TRAINING IN COUNSELLING & PSYCHOTHERAPY FOR DOCTORS
Posted by Dr. Rajan Bhonsle on Sunday, 12th April 2009
The World Health Organization (W.H.O.) has stressed on the need to counter the deteriorating mental health in society. Statistics show that the rate of psychological disturbances leading to Suicide, Homicide, Marital breakdown, Alcoholism, Drug abuse etc. are increasing at an alarming rate. Cases of depression, stress, nervous anxiety and psychosomatic disorders are on the rise.
According to the National Mental Health Program document, about 20-30 million Indians are in need of some form of mental health care. Every year 2,50,000 new cases are reported; but these figures do not include the thousands of others who may be suffering in silence without access to help. With timely intervention and proper care, at least 60 % of these disturbed people can recover completely and at least 70 % can avoid chronic illness and disability. Psychotherapy & Counselling has never been more needed than it is today. There is an urgent need to rescue toxic and failing relationships; the relationship of man with himself, relationships within the family, and relationships in the community.
Heart To Heart Counselling Centre run by the Heart To Heart Foundation is an active effort to fulfill this need of society through various training programs and other activities. The Heart to Heart Foundation is a registered social organization committed to the promotion of Mental Health and Emotional Well-being through Counselling Services, Training Programs, Counselling Courses, Self-help Workshops, Awareness programs, Research and Publishing related material.
Activities at the Heart to Heart Counselling Centre
• Facility for personal counselling, couple counselling and family therapy.
• Pre-Marriage counselling, guidance and complete pre-marital medical check up.
• Marriage & Relationship Counselling.
• Sex Counselling and Therapy - For all sexual and psychosexual problems.
• Teenage Guidance Clinic for teenagers and parents.
• Sex education programs for schools, colleges and the adult community.
• AIDS Counselling
• Training programs in Personal Counselling (Client Centered Therapy and Cognitive Behavior Therapy)
• Workshops in Rational Emotive Behavior Therapy (REBT) for those having prior training in counselling skills.
• Training Program to become a Sex Educator.
• Self-Help Workshops such as Self-Help Through Creative Writing, Secrets of a Healthy Marriage, Stress Management (Multimodal approach), Golden rules of Parenting, Art of Communication etc.
Some Question-Answers Related to Subjects we are dealing with
How important is mental health? What is the role of the family doctor in the area of mental health?
Ans: Man is obsessed with, and doing so much for increasing the longevity of mankind, but have we ever thought of the quality of life we lead? Physical well being and health is given the highest priority with newer drugs flooding the market everyday. Has anyone ever thought as much about emotional well being and mental health? The World Health Organization has declared that the emotional health of humanity is declining. Cases of depression, stress and nervous anxiety and psychosomatic disorders are on the rise and therefore family doctors are urged to look for signs in a patient which would indicate the need for counselling. In a society where going to the gym for physical fitness training and workouts is considered as the 'in' thing to do, it is sad to see that mental and emotional fitness and training is not accorded the same status. There is an invisible stigma attached to counselling, wherein general practitioners hesitate to refer cases for personal counselling fearing that the counsellees may take offense. Denial of the need for therapy only compounds the problem, for if there is anything worse than having a problem, it is denying that you have one. Timely intervention of counselling can avert many a disaster. For this, the support of general practitioners, social workers, other members of the helping profession and above all, the media, is extremely important. They are the ones who need to create awareness of the entity of counselling, the need for it and help in removing the stigma attached to it.
There is an urgent need for establishing meaningful human interaction between people. The fast-paced highly competitive urban world, the break up of the joint family system, more women working outside the house, single child norm etc. means that a 'friend in need' is even more required today. If we can increase the number of such 'friends' who DARE TO CARE, the rate of disturbed individuals becoming chronically ill and disabled will most definitely reduce. It needs to be mentioned that such caring not only benefits the receiver of care, but also benefits the care giver who gets in touch with his own human side, thus exerting him to be the best human being that he can be.
What is Counselling? How do counsellors help? What is their role?
Ans: Mental health is achieved when man is completely psychologically mature or self-actualized, and psychological disturbances, are nothing but a failure of such development.
A large number of disturbed people can be helped by establishing a caring human interaction which makes the disturbed individual open to explore and understand himself, and finally change something within himself to solve his problem. This is called counselling.
There are several misconceptions about the nature and intention of counselling and therapy. Many people believe that the purpose of therapy is to talk about their problems, rather than devising active means of solving these problems. It is not talk that is important, but action.
