I Have Been in Psychotherapy for 8 Years. This Is What I Learnt.

As someone who has gone through psychotherapy and counselling for the past 8 years, working through depression, anxiety and trauma, I can attest mental health is an urgent, yet difficult and highly nuanced conversation for our society today. I’m thrilled to see people are more willing to talk, unlearn and seek support now than they were when I had to lie and secretly visit my first therapist in Dhaka many years ago.

In learning to work through mental health issues of your own and those of someone you care about, it’s helpful to understand a few tenets of reality. I am not trying to preach because I am not an expert. These are lessons from my own experiences that I hope can inform other people’s expectations.

[1] It is critical to acknowledge mental health and mental illnesses on par with physical health. Mental health is a public health issue. If someone comes to you saying they have sharp, biting chest pain, you don’t always recommend গ্যাসের ঔষধ। At times, you wonder if it’s a heart attack and help find a specialist. Mental health is not as widely researched as many physical diseases and some mental illnesses are. If you want to take mental health seriously, you should appreciate chronic মন খারাপ and অনেক জ্বর in somewhat similar, yet unique ways.

[2] Mental and emotional wellbeing have levels. The “I am here if you want to talk” approach works in very early stages or levels, and can encourage in building trust — only if you genuinely take the time to listen. If the issues are more complex, it’s very very important to learn to back off and find a professional. People spend at least 4-6 years in school to get medical degrees on psychiatry or psychology. Mental health counsellors spend 2-3 years in school and training. A small misstep or well-intended but out-of-line reaction can literally be suicidal. Therefore, let the experts do (and keep) their jobs.

[3] Our impression of therapy is largely influenced by White Hollywood. You have a picture of perfection in your mind: nice, ironed cushions, well-lit room, an extremely insightful, witty therapist and no personal inhibition in sharing your deep, dark stories. Unfortunately, in real life, finding a therapist or psychologist that works for you is REALLY, REALLY difficult. I went to 13 different therapists before I found “the one”. And I’m still not sure if she is “the one”. I have met therapists in not-so-nice neighborhoods or at very poorly-lit offices. I felt it’s MY fault that I did not “like” my therapist immediately or that I was struggling to open up. This is normal. Don’t let yourself or others make you believe you’re the problem. You’re not.

[4] In Dhakaite elite circles, there is a prevalent belief that White “bideshi” therapists “understand” problems better. This is objectively inaccurate. Your therapist is YOUR therapist, which means your preferences are influenced by your own biases, upbringing, politics and environment. I personally did not find my White and/or male therapists effective or relatable. They were unable to grasp the nuances of my experiences — both in the US and Bangladesh. I did not have the patience to break down structural racism, sexism and colonialism to them. I desperately searched for a woman of color, someone who “just gets it”. And I can attest how exhausting the search was. The field, like most others, is dominated by White people and culture. This being said, again, your therapist is YOUR therapist. It is a micro-targeted, highly subjective fit — and it is institutional responsibility to ensure you have options across the board.

[5] Speaking of, therapy is very expensive. While all the talk about mental health is good, if you’re a minority or historically disenfranchised because of your race, gender, sexuality, religion, nationality, caste and/or socioeconomic status, there is a very high likelihood you cannot afford professional support. I went to therapists in Dhaka who charge 4000-10,000 taka/hour (that I could not afford at the time as a social entrepreneur). I’ve briefly met therapists in San Francisco, New Orleans, Washington, DC and Seattle who charge $80-150/hour. The ONLY WAY I could afford this is when my employer or health insurance provider subsidised mental health packages. It is not your personal failure. If your boss or organisation is talking about mental health, and if you’re a strong advocate, tell them to put their money where their mouth is.

