There is no psychotherapy without a theory of man and a philosophy of life underlying it.

(Viktor Frankl)

Psychotherapy is an integral element of any modern-day mental health service. The established role and contribution of psychotherapy in providing relief to the vast majority of agonised individuals is in itself a confirmation that mental health issues are not biological in nature as the pharmaceuticals generally claim. Psychotherapy can be defined in a lay manner as an intervention-based on psychological theories on the functioning of the human mind.

Psychotherapy is administered by trained personnel (psychotherapist) to address a disorderly state of mind (feeling, thinking, functioning and connecting). The disorderly state (psychopathology) can be called depression, anxiety or psychoses, depending upon its presentation and manifestation. These presentations may range from stress and emotional upset to psychosomatics. The psychotherapist, after developing a therapeutic relationship and meticulous assessment, suggests a layer of hypotheses around the possible reasons for an individual’s difficulties. These hypotheses are analysed, one by one, by putting interventions around them. Contrasting other remedial approaches, psychotherapy requires the active participation of the individual (client) to reach the desired goals. Psychotherapy is not a passive process of treatment like pharmacotherapy, which may require no more than gulping a pill with a few sips of water. It is an active and desired endeavour to change the way of experiencing the life events and then altering their imprint on the human mind. Psychotherapy becomes a tablet of paracetamol if it is aimed only to cure depression but not altering the melancholic manner of seeing life, which ultimately triggers depression.

An overarching and delicate process of intervention obviously requires a refined skill set, personal traits and training for the psychotherapist for a careful handling of clients and their difficulties. Psychotherapy requires creativity on top of the textbook knowledge to understand the connection between psychopathology and human experience and it heavily depends on the novel and tailor-made therapeutic solutions. A psychotherapist cannot prescribe the same interventions for clients because psychotherapy is not similar to prescribing medicines. Psychotherapy can be a remedial and preventive venture at the same time as it underpins the growth processes directly linked to human development.

Two key factors make psychotherapy a little intricate: one – the complexity of therapeutic process and training required to administer it; two – the involvement, engagement, and willingness of the client to actively pursuing the goal of altering outcomes of past learning.

Pakistan had no proper training centre for students of psychotherapy until 1984. That year two centres for clinical psychology were inaugurated, one was attached to Karachi University and the second with Punjab University, Lahore. After having some experience of working and collaborating with well-reputed training institutions of clinical psychology in the Western world, we can confidently say that the academic programmes established at these two centres were undoubtedly up to the mark. The exposure to the wide variety of subjects, a holistic model of education, involvement of professionals from across the disciplines, and heavy investment in supervised training of students was par excellence.

The graduates of these two institutions, however, could not make their presence known in the society like the psychiatrists. Firstly, this was due to the prevalence of and the faith in the medical model of treatment. There was no concept of healing without any form of medicine. Secondly, the models of psychotherapy these graduates were trained with were all Western and had nothing to do with local norms, cultures and population. Resultantly, a majority of these clinical psychologists were unable to market themselves self-reliantly. They had to work either at public sector hospitals or the private clinics of some psychiatrists.

In both ways, they were dependent on referrals from psychiatrists. In the first decade of this century, a mushroom growth of centres for clinical psychology has been witnessed at both public and private sector universities. A good number of new graduates are out in the market and striving to create their market. The biggest hurdle they encounter is their lack of skills in producing the desired therapeutic results. It is essential for their success to provide relief to their clients and to market them and their profession. Despite the established fact that psychotherapy provides a better remedy in many disorders than medicine, the mental health sector in Pakistan is still relying on psychiatrists and pharmacological interventions. The main factor behind this over-reliance on medicines is the dearth of properly trained psychotherapists in our cities and towns. This situation is neither helpful for psychotherapy nor for psychotherapists, as it jeopardises the credence of both.

The psychotherapists in Pakistan need to keep the society and people in view to evolve an indigenous model of psychotherapy. Mental health issues generally start manifesting in physical symptoms (like bodily pains, insomnia and psychosomatics) in Pakistani population. Pakistani clients may not be good at doing therapeutic assignments as they are recommended in psychotherapies developed for the Western population. The psychotherapists in Pakistan may not be given the amount of time suggested in their training manuals. A psychotherapist in Pakistan will have to do two things at one time; first, market psychotherapy as a treatment of choice in many instances and second, to prove this point by producing the promised results. The needs of a client in Pakistan are less likely to be addressed by models of psychotherapy developed elsewhere. Teachers, researchers and practitioners of psychotherapy need to work on indigenous models. They have to self-regulate their professional bodies to control malpractice strongly and effectively. Pakistan Association of Clinical Psychologists (PACP) will have to handle a massive task to monitor the training of psychotherapy. The centres working without required faculty need to close down. Most importantly no one should be practicing psychotherapy without a licence. Legislation has been passed in this regard but, like many other laws of the land, it is not being executed.

Both writers are principal     clinical psychologists at   Brothers of   Charity Services in   Clonmel, South Tipperary, Ireland