 My name is Dr. Ratna Isik and I'm a clinical psychologist and I've been working as a therapist in Bangalore for the last 20 years or so. I'm here today to give you like a quick introduction to the world of therapy and hopefully make you to learn a little bit more about it. I've seen a huge shift in attitudes and awareness of therapy in the last 20 years. 20 years ago in a very few people saw therapy for themselves. Unless you had some mental health issue that was diagnosed or referred by a psychiatrist, people were not really looking for therapy. But now that's changed and more and more we see self-referred clients who are coming on their own because they wish to sort themselves out. Can we shift to the next slide please? Yeah. Also more clients who are coming, not with some psychiatric diagnosis but just with a sense of being unhappy with their lives. 20 years ago also there were very few therapists who were available or therapy centers outside of Nimhans but that's also something that shifted right now with more therapy centers as well as more good quality mental health professionals who are available, especially in a city like Bangalore. While we may not as yet be at the point that is described in the port where if you don't have a shrink people think you're crazy, definitely there's a much more acceptance of psychotherapy right now. Therapy certainly seems to have got the imagination of people at this point in time and I think everyone has some opinion on it whether good or bad and there are so many perspectives and so many misconceptions about what therapy is that I welcome this opportunity to sort of explain, demystify and hopefully make therapy a little more accessible to you. So next slide please. Let's start with looking at what psychotherapy is. Psychotherapy is also known as a talk therapy because it's a way of helping people with a wide range of mental illnesses with emotional and relationship issues all through having focused kinds of conversations. There are several different types of psychotherapy each of which may be more particularly useful or applicable to a specific kind of problem and it can range from a smaller issue like dealing with a difficult boss or a more specific issue like that to a much more wide-ranging issue of maybe recovering from childhood trauma or wanting to change the way you function itself in general. Next slide please. So all forms of therapy however do share certain common characteristics. They offer a safe and confidential space in which you can talk about what it is that you're thinking and feeling. The therapist offers a non-judgmental and bond relationship which might help you to be more open about what's happening inside you. It helps you to be more aware of yourself reflect on yourself and life and also all therapy does have a particular purpose now whether it's to alleviate distress or help you feel happier more adjusted more confident more secure more comfortable with yourself while that can range there is definitely a purpose to this conversation. Next slide please. However this is also a good time for me to tell you what therapy is not. Therapy is not a panacea or a cure all which is going to take away you know change your biology change all your circumstances remove every bad feeling introduce all good habits and just kind of make you from being what you are to being perfect or ideal. All we can really hope for is that it will get you to feel better than before. For instance now some of us may be born slightly more sensitive or more easily upset by circumstances or by things which impact us. A person who is more sensitive to their environment isn't going to really change and become you know as cool and calm as someone else you see who you might want to be like but therapy can help you to understand your sensitivities a little better learn to think about them and deal with them a little differently or accept yourself and become more comfortable with these sensitivities and basically kind of mitigate the negative influence that some of these characteristics might be having on your life. Therapy is also not a medicine in that it's not something external which is put into you and then changes you without you're being aware of it or without you're doing anything more it's like an exercise program where what you get out of it is kind of based on what you put into it as the famous joke goes you know how many therapists does it take to change a light bulb the answer is one but the light bulb has to want to change and so what you as a client bring into therapy is an extremely important factor in what you're likely to get out of it next slide please. So let's look at this therapy work more than seven decades of research of different sorts overall suggest that about 80% of therapy clients are benefited or feel report a significant improvement after having been in therapy of course there is also a 5 to 10% who reported deterioration or not feeling as good we have research based knowledge on like specific treatments for instance emotion focus therapy for couple distress or on specific techniques like using behavioral activation we know is very effective in lifting depression and we also have research knowledge on processes or what happens in therapy that leads to a good outcome for instance we know that the quality of the therapeutic relationship is a very important predictor of outcome. So while it is an art and it is something that is individually tailored for each client needs therapist practices it differently and each client may receive something different on the whole therapy does seem to be something that's effective. So rather than sort of asking you know can therapy help me maybe a better question would be what can therapy help me with. So next slide please let's look at some of the things that can indicate to you whether you need therapy or not. So some of the questions you can ask yourself is there anything about myself that I wish to change or that I would like to be different. This is important because therapy is definitely more effective in changing the client than it is in changing the world in which the client lives. Are there emotions that you're not happy about that you feel are too intense or too long