In 2017, nearly one in every seven people in India, or some 200 million people, were suffering from mental health disorders. As per research from the same year, worldwide, over 250 million people were said to be suffering from depression and almost 300 million from anxiety disorders.
An already alarmingly dangerous situation, combined with a global pandemic that has taken the lives of millions and left many more without the security of any kind, has put the world on the brink of another unprecedented and unforeseen crisis– the next pandemic, the pandemic of mental health. A global crisis, waiting to happen.
At such a juncture, in order to avert this future crisis, it has become more important than ever before to ensure that those who need help are provided with the agency to seek help.
Moreover, it has become just as important to ensure that those who are already seeking help are given the care they’re looking for. But, are they?
The reality though, maybe suggesting something different. Research suggests that one in five people drop out of therapy before reaching an acceptable level of recovery and another 37 to 45% only attend therapy a total of two times.
Having gone past the initial hesitancies that come with seeking help and after being able to see therapy for the helpful thing it is, many people still tend to withdraw from therapy. And while it stands to be true that they really have gone past the initial hurdles of seeking help, there may still be factors that can keep them from getting the help they need.
“Therapy can hold space for all kinds of goals provided they are realistic. For instance, a goal like ‘I should never feel sad’ might not be achievable,” says Ms Mohitha Manoharan, a psychotherapist.
Though an ever-evolving idea, what we hope to achieve from therapy, before and while pursuing it, is said to be crucial in its success. Therapy is a place for us to learn how to build a healthy relationship with ourselves.
‘Solving’ problems, finding a ‘solution-oriented approach’ are terms we are forced to adopt in our life. Entering therapy with the expectation of it being an immediate quick fix to every problem can only impede the progress one could make.
Going to therapy with unrealistic ideas of what one seeks to get out of it can make things more difficult with increased pressure to perform or achieve. As a result, leaving one with little to no satisfaction from therapy and hence making it seem like a futile exercise.
Setting goals helps with that and accelerates the progress we make. “Goals can range from understanding the self more, forming more intentional relationships, working towards building resources to cope with mental health struggles to having somebody who can hold space for your experiences and connect with you,” she explains.
Therapy is never a simple or straightforward process– it requires time, effort, and commitment consistently over a long period. Sometimes, a person’s emotional state may limit the commitment they’re able to put into therapy.
For Abdullah*, who was suffering from depression at the time, the mental space he found himself in contributed to his exit from therapy. “I realise this now, but for all the things that were going right, I could only see what could go wrong and what I felt was going wrong,” he says.
Ms Yogeshwari, a therapist at Guftagu Therapy, attests to this saying that an individual’s issues may hamper the therapeutic process. “People may feel that they’re not able to work on their feelings or anxieties at all and they may feel the setting isn’t working for them and may call it off,” she explains.
“I didn’t feel good after the sessions. It felt like I was paying someone to make me feel gloomy,” says Samairah*.
Not having the right therapist for ourselves can leave us feeling worse than before. Like with any relationship, the relationship one has with their therapist has to be the right fit.
Ms Manoharan believes that the therapeutic relationship between the client and the therapist is the most important part of therapy. “The process is not about providing answers to clients, many of which the therapist might not have because of the nature of existence, but about creating safety to fully experience their internal world and explore possibilities,” she explains.
For many, finding the therapist that they feel compatible with can be challenging. And for Samairah*, that became one of the major challenges to her presence in therapy.“Things became triggering after a while. I felt my therapist was trying to rush me into things that I didn’t feel quite ready for,” she says.
If a person ends up feeling that their therapist isn’t respecting their concerns, they might start questioning the degree of openness they share with their therapist.
Moreover, the idea of having to go through the entire process of finding a therapist, familiarizing oneself and trying to find the compatibility can be exhausting in itself, thus making them leave their pursuit midway.
Therapists suggest that the surroundings we find ourselves in play a significant role in effectuating therapy. As Ms Manoharan puts it, “We all live in a context; hence mental health cannot exist in isolation as well. Familial support can increase access to mental health resources, provide a supportive space for individuals to heal and nurture themselves and facilitate the change they want to see in their lives.”
As beneficial as a good and healthy support system can be to those who avail therapy, an unhealthy support system or one that rebuts the benefits of therapy itself can do the exact opposite.
Unfortunately, for Abdullah*, the latter came to be true. “There were a lot more times when I felt guilt or embarrassment for needing therapy. I began to doubt a lot of things,” he says.
A vital contribution to the success of patients recovering from a major mental health condition comes from the support of people close to them and when not there, the absence can be felt deeply.
The pandemic has left no aspect of our lives unchanged and the case of psychotherapy is no different. Like much else, it has also moved to a virtual space and while that has helped those far-off in availing therapy, it has also introduced a different kind of problems.
Factors like connectivity issues, privacy concerns, boundaries and the technological competence of both the therapist and the client have come to the fore.
And, for some like Samairah* who opted for therapy during the pandemic, it dehumanised the person at the other end– their therapist.
“It felt like I was speaking to a brick wall on the other end,” says Samairah*. In the absence of personal interaction, the therapist’s replies may lack a nuance that can make it come off as impersonal and apathetic. Hence, making it difficult for a conducive therapeutic relationship to develop.
Half of all mental illnesses are said to have begun by the age of fourteen. The consequences of not addressing concerns at the beginning can extend to adulthood, with a chance of impairing both physical and mental health.
Though, given the growing awareness around mental health concerns, more and more adolescents are reaching for help. An obstacle that comes in the way is money– adolescents and young adults may still be dependent on caregivers for financial support, implying a state of financial insecurity. Such circumstances may force them out of therapy.
Ms Yogeshwari considers it to be an emerging trend, in her experience. “In India, when a student or a young adult is in therapy, their dependence on their parents can force them to leave, even when they don’t want to. They are, sometimes, bound in that space,” she says.
Job uncertainty, unemployment, increased expenses and income insecurity– the pandemic has brought financial instability at a scale that hasn’t been seen before. And, as a result, priorities have shifted and mental health concerns and treatment have been forced to take a backseat for many, due to the limited resources available. At a time when the emotional wellbeing of millions has been affected, they have been forced to prioritise other things over their mental health.
Though many therapists have been accommodative of people’s circumstances, such factors have restricted the capacity of many to avail therapy.
Recovery can mean different things for different people. For some, it will mean no longer having symptoms of their mental health condition. For others, it will mean managing their symptoms better, regaining control of their life and for the rest, it could mean learning new ways to live the life they want. Regardless of what recovery means to whom, each and every one of us deserves an equal opportunity to achieve it.
Individuals in therapy are those who have been able to recognise the existence of problems that may go beyond their reach.
As Ms Yogeshwari says, “It’s not just that one person in therapy. They’re coming with a systemic approach, societal norms and lots of diverse generational concerns. The person sitting in the room with the therapist is the one who is trying to change these norms and patterns or the systemic approach they’re coming.”
These are people who are trying, trying to mark their personal journeys with the goals of hope, empowerment and autonomy and they deserve every chance to do so.
Mental health activism can reduce the stigma associated with seeking therapy, making space for healing in society. We, as communities, need to begin taking responsibility for mental health instead of putting the onus entirely on individuals. Awareness can be the start of the process but shouldn’t be the only means of tackling the problem. Pre-existing systems have to be improved. The pandemic of mental health could come and for its cure, there will be no vaccines. The time is now and the need, urgent.
*Names changed to protect privacy of the individuals.
Note: The author is part of the current batch of the Writer’s Training Program.