Daily Archives: May 30, 2019

#AgeofAdolescence – In Conversation With Clinical Psychologist Sonali Gupta On The Growing Trend Of Therapy Amongst India’s Adolescents

Growing up an adolescent and being a parent to one has always been challenging. But with the changing world we live in, one cannot deny the multifold challenges that present themselves in a tech-driven world – cyberbullying, self-image, anxiety, peer pressure, amongst others. Parallelly, family structures are altering, communication gaps are increasing and parenting styles are evolving. In this constant state of flux, life becomes difficult to handle for most of us, especially young adults, adolescents and their parents. 

Over the years, the stigma and taboo attached to mental illnesses is reducing, discourse is increasing, pushing parents to seek help for their adolescents through therapy and counselling. 

Drawing on real-life stories from her clinical work with children and parents across the country, Sonali Gupta, Clinical psychologist and columnist for Mumbai Mirror, offers insights on the growth of therapy amongst India’s youth and adolescents in addressing looming mental health challenges they face. 

Q1. Tell us about your work as a cynical psychologist. Why do you believe there is a growing need for therapy in the lives of young adults/ adolescents today? 

A: I have been working for about 14 years now, of which I worked with the Tata Institute of Social Sciences (TISS) for about 9 years as a student counsellor. I have also worked with young adults, teenagers and with an NGO that worked with children of commercial sex workers. Today, I have moved to the private practice where I work with young adults, adolescents and children.

Today, there is a growing need for therapy amongst young people, far higher than it used to be, for a couple of reasons. One of the primary reasons is exposure, that is in context to technology and the access to information. Things happen at a much faster pace and people are more aware and connected. To add to this, there is also an interplay of issues of anxiety, peer pressure, bullying, self-image that have led to the rise of the need for therapy. While this need has always been there, in the last four to five years, there has been more conversation around it. When I started work, there wasn’t as much awareness on the need for therapy amongst different age groups, but in the Indian context today there are a greater number of people reaching out. 

Another reason for this growing need for therapy has been a culture shift. We all know that people have been suffering for generations, it’s part of being a human being. But with a change in our environments, be it the economy, role and influence of media, smart phones and social media, evolving parenting patterns amongst other things, problems are rising and so is the need to access therapy. 

To give you an example, the media has been talking about mental health issues which has led to increased awareness amongst the public. Movies such as Dear Zindagi may not portray therapy in the best way, but it still led people to think about therapy. The last 5-6 years have seen a surge in awareness levels on mental health issues and the need for intervention around it, due to its portrayal in mainstream media too. 

Adding to this is the change in family structures – especially in metros and cities. More people are living alone, family sizes are smaller, and issues like loneliness are far higher. Hence, there is a greater need for people to reach out to others for help. The narrative of a family is also changing quite dramatically. Many people are still wondering if they should get married and others are raising children as single parents. In the last 15-20 years, the number of working women has risen too. 

Therefore, one cannot deny the role of this culture shift and its effect on how children are raised, how they understand and comprehend these changes, how they adapt to the barrage of influences in the ever-changing environment…and that is why the coming together of all these factors has led to a growing need for therapy. 

Q2. How do you believe this trend was different maybe 10 years ago as compared to today? 

A: Trends today are quite distinct from how they used to be. Like I mentioned, children and adolescents had problems ever since we knew of their existence. But the changing ecosystem has also significantly affected how we raise our children today and how parents are able to cope with external influences on their children. 

Today, while the age gap between a parent and child might seem larger, parents are more aware of what their children are going through (not necessarily equipped to deal with it). In the Indian context today, the therapist now has greater acceptance. Parents do not attach as much of a stigma to taking their child to a therapist as they would’ve a few years ago. 

Honestly, for the longest time, adolescent issues were never addressed and parents didn’t know what to do. Today, there are newer kind of pressures while growing up, changing how adolescents behave, that parents are not equipped to handle. 

Teenagers are very conscious of their appearance, they have a heightened sense of awareness especially with the advent of social media, the selfie culture, countless apps, daily consumption of information make this generation very aware, thus, pushing parents to become more aware too. 

Q3. In your experience, what are the issues that come up most frequently amongst adolescents in India? 

A: The topmost is anxiety, followed by body weight issues which are constant across genders. Also, the inability to regulate moods where teenagers may not have control over what and how they are feeling. Peer pressure is yet another issue that comes up frequently when it comes to adolescents – from where to go on a holiday, how they look on social media, wanting acceptance in a group in school to the dilemma of whether to date or not date someone. 