lasting. Is there a particular relationship that you're having difficulties with with a parent or a child or a partner. Have you received feedback from a family member or a friend saying hey I think that you know something's going on and maybe you need to meet a therapist. Next slide please. Sometimes the feedback doesn't come from family but it might come from your workplace as well. Often clients who've been dealing with themselves and their problems for some time they choose to come to therapy after they have a particularly strong experience that makes them sort of stop and think. And what they need to stop and think about mean for instance you know you may say okay I've been drinking for a long time and it's not really been a problem but I had this one experience where you know I had a really bad accident because I was drunk and I was driving and that made me stop and think about how I'm consuming alcohol. The next two things I'm going to refer to as signs which therapists often look for in order to evaluate or understand you which is is there any departure from the usual in terms of either routine or in terms of emotional space. You know I was saying I've never really been such an angry person but recently I find I'm losing my temper a lot. But I'm not really an anxious person but recently I find myself getting very worried. Of course in the current circumstance if you're getting very worried because of coronavirus then that's quite normal and while support is good it's not something that you necessarily need therapy for. It's also useful to look at your basic biological functioning. Is your sleep appetite or energy level disturbed? Are you finding it difficult to fall asleep or do you have a very disturbed kind of sleep where you don't really feel refreshed in the morning? Do you wake up really early and kind of feel a flood of negative and sad thoughts hitting you? These are all signs that you might be having a mental health concern and it could be useful for you to seek therapy. Next slide please. So these are some of the typical issues which people might come to meet a therapist for. Low self-esteem. I'm not happy with myself whether in terms of how I work or in terms of how I look or in terms of what skills I have and not socially effective. That's often something that people come to. Feeling low mood, no joy in life, no energy. I'm not able to motivate myself or get myself out of bed. That can also be a problem. Experiencing excessive stress or tension or worry that you're not really able to sort out or rationalize yourself out of. Relationship difficulties of course tend to get to all of us no matter how well functioning or strong we are. And sometimes people also want skill building. Like I want to be more organized or I want to be more disciplined or I want to be more assertive. Next slide please. Of course it does also happen that not everyone who seeks therapy knows very clearly that this is my problem and this is what I want to change. Sometimes all you know is that you're unhappy and you're not really sure why you're unhappy. Well this is fine because definitely therapy can help you discover that. Also we've noticed often you know the issue that you start therapy with might change and evolve over the course of therapy. So you may begin saying that you know I want to be more assertive but you may end up kind of saying that no I actually need to relook my relationship with my partner on the phone. In general the focus of therapy goes from alleviation of distress on one side to growth self-factualization on the other and often clients move between one or the other and we do try to meet both ends if we can. Next slide please. Okay so even when you experience distress seeking psychological or professional help need not necessarily be the first or the only thing that you do in order to sort yourself out. In fact it's useful for you to examine your life and see what you can start doing to help yourself. Check on your regular support systems. Is your health okay? Is your relationship, are your relationships doing well? Do you have work-life balance? Are you satisfied with your job? Try to sort of set personal goals and make plans for yourself. These could be short-term goals like something which you can do over the next week. I want to finish filing my taxes by Saturday. There could be larger lifestyle goals like I want to start an exercise program or I want to learn a new skill. And try to make plans and put some of yourself behind these goals that you set. You can access several resources including apps, websites, books, organizations. At the end of this webinar we have a list of resources which you might find useful. And finally of course you can also meet a mental health professional. Next slide please. So once you've decided to see a mental health professional you need to kind of decide who you want to see. On one end of the spectrum we have psychiatrists. Psychiatrists are doctors who have specialized in psychiatry after they finish their MPBS. So they tend to see more severe psychiatric disorders. They often treat through medication. Psychiatrists visits are likely to be preferred and more spread apart. Although many psychiatrists do do therapy as well that's not necessarily always the same function. At the other end of the spectrum we have counselors who deal more with psychological and life issues rather than with psychiatric disorders in particular. Counselors in India they have varied training backgrounds. You can have a master's in counseling psychology. There are several short term courses or contact courses offered by counseling centers. Some of these are more generic and some of these are more specific to a particular model or type of therapy. The clinical psychologist sort of straddles the ground between the psychiatrist and the counselor. And it's typically somebody who's studied psychology and so has a basic knowledge of human psychology as well as specialized knowledge on abnormal psychology and psychotherapy which is the treatment of psychiatric disorders. And of course also can deal with psychological and life issues using their knowledge of psychology and psychotherapy in general. Next slide please. Okay so any therapist regardless of