Enabling dialogues- how I work in my ‘counseling’ practice

These are figures in a museum in Greece. My idea was to think of the word ‘supporting’ and look for an appropriate picture. I thought everything needs support- even the past needs support and appreciation before it can be preserved and presented to another time. This picture is representaional of that support.

This is a first write-up, of sorts, for the kind of work I do in my counseling practice. The timing of this is a little tricky and I must explain- this is the peak of my thesis-writing. I cannot devote a lot of time towards writing this piece or to share in what manner the work I do unfolds in every counseling situation. Yet, in response to the fact that many people ask me what I do or how I do counseling, I feel this may answer some of their questions.

First of all the practical framework to understand the work merits a mention. For all the years I have understood counseling I have seen it to be a form of support/help/intervention which has been developed by people in developed, industrialized and now affluent countries of the West. This does not make them invalid in other settings, but a lot of times the situations in which these practices developed there are vastly different from what we face in a country like India. I have always been concerned about knowledge and transfer of knowledge,  and whether what is happening in one part of the world can respond to what is happening in another.

So what I have been doing is to take some philosophical principles developed in other parts of the world, with due acknowledgement to them, worked with some of my own experiential perspectives, and keep honing them. My lived experience of bipolar disorder, for which I have been a compliant, medicated patient for 18-years, becomes a significant starting point for me to create this pathway, for I do not think I can simply write-off my considerable experience as though it doesn’t mean anything. But be assured I am not going to bore you with my knowledge ideas here, but the practical outcomes of it. I will leave that for another day, another audience (the more academic, research-minded ones). For an audience, though I am told increasingly that nobody wants to read lengthy content nowadays, but listen to videos…this is my little offering.

A line of clarification- I write myself as a ‘peer-therapist’ only to distinguish myself in the field. I am neither a peer nor a therapist- for these are NOT my preferred words. A peer in the context of mental health is someone who is currently a patient, also taking psychiatric medication, just like the person they work with. I am not on any psychiatric medication for a long time, and in all likelihood not getting there either. The second idea is why I am not a ‘therapist’ in a traditional sense. I believe that therapy is a clinical term and I do not wish to occupy a clinical space in any sense because people who are suffering are not ‘patients’- they are simply humans, who need support, help, listening and talking to. That is all. If I use the word ‘therapist’ it is only to suggest what I do, and not necessarily my philosophical position, or my ethical stance (be assured I have all these in place) or the camaraderie I share with most of my ‘clients’. I am using the word ‘client’ until I find a better one, that shares my collaborative, dialogic mindset.

Contours of my work…

What I am about to share here is what a ‘client’ wrote back to me on email. He is a  22-year old young person, studying for a degree in engineering. I see him as inquisitive, intelligent, genial and having a gift of communication, somewhat unlike many young men with an unusual ability to articulate his distress very well in the written word. Since we have been together in our collaboration from September 2018 until now, it seems to be a fair time to look back at the gains we have made and what needs to be worked upon. Upon my request to respond to a few questions he wrote back the following.   At the time he came to meet me, he had a bipolar diagnosis and was on several medicines for the same.  

‘Your counseling system is quite good. Your first motto – to get rid of medicines made me believe in you. I was skeptical during the last year that is it is a strategy to get rid of medicines and to make someone dependent on the “constant” sessions i.e. (create) just another mode of dependency other than the medicines? But gradually, it made a clear picture. A counselor or the group of them needs to make a living and some profit too for a standard of living (so they need to be paid for their work, or else why would a stranger want to do anything with you?) But when you have a personal connection with her/him/or them, you can better realize where it is all going! I used to think that mam will deepen my understanding and thus the wisdom and I will recover – but now I know there is a difference between a sign board at a circle and the path on which you walk by yourself after overcoming inertia! I will remain in contact with her in any form and so I don’t think about myself as a patient or customer. I wish it to be the same with all the future people and I want her to make it clear to them what I initially thought.

P.S. There is nothing personal. Initially, it was hard to make a trust bond when you contact someone via internet. So, I thought in that manner, but now it’s wonderful. And I also believe in making a living with profit[1] as far as you are doing good for people in your contact. Intentions matter. I’m saying this after having many years of encounters with psychiatrists who are just profit making men. I don’t know why they are unable to think like you!’

In response to another question he writes (I am choosing to keep this feedback in normal font, only italicizing whatever he quotes from others)

My question – What is the difference you see in working with a person like me as opposed to a psy-professional, like a psychiatrist and/or a clinical psychological? Are you able to differentiate between our respective methods?