[6] My dog is an emotional support animal. After anti-depressants, meditation, healthy eating and failing at picking up a new hobby, my therapist in Seattle recommended I adopt a pet. I adopted Stark a while back, before I had come to terms with my own mental health, and so, I felt enormously guilty about adopting another pet. I went to Paws Animal Shelter in Lynnwood and fell immediately in love with Stella. She is moody, introverted and has her own trauma from being abandoned in the streets — so we helped each other. Having Stella in my life, especially because I was living alone, and her unconditional love completely turned things around for me. Taking care of her has made me more grounded, more thoughtful and more open. As a registered emotional support animal (ESA), Stella and I are legally inseparable in multiple countries. ESAs are not always recommended nor does it help everyone, but I can personally vouch that my furry friends are truly my best friends, confidantes and earnest-est listeners.

[7] Unlike what pop culture tells you, no one goes to therapy and immediately spills their beans. If your therapist starts with “tell me more about your problem”, chances are they are seeing therapy as a solution rather than a process. You can’t cure a mental health challenge the same way you can’t cure diabetes. You can manage it, find effective tools to counter the worst of it, and so on. Sometimes, you get really lucky and are able to manage it faster than others can. Psychotherapy, for example, is a long, long process. I’ve been at it for EIGHT YEARS and I am still a work-in-progress. In my first 4 sessions, my (current) therapist and I talked mostly about my day.

[8] There is reason to be cautious of our expectations around platforms, apps and artificial intelligence to treat mental health. I love the fact there are many platforms to discuss and help with mental health in the world and in Bangladesh today. I deeply appreciate that there are now free or low-cost apps and hotlines that allow people, who otherwise cannot afford a therapist, to seek mental health counselling. They are a fantastic first step in educating yourself. There is, however, a thick line between professional counselling and preaching (commercial) self care. Besides the fact that self care is itself work and correlated with wealth, it is only as effective as running is in reducing the risk of heart diseases. If you already have a hole in your heart, it is not all that fab anymore. Therefore, if you feel perpetually discouraged, get off that app and try getting (or help someone to get) a face-to-face session with a psychologist.

[9] The reckoning that you need help is a long, arduous journey — both personally and as a community. I was in denial of my own mental health issues for years despite being educated and surrounded by thoughtful, well-meaning people. It was not until I was pregnant and began to be more conscious of specific behaviors that I felt I needed expert second opinions on. In Bangladesh, where people are routinely denied basic medical treatment, mental health care is perceived as a luxury (it is not). The institutional lacking is compounded by norms: talking about depression, anxiety or stress is still considered a taboo. We also harbor a harmful, competitive culture where mental health is narrowly defined as an elitist problem (“কত গরীব মানুষ না খেয়ে আছে!” / “এসব মন খারাপ অলস মস্তিকে তৈরি হয়।”). Don’t allow yourself or others to let you believe your problems are trivial. They are not.

[10] We have a long way to go in understanding confidentiality and accountability. We also should not literally allow everyone to share their advice on coping with mental health. I remember a video that was released a few years ago that recommended people struggling with depression should get into a hobby to “deal with it”. I cringed. I have been invited to numerous seminars and webinars to discuss “my trauma.” I was unprepared at the time and turned them down. There are many strong mental health advocates who are public about their journeys while there are others who have confided to specialists and friends. As a counsellor or service provider, it’s extremely important to educate yourself on the humanitarian and legal components of mental health counselling. As a friend, it’s important to know that someone has entrusted you with their stories and it is only their stories to share — not yours to amplify.

In 2018, Bangladesh signed the new Mental Health Act that provides safeguards against negligence in treatment and forced cooperation, and institutionalised support for longer term mental illness patients. I’m thrilled that there are experts, some of whom are my friends, working tirelessly to update the bill to ensure it’s more inclusive, robust and comprehensive. This is a journey that requires tremendous patience, non-judgemental and learning. And it requires a community to come together. The first step is to acknowledge mental health is not a personal issue that can be swept under the rug — rather a collective reckoning that can be reflected through policies, programs, culture and social networks.