Shilpa Jain: For the benefit of our young women at AFH, can you explain the difference between a Psychiatrist, Psychologist & Psychotherapist? And is it possible to pursue either of that as a career option or does it necessarily entail all three?
Hvovi Bhagwagar: Psychiatrist -Medical practitioner with an MD in Psychiatry. Psychiatrists are also referred to as psycho-pharmacologists and provide mainly prescriptions and medication management; however some psychiatrists may also practice psychotherapy.
Psychologist – In addition to performing talk therapy, they have training in psychological testing (i.e., the Rorschach test, among others). They can also perform research protocols. Psychologists can work primarily with mental illness (Clinical psychologists), with adjustment issues (Counselling psychologists), medical illnesses (psycho-oncologists) and so on.
Psychotherapist – This is an umbrella term for any professional who is trained to treat people for their emotional problems. Depending upon their academic degree, a psychotherapist can be a psychiatrist, psychologist, or social worker (among others), and work with individuals, couples, groups, or families. Psychotherapists do not provide psychotropic medications such as anti-depressants.
One can Take up Psychiatry and later train in psychotherapy, if interested in working with the emotional aspects of mental health.
SJ: What does one need to qualify in in order to pursue a career in Psychotherapy?
HB: In India, a Masters Programme (MA/MSc) is mandatory. The person can also pursue an MPhil in Clinical psychology which will allow them to work primarily with assessment, diagnosis and treatment of mental illness. One needs to take advanced training in specific Psychotherapy modalities after Masters/MPhil. These courses are usually offered by Private Institutes such as REBT training at Ellis Inst New York, or CBT at Beck Inst, Philadelphia. Some Institutes offer Psychotherapy trainings in India too. Eg: emdrindia.org; Morphic Minds, Arts based therapy etc.
SJ: Can you briefly take us through the various treatments you provide?
HB: Most therapies have a similar goal which is to reduce emotional disturbance. I primarily use therapies that restructure the client’s belief systems to help them develop balanced thinking and reduce their extreme emotional reactions. The two modalities I use are Eye Movt Desensitization and Reprocessing (EMDR) and Cognitive Behavior Therapy (CBT). EMDR therapy is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. This therapy proposes that the basis of mental disorders are dysfunctional memories rather than only irrational or negative thoughts. When something disturbing happens to us whether in childhood or adulthood the brain stores this information as raw undigested memories and these memories continue to create interference in our daily lives and the result are disorders such as anxiety, depression and even personality disturbance.
EMDR therapists work on these disturbing memories using bilateral stimulation in the form of eye movements, tones, taps etc. Working on disturbing memories often has the benefits of treating the person from the root and preventing further dysfunction from taking place.
My experience with EMDR: I trained in EMDR in 1999 with the first batch of EMDR practitioners to be trained in India, and since then have used this therapy extensively in my practice. I have also worked with EMDR on mass scale natural disasters along with an EMDR team- first during the 2001 Bhuj earthquakes of Gujarat, and later during the 2014 Kashmir floods. My research on “EMDR in the treatment of Panic Disorder and Agoraphobia”, was the first case study on EMDR from an Indian practitioner, published in the Journal of EMDR Practice and Research in November 2016. Full article access: http://dx.doi.org/10.1891/1933-3184.108.40.2066
CBT is a psychotherapy based on the cognitive model, which is, simply that the way we perceive situations influences how we feel emotionally. CBT is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in over three hundred clinical trials for many different disorders. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. Courtesy: Beck Institute https://www.beckinstitute.org/get-informed/what-is-cognitive-therapy/
My experience with CBT: CBT training is still at a nascent stage in India and therefore I have undergone trainings at the Beck Institute in Philadelphia, USA in order to learn this therapy more effectively. CBT was developed by Dr Aaron Beck and his daughter Judith Beck, both of whom are profoundly influential teachers. In 2014 I underwent a specialized training on anxiety disorders at the Beck Inst and learnt CBT techniques for conditions such as Social Anxiety Disorder, Panic Disorder, OCD and Generalised Anxiety Disorder under Dr Amy Wenzel and Dr Judith Beck. In 2015 I returned to the Beck Institute to take another training for Personality Disorders (PD) under the guidance of Dr Judith beck and Dr Amy Cunningham. As a therapist I find that CBT works quite effectively for most diagnosable mental illness.
SJ: Does it necessarily involve medication?