Another issue specific to adolescents is the huge communication gap with their parents and family – from lack of understanding each other, academic pressure, space and privacy, dating rules. At times, parents demand too much from their children, put them into tons of classes and so there is a constant pressure to always perform. Even with the access to information and awareness, the number of children or parents that reach out is far less than what it should be. If there are supportive families, they reach out on their own. However, the primary concern of the parent is typically different from the underlying issue. Some of the more complex issues sometimes come out through a different context altogether. For instance, I was approached by a parent for a child facing peer pressure and being unable to perform at school. Through the therapy session it was gathered that the child was not fitting in and being accepted, and therefore addressing issues of self-image became imperative. Therefore, the underlying issue is often overlooked by parents at times.

As far as gender-specific issues between boys and girls are concerned, the number of girls who come to therapy are much higher than boys so it is hard to pin down the gender-specific issues or reasons for therapy. 

To understand adolescents from a bird’s eye view, the underlying issue is of low self-esteem, because many of them are unsure of who they are, who they want to be, pushing them to act in ways either to fit in, stand out or figure out themselves better through trial and error, lending itself to the chaos and confusions that go with being an adolescent.  

Q4. How do you believe therapy can act as a preventive tool for mental health amongst adolescents? Provide us with examples from your work. 

A: Preventive work is something I strongly believe in and have seen is healthier for the long-run, as it addresses issues at an early stage, that have the ability to go out of control. I have worked with clients (adolescents) before they go abroad to study, understanding how they can take care of themselves, deal with apprehensions of moving to another country and make a smooth transition. 

I often get adolescents who want to know how they can manage their temper better or cope with anxieties. There are adolescents who have come to me to understand how to sustain friendships or how to maintain healthy relationships too. 

For example, there was a 13-year-old girl who came to me as she was confused about what friendship means. Her primary issue was of knowing what sustains friendship and whether friendships last or not? All of this was making her anxious. There were also some adolescents who came to me because their parents felt they were over-using their phones and mobile apps. Another time, an adolescent came to me as she was affected when her best friend was harming himself. Self-harm and cutting are far more complicated and layered issues, therefore one can’t pin it down to a single underlying cause for the same. 

Therapy always works better when people come to us on their own, willingly. It could be a simple issue or sometimes a complicated issue of bullying that has led to further bullying. Sometimes, children who have been bullied become bullies. The attempt is to change the narrative in a way to prevent these things from happening, not only intervene when the worst crisis has hit them. It is important to equip the child with skills so that he is better aware of how to cope. Any preventive work in therapy helps to build resilience, and skills to assert themselves better (in the case of bullying) and learn to say no. 

For instance, a parent approached us because the child was being pushed into a corner by a friend. The friend kept asking the child for her laptop to copy her project. The adolescent was unable to say no in this situation. A lot of work during the therapy sessions was focused on how to set healthy boundaries and maintain them. By being able to do this in one situation, it becomes easier for the child to address this across circumstances in life as he or she grows older, before it snowballs into a massive problem. 

Another 15-year-old boy struggled to say no to his best friend who would eat his tiffin every day. So much so that the 15-year-old would remain hungry every day, till one day that he was giddy out of hunger. The other child who ate his tiffin did not mean ill. Here, the parents handled the situation delicately and went to the school counsellor and he suggested therapy for the child outside the school. They said that they cannot blame the other child and it was important that their child learn how to set his own boundaries, also because he was his best friend. As parents, they did not want to pass a judgement on the other child. I worked with the child for six months until he developed skills to become assertive. 

What is evident through years of practice is an attitude shift in parents and the community as a whole, which is a great start! Therefore, the merit of addressing a problem in its early stages, and using preventive tools for therapy for young people cannot be emphasised enough. 

Q5. How have attitudes of parents changed today towards mental health challenges faced by their children? What do you believe has brought about the shift? Also, how does one maintain confidentiality with details shared by adolescents? 

A: Today, parents hear stories of issues faced by other adolescent children – from academic pressure, suicides, panic attacks, bullying etc. It is by awareness created by the media, and fear that this could happen to their children too, that parents have come to accept and appreciate the role of therapists in their lives and the lives of their children. 

In the last few years, there has been a rise of children coming into therapy, before and after the exam results. At this time, they deal with anxiety issues. Parents have realised that in today’s time mental health is fragile, which makes them even more worried, pushing them to start the process of therapy earlier. Nowadays, schools too, organise talks and workshops where parents learn how to take care of their child’s mental health. Having said that, it is still the upper and middle class that bring their children for therapy, of which the number of children from the middle class who come for therapy is far lesser. Very few children from lower middle class have access to therapy. 

