by Tooba Fatima

For our 1st issue under the theme: “Womxn’s mental health during quarantine and lockdown”, we interviewed Tooba Fatima.
Tooba is a therapist based in Lahore. She has over 1000 clinical hours and is a Fulbright Scholar, with a Master’s in Counselling Psychology from Boston College. Tooba works with young adults and adults working through trauma, mood disorders, anxiety, and relational issues.

In the first part of the article, She goes into detail about what she believes therapy is, what it isn’t, responsibilities of a therapist when to go to therapy, etc.

In the second part, she answers some questions sent in by our audience.

PART 1

When I was training to become a therapist, my supervisor described it like this: Your client walks through a forest where they have lived their entire lives. You as the therapist get dropped down from a helicopter at a certain point in their journey. You cannot walk behind them, because they would keep walking the same circles. You cannot lead them, because it is their forest and they know it best. But you can walk alongside them—using your knowledge, skills, and an empathic ear. So, a therapist is not so much an expert on your experience as a trained companion on an inward journey.

I currently work as a therapist in Lahore, largely with young adults and adults who are navigating trauma, anxiety, mood disorders, and relational issues. My training is in psychodynamic and feminist therapy.

Feminist therapy, as I understand and practice it, recognizes that the personal is political. It finds intersections among personal distress, systemic factors, and activism. So, when I sit with a male client who is struggling to be vulnerable in their relationships, their personal distress is not separate from gendered messages about masculinity. When I sit with a client with a history of complex trauma, their distress is entwined with systems like poverty or gender identity.

From this lens, healing is an act of activism. Internal activism—as we identify and unlearn harmful messages about ourselves that we have internalized from patriarchal, classist, racist, and hyper-capitalistic systems that surround us. And activism in the world—harmful systems that create trauma and suffering must be challenged and reimagined. Neither the therapist nor the client can be politically neutral. When we recognize that systemic injustice creates suffering, we cease to see clients as “dysfunctional” or “malfunctioning” individuals.

Therapy is a growing field in Pakistan, mostly accessible to middle/upper-middle class residents of major cities. While we continue the work of making quality mental health care accessible across geographies, social classes, and languages, I hope this article offers you a helpful understanding of the process.

What is therapy?

Therapy is a space for people to address their mental health. It can be used for self-reflection, noticing one’s own patterns of thinking or behavior, and building healthier relationships with the self and others. Therapists can also share tools and skills for specific mental health concerns like anxiety, low mood, or negative thoughts.

Therapy is private and confidential—it is your therapists’ responsibility to protect your name, identifying information, and what you discuss with them. Therapy is more process-oriented than outcome-oriented. It is a non-judgemental, deeply validating, and deeply challenging space—inviting us to discover our whole, authentic selves.

What is not therapy?

Therapy is not advice-giving. Your therapist cannot give you “the answer”, “the solution”, or what is “right/wrong”. However, they can help you better understand your own feelings, perspectives, and priorities.

Therapy is not “just talking”. Whether the session looks structured, fluid, or somewhere in between, good therapists draw on knowledge of human behavior, clinical experience, and evidence-based treatments in their work.

Although they work from a place of genuine care and compassion, your therapist is not your friend or like a friend.

Therapy cannot “fix” or “cure” you; in fact, therapy does not see you as broken. It can, however, give you space and tools to better understand yourself and make informed choices.

Who is a therapist?

The terms therapist, psychotherapist, and mental health counselor are used interchangeably. Therapists are professionals who are trained to diagnose and rehabilitate mental health conditions. Most therapists have a background in psychology—the study of human behavior. However, not all psychologists are therapists!

At a minimum, a therapist should have a master’s degree in clinical or counseling psychology from an accredited institution. Alternatively, therapists may have completed a certification or diploma in counseling or psychotherapy from an accredited training program. I recommend that you ask your potential therapist about their education, training, and the kind of therapy they practice.

Important: Psychiatrists are medical doctors who have specialized in mental health. Psychiatrists can prescribe medication; psychologists can never prescribe or suggest changes to medication.

Who can go to therapy?

Anyone who would like to address their mental, emotional and relational health can seek therapy. There is no specific reason, ailment, or minimum bar of suffering to see a therapist.

Different people use therapy differently. For some, it is a place of self-reflection and self-care. Some people want to work on their relationships. Others still might be struggling with stress, anxiety, anger, or depressive feelings. It can be helpful to seek therapy around stressful events in the present or past—illness, grief, loss, or trauma for example.

Therapy is recommended for people who are adjusting to serious mental health conditions such as schizophrenia, bipolar disorders, severe depression, or complex trauma.

