Needed: Parivarthan on psychiatric counselling

How is the profession viewed today, what ethics govern it and how relevant is it in today’s society? How can the gap between counselling and other professions be bridged? These are the questions that were thrown up and discussed at length. The conference marked the 20th year of Parivarthan, a counselling, training and research centre based in Bengaluru.

Mental health services are just making their foray into mainstream life in India. Parivarthan has grown in leaps and bounds since its founding and over 3,000 counselling sessions were conducted in 2014-15, according to their Annual Report. It was founded in 1995 by Saroj and Carlos Welch, both well-known psychotherapists.

“Back then, all we had was the occasional client. That was what the organisation wanted to change - people were reluctant to come to us and we wanted to make counselling less intimidating for them,” said Malini Sridhar, Executive Director, Parivarthan. Despite its growth, “counselling is still on the fringes of society,” said Maitri Gopalakrishna, a counsellor and supervisor from Parivarthan. “People dismiss anything to do with the mind and seeking help is seen as a sign of either weakness or madness.”

There are a lot of people who need counselling, but there are very few trained counsellors, said Sridhar. “We needed a place to train counsellors, because that is crucial. It’s not just about saying, ‘people talk to me anyway’, because there’s a lot more to it than that.”

The organisation was set up in a quiet residential corner in Indiranagar, chiefly because it provided a less intimidating setting than a hospital. “Even those who are ready for counselling think twice before they walk into Nimhans. Parivarthan is more non-descript, a client can walk in and still be discreet.”

Counselling is one the chief services they offer. Individuals, couples and even families can receive help. They also offer career, school and college counselling. “A change that we have seen is that clients are more open to more sessions, they don’t want to come in simply for one or two.” Alongside this is coaching, which helps with individual development. The Integral Coaching, as it is called, is a one-on-one process that enables people to identify and solve their own problems and is conducted by Vivek Saxena.

Training is another vital facet of Parivarthan’s work. This is how they address the lack of trained counsellors, providing professionals with the techniques for people interested in either social work or counselling itself. Supervision is another often ignored ethical requirement. A total of 106 supervisees were trained in 2014-15, said the Annual Report. “It's mandatory at Parivarthan for even trained counsellors to have supervision and personal therapy. They need to examine their own degree of self awareness, because if those issues are not dealt with, it will hinder the counselling process,” Sridhar remarked.

Confidentiality is the biggest worry on clients’ minds and has been one of the reasons behind the reluctance toward seeking professional help. “Confidentiality is absolute in almost all cases, except when the client expresses an intention to harm oneself or another person,” Sridhar said. “We do explain to people that a case can only be discussed with a supervisor after the client has given consent.”

Interestingly, women have always been more open to seek therapy than men. “It used to be a ratio of about 70:30 in favour of women,” said Sridhar. “That has balanced itself out slightly now, about 60% of the clients who come to us are women.”

The most common problem, especially with couples, she said, is that one partner is willing to try counseling, while the other is not. “That is changing now because for one, the counselling makes a marked difference in the person who does come to us and the partner has no choice but to adapt to that.”

There has been a definite increase in the number of men approaching Parivarthan as well, largely because “men need to invest in the relationship too, these days,” according to Sridhar.

“Women are empowered and divorce is no longer a bad word, so seeking help can be the only option.” The apparent stigma of seeing a therapist is not peculiar to India, said Maitri. “I trained in San Francisco, which is a haven for mental health professionals. However, friends in other parts of the US did tell me that seeing a therapist was still frowned upon where they happened to be. One assumes that education and openness go hand-in-hand, but that is not the case,” she said, adding, “On the other hand, Indian society allows for two strangers to talk to each other. It’s perfectly normal to strike up a conversation with someone you meet on a train, for instance. We’re more used to having people poke their noses in our business!”

As more and more people are opening up to the idea of going for therapy, the field itself needs to be better organised. “Parivarthan has a code of ethics, but there are no guidelines otherwise,” said Sridhar. “That's not safe for the clients,” she added.

At the conference, Dr Poornima Bhola, an Associate Professor of Clinical Psychology in Nimhans, pointed out that while ethics are taught, they are not emphasised upon as much as they should be.

A standardised training process is a major requirement for today. A two-week online course or a half-day workshop on counselling will suffice for those who want to enter the profession. “If we had a set of guidelines or a regulatory body, problems like these will fall into place. Supervision, ethical guidelines and standardised training are non-negotiable in the field,” Sridhar said.

As was rightly pointed out during our lunch-time conversation on Saturday, counselling is more necessary than we allow ourselves to believe. “There are very few women who can say that they have never been inappropriately touched or treated,” said Sridhar. “A lot of damage can be avoided if people would just seek some help,” she added.