HB: Both medication and therapy have been shown to be effective with mental health issues. The type of treatment used depends on the nature of the problem. Generally, medication is often prescribed for conditions known to have strong biological components, such as major depression, schizophrenia, bipolar disorder or panic disorder. Research suggests that use of medication and psychotherapy together may be the best approach, especially for more severe conditions. The medication offers relief from symptoms, and psychotherapy enables the individual to gain knowledge about the condition and how to handle it. This combined approach offers the fastest, longest-lasting treatment.
SJ: Even in today’s progressive world, many people associate someone undergoing therapy as “mad”. It is very sad but true. What is your advice to them?
HB: One of the biggest stigmas surrounding mental health is that only “crazy people” need it. Even the terms “mental” or “crazy” have such a negative connotation that it deters people from seeking help. Most people who visit my clinic for the first time do it with a lot of trepidation and believe that they don’t really need therapy. So I usually provide some psycho-education around mental health, and try to normalize it. For eg saying that One would visit a doctor during an illness, or take the car to a mechanic for repairs because those experts know better at handling such problems. So seeing a trained expert for problems such as depression, mood swings or marital conflict is not a sign of weakness or “madness”. Instead, taking psychotherapy is a sign of being smart because taking help prevents problems from worsening, and interfering with one’s functionality.
SJ: Do you see an increase in the number of cases in the young age group who need some sort of therapy and counselling? If yes, why so?
HB: Yes, the youth of today is quite stressed. According to the World Health Organisation (WHO), half of all mental illness begins by the age of 14. In India the leading reasons for injury burden among the youth is suicide and self-harm, as per a Health Ministry report released in 2017 called ‘India: Health of the Nation’s States 2017’. Harmful use of alcohol and illicit drugs among adolescents is also a major issue in many countries, including India and can lead to risky behaviours such as unsafe sex or dangerous driving. Eating disorders are also becoming more obvious among teens.
Perhaps the reasons could be reduced involvement among Indian parents, which some reports indicate. Another reason is definitely the huge gap that exists between parents and youth when it comes to technology. With the youth being digital natives while the previous generations are digital immigrants, parents and children of this generation face the unique problem of miscommunication due to technology use. This probably explains why the youth of today feel they lack guidance and support, and also explains the high stress in this age group.
SJ: You also conduct mental health & stress management workshops. Is this for a group of people or aimed towards corporates?
HB: Right from the early part of my career I was interested in reaching out to larger audiences. In my second workplace (at an NGO called Sweekaar), my aim was to initiate group workshops for teens, parents and women, which ran quite successfully. Later, I was also associated with Dr. Reddy’s for a project with the nursing population, imparting trainings on patient counselling and stress management across healthcare facilities in Maharashtra. When my son was born, full time private practice wasn’t possible immediately, so I took up freelance projects conducting trainings with various corporates on life skills, parenting, communication, stress management etc. However, in recent times my private practice is so busy that such trainings are no more possible. So I only do selected talks for creating community awareness on mental health.
SJ: You also write blogs on creating awareness on mental health. Where can we find you?
HB: So my blog is more a compilation of some of the articles I’ve written online and in the print media. Most of these are available at https://www.manashni.com/manashni-blog/
SJ: As our primary cause is aiming to make young women financially independent, why is being financially independent important to you?
HB: Well the cliched answer is that financial independence is necessary for most women, to balance gender stereotypes. In my case, financial independence was a necessity because I grew up in a fairly patriarchal home. However, I think for a woman financial independence is actually a state of mind. Learning to live within a budget, avoid overspending, saving money and investing wisely require developing character traits rather than financial acumen. Therefore, to me, a woman can be financially independent when she not only earns money but also manages it well.
SJ: Any message to the members of Aspire for Her? And any message for the Foundation in general
HB: It’s a unique platform-but it fills a huge market need. While career guidance is available for most youngsters, what is offered at Aspire for her is peer interaction as well as mentoring, which can be a major support when the youngster is lost in the maze of career options.
Question: One person, fictional/real and dead/alive that you want to have dinner with
Question: A book on your career field that you would recommend to readers
Man’s Search for meaning by Victor Frankl,
The Body keeps the Score, by Bessel Van der Kolk
Question: 3 things on your bucket list
Starting a support group for people with Complex trauma in India.
Travelling to a long list of places I’ve wanted to visit among which are Geneva, St Peter’s Basilica, and Plum Village.
Free Psychotherapy for lower income groups