The psychotherapy we need

It is time to contemplate the future and likely development of psychotherapy in Pakistan

The psychotherapy we need


n 2017, Irbil became a haven for those fleeing from the Islamic State of Iraq and Syria (ISIS). The town is located 80 kilometres away from Mosul, the epicentre of atrocities committed by some of history’s cruellest men. This girl with medium height and frail body was only fourteen. She had been raped multiple times. Her eyes were too lifeless for anyone to gaze into them. She had a habit of staring blankly at everyone she encountered. At a camp set up by a non-governmental organisation, I was asked to see her. Her droopy eyelids, lethargy, and unyielding numbness pointed to her being on high doses of psychotropic medicine. She had been missing for months after being kidnapped. She was found after the monsters fled the region. After a year of medication, her condition had not improved. No therapist had been able to work with her since she would not talk. Mental imagery-based psychotherapy was employed by an under supervision lay therapist to help her. The intervention had been modified in light of her condition, situation, experiences and the resources available at the camp. This got her talking, revitalised and gradually returned her to life. Only a highly individualised form of psychotherapy could elicit this kind of response. The need for such therapeutic structures is rising in the world as social conditions change.

Like other scientific disciplines, psychotherapy has its guiding principles and established procedures. Psychological and psychotherapeutic approaches differ greatly from those of conventional medical practice. Therefore, it is inappropriate to use research procedures created to evaluate the efficacy of medication to appraise the outcomes of psychotherapy. Like any other branch of science, psychology and psychotherapy have evolved. The time has come to contemplate the future of psychotherapy in Pakistan and its likely development.

Until around 30 years ago, it was generally accepted that a psychotherapist’s ability to help people in various cultures was the same regardless of where they were trained. Post-modern trends in psychotherapy have challenged this way of thinking. That is the reason why the value of indigenous therapeutic methods is currently the subject of much discussion. I am not talking about models that have been “culturally adapted,” in which the only real variation is the label than anything else; as theoretical foundation remains the same and only some superficial changes have been made in the mechanics.

The most important thing to keep in mind is why it is preferable to promote culturally produced (rather than adopted) models. The explanation is clear and uncomplicated. Large-scale social shifts and challenges are being felt on every continent. Socioeconomic issues peaked after World War II. The current wave of immigration is the largest in human history. Most people who go abroad do so in pursuit of safer or better living conditions. There are many people in the Third World who still live in their own countries despite the fact that things like war, terrorism, massacres, genocide, economic collapse and political upheaval constantly threaten them. They include people from many different backgrounds and with many different experiences and traumas. Those who advocate a “one-size-fits-all” approach are, thankfully, becoming a minority. Psychotherapy models that put the therapy seeker’s unique experiences first are gaining ground. Tailor-made therapies, as opposed to prescribed and manualised ones, where each intervention is set and decided in advance, are required for such an undertaking. With the reintegration of therapy into people’s experiences, philosophy is likely to return to the fields of psychology and psychotherapy. Human trauma is hoped to be studied more thoroughly than standard procedures.

The severity of trauma increases as the aforementioned socio-political situations worsen. Hence the widespread use of trauma therapy. Various iterations are available, each with its own set of selling points. However, it is a major step forward for psychotherapy to incorporate bodily experience. Academics and instructors believe that beyond Freud’s period, the body has never been the primary focus of treatment. My mentor, Dr Akhter Ahsan, was the first to incorporate body into his therapeutic approach. He did this long before health psychology established itself in the 1970s. His theoretical and therapeutic approach allowed him to address many psychosomatic problems. He showed empirically how trauma is recorded and stored in body. It’s become trendy recently to look for signs of trauma on the body. Neurological evidence has lent credence to the idea.

A therapist needs to step out of the clinic if they want to learn about the patients’ social, political and economic environments. A therapist can’t afford to shut off real-world events. To comprehend how these occurrences can manifest in the symptoms of a presenting disorder, the therapist needs to employ professional mechanisms, as opposed to personal or biased ones. A comprehensive understanding of these characteristics should determine the course and form of a unique therapeutic intervention suitable for a certain civilisation, country or culture.

In my perspective, these are the two most pressing and timely concerns in the field of psychotherapy today. The integration of technology into psychotherapy is another development I have noticed. There is scant evidence that technological interventions have been applied in process-based therapies so far. So, it is a little early to see how therapy may be administered through digital technologies.

The writer is a clinical psychologist. He can be contacted at

The psychotherapy we need