Writings

Rethinking Psychotherapy

I am rethinking psychotherapy. Not only am I rethinking it, I am re-applying it. In the words of modern era of technology, I am hacking psychotherapy.

First of all, when I use the term “hacking”, I do not mean to imply shortcuts or unethical and unprofessional practice of psychotherapy. These days, the term “hacking” has become synonymous with cutting out parts to capitalize on what is being hacked, such as “sleep hack”, “diet hacks” and even “study hack”. This is not the kind of hacking I am considering. I hold very strongly to my values in ethics and responsibility in all my work, regardless of what I do. With that clearly explained, I will describe the sort of hacking of psychotherapy I am considering.

So, what is psychotherapy hack and how do you hack psychotherapy? Simple answer to a complex model is that you simply broaden and contextualize it.

There have been many current attempts and models out there, such as reflect and talkspace . There are self-help mobile apps such as headspace and PTSD Coach. Other than reflect therapist matching service, I have not used any of these other products and cannot attest to their efficacy. I have had a client who found headspace through own initiative and used it, and so I had a second person perspective of how it worked for my particular client. PTSD Coach had claimed some amount of research on effectiveness and had been created by the National Center for PTSD, so there could be some credibility to its program. I provide online counseling, and you can even make an assertion that tele-mental health or online psychotherapy is one new model of psychotherapy. I also have provided short-term counseling through Employee Assistance Programs, which is another model to deliver mental health services in a more accessible way using a medium (workplaces/employer) where many spend most of their waking hours at.

Though there have been new modes of delivery of psychotherapy, they still base their models in the traditional concept of psychotherapy, which is often one-on-one or therapist-client sessions that are focused on individual problems, and diagnosing mental health problems as individual problems. My training in the family systems theories and my cross-cultural experiences inform me broaden this perspective. Instead of the psychotherapist as the facilitator of behavioral change, the hack is recreate the psychotherapist as an agent for empowerment so that health can be regained.

What I propose sound the same as the previous models, but it is really not the same.

Even a family therapist that works through the systemic model acts as a facilitator of behavioral change, as an expert that comes into the system to manipulate change through building rapport, therapeutic alliance, and empathy. An agent of empowerment works differently through creating an environment that is equipped to effect change by returning the person(s) to healthy homeostasis. The psychotherapist often stays in the background in this model. However, it is in this background, or backdrop, where the nurturing and nourishing elements are held at constant and made available whenever called for by the person(s) in the space. In this model, the person(s) to be effected (often are those whom we refer to as patients and clients in traditional model of psychotherapy) take reign of the playing field. They are the authors and creators of their worlds to be transformed, and at times, to be re-invented.

Although the psychotherapist as the agent of empowerment, as the backdrop, may appear passive, he or she plays a very active role. But this active role is not center-stage. It is not the “go to” position between client and therapist. The psychotherapist’s presence and involvement is more subtle but highly crucial.

Using such a model opens up psychotherapy to various contexts and definitions. For example, psycho-educational workshops provided for both health professionals and laypersons can be considered a form of psychotherapy because community education creates a learning environment that will equip and empower the communities with not only content knowledge but also the network of resources made available to them. In this sense, psycho-education becomes therapeutic. Yes, the expert of the instructor or presenter may be there at the workshops, but it is just as an avenue to allow for the knowledge and skills to be passed onto the people. It will be the people who will use the newfound knowledge and skills to effect their own change, based on the combination of courses they have taken and the new network of resources they have connected to with their classmates. How many of us have taken psychology courses to better understand ourselves or our family and friends a little better and perhaps to even help equip us to interact them?

Another example is creating a network system. In this manner, the field of social work and activism is highly involved. However, it moves beyond coordinated wraparound services as a mental health care model, and includes creating a network of stakeholders and providers that plans, develops and advocates, for lack of a better word, the field of psycho-social care, for the people’s and communities’ wellness. The parties involved in this network of care are all psychotherapists in their own rights as they participate in creating the larger cultural and systemic contexts for how and what standard of care can be made available for the people. It is therapeutic because it heals systems and communities, and systems and communities are made out of people. The stakeholders in this network will mold and shape to the needs, cultural contexts and relevance of the communities and target groups of people. They will draw on the current models that are already working, fill in where there are gaps, and intervene where there are areas to be attended to. I see this in Myanmar.

In past 3 years, I have been returning to Myanmar on a regular basis to contribute what I can to the development of the country that is recently democratized after 60 years of dictatorship. This past year, I became involved with a very active group of providers who are developing the psycho-social support services in Myanmar. There is the Mental Health Psychosocial Support (MHPSS) working group that meets monthly and they hold the space of network of care that I have mentioned in the above example. Through one  of the co-chair’s agency, a Facebook group called “Myanmar Mental Health Network” was created, as well as a Viber group (which was created by participants after the workshops and conference I organized and presented at), both of which have been active in sharing information, and also building support connections, so that the professionals can better provide services to their clients/patients or help empower their communities. The stakeholders are not just psychologists (for which there are very few, of about at most 10 in the whole country of 52 million) and psychiatrists (there are only 200 in the whole country), but also primary care physicians who are the first point of contact for those patients who are suffering from mental health and family problems, youth workers, social workers, development workers, and teachers. Through this network, psycho-social change in the communities can be effected on many levels.

Psychotherapy can be hacked to accommodate for the lack of resources (especially for countries where there are insufficient number of mental health professionals), the cultural barriers (such as taboos, stigma, and unfamiliarity with a western concept of psychotherapy and psychology theories), scale of change needed (such as a country that had been oppressed for over half a century and there is high rate of trauma that manifest in many varied forms), and lack of funding.

Hacking in this concept means innovative way to approach a known entity, and in a way that is disruptive from the status quo, but also a way that can be applicable to make the most out of what is given.

I like to hack psychotherapy by taking beyond the therapy room, into the realities of the worlds we live in. For after all, isn’t the point of psychotherapy is to effect change in the lives of those who can benefit from it?

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