As a follow up to our previous two pieces Structuring care for the caregivers and Hoping and responding for care, we bring to you the final part of our three part series. In this part, we explore the way care is structured or the gaps in this system that mental health professionals access. We look at what care looks like for mental health professionals through an exploration of some studies and interviews with supervisors and therapists.
The COVID-19 crisis has transformed the lives and practices of psychologists and has highlighted the need for time-efficient self and collective care. In the context of the data we shared about the workload and the scarcity of mental health professionals in the country, there are many psychologist psychiatrists and other professionals that are currently navigating heavier than usual workload, significantly higher levels of grief and stress, and virtual sessions. A paper published by Pankhuri Aggarwal and Sujata Sriram on Exploring well being among mental health professionals in India (2018) talks about the construction and experience of happiness and well-being among Mental Health Professionals (MHPs) in India. They share an analysis in the paper that shows that despite happiness being a desirable and pleasurable state, participants rarely devote time thinking about it. One of the possible reasons why well-being has received little attention in the field of mental health could be because it is not regarded as a source of therapeutic concern in the field (Bentall 1992). The aim of traditional forms of psychology has almost always been to decrease distress and suffering rather than enhancing well-being. Another plausible reason could be the vague nature of the construct of happiness itself, as well as lack of clarity on the ways in which it can be measured (Seligman, 2013)
In order to understand how self care and well being is and can be practiced by the mental health professionals during this lockdown I got the opportunity to talk with some experts in the field.
Jehanzeb Baldiwala(JB) is a therapist, supervisor, trainer and part of Ummeed Child Development Center’s management team since 2004. She has aligned herself with narrative ways of working over the past twelve years. Her work at Ummeed includes consulting with families and children in responding to a range of issues that include anxiety, depression, school related issues etc in addition to training and supervising the mental health team at Ummeed.
She has a keen interest in exploring narrative ideas in supervision and organizational development, particularly in supporting the development of professional identities of mental health workers.
Chetna Duggal (CD): Is an Associate Professor at the School of Human Ecology, Tata Institute of Social Sciences, Mumbai. She is a psychotherapist and a supervisor with more than 14years of experience. She heads the School Initiative for Mental Health Advocacy (SIMHA) and Rahbar (an initiative for supervision and professional development of mental health professionals). She has also been on Apni Shala’s board right from the start and helped give shape to its programmes.
Here are the excerpts from our interview:
As a therapist yourself or someone that supervises others, what impact or consequences do you see on the therapists/MHPs of counseling/helping/holding space during the lockdown or pandemic?
JB: I think as a therapist for me it has been a movement between hope and sometimes experiencing despair at all the sadness, anxiety, and hopelessness people are experiencing. What helps is to hold on to the reasons why we do the work for me and in my relationship as a supervisor. To focus on the little things that people are always doing to manage, make things better. To share and be inspired by the resilience people use to stay close to what is important to them. To listen to all the creative responses and skills people have. Because the safe spaces where people can think together, share connections and stay hopeful are so vital for us.There are so many beautiful little things people are doing that I have been noticing and also creating collective documents of when I interact with groups of therapists
CD: The pandemic and subsequent lockdown has impacted mental health professionals in many ways. During the initial phase of the lockdown, therapy work had to move to an online/phone format, and there were many concerns on how to manage our relationships with our client, how to transition to an online format and what are the ethics around that. Ensuring that they could continue their therapeutic work in this format required a lot of work. Also, at this time many therapists and counselors started volunteering for helplines for COVID 19, which increased their workload considerably. What it meant was engaging in crisis counselling and responding to high distress clients, along with providing care to their ongoing clients. That apart, due to the crisis of the pandemic and the lockdown a lot of clients who had previously been in therapy also started reaching out, as they were experiencing some challenges or were experiencing distress triggered by being at home or due to worries about their health. All of this added up, in terms of workload for therapists and demands on them. While therapists reached out to provide care, it gave them very little time to process how they were feeling and what was going on for them. A supportive space to process what was happening was something that many therapists needed at that time. As this was a time where therapists were also dealing with the pandemic, just as their clients were, therapists own self-care was also very critical.
What are the ways that therapists can care for themselves or that we can create space for collective care?
JB: I think having a partner/group to share thoughts with and supporting each other to focus on our hopes, values, and skills in this current time. Taking time to do little things that bring happiness and connection for us as workers can help.
