Helping Beyond the 50-Minute Hour

Therapists Involved in Meaningful Social Action

Jeffrey A. Kottler, Matt Englar-Carlson, Jon Carlson, Jeffrey A. Kottler, Matt Englar-Carlson, Jon Carlson

• Publisher: Routledge
• Year: 2013
• Topic: Psychology
• eBook ISBN:
  9781136659959
• Subtopic: Mental Health in Psychology
• Index: Psychology

"Slacktivism" is a term that has been coined to cynically describe the token efforts that people devote to some cause, without long-term or meaningful impact. We wear colored wristbands, pins, or ribbons proclaiming support for a particular organization. We might post something on social network sites or send messages to friends about causes dear to our hearts. We might even volunteer our time to work on behalf of marginalized, oppressed, or neglected groups—or donate money to a charity. Yet the key feature of significant social action is follow through—continuing efforts over a period of time so as to build meaningful relationships, provide adequate support, and conduct evaluations to measure results and make needed adjustments that make programs even more responsive.

This book is intended as an inspiration for practicing psychotherapists and counselors, as well as students, to become actively involved in a meaningful effort. The authors have searched far and wide to identify practitioners representing different disciplines, helping professions, geographic regions, and social action projects, all of whom have been involved in social justice efforts for some time, whether in their own communities or in far-flung regions of the world. Each of them has an amazing story to tell that reveals the challenges they've faced, the incredible satisfactions they've experienced, and what lessons they've learned along the way. Each story represents a gem of wisdom, revealing both questions of faith, as well as of sustained action. The authors have been encouraged to dig deeply in order to talk about the honest realities of their work. After reading their stories, you will be ready to pick a cause that speaks to you and begin your own work.

PART I

Re-Visioning Clinical Practice

1

THE POWER OF TRANSCENDENT EMPATHY

Empowering Lower-Caste Girls in Nepal

Jeffrey A. Kottler

I had been working as a therapist on and off for almost 30 years when the trajectory of my life and work abruptly shifted. Through the years I’ve worked in a variety of settings, beginning with my first jobs in a crisis center and community college. After an internship in a psychiatric unit in a teaching hospital, I supervised therapists in a community mental health center and then in an outpatient psychiatric clinic. Although I have spent a fair bit of time training and supervising therapists in various countries around the world, most of my clinical work has been in private practice, with mostly affluent professionals.

It isn’t that I haven’t found my work as a therapist satisfying and fulfilling, but rather that I feel replaceable: many others could do my job with equal (or superior) effectiveness. There have been times when I would listen to my privileged clients complain about their troubles and I found it hard to remain compassionate. During other periods, those complaints began to sound like incessant whining, and the critical voice inside my head would scream: “You’ve got everything anyone would want in life, and still it is not enough for you!” It took me awhile to figure out I was speaking to myself as much as to my clients.

I stopped practicing therapy altogether for a period of time, concentrating instead on my teaching, research, and supervision. I had become burned out and found it difficult to listen to my clients anymore. They all began to sound the same. I found it more and more challenging to remain present with them. I became bored not only with them, but also with myself—I was tired of listening to my own stories.

Then I gradually selected new clients very carefully, choosing only to work with those who presented novel or interesting challenges. After all, I felt like a hypocrite teaching and writing about a profession that I was no longer actively practicing. With a very small practice, I once again found myself energized and intrigued with my work, yet something was still missing. I suppose this feeling might be inevitable and familiar to those of you who have been in the field for many years—it is hard to keep things fresh and exciting, the way it felt during the early stages. I have seen enough other therapists as clients to know that I was not alone. This is the context of what was going on in my life when everything changed for me.

What Would YOU Do?

