Mental Health and Counselling in India:
Our guest today is Dr. Kusum D’sa, a counselor from Mangalore. Dr. Kusum has an extensive resume working to support people with mental illness and their caregivers. From 2017 to 2020, Dr. Kusum worked with the prisoners at the Mangaluru prison, focusing on counselling, educating and rehabilitating the inmate. During the COVID nears, she was one of the volunteers for the mental health hotline in Mangaluru. Dr. Kusum is part of the Mangaluru district Drive against drug addiction and has trained the police, teachers and students. Currently, she has a private practice where she counsels kids and adults.
Dr. Kusum, thank you for joining us here at For All Our kids. How did you know that you wanted to be a counsellor? What inspired you? How did you get started?
I don’t think I started my career with this goal that I will be a child therapist one day. This just happened. Going very long back in my childhood, I was a caretaker to my mother, who was diagnosed as schizophrenic and bipolar. And this is what interested me to dwell deep into the field of psychology. But in my hometown, we did not have any course in psychology. So I was not able to take the subject to study in my degree. Later on I went on to become a English teacher and then I headed colleges and then school. So when I came to school, as the head of the school, this is where I plunged into different aspects of child psychology and on job training.
And at that point of time we had a dearth of teachers…, of special education teachers in the part of the country that I live and I had resorted to self-learn in this area. Eventually there was a course that came up in my town where I could work as well as do my course in counseling and therapy. So that’s when my journey in this area began as a certified therapist.
But throughout my career, I realized, and I noticed that whether it was parents, teachers, or children, they would naturally come to me and confess the darkest secrets in their life. So, this prompted me to first of all, take a course so that I will be certified. And secondly, I thought why not? I’ll also start a second career or maybe a career after my retirement, or probably along with my job. So, this is how it began and eventually I added up a lot of add-on courses in this area.
I’m a certified de-addiction counselor and I have done various courses in therapy be it in child therapy, core transformation. So, this is how it happened and inspiration…definitely, it all began with my mother…my lack of knowledge, lack of coping skills, lack of understanding of mental health disorders.
What education, schooling or skills are needed to become a counselor?
There’s one thing in terms of certification and there’s whole lot of other things in terms of your attitude, aptitude and passion. So, the educational qualifications or requirements was a Bachelor’s degree in psychology, a Master’s degree definitely, and then a doctoral degree, PhD in psychology, clinical psychology. Nowadays we have a whole lot of specializations in this area. You have clinical psychology, you have just counseling as a specialization, counseling in school, de-addiction counselling, developmental psychology… there are so many options available now for the aspirants to go through and become a psychologist or a counselor.
Now, it’s not enough that you just have a degree. You satisfy this with that piece of paper, in terms of certification. I’ve seen in my career as a school head, I get easily people qualified with certifications, but they lack the skills, unfortunately, to deal with children or young teenagers. So, the skills required for a counselor or a therapist or a psychologist… effective communication skills, most importantly empathy, critical thinking, sometimes we have to think on foot and decide what suits the client who’s in front of you, problem solving skills.
As a therapist and counselor, we are not supposed to give advice or give them solutions to the problem. We could definitely help them to arrive at their own solutions. These are very important skills that psychologists, counselor, anyone who’s working in mental health needs. And of course, along with this, research skills are very important because we see so many innovations that happen in the field. Updating your skills is very, very important. Every day there is something new that’s coming up in the field and it helps a lot for us to read. We know about this new therapy and that can be very helpful to the client.
How long have you been in this field and how long have you worked with children?
I have been in this field with and without certification. I was told I was a good listener, and I don’t make judgments and this prompted me to get into this area. And that includes the first half of my career, maybe the first, fifteen years of my career. After that, I have done my certification. And updated a lot of different other certifications. After this certification, it’s more than fifteen years I’ve been working with not only children, but people in different age groups.
Dr. Kusum, how would you describe a typical day?
In a school and as a head of an institution, it’s very difficult to plan meticulously because most of the time you’re a firefighter and you have to immediately run, rush here and rush there to get your solutions to the problems that crop up in your everyday life. But then, the time I get after the school is something that is static. If I’m not in my workplace, if there are holidays, I schedule the sessions with my clients.
What I do loosely is this. I’m not just a counselor, and a therapist. I’m also a consultant for schools and colleges. I’m a teacher trainer; I translate. I have many translations published! And then, I’m also a research guide in a university. And then I have itchy hands, so I’m most of the time doing something with my hands, either painting or weaving. My day includes all of this.
What age groups have you worked with?