P.S.: I go to therapy! It has helped me practice good self-care, set good boundaries, build healthier relationships, and grow as a person. It keeps me connected to my happiest and saddest emotions.

How do I find a therapist?

There are two parts: the logistics and the ‘fit’.

You can find therapists by referral—for example, a friend, colleague, your workplace, a psychiatrist or doctor, or another therapist might share contact information for therapists. Counseling.pk has a list of screened, qualified therapists working in major cities and online. Organizations like Mind Professionals and Therapy Works employ a number of therapists they can connect you with. You can text a few therapists to ask if they have space, if they have referrals, or if they can add you to a waiting list. Most therapists do have waiting lists, and my recommendation is that you add yourselves to a few. Different therapists charge differently based on qualifications and experience, but many use a sliding scale and are willing to adjust the cost.

The second part is the fit—is this therapist is the therapist for you? You might have preferences about age, gender, qualifications, or what kind of therapy they practice. You will also have a feel for what kind of person they are, and if you would feel comfortable working for them. Therapy is above all a human relationship, and I encourage you to find the one that feels right for you.

Part 2

As I said in the article, therapists are not advice-givers. My responses to the questions below are reflections, guided by what I know about human behavior and mental health, but are not solutions per se.

How should womxn in quarantine deal with anxiety and emotional disturbance that comes with it? Especially since the pressures they experience have increased during this time?

The lockdown is certainly an example of how larger systems like gender-roles disproportionately disadvantage and burden womxn. There are reports from across the world of increasing domestic and gender-based violence, as finances for shelters decreases. Even without the pandemic, womxn are under-paid by the economy while often performing an unpaid double-shift of domestic labor, child-rearing, and caring for the family. Having a home, family, and office in the same vicinity has not helped, making boundary-setting difficult.

It can be helpful to take time out for yourself and practice healthy boundaries. You could sit with your family and negotiate a more egalitarian redistribution of chores so that the burden of work, studies, and housekeeping is not unevenly divided.
When you, your work/studies, your family, and the house exist in the same space, you might find yourself multi-tasking. Instead, I encourage you to set a dedicated time to focus on work, on your relationships, and on yourself.

If there is an active threat of violence, I recommend prioritizing your physical, emotional, and psychological safety by picking your battles. There are hotlines, shelter, and legal aid you may be able to access as well.

I am mindful of not suggesting too many ways of adapting to a bad situation because it is important to recognize that the situation is bad. Ultimately, the work is to challenge the status quo in our personal lives and as a community.

How should one deal with negative thoughts and negative emotions, such as hopelessness, during a lockdown?

All emotions are healthy, even the ones that feel bad. We can be tempted to push away or avoid negative feelings. However, the more we suppress them, the more dysfunctional the ways in which they eventually manifest. I encourage you to process and feel your feelings rather than wrestling with them. Sadness, fear, and loneliness are normal emotions in these times. Think of what helps you be with your feelings? Does it help to write? Draw? Dance? Talk? Be with yourself?

There is real starvation for human touch and human contact and in some ways, there is truly no substitute for physical presence. However, the reach and ease of technology create an opportunity to connect. Try making dedicated calls—i.e. when you call someone, focus only on the conversation (rather than talking to someone while doing other things). Be creative—plan for movie nights or online meals together.

A great way to shift negative or heavy feelings is through movement. As simple as stretching or walking, or as dynamic as dancing or exercise. Mindfulness and meditation can help ease racing, distressing thoughts by grounding us in the present moment, and calming the body. And finally, setting a routine and bringing some flexible structure to your day can help.

As an ally, how should men deal with the emotional pressure that comes with unlearning such behaviors and the responsibility of being part of the problem?

The patriarchy might be beneficial to men, but it is not good for them. It is not good for men to be disconnected from their feelings, to be shamed for vulnerability or emotional expression, and to commit or be exposed to aggression and violence as something “normal”. While womxn certainly face the brunt of the harm, patriarchy also oppresses men by assigning rigid gender roles and pressuring men to disconnect from their own emotions. So, the work of unlearning the patriarchy is felt as liberating and useful for men as it does for women.

While unlearning is certainly difficult, it is important to remember that our privilege inevitably offers us more protection, and can never be equal to the real damage it causes to those who are oppressed. For example, I as a cisgender woman have educated myself and made mistakes as I work with trans/non-binary clients. However, in every day, I navigate work, home, school, offices, and public spaces with more safety.

So, when we carry privilege (and we all carry different kinds of privilege), it is about learning to contain our distress, continuing to unlearn, and using our privilege in useful ways. And sometimes the most useful thing we can do is not make it about us!

 

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