the COVID situation and the isolation brought by the lockdown has made situations worse for people with mental health issues.  Neil Pate mentions in his article Covid19 lockdown has brought about a pandemic of anxiety and depression, that according to the Indian Psychiatry Society, the number of mental health cases – including anxiety and depression – has risen 20 percent since the lockdown was first announced.  With this data to start with, I began to explore and understand the issues faced by people seeking help, and the therapists providing support in this pandemic. I started with thinking about my own experience. When I needed help all I can remember doing is calling my counselor, fixing a date together, and then meeting. Now, with the changing situation, meeting in person is no longer possible. The only way to now meet with the therapist or counsellor is a  video call or a phone call. 

To understand the impact of this changing scenario on both the therapists and the clients further,  I reached out to interview some therapists from Mumbai and Delhi. In my conversation with these therapists, I was able to gather some facts and lived experiences of therapists, their clients and their challenges in this pandemic. 

Our interviewees:

Sadaf Vidha (SV): is a therapist with five years of experience. She did her Master’s in clinical psychology from Tata Institute of Social Sciences (TISS) in 2015. She has done certificate courses in arts-based therapy, queer affirmative counseling practice, and couple and family therapy. 

Shivangi Gupta (SG): Is a psychotherapist with experience of working with clients through online mediums. She completed her Masters in Clinical Psychology from TISS, Mumbai. She is the Program Director of Project AeSha, an intervention program that works with families of single mothers, experiencing intersectional marginalization. She is enrolled in a PhD program at Virginia Tech University for Fall, 2020.

Lamia Bagasrawala (LB): Is a practicing psychotherapist, Arts-based therapist, and queer affirmative counselor. She is the Project Coordinator for the School Initiative for Mental Health Advocacy, Tata Institute of Social Sciences, Mumbai. 

Here is a glimpse of my conversations with them:

When you started out, what were some emotions that you had to process or work through?

(SG): Looking at the current time, it will be of interest to know that in between I didn’t practice for a bit. I started practicing again because of the COVID 19  context and it was largely because of the amount of distress I could see around me and I also wanted to help. I realized that I did have a skill that could be used. And so I started practicing. Also previously I was doing online sessions so it was easy for me to adapt. So, it was a flurry of emotions to process including apprehension about getting back, concern for my own capacity to deal with this change, worry/doubts about whether this was a good decision at all, excitement about being a co-traveller in people’s journeys. Another emotion that I did experience, from the outset was a lot of pride in my clients because I could see how resourceful they were, I could see how they were able to carry on despite facing a lot of challenges. This made me extremely grateful as well.

(LB): I am a person who has anxiety and so the anxiety of the pandemic and uncertainties didn’t quite hit me directly. In fact it allowed me to pause. I generally function with a lot of anxiety but the pandemic has slowed me down and has somehow legitimized my anxiety. It has allowed me to function at my own pace and time and I am no longer worried about having to start by day and work from 9-5 as it is often prescribed. When the pandemic started it was also a period of mixed emotions for me because on the one hand I felt grateful and I realized I have a lot of privilege – the privilege of having food, shelter, resources and much more. I have had the privilege of working from home. And along with gratitude, I also felt a strange feeling of helplessness as the number of clients reaching out for support increased. I realized that although we were in different boats, we were all in the same storm. Work has been tough during this period and pausing for a while and acknowledging the larger situation and recognizing small efforts me and my clients are making has helped.

What are the kinds of challenges or concerns or distress that people are coming to you with now? Do you see a trend or commonality in the experience?

(SV): Yes, uncertainty is a very common concern right now. It is leading to a lot of anxiety, panic, and depression. But these are absolutely normal reactions to an abnormal time.  Another spike I’m seeing is the mental health implications of being locked in with toxic family members and being locked away from loved ones. This is leading to helplessness and frustration.

(SG):People are facing a host of challenges because of the strange and distressing times that we are living in. I think a lot of people are struggling because they are confined to a particular home environment. Some of my clients are expats so they are from other countries and they were here for a holiday or they were visiting their relatives/parents and they were not able to go back because of the international travel restrictions. For some of them, the problems range from having their work visas canceled outside to not being able to meet their partner. So being away from the environment which you are used to, whether it’s stranded in another country or stranded in another city where you are there to work and not be able to come back to your family, not be able to visit people who otherwise you used to visit regularly, etc. The other thing is that, in the homes that many are living in, those places are also constant, which are often not very warm, welcoming and not extremely good for their mental health. Being exposed to a lot of unhealthy communication, not being able to set boundaries which otherwise they would have, that break from home they would otherwise have as they would not have to stay at home all day long; that sort of challenge is coming. A lot of people who derive energy from their social contacts are also finding it very difficult to deal with this environment where they can’t meet people, they can’t see people. Also particularly, people who already had issues with anxiety, for some of them this has been an exacerbator, which has added to the challenges they are facing. This has just made it worse.

