As a follow up to our previous piece (Structuring care for the caregivers) we bring to you the second article of our three-part series. In this part, we explore the hopes, values and motivation of mental health professionals in our conversations with them.
According to reports from the Indian Union Ministry of Health and Family Welfare, the country needs around 13,000 psychiatrists. To achieve an ideal ratio of psychiatrists to the population we must have 1 psychiatrist per 8000-10000 persons, but currently the country has just one psychiatrist for over two lakh people! With regard to other mental health professionals, the ratio is even worse – the need of Clinical Psychologists is 20,000 and there are only 1000 available; for Psychiatric Social Workers, the requirement is 35,000, but only 900 are available, for Psychiatric Nurses, we need 30,000 and only 1500 are available quotes, Kalpana Sharma, in her article We need more mental health care professionals in India. (Source: Times of India )
The ongoing pandemic has also brought with it psychological distress experienced by so many. The ongoing pandemic has also brought with it psychological distress experienced by so many. And as I thought about the impact of the rise of this distress on mental health professionals I began to wonder about the emotional fatigue it may cause. In exploring this further, I came across the term ‘compassion fatigue’. Listening to the trauma of others can be traumatizing in itself leading to feeling overwhelmed, hopeless, helpless, or powerless when hearing of others’ suffering. Feelings of anger, irritability, sadness, anxiety, feeling detached from your surroundings or from our physical or emotional experience, poor self-care, denial, difficulty in concentration, and bottling up emotions are some things that can be observed as a result of this. These feelings of emotional distress are very much part of us but we can rarely see them. One can feel them or experience them but we can’t see or deny them.
The dearth of mental health professionals in the country combined with the issues of compassion fatigue made me wonder what inspires therapists to do what they do. With the curiosity to understand this we explored ahead with our interviews with Sadaf Vidha(SV), Shivangi Gupta(SG), and Lamia Bagasrawala(LB). (To read more about our interviewees click here)
The conversation was an insightful experience where we explored what keeps mental health professionals going, what motivates them, how they are perceiving this crisis and its impact on them, how are they holding onto optimism in this situation, what values are they holding as they continue doing their work, and what are their hopes about the future.
What brought you to choose this line of work?
(SV): As a child, I was always curious and had a rich inner world of stories. I believe this makes me good at listening and empathy.
(SG): The reason why I chose to do this work is that I really like stories. I really like people’s stories and journeys, I feel privileged to even be a part of or witness people’s stories and I ultimately believe that people are capable of taking care of themselves the best way they can, sometimes they need a little bit of help and support and I would want to be that source of support for them. I feel extremely honoured and enriched to listen to people’s stories.. I learn a lot when I witness other people’s journeys.
(LB): I really wanted to work with people. My journey started from there but was followed by a lot of twists and turns until I came across the field of psychotherapy. I started reading about counselors and as I studied psychology, it fascinated me. I think as a person I have been curious about people’s lives and I have always read about people’s lives and enjoyed listening to people’s stories. I have always found that people’s stories have so much to offer and are very significant. I found a lot of peace and strength in it. That’s how I got to doing what I am doing.
What do you think doing this work has made possible for you? Any changes, highlights in your way of being?
(SV): What it has made me see is the opposite of the effect news has on me. News makes me think that humanity is going to the dogs. My clients make me think of all the courage, resilience, and resistance they are showing every day. It makes me humble. I am grateful that my clients have chosen me to be part of the journey.
(SG): I do learn a lot from my clients. I feel hopeful when I hear my clients’ stories. Sometimes, just the amount of commitment they show to work on themselves, fills me with wonder. In the present times, being engaged in client work makes me feel less isolated. Further, it also instills in me, a sense of purpose that helps me carry on in these difficult times
What are the most important values you kept close to you?
(SV) : My most important values are empathy, kindness, respect, and humility. I let these guide my work and do not assume I know better than my clients. A slight change in fates and I may be sitting on the other side of the table. One value I keep close to me is that we do not have individual faults, we are all survivors of structural inequalities, and in that, I and my clients are in solidarity.
(SG): Social justice is the primary value, which matters the most to me. I am deeply disturbed by disparities and inequalities stemming from the various social locations and identities of people. Therefore, intersectional marginalization is what I always focus upon in any work that I take up. Specifically with regard to psychotherapeutic work, accountability is an extremely important value. I believe that I am completely accountable to my clients for the values that I uphold in my practice and the services I offer. For me, being transparent to my clients is extremely important. Therefore, I always ensure that I articulate my values in front of my clients. I also acknowledge the fact that therapy comes with an imbalance in power, with the therapist holding more power. Thus, an important endeavour, always, is to adopt various practices to equalize the power, to whatever degree I can. In addition to these values, my work and life is deeply influenced by some fundamental values such as respect, dignity of life and work, integrity and honesty.