Psychiatrist: Yes say…. (I either whisper or cry about my “issues”) that he perceives as “symptoms”. I want to share my past incidents and emotions, want to talk to him because I’m paying him and he is a doctor, so he will heal my insider. But he says, “Leave that, tell me what are you experiencing now and nowadays”.

I think I’m dumb and just tell him whatever he wants. The other people (patients) are waiting outside in a queue and I feel that I should better leave and I can’t speak my heart out when people are waiting outside.

Now the psychiatrist do some pattern recognition task, maybe matching his DSM-5 booklet inside his mind with the so perceived symptoms and the experience with different people (patients) make his to draw to a conclusion based on the probability. Then he writes something (a diagnosis) at the top and then prescribes some meds in the shitiest handwriting. Tells my father that take these meds from the medical shop in front of the road and he will be fine and well! Come after 1 month.

Then I ask if they will make me sleepy as I need to study to which he replies, “Do you have exams this week?”

I reply, “No sir.”

Then take these meds and get well.”

I exclaim, “But sir I study everyday….”

Sir, tell him something so that he will not that lazy and depressed.” My father interrupts.

Bhai wake up early morning and run and discourage from extra activities. What is the need of worry in college? Chill…” and he opens his box with the other hand which is filled with 100 rupees notes, mostly crushed, an hint to pay and let the other person (patient) come in.

My father pays a couple of notes and I’m wondering if I will be able to go for a walk (forget run) the next morning?

….

Clinical Psychologist: She asks me to tell her what’s the fault! Yes fault. I think it’s a hour long session and we have paid for it so I can talk my heart out. She, at the first, listens to me which I feel good about but then, I don’t know how, she begins to take some notes from my dialogues instead of listening to me. Then she begin to make some diagrams (flow charts) while inquiring with my parents if anyone was diagnosed before, how many siblings etc.

It seems like she had done that question practice many a times like how many times did I study for a stats exam! So frequent and  multitasking! Then she throws some picture storyboards at me and asks me to write the stories in my own words. I think some magic will come out of it and then I left after spending an hour.

The next week, she gives a diagnosis report and says he is ____ ill; confirmed with the psychiatrist’s evaluation as well.

Now we will work on a workbook. She gives me a sheet and tells me to write whatever is bothering me these days.

Then she speaks some technical jargons and give me some coping techniques. While talking, she looks at my hands and body language trying to figuring me out and I outsmart her by controlling my gestures as I know she is seeking for hints and I can manipulate them!

Instead I look at her necklace and ring finger and think about her painful marriage! (this is so funny)

Well, (maybe) that means she is doing this professionally and nothing is there to be concerned. She can’t relate to me. She just asks me to take meds regularly and using those coping techniques like breath relaxation (that is called pranayama and Anulom-vilom in our language) and distraction techniques. We pay and I decide not to go there again…!

You: In a nutshell, reverse the semantics of the sentences and paragraphs that I have written above and before. Your’s is a slow process and doesn’t belong to mere coping techniques. Listening and understanding is what I needed as always instead of searching for keywords in my dialogues.

“A food being cooking on a low flame is more healthier and tastier than the food being cooked in an microwave oven in just a minute at 200 def F”

So, it takes time to understand why it is a slow process. Hence, possibly some people leave your place thinking she is just talking, not giving any immediate solution (the truth is nobody leaves me easily because they find me with great effort only after all and usually everyone has read so much I have written publicly that they are convinced they want to work with me, before they knock at my door)

“Giving a bone to a dog will temporarily satisfy his hunger. But giving him an occupation or direction to find bones will satisfy it for life”

Well, I think it is your job to also satisfy (relax) me at the end of the session but if that is only your goal, then I may have thought why I’m talking to you! Thank god, you are different.

Getting off the meds

Recovery and doing what you want to do in your life

Made me to continue to work with you

We embarked upon our journey together on 29th September and now we are towards the end of May 2019. Whenever I felt the need for it, I requested his family to speak with me as well. I think he is in a safe place as of now, and this is as far as I can share here. The finer details would have to go in a research article.

Thank you for reading, for this is a nutshell of my professional work with my clients. I would also like to thank the young person who has written this, and permitted me to use it.


[1] He thinks I am making ‘profits’ out of my counseling practice, whereas the truth is that I am still not able to pay my bills completely J (truth and perception! What can you do about it?!) At times people in India do not understand that if you are doing a self-funded Phd, you do not get paid for the thing you are spending the greatest amount of your time. So you earn that money in other ways. I do by teaching music and doing counseling and that is not adequate to pay all my bills yet! L

One thought on “Enabling dialogues- how I work in my ‘counseling’ practice

  1. Pingback: Recovery related resources on the blog | recovering Self

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