(LB): In terms of concerns there is no common concern but there are people feeling helpless and very anxious. There are people who are feeling that things are not in their control especially with restrictions imposed by external forces and restricted movement. People are also looking for direct answers, someone to tell them what to do or give them solutions because they are already in such an uncertain space and are already feeling helpless. They are looking for some clear guidance- that is something that has come up a lot in this period. I have also noticed a lot of people struggling with relationship conflict in this period. Either with their partner or with their family. A large part to do with this is continuously being in contact with their family or with their partner. Constantly being with the same people throughout such a long period of time. At the same time, some of them come from a place of being away from their close ones. Some of my clients have quarantined alone or living alone and they are away from their partners and their family for a long time which is causing distress. I think other concerns coming up are issues of emotional abuse and triggers for a lot of my clients. In the homes they have experienced violence or witnessed violence earlier and are caught in the same space now. Even if right now they may not be experiencing or witnessing abuse or violence, at some point, they have and it is difficult now to stay in that place which has so many triggers.

As a therapist what are the challenges you have been facing in doing this work? How have you been able to resolve them?

(SV) : One of the bigger challenges is the role definition in most jobs. I have worked in startups, a school, and the NGO sector too. Most people do not think counseling is a skill in itself which needs to be well-paid. They feel a counselor must do 100 other things too, in order to deserve good pay. Another problem is burnout with unrealistic ideas of 8 – 10 sessions a day or six-day workweeks etc. The problem lies in how counselor performance is measured in most spaces. In my case I feel privileged enough to be in a family with lots of support where I can work without thinking about any other stuff. This makes my work less challenging and I am able to provide my best services to my client.

(SG): As a therapist, I face the challenge of containing distress which is compounded in the current context. Boundary setting, while being there for your clients, is a challenge when it comes to practicing over the online medium, at a time when distress is so high. This is particularly tough for me because I haven’t previously worked as a private practitioner, so I am not used to norm setting at various levels. I have resolved these challenges in various ways. Talking to other practitioners, reading up online, going back to the processes that I used to follow when I was practicing in an organization; are all strategies that have helped. I have also allowed myself to go with my gut and make mistakes.

While I am a therapist, I am also an individual living during a pandemic. So another challenge has been to take care of my own mental health so that I can be an ethical practitioner. I have managed this challenge by consciously taking out time after and before each session to ground myself. Actively making time for the small things that give me joy, has also helped and so has the conscious effort to structure each day.

As someone who liked having a workspace that was separate from home, and someone who liked going out to unwind; this time is quite difficult given the blurred boundaries between work and home. I have navigated this challenge by remaining connected to friends and indulging in video dates and so on. I also ensure that I dedicate time to recreation at the end of a tough day by watching a film or reading or writing; just so that it still feels that there is space to unwind.

Another challenge has been balancing various commitments, given that I am experiencing multiple transitions myself and am looking at leaving for the US for my doctoral degree in a month. This is a challenge that I am honestly, still, in the process of figuring. But I give myself thinking breaks and try to be okay with not feeling okay. Ranting to my loved ones has helped tremendously.

(LB):  The challenges and needs that the pandemic has resulted in have also influenced the field of mental health and psychotherapy. As a mental health practitioner, it has been difficult to navigate through these transitions. Initially, working from home was a challenge as I had to move my entire practice from in-person sessions to online or telephone sessions. This was particularly difficult as many clients also struggled with private spaces from where they could take therapy. During this time, formal supervision and conversations with peers and colleagues from the field  helped me in reframing my therapeutic practice to adapt to the needs of this period. As a professional, even prior to the pandemic one of the key challenges has always been to prioritize self-care. Earlier, transitions to and from work such as travel time or getting myself a cup of chai or coffee from a road-side stall or coffee shop would be moments to catch-up with myself. During the lockdown this luxury was taken away. Add to it the increasing number of people who were reaching out and the need to want to be there for clients and people at all times. I remember for a few days I was responding to calls and messages from clients and people reaching out without any significant breaks. It was in those moments of intense engagement that I realized that we were all in a crisis – myself included and I had to reframe self-care too. Slowly, as time passed by and through a lot of art and written reflections,  I recognized that getting up from this small workspace that I’ve set for myself at home, stretching a little, making myself a warm cup of tea before every session seemed to offer some comfort and energy. 

After interacting with these therapists it became clear to me that the news and articles reporting an increase in psychological distress are not just statistics. The challenges resulting from confinement, uncertainty and fear are real experiences and therapists are working to fight this battle within the constraints that the lockdown poses. The experiences shared by the therapists also bring to the forefront some of the systemic issues at play that act as contributors to wellbeing; the triggers that come with being confined to small spaces, to the occurrence of violence at home among others.

As we explore the mental health concerns brought by the pandemic and the  challenges faced by therapists we have started to examine other themes. In our next article we will bring to you more conversations from the frontline exploring other such themes in the mental health space. 

References

• Pate, N. (2020, June 8). Covid19 lockdown has brought about a pandemic of anxiety and depression. Deccan Chronicle. https://www.deccanchronicle.com/lifestyle/culture-and-society/080620/covid19-lockdown-has-brought-about-a-pandemic-of-anxiety-and-depressio.html 
• ‌Sagar, R., Dandona, R., Gururaj, G., Dhaliwal, R. S., Singh, A., Ferrari, A., Dua, T., Ganguli, A., Varghese, M., Chakma, J. K., Kumar, G. A., Shaji, K. S., Ambekar, A., Rangaswamy, T., Vijayakumar, L., Agarwal, V., Krishnankutty, R. P., Bhatia, R., Charlson, F., … Dandona, L. (2020). The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017. The Lancet Psychiatry, 7(2), 148–161. https://doi.org/10.1016/s2215-0366(19)30475-4