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Family therapy

Parivar on the couch


Anushk Sinha was just four but often woke up from sleep troubled by horrific nightmares. At night, he couldn't sleep for fear that he would dream again and during the day nothing could hold his attention. His mother and stepfather, at their wits' end, took him to a family therapist.

Families usually loathe taking their internal conflicts to someone else, especially in India. But as Leo Tolstoy said in Anna Karenina, "Happy families are all alike;every unhappy family is unhappy in its own way". And urban India is waking up to the power of "talking it out" as a family to a complete stranger.

"The reason why family counselling is on the rise is simply because there are more of us today, " says Reena Nath, a Delhi-based family therapist. "People are becoming aware that there are problems that need group conversations. You might want to talk but you might not find someone equipped to hear you as a family. " Nath counsels all sorts of families - from couples to middle-aged people, from families with very young children to those who are parenting teenagers.
Clinical psychology doesn't really equip you for this, says Nath. A family therapist is trained specifically to observe interactions among family members and make interventions. The idea is that everyone has different personalities and they appear when contexts change;systemic family therapy concentrates on the context of relationship in which they operate.

"It's a good sign. There has been a shift-since I started in 2003. People are reaching out, sharing stories. Also there is less stigma attached to seeking therapy;they realise that it is not meant only for those who are deeply disturbed. People are recognising shifts in the family system and if they have a problem with this, they are looking for help. Indians are very relationship-centric and heavily dependent on family and this makes the context of relationships rather appealing. Family therapy really works here," says Meera Alva, a Bangalore-based psychologist and psychotherapist, who is specially trained in family therapy.

Couples with relationship issues seek out family therapists most often. Next in queue are parents. It took eighteen months of therapy for little Anushk's family to figure out that the child had not got over the loss of his father in infancy.

"The grandparents and parents came in, everyone talked. And the mother had real fears about how she was going to cope. But once she spoke openly to the child, the nightmares disappeared. It was a dramatic turnaround, " says Nath. Most therapists agree that in cases involving children the trigger usually doesn't lie in the patient's history but elsewhere - usually within the immediate family. Parents may not realise it but children observe them and their reactions to events very closely.

"There was the case of a 15-year-old who couldn't cope with his father's almost-fatal accident. His mother took up a job and the teenager simply could not deal with the uncertainty that these changes brought in his life. We started by acknowledging the tragedy and then moved on to how it would change family dynamics and the way they lived. For the child it was relief to know that he was not expected to take charge. The child should not be made the primary patient, " says Pooja Brar, a Delhi-based marriage and family therapist.

The modern nuclear Indian family is under a lot of stress. Divorce, re-marriage, working parents, rapidly changing moral codes - a whole lot of factors contribute to this. This is where family therapists come in and they believe that answers to the many problems lie within the family as well.

"There is still a lot more room for negotiation with the extended family with grandparents helping with childcare. Here it is considered natural for grandparents to come and help out in a family crisis. These are tighter living situations with a lot more sharing of resources, " says Brar.

This form of therapy is reaching the villages too but as voluntary work. Nath is training 22 health workers in rural Haryana, who will make mental health interventions in 220 villages with women's self-help groups. "They find there the same problems as the cities. Most conflicts are centred around the woman who comes into the family - the daughter-in-law. So they have to get the husband and in-laws into the therapy, " says Nath.

Family therapy is not cheap. It can cost anywhere between Rs 500 and Rs1, 000. "Access is improving but in general, it is still expensive. But the funny thing is, people have no qualms about blowing up Rs 200-300 on a pedicure when they are stressed but they will try to beat down the hourly rate for therapy. They wouldn't that with a doctor, would they?" asks Alva.

(Some names have been changed to protect privacy)

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