whether there is a psychiatrist a psychologist or a counselor or a psychiatric social worker or any other person who's been particularly trained in therapy. Any therapist works using certain psychotherapeutic orientations or approaches or frameworks to understand people as well as to decide what one has to do or how therapy works or changes. So I'll briefly introduce you to some of the major traditions in psychotherapy which will help you to understand perhaps what you're looking for or what you need more. Next slide please. So we'll start with the dynamic tradition. This is the old traditional you know your movie psychotherapy with a person on the couch. This is based on personality theories of Freud, Jung and others. According to the dynamic tradition human psychology is shaped by childhood experiences and the unconscious. The therapist is likely to focus more on client's feelings and emotional experience and change is deemed to occur through sort of uncovering and then integrating the unconscious with your current conscious self. Next slide please. The cooperative behavioral tradition is kind of the next big school or approach to psychotherapy. This is based on learning theory which was developed by Watson and Skinner. This believes that human psychology is shaped by early reinforcement or conditioning, learned habits and beliefs some of which might be more on the surface and some of which might be deeper down. The focus of the therapist is on finding connections between the client's thoughts feelings and behaviors and change is thought to occur through developing new thought patterns understanding your thought patterns and learning new skills. Next slide please. Then we have the humanistic tradition while cognitive behavior therapy is often used by clinical psychologists especially because many models of cognitive behavior therapy have been developed you know focused on particular disorders. The humanistic tradition is something which we can see as the underpinning of sort of all forms of psychotherapy. It's based on the person-centered theory of Kyle Rogers as well as existential theory. Here human psychology is seen as being shaped by our desire for growth and self-actualization so it's a much more forward-looking perspective and the focus is on connection and awareness of all parts of yourself. Change here is deemed to happen through the process of self-acceptance as this quote by Rogers describes the curious paradox is that when I accept myself just as I am then I can change. Next slide please. Then we have the systemic tradition which is based on family systems theory and cybernetics. This sees human psychology as being shaped by relationships and feedback loops and it focuses more on the space between two people so in a systemic therapy we are not really trying to change people but we're trying to change the relationship between them or how they interact. Now you also have integrated therapies which kind of combine useful ideas or combine perspectives from all of these traditions and use them for the benefit of the client based on the client's need. Although even most integrated therapists will have like a home theory which they kind of feel more closely to or a perspective that they use more often and of course there are also like smaller specific methods like exposure and response prevention for the treatment of OCD or EMDR that's emotion sorry eye movement desensitization treatment for trauma therapy for working with the client so have trauma sorry. So there's a range from broad to narrow in the type of psychotherapy that you can get. Okay next slide please. Therapy also can have different durations and formats. You can have individual therapy which is just one-on-one. You can have couple or family therapy which is for any relationship a couple can be also a mother and a child or a couple who's married or a couple who's not yet married and then we can have group therapy where individuals with similar problems can sort of get together and learn how to deal with themselves better. Some therapies can be very short-term like lasting sometimes one session sometimes four to five sessions versus long-term therapies that can extend over years you know going to some therapies which are clearly state that you know we have open ended we will be available for as long as you want. Therapies are also sometimes more directive where the therapist is sort of telling you do this do that try this offering you advice or it can be more non-directive where the therapist kind of helps you to figure out what you want or where you need to be. Talk therapies are what I've spoken about and will speak continue to speak about for the rest of the session but there are also several alternate forms of reaching through to your experience which are not through words which are very effective like drama therapy art therapy movement therapy etc which sometimes people find also very useful. Next slide please. So whatever the form of therapy that you choose to take in selecting a therapist I think the most important characteristic is that of fit if you feel safe and comfortable with your therapist if you feel this person has the competence to help me with my problems I can trust this person then your therapy is much more likely to be an effective as well as an enjoyable experience. So I would actually recommend before you make like this big major commitment of choosing a therapist that you do a little bit of doctor shopping and see who you feel comfortable with. Next slide please. Okay so once you've decided that you do want to see a therapist you need to make an appointment which it's not always as easy as it seems deciding who to see can be difficult getting referrals from either other professionals doctors gps mental health professionals or from former clients can be useful because they can give you more clear information about a therapist of course you can feel free to do a google search and find out more about the person that you want to see. Do consider timings availability as well as cost before you decide to choose with a therapist because this is a long-term commitment and it makes more sense if you're able to see it through. Of course I should add this that you know you need to be