I have children as young as four or five years old to grandmothers of 75 or 80 years old. This is the range I work with. What I noticed recently is that it’s like a wave, so I have certain age groups who come in a wave and go. And then you have other age group coming. This is what I’ve noticed recently. Right now I have different age groups that I’m handling. One is teenagers: pre-teen and young adults, that is, from the age group of fourteen to twenty. Most of them either are in the onset of some mental issues or children with mild special needs. Or children who feel they’re confused and they need advice in their careers or what they want to do next. And there are also children who have emotional trauma.
I also have adults with marital issues. I have quite a number of people, women who are going through breakups, either with their husbands or their live-ins or their boyfriends. Some of them are on the verge of divorce. They are in different stages of separation. The third category, which off late I’m also getting is couples who come for couple therapy. They realize there’s something that they need in their relationship, so they come for relationship counseling.
I have people in different stages of grief, they have just lost their spouses or the loved one in the family and this category also is on the rise. Occasionally caretakers or patients themselves who are terminally ill…they want someone to listen to them and do the clean up. So these are the range of people that I’ve work with currently.
Dr. Kusum, what is the intake process?
There are different steps in the intake process. Like any other profession, there is a first session where I get to know the background of the issue, background of the person. And we discuss the next course of action…, depending on whether they are my online clients or offline clients. So, then I design a program for them after the information gathering in the first session. And we mutually agree on the scheduling of appointments.
So what I personally prefer and advise my clients is that they take the first five sessions and then we go for the next consecutive sessions depending on how they cope with this entire therapy. So, sometimes five is not enough. Surprisingly, there are clients who recover within these five sessions and then they come for a follow up, perhaps once in a month. There are clients who would take more than ten sessions as well.
It all depends on each person. Each person… I design a therapy which is customized to them. So, we have of course goal setting in the first session itself. I ask the client what is the goal that they would like to reach. And this all comes in the first session of gathering information and then the treatment plan is “what would be the approach? What would be the intervention? Is there necessity of seeing a psychiatrist and medications?” In that case, I have to take another extra session to explain to them and the family on the benefit of taking advice or medicines from a psychiatrist…, because this is the area where there is lot of reluctance. So this comprises loosely of what I do with my clients and then.
After the fifth session, we discuss how do we continue the therapy or services in case they need more. If not, if it is bordering towards the psychiatric cases where they need counseling, then we agree upon schedule once in a month or once in two months, depending on how they are. So, I have certain clients who take appointment once a month because they also take medicines.
Dr. Kusum, under what circumstances do you recommend psychological assessments for your clients?
Now this has two aspects. If the children come under the special needs, they have issues with understanding subjects, the assessment helps to knockout few subjects for their board exam. Psychological assessment from a government psychiatric department is very essential for these children and it’s very beneficial for them. So, in that case, I advise the parents to take their child to the nearest government psychiatric wing and get this certification done so that it’s very easy for the child to cope up with their academics. In that case, yes, it’s essential for the benefit of the child.
If it is nothing to do with their learning skills, and if I feel it’s not needed then I do not recommend any psychological assessment for children, so it all depends on the diagnosis and understanding their current mental health conditions.
What specific techniques are you trained in and with a focus on children?
I’m trained in counseling and guidance in de-addiction training, core transformation therapy, inner child therapy, art therapy and CBT. Along with this I have done short term courses in play therapy, storytelling therapy, and social skills therapy.
Now, in your experience what therapeutic approaches do you find most effective when working with children?
When working with children, it’s very essential that first we create a rapport. The child has to be comfortable and feel safe with you. So the grounding is very important. In my experience, most of the time it is winning the confidence of the child. So that aura that you create, that nonverbal communication that goes to the child is extremely important. Making eye contact and assuring he or she’s safe with you is extremely important. It’s not a good idea to approach the topic directly. In my experience, the children open up eventually to you, not immediately. so therefore there’s a lot of things that goes before the child opens up.
My favorite therapy, which has never failed, is art therapy. Children love to scribble, they love to use colors, they love to do something with crayons and a piece of paper. And that’s the grounding I teach them before I start any therapy. This is how I make the child open up. And then storytelling method, narrative therapy. It’s fascinating how the child enters into this world of story, and it’s very easy to bring out the trauma or whatever connected through this narrative therapy. This is also one of my very favorite therapy and I enjoy doing it. And I enjoy the way how the children respond to narrative therapy, or the story telling therapy, where they themselves are the characters, and they are in the middle of the story.
How do counsellors build a rapport with a new child client?
The first session is always how to create a safe and welcoming environment to the clients and of course. Another important thing is establishing the trust. “Hey, you’re in the safe hands you can trust. Whatever it is, it’s only between you and me.” It is very important. Whatever is the maturity quotient of the client, they want to hear that they are with the person whom they can trust.