At this point it would be apt to understand briefly what personal counselling entails. For that, let us first understand what it is not. It is not offering interpretation, evaluation, support or advice; but it is in fact a human technology in which the counsellor through human interaction creates certain conditions in which the counsellee is provoked into a journey of self-exploration leading to self-understanding leading to action, so that the counsellee changes his/her thinking and behaviour, thus solving the problem and bettering his/her life. In short, it is not a 'handout' but instead a 'hand up'. He is helped to help himself.
Rapid long-lasting and meaningful improvements in psychological functioning call for at least two specific areas of intervention:
• We need to correct irrational thinking; and
• We need to overcome negative behaviors.
This is achieved by re-education and a systematic re-training of the mind by challenging long-standing self-defeating ideas, beliefs and behaviours, and replacing it with rational, realistic and appropriate beliefs and behaviours of life. The counsellee is also motivated to identify and reduce his stress levels on biological, psychological, sociological and spiritual levels and to increase his adjustive resources on all these levels.
What is the difference between Psychotherapy and Counselling?
Ans: Counselling and Psychotherapy are similar but vary in degree and intensity and in the goals to be achieved. In psychotherapy the goal is to bring about a deeper personality change which may take months and even years, however in counselling the goal is to achieve a better personal adjustment and growth in maturity and therefore the duration is just a few sessions.
Does your approach / methodology at the 'Heart to Heart Counselling Centre' differ in any way from the traditional approach used by psychiatrists & clinical psychologists?
Ans: We have done a great deal of research in exploring the Psychology of Resistance i.e. the dynamics behind a resistance to heal in the patient/counsellee and the study also suggests a methodology that can be adopted by therapists/counsellors to overcome this resistance. The methodology is a unique blend of the Western psychotherapeutic techniques (Client-centered therapy, Rational emotive behavior therapy, Cognitive therapy, Behaviour Therapy etc.) and Eastern psychotherapeutic techniques ('Abhidhamma' ~ the Buddhist psychology, Meditation, traditional Vedantic philosophy etc.)
Do you expect better results with your approach?
Ans: If therapists/counsellors equip themselves with the methodology mentioned above and adopt appropriate attitudes in the counselling process, there will be a higher success rate in the recovery of patients.
Do you use any medication during the process of psychotherapy / counselling?
Ans: No. We do not prescribe or dispense any medication at all during psychotherapy / counselling. We only establish an interpersonal relationship and stimulate the counsellee towards self-actualization.
Why is there an emphasis on 'Couple' therapy?
Ans: A couple is the smallest unit of community living, and how the couple functions as a unit sets the stage for the entire family. Thus, the beginning of the family whether functional or dysfunctional, starts with the couple. A family is known as dysfunctional when the desired goals of closeness, self-expression and meaning cannot be attained by the family members. When this happens, symptomatic behaviour takes place.
Thus, we understand how important it is for a couple to have a healthy and harmonious relationship with each other not only for themselves, but also for their child.
Since the emotional health of the couple directly affects the emotional health of the children and the family as a whole, it is high time that parents start focussing on their relationship as a couple and work towards strengthening it. The time and effort put into creating harmony with each other will reap rich dividends in the form of family health.
Happy couples create happy families, which in turn create happy communities, happy nations and a happy world.
Do children require personal counselling? What is the need for counselling at such a young age? What kind of problems do you come across in children these days? What are the typical parental responses to them?
Ans: Children of dysfunctional families do require counselling. However the success of such counselling depends on family therapy i.e. the involvement of parents and other members of the family. The child of psychologically immature parents feels like an emotional orphan, and when he cannot find emotional fulfillment at home, he starts looking for it elsewhere. Juvenile delinquency is the direct result of a dysfunctional family, and teenage pregnancies, alcoholism, substance abuse, association with terrorist outfits and anti-social groups is nothing but a desperate and misguided attempt at creating a world, a family for themselves.
Everyday young children and teenagers are brought by their parents to counsellors for 'treating' "bad behaviour" such as temper tantrums, rebellion, anti-social behaviour, disinterest in academics etc., and the counsellors are faced with the daunting task of gently but firmly confronting the parents about the toxic emotional environment at home. It is most of the time a Herculean task to get the defensive parents into therapy as a family, and more so as a couple.
What is the necessity of Pre-Marriage counselling and check-up?
Ans: Like Western countries, the divorce rate in our country is steadily on the rise. On going into details, invariably the cause is found to be either a physical incompatibility or emotional incongruity between the partners. In 90% cases the trauma of divorce can be avoided, if the couple undergoes a counselling session and certain medical investigations just before getting into matrimony.
