This couch won't bite

Sep 25, 2012, 11:58 IST | Dhara Vora

Choosing the right therapist and spilling your deepest, darkest secrets is no cakewalk. The Guide helps you break down the mind barriers and other hurdles that might come in the way of you taking that all-important step towards peace and self-reliance, by signing up for therapy

While it might not be a commercially viable theme in India to script movies or television dramas based on relationships between individuals and their therapists, it continues to remain a hotly followed topic in the West, with soaps, dramas and films pandering to this intrinsic relationship common within the socio-cultural landscape.

The most recent film that touched upon this topic is Hope Springs that saw Meryl Streep and Tommy Lee Jones play a couple at odds with their interpersonal relationship. The movie explores the life of a couple with zero physical intimacy as they try to save their marriage with the help of a counsellor (Steve Carell).

Choose the right therapist
Apart from doing a background check on the therapist, it’s important to understand the kind of therapy that one is in for — be it relationship issues, clinical depression, addiction or trauma — there are different therapists for different problems.

“People in India are not very aware about the difference between a therapist and a psychiatrist. A therapist may be qualified only to treat certain problems; it’s okay to ask your therapist about their qualifications. Clinical psychologists are trained to treat all kinds of clinical problems like anxiety and depression. They have a lot more to do with chemical imbalance and medication but that doesn’t mean they can’t do talk therapy,” clarifies Seema Hingorrany, Clinical Psychologist and Trauma Expert.

“Even by talking to the person on the phone it’s possible to figure if the person has a respectful behaviour. One has to be able to trust a little bit,” says Ameeta Sanghavi Shah, Relationship and Regression Therapist.

Even the therapist needs to be given a chance for the initial three-four sessions. A therapeutic alliance is formed where the boundaries are laid out clearly by the therapist, from coming on strongly, to not calling at odd hours.

Say the unsaid
“I had a client who had relationship issues but was very happy with the family. I had to lead her to tell me if she had undergone some trauma via some other person, which was when she told about her childhood where because of her friend going through a bad time she became part of that story and developed issues. A perceptive therapist will ask about it, automatically. The patient wouldn’t realise this linkage,” shares Shah. As a patient, one has the right to start their story wherever they want from; it’s the therapist job to be non-judgemental.

After you visit your therapist, keep in mind that the therapist has to respect your boundaries and must allow you to tell your story at your pace, “If you have privacy issues and wish to keep it that way, the therapist has to respect that call. Once, I had a patient who didn’t even want to tell me his full name,” says Shah. The therapist also has to be informed whether any person from the family is aware of the visit. Typically, the therapist does not need to administer a battery of tests on the first visit.

To open up or not?
It’s the therapist’s job to ask relevant questions. “Not that they don’t want to open up. Sometimes, the patients might have undergone problems in such conditions that they don’t remember it, like childhood molestation; it is known as Dissociation. It depends, entirely on the therapist to utilise their skills to make the patient comfortable and pick up the symptoms from the unsaid,” says Hingoranny. At times, patients don’t reveal their problems for years; these are termed as Complex cases. Also, it’s the therapist’s job to provide the right resources to cope with the trauma once a problematic incident has been retold; one has to be informed of different coping exercises.

The checkpoints
Never let a therapist intimidate you. Even simple signs of checking the phone or lack of eye contact are signs that you need to get out of the clinic.

“There are physical boundaries. Sometimes, you use touch but the patient has to be comfortable with this touch, always and this needs to be done with permission at every stage. A therapist should not be dominating and taking your decisions. A good therapist gives advice but allows you to explore and lets you find your own insight,” says Shah.

Signing of confidentiality clauses ensures that the therapist does not talk to anyone, even if members of the same family visit the same clinic. Until they have the permission of the client, therapists are not allowed to reveal details to any individual except on court orders. Despite being commonly depicted in movies, a therapist cannot go out for a coffee or shopping with the patient, even if they are a celebrity. While some therapists accept patient’s calls at all hours for the fear of losing the client, it could dilute the set boundaries.

“A therapist does not have to reveal any personal insecurity, however similar it is to the patient, who is already vulnerable,” says Hingorrany. It’s not only the therapists who have boundaries but also patients. One doesn’t have to be dependent on the therapist to the extent of calling at odd hours unless suicidal. The patient should also inform the therapist about certain aspects of the therapy which they aren’t comfortable with,” reveals Hingorrany. 

Revealing is crucial
There was a 22-year-old woman who harboured anger towards her father and was unable to sustain a relationship. She would even slash her wrists for the purpose of deliberate harm, a case of chronic, agitative depression. But for some reason, the patient suffered from severe headaches and migraines due to deep-rooted memories, for which she even got checked by a neurologist and got an MRI for chances of physiological problems; the anger issues were slowly being resolved. However, after almost eight months of therapy, the woman revealed being sexually abused by an uncle at the age of seven years, an information only the grandmother who hushed up the child knew of, during a trauma therapy session. The chronic pains subsided immediately after the discussion.

Over depend and attach
An 18-year-old never got love from her mother, who had also received a similar treatment from her mother. Due to the lack of affection and self-esteem, the girl was bullied in school and wasn’t good in studies. But due to the interest taken by the therapist, the girl developed what is known as Transference, or substitution of affection from one person to another. First, it began with a request for extension of the usual therapy duration to arriving an hour before the said time. The girl managed to get the landline number of the therapist and called at odd hours to gain sympathy by making up stories and buying cakes for the therapist. “In such cases, the therapist shouldn't run away, which would be known as counter transference. One has to be firm about not taking calls,” says Hingorrany. 

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