Another important thing is to listen actively. Many a time there would be pauses. There will be long silences. Over the period of time, I have realized that that silence itself is loud. All they require is that empathetic silence. There are people, even adults, who are not able to express at all. They can’t express their feelings, emotions. Then I have to build up some other play-way method even for adults and make them respond to feelings and emotions; and of course, respect boundaries of the clients.
Initially, they would not want to share much. so instead of forcing or telling them, asking them repeatedly, that’s not going to work at all. Then, as a therapist, this is what I would say. “I understand you’re not able to speak about it now. Whenever you feel like you can always tell that to me.” So, this approach helps. And this also helps in building the wrapper gradually and then eventually they open up. And of course, then it depends on each person. Some of them I have seen, they love humor. A joke here and a joke there and some of them…,they have this ability to laugh at themselves. I’d catch that or try to catch what works with them. If it’s humour that works with them, yeah, I use humor.
I try to understand what motivates my client and what is their fear, and then play around with these two things. And I always feel that we appoint one person in the family and send them for counseling. It’s not so simple. It’s the whole family that needs sessions, counseling sessions and this is where I have a contract in the first session itself that people, all the members in the family will be engaged at least in one session, for me to understand the problem better. So, this is the contract that we… this is how my sessions will be.
It’s not one person, it’s the whole family eventually. And of course, you need to be genuine, cannot fake. And then of course, we have to respect the person. He may have done the heinous of the heinous things in life. But still, dignity is something everybody expects. It may not augur well with your belief system, with your values and all that, but I cannot bring that to the table when I have a client in front of me. At that point of time, it’s only the client’s dignity and client’s need that is most important.
I have them in my WhatsApp group and send them messages, motivational messages every morning…, so they are there in my radar; and they feel that “Okay, there is someone who is thinking about me!” This is what most of the clients told me as a feedback. So it’s not that “One session and you’re out” and I meet them only in the next session. It’s a very personalized approach and they are in my WhatsApp group and even after the counselling and therapies, everything is over, if they wish, I still send them my morning motivational messages and I engage them…irrespective of whether they are my clients now or not. Even those who have finished, their therapies, I throw challenges to them- a 30 days challenge, 20 days challenge, different kinds of challenges to know oneself!
Do you involve parents or guardians in the therapy process? Have you ever had to do family counselling?
As I mentioned before, yes, I do. Counseling cannot be a stand-alone process for one designated person in the family. There is trigger points within the family system. And if the trigger points are not addressed, there’s no point in counseling one person because the triggers will be as they are and the counseling session won’t be effective for good. It may be effective only for a short period of time. Therefore involving the entire family is very, very important.
Our Indian extended family system is a double-edged sword. It can be a source of great support or put extreme pressure on the kids and parents. How does that family dynamic impact a child’s progress?
I always say there are two Indias. You have the India and Bharath. India is living in the urban spaces where there are nuclear families, and you have Bharat in the two tier, three tier cities and villages… where there may be extended family or there may be extended family living close by.
Whether they are in urban spaces or in village spaces what I have observed is in certain communities, the decision making is not a father or the mother. It’s not just in the family. The decision is taken by the sometimes father, mother, grandfather, grandmother, uncle, aunt. In certain communities, I feel, not I feel, I get clients…, they don’t come alone. They come with these many. They have appointed one for counselling and there will be fifteen of them accompanying the person to the counsellor.
Of course, it has its advantage. You have a good support system. Another beautiful thing about this is it’s a shared responsibility. I’ve seen the uncle, aunts, grandmother, grandmother, everybody come to the rescue of the family or the person in the family. So, this is really very good when it comes to family or extended family getting involved.
Other side, the challenges are these: there are lot of comparisons, interferences, pressures and expectations, “because I belong to a family…big family and community.” And of course, another big menace is the comparison with others in the family the same age group. Then, when there should be privacy, that privacy is totally not respected.
I remember there was one case where the case was with the woman, young adult, who ran away from the family; and the mother, father, the fathers, brothers and their wives, three of them, grandfather, grandmother, around these fifteen people entered my workplace. And the father, mother didn’t utter a word. It was the others who were talking, and others who were making decisions for that child. And I could see the expression of the mother…that she had to say a lot. But she couldn’t open her mouth in front of these people. So, this kind of limited privacy will be there. So, we can see both sides.
In Indian society, therapy has such negative connotations. Has that prejudice impacted your work?
Look at it in a pre-COVID and post COVID situation. In pre-COVID situation, I would agree with this statement a hundred percent! It was very tough for me to convince parents to take their child to a therapist or a counsellor or whatever, anything related to mental health. But during COVID and post COVID, it’s become quite easy for us and people are more open now to come to a counsellor. And I have seen families very openly bringing whoever is affected. They think that they need counselling, search and come visit the therapist. So, this is the difference that I have seen in the pre COVID and post COVID periods. Broadly this is what I see.
