Rebuilding Therapeutic Spaces
Questioning the comfort zone
As a mental health therapist as well as a therapy service user, I must confess that hospital settings have been my safety net – as familiar places on which I can fall back in the midst of hardships, discomfort, uncertainty, confusion. It is the assurance of an established system that has made my work easier, allowing me to follow a standard pattern of working in therapy, which includes a list of do-s and don't-s and derives from a collection of well-researched manuals. With this kind of learning and training, there is no doubt that I had internalized the systems that informed most of my therapeutic decisions. Yet I now believe that such established psychological systems do not really allow for inclusion, or for diversity of thoughts and actions, but merely tolerates these.
For the work of individual MHPs to be informed by values of inclusion and diversity, and intersectional concerns, collective efforts are required that focus upon changing the environment of psychiatric hospitals, institutions, and asylums. In my own short experience as a mental health professional, taking a hard look at my own work allowed me to identify certain areas that needed “softness” and rebuilding, for me to be able to emancipate the therapist within.
Building security in the absence of systems
The internalization referred to was sustained for me because it often served the function of personal protection. Becoming aware of this allowed me to make the crucial decision to unlearn the psychiatric system, fuelled as it was by power dynamics and “I-know-better” attitudes. Eight months ago, I decided to start online counseling from my residence. As exciting as it was, I struggled to make adjustments. There were logistical difficulties, and instead of working with colleagues I was now working alone. Initially, I found it hard to strike a balance between my personal and professional lives – it is still difficult at times. However, along with these hardships came some ease. Working alone meant looking for answers within, as opposed to searching in the world outside, which pushed me to develop a sense of autonomy, and it fostered my growing intuition as a therapist so that I was not relying on conscious reasoning alone. Gradually, I began to rely less on my formal education, and to use my personal situation to explore the struggle and challenges that online counseling presented and continues to provide. Most of the MH frameworks I had been taught were inspired by Western concepts such as Cognitive Behavioral Therapy and Behavioral Therapy, rooted in ideas of individual psychology and ableism that were proving ineffective in my context. Recognising their limitations allowed me to look for answers outside the system, and opened new gates for me: I gleaned information from social, political, historical and intergenerational contexts that began informing my practice. These contexts had always been present, but were often sidelined in the work environment; yet they are crucial because they reveal to us the ways in which mental health is a public health concern and not solely an individual/individualized phenomenon.
My initial fears and insecurity about working alone pushed me to reach out for support, in the absence of the walls of hospitals and asylums, in the work that I do. I gained a sense of security with the help of the mental health community and their affirmations, and through paying attention to lived realities while honouring individuals and scrutinizing the contexts that contribute to developing and maintaining mental illness.
Shifting the power: from fear to vulnerability
Institutional structures and systems wield power, which may result in service users being afraid to communicate honestly. Hospitals and asylums tend to perpetuate these power hierarchies, along with a reliance on the “curing” capacities of their MHPs. As a mental health professional myself, I realise how these sanctioned systems left me with little room to acknowledge, accept and express my own vulnerabilities within their confines. The shift from the physical hospital space to a solitary digital one gave me an opportunity to sever the power structure based on notions of experts and their subjects, and helped me make room for vulnerability in my practice. For instance, when clients asked, ‘How are you?’ I would respond with a generic ‘Good’ or ‘Fine’, but of late, I am being more honest about how I really am feeling. I have also learned to ask for forgiveness when I fumble, or have forgotten to send a client a helpful article I had promised. I believe seeing me as vulnerable, too, makes clients feel safer about expressing themselves, and articulating distress, more freely.
I strongly believe that the foundation of a safe space for service users as well as service providers creates an environment that helps dissolve power and embrace vulnerability. Such spaces provide greater agency to service users, which is essential for self-determination – and facilitating greater levels of self-determination ought to be one of the collective goals of the mental health community.
The freedom to think creatively
The journey of emotional healing is a creative process that involves many stakeholders. It includes working with individuals to dismantle biological, psychological, social, political, generational, and historical constructs. Rigid and formal mental health institutional structures act as barriers to the free flow of creative thought; their hyper-focus on “objectivity” relegates subjective thinking and action to the peripheries.
The creative journey to mental health and wellbeing is not, and should not be, limited to empowerment, but must aim for an emancipation that allows for diversity in treatment and in structures, for voices of change to flourish, and for many truths to coexist in harmony. Such a process involves breaking free of old systems, reforming old ideas and finding new pathways, speaking a new language which is vulnerable, honest, radical and freeing. A lack of such diversity and openness does little for individual and systemic growth.
Discovering new tools to dismantle old structures
Many clinical spaces, too, are consciously evolving, with efforts being made to branch out into community settings, classrooms, digital spaces, and to move gradually towards deinstitutionalization and greater social inclusion. Problems arise, however, when the manner of evolution and inclusion comes from the very structures that are prone to discriminate against and stigmatize users: hospitals being made the primary dispensers of mental healthcare often works against openness and diversity.
It was this very lack of, or inability to nurture, diverse spaces and voices within the dominant institutional setting, that had prevented me from thinking and working through its obstacles and limitations.
Only when the dominant MH systems begin to embrace a diversity of spaces, along with fresh techniques and ideas about healing from both service users and providers (and not view these as threats), will we be able to initiate justice in care work. Only when we look at vulnerability as one of the guiding sources of power will we learn to let go of the heroic qualities associated with and expected from MHPs. Only when I allow myself the discomfort of new methods and approaches will I push myself to acknowledge, accept and embrace diversity, and move towards creating spaces to promote the healing that service users seek.
“Most of the MH frameworks I had been taught were rooted in ideas of individual psychology and ableism that were proving ineffective in my context.”