It had always been one of my life’s dreams to travel to Nepal and trek in the Himalayas. I am an avid hiker, climber, cyclist, and adventurer who has used travel as a way to stimulate me when my work felt stale and repetitive. There are courses I’ve taught over 100 times, and conversations I’ve had with students and clients that often felt predictable. The times I’ve been in therapy as a client, sought supervision, attended workshops, or read books couldn’t affect me nearly as dramatically as some of my adventures abroad (Kottler, 1997; Kottler & Marriner, 2009). I’ve spent months working in Australia, New Zealand, Iceland, Peru, and on Semester at Sea, and have always returned a profoundly different person than the one who departed. Yet none of these experiences prepared me for what occurred during my first visit to South Asia.

One of my Doctoral students, Kiran, was an obstetrician in Nepal who was researching childbirth experiences in remote regions. She wanted to learn qualitative research methodology to investigate why her country’s maternal mortality rate is among the highest in the world. Kiran invited me to follow her on her rounds to isolated villages in order to teach her qualitative interviewing and grounded-theory analysis. What a perfect excuse for me to do some trekking!

It was during our visit to a remote village along the Indian border that I first learned about girls who were disappearing. While Kiran was examining her patients as the only doctor who ever visited that district a few times each year, I spent time in the school working with the children and teachers. I kept hearing rumors about certain girls who were “disappeared,” but couldn’t quite get a handle on what that meant.

“I don’t understand what this means,” I finally pressed the school principal, although he seemed to pretend he hadn’t heard me.

When I asked again, the principal stared at me for a minute, as if deciding how he would respond. Finally, he shook his head and pointed to a girl of about 12 years old who was talking with some friends. “Do you see that girl? She will be disappeared next.”

What a strange thing to say, as if she were a performer on stage with a magician who would wave a magic wand and she would vanish. What I learned instead is that “disappeared” meant that this girl would likely not be around much longer because her family was too poor to keep her in school.

“But where will she go?” I pressed. “What will happen to her?”

The principal shrugged, and that’s all I got out of him. But it was enough to pique my curiosity. Eventually I learned that all families have to pay to attend public school, and when they have multiple children and limited resources, they often allow the boys to attend school and keep the girls at home. Since they can’t afford to feed them all, the girls end up being married off as early as age 12; the unfortunate ones end up being sold and smuggled across the border, where they end up as sex slaves in brothels.

Upon further investigation, I learned that each year 12,000 Nepali girls end up stolen, kidnapped, or sold into slavery—some as young as eight years old. I don’t know about you, but this is just about the most horrifying thing I’d ever heard.

So imagine yourself standing on the school grounds, staring at a vibrant young girl with tremendous academic potential, but who lives in such poverty that she has no future other than as a child sex slave. In addition, some Indian men who frequent the brothels of Mumbai are HIV positive and believe that having sex with a virgin will cure their disease. That is why young virgins are in such demand, especially innocent Nepali girls who have no rights or recourse. What would you do if you encountered this situation?

“So,” I asked the principal, “how much would it cost to keep this girl in school for a year?”

“Oh, sir, it is very, very expensive.” As he said this, he rubbed his fingers together.

“Yeah? Well, how much are we talking about exactly?”

“It would cost many rupees. She needs to pay her school feels. She needs books and supplies. And of course her uniforms—she needs one for Winter and one for Spring. Then there are other …”

“Okay,” I interrupted, “how much are we talking about?”

The principal did the mental calculations in his head. “I’d say about 3,000 rupees.”

“3,000 rupees? That’s like $50. Are you saying that for $50 Inu could stay in school and wouldn’t be disappeared?”

The principal shrugged and wiggled his head in the characteristic Nepali way of signaling ascent.

I don’t know about you, but the thought that for $50 I could save a girl’s life was irresistible. Without considering the consequences of my action, I reached in my pocket and pulled out some money and put it in the principal’s hand. “This is for her. She stays in school. And I’m coming back next year to make sure that she’s okay.”