As family physicians, very often doctors are expected to give guidance to those who are getting into matrimony. Parents find it difficult to explain everything to their sons or daughters about the new relationship they are entering into; either out of hesitation or lack of knowledge. Unlike more developed countries, sex education is still not widely advocated in schools or colleges in our country. At such occasions family doctors are invariably asked for help and are expected to oblige the parent community by doing the necessary briefing. In a busy practice, most of the doctors do not find adequate time to devote to Pre-Marriage Counselling, and are very often not too comfortable with counselling.
It is also very necessary to know about the physical well-being of both the partners before they marry, particularly about one’s reproductive ability and diseases that could be transmitted sexually. Our centre has this unique facility (Pre-Marriage Counselling & Check-up), in which both the partners can have all the concerned investigations done under one roof, and also get a healthy & complete understanding of all the aspects of the male-female relationship. We have a full-fledged Radiology, Sonography & Automated Pathology Laboratory set-up to meet every need in these cases.
In India, match making is still done on the basis of Horoscopes and the religious & financial backgrounds of the two families. It is high time that we start ascertaining the compatibility of the couple on more practical & realistic grounds by undergoing such medical check-ups & pre-marriage counselling.
Having done this, the youngsters will definitely be able to tie the nuptial knot with more confidence & self-esteem and start their new relationship on a more sound footing.
Besides providing the facility for 'Counselling & Psychotherapy' for individuals, couples & families, do you intend to extend your knowledge/ experience in any other manner?
Ans: We have already started conducting certificate courses in Personal Counselling based on humanistic psychotherapy for those in the helping profession e.g. psychiatrists, doctors, nurses, psychologists, counsellors, social workers, teachers, trainers, HRD personnel etc. through the 'Institute of Human Technology'. This 5-week certificate course in personal counselling, aims at meeting the need for continuing formation of professionals. We teach the Robert Carkhuff model of Personal Counselling in this course, which is an extension of Carl Rogers' Client-centred Therapy.
What is the Robert Carkhuff model? What is Client Centered Therapy?
Ans: Carl R. Rogers, a great pioneer in the United States, conducted a scientific research on the process of helping i.e. he tried to pinpoint the ingredients of the helping relationship (counsellor-counsellee) which, according to him, is the main factor in helping people with problems. He offered a blueprint for counselling in his book, Client-Centered Therapy. We owe much to Carl Rogers for bringing to the attention of counsellors the need to focus on the interpersonal relationship between counsellor and counsellee.
The American psychologist Robert Carkhuff, accepted all that Rogers had to offer and developed it further. Carkhuff concluded that the counsellor must function at a level higher than the counsellee's level of functioning; otherwise the counsellee will deteriorate. Later Robert Carkhuff presented a model of counselling (through his book Helping and Human Relations) which is both a recognition and an enriching extension of Rogers' model. We conduct training programs based on his latest and updated model.
What is Rational Emotive Behavior Therapy (REBT)?
Rational Emotive Behavior Therapy (REBT), founded by Albert Ellis is a “cognitive-behavioral” therapy. It was earlier known as Rational Emotive Therapy (RET). It is based on the concept that emotions and behaviors result from cognitive processes; and that it is possible for human beings to modify such processes to achieve different ways of feeling and behaving.
Rational Emotive Behavior Therapy (REBT) maintains that our emotional problems and counterproductive behavior are largely the result of ‘crooked’ unhelpful thinking. The basic premise of this approach to counselling and psychotherapy is that it is not events that cause our problems, but the way we think about them.
REBT believes that human disturbance is essentially ideologically or philosophically based, and so it strives for a thorough philosophic reorientation of a person's outlook to life. It uses the didactic approach i.e. teaching and re-educating the client in balanced and correct ways of thinking and behaving, and thus helping him acquire rational, realistic and appropriate beliefs of life.
Albert Ellis, founder of Rational Emotive Behavior Therapy (REBT) reasoned that therapy would progress faster if the focus was directly on the client’s self-defeating ideas, verbalizations and ‘beliefs’. He observed that client’s tended to get better when they changed their ways of thinking about themselves, their problems, and the world.
Albert Ellis calls our unhelpful thoughts “irrational beliefs” and says that they are at the core of much emotional disturbance. Rational beliefs on the other hand, are flexible, helpful ways of thinking and enable us to be psychologically healthy. In REBT the counsellor helps the client understand the role of such irrational "beliefs" and self-defeating value systems, in causing and maintaining problems in his life.
Rational Emotive Behavior Therapy (REBT) workshops help counsellors to develop knowledge and skills in this very effective, efficient and empowering method of personal change.
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