CD : One is that at a time like this when there is a pandemic going on and therapists as a collective are responding to a lot of mental health concerns that people are experiencing, we can create spaces where therapists feel supported, they have time to reflect and think and process what is going on with them. We run an initiative called Rahbar where we create spaces for therapists to reflect on how they are making meaning of this situation, what is happening in their therapeutic relationships, how they are coping, and how they are taking care of themselves. It is very important that therapists take care of themselves (take breaks and nurture themselves) and also connect with their support systems, their professional peers, and their supervisors.
At a time like this, what are things you are seeing about the mental health profession or about the work of therapists that may need to change? These may also be changes we need to see in the different systems that are operating?
JB:I think as a mental health worker who is aligned to narrative practices making visible the influence of systems that marginalize people has always been a part of my work. The pandemic has made these more and more visible to most people. I continue to hold on to my ideas of collaboration with people, believing that they have many skills that will support them to reach their preferred ways of being. That conversation we have can influence people by making visible what’s important to them/ their hopes, that will generate the sense of choice/ agency to live lives that they prefer and also to co-create alternate versions of life. And to also continue to help people experience less isolation and more connection to people/voices that will support these preferred ways of being in whatever ways possible. What has changed is adapting to using a phone, online means to stay connected. A lot of work these days also is focused on making visible the skills that make it possible to get through one day at a time and manage change/unpredictability. But I have been witness to so many stories of people doing this, which is a privilege.
I have also seen a lot of workers trying to stay connected with others and collaborate much more and share more willingly whether it is resources or ideas which is beautiful
CD : Moving to online therapy has been a big change and that might need to continue for sometime. The presence of a therapist can make a huge difference in therapy, and the alliance between client and therapist is extremely important and that is something we are learning to navigate in online work now.
In response to the pandemic, we are also noting that there are conversations on promoting well-being and fostering resilience in educational institutions and other organizations, I hope this continues and we bring into the ambit of our work promotive and preventive care, so we can create systems that care and provide nurturing and safe spaces to people. Another important aspect at this time has been setting up of free helplines for those who need mental health support and care. I hope such systems can be created and strengthened for reaching out to individuals and communities across diverse contexts.
Also, while mental health professionals reach out to those who need support, systems for their self-care and professional development also need to be strengthened.
What is your hope for the persons seeking help during this time and for those helping them?
JB: That we continue to collaborate in respectful ways with people who consult us and with each other. that we hold on to hope and that we create many more spaces and communities that are safe for us as professionals and therefore for all those who share their lives and difficulties with us
CD: The hope is that human resilience will triumph, all of us will bounce back from this adversity and our strength and resilience will outshine everything. There are beautiful narratives that emerge every time I speak to someone. I do a lot of one-on-one work with clients and I can see that people are connecting to their strengths and resources, responding with compassion and commitment and supporting others as well.
In their article ‘Dear Mental Health Practitioners; Take Care of Yourselves: a Literature Review on Self-Care’, Kirsten Posluns and Terry Lynn Gall state that mental health practitioners (e.g., counselors; psychotherapists) work in a culture of one-way caring (Guy 2000) in which they are required to demonstrate empathy, compassion and patience, without the expectation of receiving such care in return from their clients (Skovholt et al. 2001) (Source-Springer Link).
For us to move towards a system of collective care calls for changes at several levels. From the data and my conversations with supervisors/experienced therapists some key areas of possibilities emerged:
- Addressing the dearth of professionals to ensure that we are not all stretched for resources to care for ourselves and one another. This would mean perhaps rethinking the way we look at the profession. We may need to consider alternative forms of training and creating access to preventive and curative psychological first aid and care in a way that contextualizes it in the strengths and wisdom of the community we serve. Relying on the expertise of mental health care practitioners and the community that seeks care revisit and reimagine how the practice can evolve.
- Destigmatize mental health by integrating it from the beginning into schools to thereby make the language accessible and making it ok to seek help. A bye product hopefully also becomes the humanizing of the therapist or MHP
- Institutionalizing collective care systems in the form of formal or informal support or supervision groups for therapists /MHPs/community mental health workers. This will allow for them to be able to work on both personal and professional development while also seeking safety in being vulnerable about the challenges of their practice and their personal lives.
As we come to the end of our three series article, we invite you to consider what role you might be able to play in strengthening systems of care?
About the Interviewer
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.