I walked away from that encounter as if walking on a cloud. I had this huge grin on my face. It felt like that was the single most meaningful and important thing I’d ever done in my life. I’d spent the previous decades doing all kinds of things to be helpful to others: volunteering my time to causes, working pro bono for clients who couldn’t afford my services, and working for universities in which the vast majority of my students were minority and first-generation immigrants. Yet it always seemed to me that if I weren’t there, somebody else would be—who could do the job as well as I could. But this was a case in which if I didn’t intervene, then nobody else would. I felt as if my whole life had been redeemed in that moment, that if I did nothing else, this single effort was my most important legacy. Forget the books I’d written and the other lives I’d touched—this was what mattered most.

My student, Kiran, watched this whole episode and saw the tears in my eyes. “Well, Jeffrey,” she said gently, “that was a good thing you did.”

“Yes, it was, wasn’t it?

I was feeling so damn proud of myself. I couldn’t believe that for $50, for the cost of a good meal, I’d just saved a girl’s life. Even more meaningful, this was a girl I’d actually met; I could see with my own eyes what a difference it would make in her life.

“So,” Kiran continued, “what will you do now?”

“What do you mean?” I answered, a bit surprised. Wasn’t this enough? I mean, give me a break—I just saved this girl.

“That is a very good thing you did, Jeffrey. What I wonder is what will you do now? There are thousands of other girls like her. What will you do about them?”

I had no idea when I reached in my pocket and pulled out a bit of money how this would change my life, my commitments, my priorities, my very life path. I went home soon after that and resumed my usual duties—teaching students, seeing a few clients, writing more books about therapy—but I frequently found myself thinking about the girl and wondering how she was doing. Since she lived in a place without electricity, without even an address that could receive mail, the only way I could check on her was to return to her village. I immediately made plans to do so, as well as to plan with Kiran ways we might identify other academically gifted girls who were at greatest risk of being sold.

PHOTO 1.1 Jeffrey Kottler spending time with some of the scholarship girls in the Everest region. Empower Nepali Girls provides scholarship for at-risk girls who would otherwise not be allowed to attend school.

Kiran’s research study was groundbreaking; it revolutionized obstetric care in Southern Nepal (Regmi & Kottler, 2009). She discovered from her interviews that the main reason why so many women were dying in childbirth was not only because 90% of the country had no access to health care whatsoever, but also because even when it was available, women refused to avail themselves of the services. One reason was because lower-caste women were treated like animals by the male doctors, who humiliated them, touched their private parts, and put “snakes in their arms.” The latter refers to inserting intravenous tubes without explaining what they were for—or for that matter, without talking to the patients at all. The few women who did go to the hospital for complicated pregnancies returned to their villages and warned their neighbors never to go to that place where they were treated so poorly.

As disturbing as these stories were, nothing prepared us to learn that the other reason pregnant women did not seek help was because their mothers-in-law would not permit it. Their husbands’ mothers believed that if their daughters-in-law were having a difficult labor, it was because they did something to anger the gods, and that it would be better for them to die so that their sons could find stronger wives. Even Kiran was shocked by this finding; it led her to train other doctors to involve mothers-in-law as part of the medical team so they would become allies rather than adversaries.

Kiran and I decided to pool our own funds to support more girls in school. For a few hundred dollars each year, we could provide scholarships for a handful of other girls. I began thinking about all the ways that I fritter away money on superfluous indulgences: $50 for a good meal—that’s the cost of a girl’s life; $150 for a pair of shoes I don’t really need—that’s three girls who could be saved; $500 for a new chair—that’s 10 girls! These were the calculations I began doing in my head every time I spent money. Now, don’t get me wrong—I really enjoy spending money on gadgets, clothes, trips, and other things. It wasn’t so much guilt that was motivating me as a newfound understanding of ways I could spend my own money and time.

The next year, I returned to Nepal to check on the girl and distribute scholarships to three other girls in her village. The year after that we expanded to another village, then another, then another, each in a different district. Before we knew it, we were supporting dozens of lower-caste girls, all of whom had great potential but few resources. Kiran and I had this audacious vision that we might grow the next generation of women doctors who could save other women at risk.

