Psychosocial Counseling in Nepal

A Term Paper Submitted for the Partial Fulfillment

as the Requirement of Post Graduate
In
Psychological Counseling
Paper IV
Counseling Psychology

Tribhuvan University
Tri-Chandra Multiple Campus
Department of Philosophy and Psychology
PGDPC, Program

Submitted By:
Dristy Gurung
Roll No. : 13
Symbol No. : ____
2009
List of Abbreviations

CMC Center for Mental health and Counseling

CPSSC Counseling Psychology and Social Studies College

CPN-M Communist Party of Nepal- Maoist

CVICT Center for VICtims of Torture

PPR Nepal Forum for Protection of People’s Rights Nepal

TOT Training Of Trainers

TPO-Nepal Transcultural Psychosocial Organization-Nepal

Introduction

Nepal has suffered immensely economically, structurally and socially during the

decade long armed conflict between security forces of Government of Nepal and the

Communist Party of Nepal- Maoist (CPN-M). Many lost their lives and many more were

displaced. Many civilians were subjected to various forms of violence such as physical abuse,

torture and rape from both sides. This has resulted in various forms of psychosocial and

mental health problems in the Nepalese community (Jordans et al, 2007). It is recognized,

that many mental health and psychosocial problems exist in Nepal especially among affected

populations (e.g. torture survivors, refugees, trafficked girls and women), and that typically

adequate assistance is not available (Jordans et al, 2003). There is an immense need of

psychosocial and mental health care to deal with these rising problems and psychosocial

counseling is one of the major components of that care.

Worldwide, more and more attention is being given to the psychosocial component of

development in the conflict affected and developing countries, which is proven by the

number of recent publication of books and articles on the particular approach (Jordans et al,

2002). This shows that psychosocial approach has gained popularity and is very effective in

today’s development module. In Nepal, the psychosocial component was integrated in mental

health component through Training of Trainers (TOT) in psychosocial counseling for mental

health workers in 1991 to provide psychosocial counseling to torture victims. Later, the short

term TOT was modified to 5 months long term training as the TOT mostly provided by

visiting expatriate having minimal knowledge on cultural issues was deemed ineffective.

From this a structure of psychosocial counseling was developed that was "new" but that was

culturally feasible. (Tol et al, 2005). Today, various organizations have incorporated the

psychosocial component in its development module where psychosocial counseling is an

integral part.
 The term psychosocial is used to emphasize the close connection between

psychological aspects of our experience (our thoughts, beliefs, desires, emotions, and

behavior) and our wider social experience (our relationships, family, peers, school,

community, social norms and values, traditions and culture). Psychological symptoms arise

because of social events or processes. Therefore, social events can be causes of psychosocial

problems whereas psychological symptoms or processes are the manifestation of

psychosocial problems (Sapkota et al, 2007).

Counseling is a planned intervention between the client and counselors to assist the

client alter, improve, or resolve his/her present behavior, difficulty, or discomforts (Jordans et

al, 2001). In other words counseling helps the client to understand and work on social,

emotional or psychological problems, through a process of listening, expression, empathy and

support, aimed at functional improvements of the client’s social life, reducing problem

situations and/or the impact of problem situations. It is called psychosocial because it aims at

enabling the person with problems of psychological and social in nature. The word

psychosocial is put in front of counseling to focus on both individual aspects brought to

counseling as well as the social aspects, consisting of wider community connections, existing

healing resources, and culture and values (Tol et al, 2005) and because it qualifies to be

called as psychosocial counseling as it has been believed that interventions qualify as

psychosocial if they are primarily directed towards a functional improvement i.e. expanding

the individuals opportunities to live in the community and to participate in societal life. In

present context psychosocial interventions are important because of therapeutic alliance,

shared decision making and the inclusion of the subjective patient’s view in the therapeutic

process (Rossler and Haker, 2003). Psychosocial counseling has been found effective in

dealing with psychosocial problems (Tol, et al, 2005; Jordans et al, 2007).

Objective
 The major objective of this paper is to understand the concept and analyze the

situation of psychosocial counseling in Nepal.

Discussion and analysis

In Nepal, where community is laden with taboo related to mental illness and where

traditional and indigenous form of healing (such as dhami, jhankri, mata, baidhya etc) is more

popular than (almost non-existent) formal mental health system, introducing and integrating

psychosocial counseling that is borrowed from western concept is very challenging (Jordans

et al, 2002; Tol et al, 2005). The social and cultural influences upon an individual make

counseling complicated as a Nepali client relates differently to a counselor than a western

client. The way of relating to other people in Nepal is guided by social hierarchy, avoidance

of conflict, gender issues, notion of respect for elderly etc. Open expression of emotions is

not appropriate in Nepali culture and so most of the clients express their problems in a body-

centered (somatoform) way (Tol et al, 2005). Although, CVICT together with other

organizations working in the psychosocial field and practicing psychosocial counseling have

culturally adapted to the context of Nepal, the challenges of its acceptance by community as a

method of healing through “talking” and the misconception regarding counseling as a process

of giving advice is still prevalent (Jordans, 2007). Other than psychosocial counseling,

counseling as it is generally practiced in Nepal is of two types: a) advice oriented counseling

b) informative counseling (Jordans et al, 2002).