(LB): The current times have been full of unprecedented challenges for all of us. And personally, I recognize the privileges that allow me to be who I am and do what I do even through this period. Gratitude has therefore been extremely critical for me in this period. I’ve been consciously very grateful for things I have, mereby by the privileges of my social location. At the same time, I’ve also been very conscious of all the disparities and vulnerabilities that this time brings for all of us. As a professional and at a personal level too, being political is a value I hold very closely. I have struggled with having enough energy reserves to amplify my voice and utilize social media platforms, but I’ve ensured that my therapy spaces and conversations with peers and family/friends are not devoid of politics of language, context, and social justice in these times. This value can also seem laborious at times and hence a very important value I keep close to myself is self-preservation. Over the years I’ve recognized that I value being present in the things I do and the interactions I have and that is possible when I take adequate care of myself and place importance on acts of preserving my inner resources and strength.
How often do you get time for self-care or to channelize your emotions? What do you do to ensure or work on your own well being?
(SV): I have some non-session days. I also have a limited number of clients and sessions. My stress busters are painting, music, and playing with my cats. I try to do a bit of these every day.
(SG): To be honest, I used to be a person who did not prioritize self-care a lot before the pandemic. This pandemic has forced me to prioritize my self care because you cannot pour from an empty cup. Besides, this is an extremely uncertain, anxiety provoking time which calls for doing more for ourselves.What really helps me is structure. So, I have tried to create a basic structure for my days, which ensures that I am able to feel a sense of stability and predictability. Being connected to support systems and actively reaching out for support has helped tremendously. Taking each day at a time has helped me take care of my own wellbeing and so has cutting down on the amount of content that I am consuming on an everyday basis. I consciously remind myself about the transience of the situation to ward off the hopelessness inherent in this situation. In addition to this, I ensure that I include activities that bring me fulfillment and joy in my daily routine. This includes cooking, exercising, writing, playing games online, reading and so on.
(LB): I’ll start by saying that if I handed over the reigns of my life to work, I’d probably not get time. And this is why a large part of my self-care has been to “make time for myself”. Over the years, being in the profession that I am, self-care is a word that’s very commonly used (often misunderstood) and has been something I have consciously deliberated upon and practiced. Self-care for me is what Audre Lorde talks about, it is maintenance and it is a political practice to preserve myself. And I often use this analogy with my clients that if you were to go on a road trip, your vehicle would need maintenance. You can prep your vehicle all you want at the beginning of the journey but it will need regular pit stops. And this maintenance will look different. It can be a change of tyres, washing the car, cooling it down, oiling it, or even refueling. Self-care is therefore not something prescriptive for me. It is more about listening to my needs and discomfort and addressing that. Some practices that I know over time have helped me refuel are running (in the lockdown times, it’s morning work-outs), painting and conversations with friends and close people. Additionally, practices that I indulge in almost daily to soothe myself include journaling, creating zentangles or doodles, meditating, and some gardening. In the last few days, I got inspired by a friend and learned that singing loud (like karaoke without any equipment though) has been quite reenergizing for me so that’s an add-on to my list.
After having a conversation with these therapists it made me wonder, “how can someone be so passionate about their work while they are also managing the structural challenges of overload and fatigue?” How can one show so much humility?”
In my conversations with Lamia, Sadaf and Shivangi, I noticed how they have repeatedly spoken about their own learning and growth in being engaged with clients they work with. An analysis of the context itself and my interviewees’ persistent engagement with wellbeing of their clients tell us that caregiving is a two-way, and at times multi-way, process. I am reminded of Erik Erikson’s words, “life does not make any sense without interdependence. We need each other, and the sooner we learn that the better for us all.”
In our next and last part of this series, we will bring you some insights from the supervisors and mentors of therapists/ mental health professionals, and how this collective of caregivers is supporting people in this pandemic.
About the Author
Shahbaan Shah is a Programme Facilitator at Apni Shala Foundation. In his role, he facilitates social-emotional learning for children, educators, and parents in a variety of settings and supports Research & Development initiatives. He holds a Bachelors in Sociology and is an alumnus of Apni Shala Fellowship.