Of course, prejudice is there. I’m not saying it’s gone completely, and I would say prejudice comes definitely because “I’m not aware… my understanding of mental health is very low. I only have opinions that are circulated within my community or where I live.” And some of them we see, they don’t want to seek help. They’re very reluctant. “This is how I am. This is how I am designed. I cannot change!” This is the attitude. And acceptance of professional help… no, not there! They don’t want to take this.
They feel that “Okay, it’s safer for me to go to my religious heads rather than go to a therapist; Or, it’s safer for me to pray to God. God will change me,” rather than be practical and go to a therapist. So I joke with the such people, saying, “God has sent the therapist to you. God is very busy. He can’t come. So that’s why the therapists are helping you.” Then, of course, the stereotypes, we have stereotypes in all professions; so we have stereotypes in mental health professionals as well.
Some of them are scared of their privacy. They feel that, okay, they have this darkest secret and that will come out if they see a therapist. And if the therapist is in the same town or it’s a small town, they feel that, “Okay, now, if I tell this one, it will go to this one-that one!”There will be someone you know, who, common friends or something like that. Because of this I have a lot of online clients. What I realized is they feel very safe when it is online, and they are from different places.
, this therapist is unknown and, in a space, where it’s online and no one knows that they are even seeking a therapist. This is another trend that I’m observing. Most of ,who are my online clients, their family don’t know that they are seeking help. So, they want it to be kept that way. This technology also has helped in seeking the help of a professional mental health person. I think technology has definitely helped and these days I see a lot of acceptance in seeking help. It’s good, the change is good. That’s why I see more clients now.
Do you find that parents wait long before seeking help from professionals? What did you see in your practice?
Yes, I think the mental health professionals are visited as the last option, never as a first option. Very rarely they come to me as a first option. And 99% of the clients I have, they also would have visited other psychiatrists or other counsellors, and it does not work with them and therefore they come to me. So, they would have done a lot of shopping! Shopping of other professionals in mental health, shopping of psychiatrists, shopping of all religious places! They would have gone to different gods, different prayers. They’ve done so many things and then have sought help with the professionals. Yes, this is as the last option.
Why does this happen? We always have this, even you and me or whoever it is, we always think that we should not go to a doctor. Let me do some home remedies. So, this is how it begins. “I start with my home remedies. Let me do natural improvement,” and there are a lot of people advising you. “Oh, you’re feeling depressed? Okay, go for a walk. Do this! Do that!” Advices come in and they would have tried it. They waste a lot of time doing all these things. To some, financial constraints! I don’t know how to explain this.
This is the logic I give to my clients. “You purchase a saree worth of – – on your everyday or weekly expenditure, or monthly expenditure. There are so many expenditures which are not needed. You still do it. And we don’t have any qualms doing it. But when it comes to seeking professional help, then we can’t spend that money. So, this is one of the problems that I see. Of course, there are genuine financial constraints, which I understand. And also, there is reluctance in paying the mental health professional. I don’t know why this happens. Both sides I have seen.
And sometimes there are some areas, because I do get clients from different villages of nearby places, where they don’t have this facility or even if they have a so-called counselor they, she or he may not be meeting up to their expectation is this is the feedback I get.
Another thing which I have noticed is this: perception of “how severe is the problem of the child?” We normally don’t take children’s mental issues seriously. One is because a child is not able to communicate the severity of the problem to the adults in that language. The symptoms may be seen, and if you’re not trained, you may miss this symptom. That’s one of the hurdles that I’ve seen. And this creates a perception that the child is acting, the child is faking! The child does not want to go to school or college. That is the reason the child has an attitude problem. This is how perceptions are formed. And that is one of the problems, most of the time I see this perception problem.
That’s a big, big hindrance – for anyone, I mean, any age group. Yeah, I’ve seen this even in older people, in grandmothers, grandfathers, especially when they come to the onset of dementia or any other geriatric issues. This is highly resisted within the family, members say, “No, she’s fine. She’s acting. He or she is, you know, fine! She can remember this, but not remember that?” There’s so much ignorance and perception forming in this area. I think the major culprit is perception. My perception, and my perception is based on my limited knowledge in the area. So, this is how we are caught in these two things.
With this we end this episode. Part 2 of our interview with Dr. Kusum D’sa will be aired on February 21st.
If you are looking for a verified mental health professional, you can use the services of Mindclan to find someone in your area.
Other podcasts in this season include:
Occupational Therapy: Interview with Dr. Isha Soni
OT and Early intervention: Interview with Dr. Isha Soni, Part 2