prepared for a wait I sometimes get calls from clients saying that I have this issue and I want to see you this afternoon. Now that's very very unlikely that any therapist is going to have a slot open that afternoon your wait might go anywhere from two weeks to two months for the therapist as well taking on a new client is a commitment of time and effort and unless I know that I have not just one hour to see you but one hour every week or every other week over the next six months to see you it's not really okay for me to take you on as a client and so you do need to kind of plan and be ready to wait for a while before you can access a therapist. Next slide please. Okay so this is something which again I hear quite often from friends or from clients something which maybe I've felt myself as well that I've been doing this I've been trying therapy but it just it doesn't seem to be working I still feel miserable so the first thing I'd say is be patient with yourself problems which have taken years to develop are unlikely to be solved in which is a couple of hours of thinking about them or a couple of hours of effort it will take time for you to figure and sort yourself out. Secondly be patient with the relationship we can't immediately trust somebody just because they are a therapist it is ultimately a relationship between two human beings and until you get comfortable and are able to trust your therapist therapy doesn't really start to be meaningful and it takes time for that relationship to deserve to evolve. Remember that therapists also can have bad days that sometimes they may be insensitive sometimes they may miss a point sometimes they may not be tuned in so do give your therapist a second chance and finally and most importantly if there's anything about your therapy that you're not satisfied with please talk to your therapist about it. When clients tell us that hey this is what I want like I want more specific solutions or I don't want any solutions I'd like you to just actually hear me out it makes our job much easier and most therapists are extremely happy to oblige so if you're not happy with the way your therapist is going please bring it up with your therapist and they will help you to figure out how to make it better. Of course it is possible that therapy doesn't work for you and if that's happens then it is also okay to sort of think about stopping or changing your therapist we'll talk about that again a little later. Next slide please. So what are some of the things that you can do to kind of help yourself make therapy more effective to keep the relationship professional one therapists appreciate clients sort of show up for sessions and who are on time because we tend to have bad days clients who work on themselves in between sessions are also much likely to find therapy more useful than those who are not able to. I'd also say don't forget to pay most therapists do really care about their clients and have a genuine emotional concern for them but it is our profession as well and our income is important to us and finally you do need to accept therapist boundaries. One of the things that makes therapy work is the fact that in the therapy room is a little bubble where just you and the therapist exist and that bubble enables you to be freer in exploring yourself. When the relationship goes outside of the room as well that can impinge on the bubble and kind of it messes up with what you can do in therapy also. So if your therapist is not wanting to have dinner with you or not you know declining a Facebook friend request or a LinkedIn request it's not really because they don't like you or they don't think much of you it's because we are obligated ethically to sort of not have relationships with our clients outside of the therapy room. Next slide please. Okay so we're coming to the end as I was saying sometimes you as a client might feel that you know I'm I think I've got all the benefit that I have out of therapy and I want to stop or you may feel I don't really have the time or the money to do it anymore or you may feel I don't like my therapist anymore it used to feel great but it doesn't. All of these can and do happen and they're perfectly valid responses to being in therapy and it's perfectly fine for you to initiate a discussion about this tell your therapist what you're feeling sometimes and your therapist will help you to understand that and make a plan based on what it is that you're feeling. Sometimes your therapist might say hey I think you know we've been seeing each other for long enough and you're doing well and you can carry on. You may not always feel very ready to do that that's also something that you can talk about. So discussing your feelings and plans with the therapist is again something which is useful for you this enables you to make a crisis plan okay I'm planning to stop therapy but if I have that problem problem again then what do I do or it can help you to set future goals for yourself. You know I've come so far with my therapist now what is the rest of the journey that I want to do on my own and and that also can be useful and finally it is possible too and pleasant to part as friends. So with this I'll end the presentation part the next slide please. I've just given examples of a few mental health resources it's not possible to really be comprehensive but there are tracking apps which kind of help you to track what is my mood what's my pattern what's going on with me or mindfulness apps or meditation apps like Headspace which help you to sort of calm down that are Instagram and YouTube accounts which you might find useful. Very often clients have seen something very transformational in some YouTube talk and they bring that into therapy and talk about it and I see that there is a lot of good information that's available as well. There are informational websites for instance the White Swan Foundation or the Love Live Laugh Foundation and most importantly there we now have therapy directories which will help you to find locate and get contact information of therapists whether psychiatrists, counselors, clinical psychologists etc for instance the name hence Ra is right now quite a comprehensive and good directory for clients. So thank you.