Inside out understanding psychotherapy

15 million people in Pakistan suffer from mental illnesses and medications are not the best option

With growing awareness about the benefits of psychotherapy many individuals around the globe don’t shy away from opting for it. Unfortunately, Pakistan is still very far from acknowledging mental illnesses, let alone recommending psychotherapy as treatment.

By definition, psychotherapy is a treatment of mental disorders by psychological rather than medical means. According to Dr Taha Sabri, a graduate from Aga Khan University Hospital (AKUH) in Karachi and a freelance health consultant, therapy sessions offer a form of catharsis.

Benefiting from psychotherapy

Through a series of sessions, psychotherapy aims to make individuals consciously talk about things that may be bothering them. “The treatment consists of dialogue which aims to increase the wellness of the patient,” informs Dr Rubeena Kidwai, a consultant clinical psychologist and a professor at the Behavioural Sciences Department at National University of Sciences and Technology in Karachi. Moreover, the therapy aims to rehabilitate individuals who may have mental illnesses either through biological factors or illnesses that may have been caused by adverse life experiences such as emotional trauma. Trauma can be attributed to a number of causes such as the loss of a loved one, dysfunctional relationships or a history of physical, verbal or sexual abuse.

For 35-year-old Shamsa Wahidi, psychotherapy sessions helped her get out of a toxic relationship with her husband. Initially, upon diagnosis of depression, Shamsa’s psychiatrist prescribed medication. However, soon she was advised to try psychotherapy sessions and it helped her to make a conscious decision about her life. “Medicines may have helped me overcome depression to be able to cope with my daily routine but therapy helped me gain confidence and strengthened my willpower,” explains Shamsa.

According to psychiatrist Dr Uzma Ambreen, psychotherapy sessions are tailored in accordance to the patient’s requirements. “It is important for the patient to have an understanding of what they are hoping to achieve in life,” says Dr Uzma, adding that if specific goals are voiced by the patient then the therapy focuses on achieving them. The number of psychotherapy sessions depends on the condition of the patient but a minimum requirement of 12 sessions is mandatory.

How should I choose a therapist?

Consult a doctor and he/she will be able to recommend an experienced therapist. Remember to choose a therapist of your own choice as different techniques work for different people. Most importantly, don’t trust a psychiatrist who prescribes a lot of medication without discussing other options.

Types of therapies

Psychotherapy is an umbrella term for different types of therapies that are available. Some of them are:

Psychodynamic therapy – The therapy focuses on feelings that we have for others, especially people who are a part of the family or we are close to. The therapy aims to make us understand how these feelings have an impact on our lives. It enables the patient to understand their issues and behaviours.

Behavioural therapy – The goal of the therapy is to make an effort to change behavioural patterns of the patient. The main focus is on behavioural changes during encounters of anxiety, worry, uneasiness, fear, suspicion or other social problems.

Cognitive therapy – The patient’s way of thinking is changed through cognitive therapy. They are encouraged to think positive and block out any negative or destructive thoughts. They are taught to understand the difference between emotions and act to bring a positive change in their lives.

Family therapy or group therapy – As per its name, the basic requirement of this therapy is to bring the entire family together for the session. Usually, it is conducted when a family member is suffering from a serious mental disorder such as schizophrenia.

Marital therapy – The aim of this therapy is to eliminate any differences between a wife and a husband and strengthen their relationship. It aims to solve problems through mutual understanding among both parties and the presence of both is crucial. Unfortunately, due to a lack of trained therapists available for marital therapy in Pakistan, the full potential of this therapy hasn’t been achieved.

Making an informed decision

Unfortunately, in Pakistan there is a lack of understanding relating to the concept of psychotherapy. Dr Rubeena opines that people confuse psychotherapy with counselling sessions. “The goal of psychotherapy is to improve the psychological and emotional wellness of the patient as well as their ability to functional normally,” says Dr Rubeena. She adds that psychotherapy doesn’t only aim for present recovery but it intends to help them manage their illnesses in cases of relapse. As a result, identifying the problem is key towards full recovery.

On the other hand, the stigma attached with mental illnesses in our society also becomes a hindrance in benefiting from psychotherapy. As a result despite the presence of 15 million people in Pakistan suffering from mental illnesses according to the Karwan-e-Hayat Institute for Mental Health Care, lack of awareness about whom to approach and what kind of treatment to opt for make it difficult for people to overcome it.

Furthermore, proper licensing of psychiatrists can also help people to make informed decisions. “There are many centres in Pakistan, where psychotherapy is conducted by individuals with no background in psychology,” says Dr Rubeena. “The lack of regulation puts the patient’s life at risk,” she adds. However, not all is bad for psychotherapy in Pakistan. According to Dr Taha, the Pakistan Association of Clinical Psychologists have made laws to ensure that all psychiatrists can only conduct therapy sessions if they have a diploma in clinical psychology after completing their Masters in psychology.

However, according to Dr Nargis Asad, an assistant professor at AKUH in Karachi, psychotherapy won’t work on patients suffering from a severe mental disorder. “There is a need to control the symptoms through medicines and in most cases medication is the first line of treatment,” says Dr Nargis. As a result, in such cases seeking complete solace in psychotherapy only may not be the best option. Therefore, if a psychotherapist feels the need for a patient to visit a psychologist or a psychiatrist, they refer them to one accordingly.

Ishrat Ansari works on the Karachi desk at The Express Tribune

Published in The Express Tribune, Ms T, August 16^th, 2015.