In all of our cases, we always maintain confidentiality. In the first session, itself, we draw the boundaries and explain to the child and the parent what we will and will not share. In extreme cases, when the adolescent has spoken of suicidal thoughts for example, we inform the parents, so that they are vigilant at home. There exists a fine line between what we should and should not share, and it becomes that much more difficult when parents are not respectful of these boundaries. 

Q6. With the advent of social media, how do you believe the dynamic of relationships has changed in the lives of young adults/ adolescents? 

A: I think with the advent of smartphones, there has been a greater pressure in the context of how adolescents perceive and portray themselves in the context of social media. It has also led to issues like cyberbullying. To add to this, there is an added anxiety and a constant pressure to look perfect all the time, say the right things, appear in a particular way, get more like and followers, which constantly consumes the minds of young people. 

As the author of the book The Big Disconnect mentions that for children today, their biggest competitor is the screen when it comes to parent’s attention. I personally feel it’s not just social media but also technology which is responsible for how parents and children react and respond to each other.

Q7. While an increase in the discourse around mental health is a positive welcome, how do you believe the labels associated with mental health that children/ adolescents carry to their adulthood affect them?

A: If children are raised in environments where sadness or feeling low is associated as a weakness, it makes it harder for them to seek help. Also, children who grow up in families where there was lack of emotional love and attention, might have normalized those narratives. If our anxiety and mood issues are seen as reflection of our inability and a problem, it would make it harder or almost impossible for children to seek help. To begin with, we as a society and parents need to work towards acknowledging and accepting that it’s okay to struggle with mental health issues.

Q8. In your experience, how important are childhood experiences in shaping one’s adult life? Please share an example. 

A: Childhood trauma has a deep and lasting impact in shaping one’s adult life. It can impact a child’s sense of trust towards others and how they perceive the world. Today, many clients who come to me as adults talk of anxiety saying that they have always struggled with it, but it was never addressed. When they reached out to their family members, they were told that “Ghabrahat hai, chali jayegi (This is fear, this will go away). As a result, sometimes people have reached out when they are having massive breakdowns as the anxiety has lingered for years and spiraled in to massive debilitating illness.

The childhood trauma whether it’s physical, sexual abuse or emotional neglect, living in households where there is violence, or a parent struggling with drug problem has a deep far reaching impact on a child’s life.

Q9. In the India context, there are not many adolescents who have access to therapy or counselling. Often, we hear/ read of children from lower socio-economic backgrounds, receiving no social protection from the Government, growing up in unstable families, being subject to severe abuse, violations and violence right through their childhoods, who often turn rebellious or grow into juveniles in conflict with the law. What are your thoughts, comments, insights on the state of juvenile justice in India, and what role do you believe therapy and counselling can play if made accessible to all children?  

 A: A lot of work I do with NGOs is with the underlying objective of reaching out to underprivileged children in rural areas and urban slums at a family, school, community level or within formal structures such as Aanganwadi, village or the Panchayat level. Here, we emphasise on making them understand what skills parenting may entail. Or, when it comes to directly work with adolescents, we engage with them in group therapy sessions, work on concerns that may be challenging for them such as low self-esteem, difficulty regulating moods, impulses via workshops or using creative outlets such as art or drama.

For troubled children, in particular, either with no family support or limited access to basic services, one needs to work with them on developing their core skills, resilience, helping them find social support through community initiatives and helping them manage their mood amongst other things. 

At the grassroot level, we need more mental health professionals and greater funds to execute some of the initiatives and being able to sustain these programs in the long run. 

While therapy and support services are far from being made available to all children, a lot more work is happening today that it was a few years ago. The ambition is to reach those children and people who need it the most. 

Q10. At a policy/ advocacy level where do you think India lags behind? What do you see as gaps in the mental healthcare space (specifically for young adults) and which direction do you believe the country should be headed?

A: In 2016, for the first time, the Mental Health Bill was discussed in great detail and thus there was a lot of discussion both at a policy and advocacy level. Even at the state level, we saw work happening. However, there is a lot of work that needs to be done to bring the larger issues of mental health at the forefront. 

There are about 5-8 helplines initiated by mental health advocates, government, NGOs and forums that can be accessed by anyone. 

Of course, there is a lot more work to be done so that mental health has greater accessibility and people can get timely help, without being stigmatized. But India is definitely making headway. 

Sonali has written features for The Swaddle about parenting and relationship issues. She also used to write a weekly advice column for DNA focusing on parenting and teenager concerns. She uses, television, podcasts, her writing and social media to promote mental health narratives.

To know more about Sonali Gupta’s work, you can read her weekly column for Mumbai Mirror titled ‘Terms of Engagement’ which focusses on love, intimacy and relationships, follow her on youtube channel – Mental Health with Sonali or follow her Instagram, twitter, youtube and her website.