I’ve heard the term “grassroots,” but was never sure what it actually meant in practice. So far, we had funded our project solely from our own pockets, so we had no paperwork to keep track of and no bureaucracy. We knew each of our girls personally and could monitor their progress carefully, and make sure that all funds were spent solely to support them. In a region where corruption was so rampant we wanted to be as careful as possible with how our money was spent. In addition, I was skeptical about the ways in which big charities and organizations operated. I had read that in many of these operations less than 20% of the donated money actually gets to those who are supposed to be helped. I’d seen representatives from the well-known charities staying in 5-star hotels and driving around in Range Rovers, receiving six-figure salaries. Because we had so little money in our budget, I wanted to make sure we could stretch the funds as far as possible.

Friends, colleagues, family members, and students learned about what I was doing and asked if they could help. Sure, why not? I began to collect donations that made it possible to double, then triple the number of girls we were helping—20 the next year, then 60, and now well over 150 children in nine villages around the country.

It became necessary to register as a charitable organization in the United States, as well as in Nepal. But I was still determined that we would remain solely volunteers. We would have minimal overhead, no office, no paid staff, so that almost all of the donations would go directly to support the girls.

About this time, someone who had been thinking about making a donation said, “How do I know what happens to this money? I’ve never heard of you. How do I know that the money goes where you said it will?”

I suppose there is a theme of impulsivity that runs throughout my story, because my immediate response was, “Why don’t you come with us on the next trip and see for yourself? Why don’t you meet the girls and their families yourself and see what is happening? That way, you can act as a witness for anyone else who wonders about what is really going on.” That’s how the next stage of this project evolved into a kind of reciprocal exchange process, in which our volunteers have been affected almost as much as our girls.

As a psychologist, I’ve long been frustrated by how long it sometimes takes therapy to work, and how the effects are often short lived. I’ve long had fantasies of being a travel agent, planning the kinds of trips for people that would transform them dramatically in a relatively short period of time—with enduring effects. As I mentioned earlier, such travel experiences have been the most powerful change experiences in my own life. I once made a study of people who had changed their lives while on particular kinds of trips, and catalogued the factors that were most associated with such effects, especially those that were most enduring.

I found some interesting results that helped shape the way I planned to take volunteers with me to Nepal. First of all, adversity seemed to have the greatest impact on people. When travelers become lost, when they find themselves in novel environments in which they must meet their needs in new ways, when they must develop new resources to face challenges, or when their most cherished assumptions are challenged—that’s when the real action takes place. The lessons are most enduring when there is high emotional involvement.

Keeping these principles in mind, I wanted to design experiences for our volunteers that not only maximized their commitment to our cause but also exposed them to the kinds of things that have been so influential in my life. It is just amazing to spend time with people who, even though they have so little (most don’t even have shoes and eat one meal a day), are so spectacularly happy. I don’t mean to over-idealize their plight, but so many Nepalese people we meet along the way greet us with “Namaste” and the most glorious smiles you can imagine. They have nothing but the clothes on their backs, but their Buddhist/Hindu beliefs guide them to appreciate whatever small gifts that life might offer them. It is both exhilarating and disturbing to encounter people who have so little and yet appear so content, especially for those of us who have so much and always hunger for more. Team members often return from our visits completely disoriented about what they have discovered, and determined to put into practice what they have learned from our children.

I have long been a fan of the idea that our clients are our best teachers, and so it has been with our scholarship children and their families: they help us as much as we help them.

It has now been 13 years since we began our project. Our very first girl is the first in her...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• CONTENTS
• Preface
• About the Editors
• About the Contributors
• PART I Re-Visioning Clinical Practice
• PART II The Dreamers: What Change Could Be
• PART III Community Action
• PART IV Global Outreach
• PART V Closure and Reflection