Advice oriented counseling as is practiced by many organizations in Nepal refer to a

process of giving advice on how to solve the person’s problem. In short, this form of

counseling aims at reducing the problem by providing direct solutions to alleviate the

distress. Here, the helper is mostly a well intended though uninformed (at least not for this

specific work) staff member and provides assistance from his/her perspective of what the
person needs. It has acquired the name of counseling, which is unlike the process that is

commonly understood by counseling. Informative counseling refers to a commonly found

interpretation of counseling that aims at providing information to people; at times this

includes the aim to persuade people with the information that is provided. In Nepal, this

concept is derived from the field of family planning that has used the word counseling for the

purpose of persuasion to use temporary and permanent methods of birth control (Jordans et

al, 2002). However, psychosocial counseling aims at enabling a person with problems, that

are psychological, social or emotional in nature, to express his/her emotions, thoughts and

difficulties in order to assist this person through emotional support and/or to find solutions,

all through a process of listening, empathy and clinical communication, and counseling skills

(including experiential techniques such as use of drawings, play, relaxation, diaries). This

type of counseling mostly works from the client’s perspective, as opposed to the (expert)

perspective of the helper. Giving advice is not practiced in psychosocial counseling as it may

make a client dependent. Also, psychosocial counseling needs to be differentiated from

psychotherapies and psychological interventions (specialized treatment) that can only be

carried out after having received the proper education for these (Tol et al, 2005).

Psychosocial counseling training and education

Training in psychosocial counseling began in CVICT in 1991 as a TOT. Later a 4-5 months

paraprofessional course and 1 year post graduate course in affiliation to Purvanchal

University was initiated in CVICT itself. Sahara Paramarsha Kendra too started providing a

short term course on psychosocial counseling as did Antarang whose training module was

prepared to adapt to the cultural, social and political milieu of Nepal. Today, together with

CVICT, TPO-Nepal (Transcultural Psychosocial Organization), PPR Nepal (Forum for

Protection of People’s Rights) and CPSSC (Counseling Psychology and Social Studies

College) are providing long term (4-6 months) training for paraprofessional psychosocial
counseling in Nepal (CVICT, ongoing study). There are various other organizations that

claim to provide trainings in psychosocial counseling which are however 5-10 days

unsupervised orientation programs. Nepal does not currently have a system of licensure and

certification for counselors, thus anyone doing a “social work” or having little knowledge on

counseling could refer to him/herself as a counselor. This raises questions about quality

control of good counseling and potential stigmatization of the efforts made by untrained

counselors (Kohrt, 2006).

Psychosocial counseling service

The non-governmental community in Nepal is responding rapidly to the psychosocial

needs related to conflict. Currently, quite a few of the trained counselors are working in

center based rehabilitation centers, mainly in Kathmandu and few in PNGOs and local NGOs

of other districts as well. Some of the major organizations working to address the

psychosocial needs and providing psychosocial counseling service currently are CVICT,

TPO-Nepal, CMC (Center for Mental health and Counseling), PPR-Nepal, CPSSC and

Sahara Paramarsha Kendra (CVICT, ongoing study). Although many other organizations in

Nepal conduct counseling, some of these interventions cannot be categorized under the term

psychosocial counseling (Jordans& Sharma, 2004).

Psychosocial counseling service starts with the complaints that a client bring into the

session, and is aimed at decreasing disability. The client is assisted in dealing with problems

himself/herself within a counseling process, or is sometimes referred to traditional healers or

other existing resources (formal or non formal), if the counselor feels that to be more

appropriate (Tol et al, 2005). Most of the clients, as mentioned in a research article (Jordans

et al, 2007), had psychosocial problems such as anxiety, aggression, fear, difficulties with

reintegration into society and family life and stigmatization, other family issues, loneliness,

trauma, suicidality, insomnia, domination by others, guilt, and inability to concentrate. The
clients received in average 4.8 sessions. Most of the clients who were interviewed had good

understanding of psychosocial problems and were satisfied with the service. Many of the

clients responded that counseling was effective and helped them solve their problems. This

demonstrates that psychosocial counseling in Nepali context too is feasible and helpful.

Situation of psychosocial counselors

There are approximately 200 (4-6 months trained) psychosocial counselors in Nepal,

many of whom are providing psychosocial counseling in various I/NGOs in Nepal. However,

there are many others who are working as managers, accountants, program officers, teachers

etc (CVICT, ongoing study).Those who do work as counselors have additional

responsibilities and duties in the organization such as accountants, program coordinator,

social mobilizer and mediator, maintaining logistics and other administrative works. Some

organizations are driven by donors, who want the service to benefit large number of people,

and hence have to take a certain number of clients hampering the quality of the service

provided. Similarly, the management, not truly understanding the concept of counseling,

wants immediate result and they do not provide the needed resources. Many of them feel

incompetent to be a counselor due to insufficient and lack of focused training, as well as due

to organizational difficulties and uncooperative clients (Jordans et al, 2007; CVICT, ongoing

study).

Conclusion

Integration of psychosocial counseling in the mental health care of Nepal, which is

mostly represented by medical-psychiatric model, and which receives very little attention

from government or community level, is an immense challenge. The cultural and social

influences of Nepalese community pose another obstacle in the path for its development.

There is lack of understanding and misconceptions regarding counseling as a helping

profession. Also, lack of establishment of minimum standard of training, guided monitoring

and supervision as well as lack of certification or licensure for counselors has raised

questions regarding the quality and effectiveness of the counseling service and counselors.

Counselors feel incompetent to provide counseling service and are working in areas other

than psychosocial counseling. However, counseling (although in a slow pace), is being

integrated within the service provision spectrum for the vulnerable groups. The understanding

of psychosocial counseling, its need and effectiveness is gradually being realized and is being

implemented in the development modules of many organizations and bodies. If awareness

regarding psychosocial issues and psychosocial counseling is provided together with

congenial environment for counselors and proper education and trainings, then psychosocial

counseling and psychosocial care will prove to be an effective intervention model in

Nepalese context.
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