We talk to Lahore based therapist Izzah Zainab about mental health practices in Pakistan, tools to overcome anxiety and what you should look for in a therapist.

Can you tell us a little about your work and your education?

I am practicing as a mental health counselor in Lahore, Pakistan, and I work primarily with adults (ages 18-65). After my undergraduate from Lahore University of Management Sciences, I went to New York University as a Fulbright Scholar for my Master’s in Counseling for Mental Health and Wellness. I received my professional training in New York City as well, at a mid-sized private practice in Soho.

What led you to begin a career in therapy?

My interest in psychology dates back to my childhood when I would religiously follow the “Psychologist answers” section in every magazine I could find. I always had a penchant for understanding the human experience, but for some time, that inclination was overpowered by the drive for more “socially desirable” careers and the race to climb the corporate ladder.

I quickly found my way back when I realized that the most rewarding moments of my day were the ones in which I experienced raw vulnerability with another human being – whether it was sitting with someone in their pain or hearing them talk about their dreams with a spark in their eyes. I thrived in those hours of connection and that realization made me commit to this field as a lifelong career. I couldn’t be happier with that choice.

What, in your opinion, are some challenges of being a therapist in a country like Pakistan?

One big challenge is the lack of resources and formal networks such as support groups, rehabilitation centers, helplines etc. An individual’s mental health is not a one-person job; it needs several systems to thrive. Those who finally seek counseling are often restricted by their financial, social, and systemic constraints in the face of their challenges.

There is also a huge gap in the increasing demand for therapists and the limited supply, and many therapists have months-long waiting lists. It hurts to send people away who reach out to you for support just because you don’t have the space to accommodate them.

What are the different sorts of therapies and which one do you practice?

I use a trauma-informed, emotion-focused, and integrative approach to suit each clients’ unique needs and goals. I borrow from several modalities, including Psychodynamic theory, which looks at your unmet needs and the role of caretakers in your early childhood; CBT (Cognitive behavioral therapy), which focuses on dysfunctional thoughts and beliefs; Gestalt and relational therapy, centered on the experience of ‘here-and-now’; and Internal Family Systems (IFS), which explores how different “parts” of us interact with one another.

Has there been an increase in virtual therapy since 2020?

Definitely. 2020 changed the course of therapy services across the globe. Clients and therapists alike are exploring the newly discovered power, accessibility, and convenience of virtual therapy. In fact, many therapists now practice entirely online. However, telehealth comes with its own limitations. A lot of body language cues are lost in transmission errors and masked behind the 17-inch screen.

What should people look for in a therapist? What some important qualities a therapist should have?

Besides the appropriate training, experience, credentials, and adherence to established ethical guidelines, the right therapist meets you where you are, while providing enough challenge to encourage growth. Here are some questions to ask yourself: Do I feel understood by my therapist? Do I feel seen? Do I feel respected? Do I feel challenged?

The same therapist may be a great fit for someone else but not for you. Hence, the process of finding your ‘fit’ requires some trial and error.

What are some of the most common mental health issues you see amongst people in Pakistan?

I’ve found anxiety, depression, and emotional dysregulation to be fairly common across clients. Most of my work is with young adults struggling with difficult family dynamics, life transitions, and self-esteem issues. Particularly in Pakistan, I see clients repeatedly bring up the theme of societal pressure and judgement toward their choices.

What affect has covid had on your patients? Has there been an increase in the number of patients?

Certainly. For many of us, this pandemic marks a time of unprecedented uncertainty and collective isolation. The lack of human touch and social stimulation led many into a downward spiral with their mental health. In contrast, some of my clients with social anxiety found comfort in wearing masks and the reduced pressure to socialize.

Covid-19 also left a traumatic impact on our collective grieving process. Those who unexpectedly lost loved ones were often unable to travel, hug, and comfort their family members. I believe that even after the pandemic ends, the mental health repercussions will probably linger for generations.

What are some tools that you recommend to people who are struggling with anxiety or depression?

Many CBT-based tools for anxiety are easily accessible online. You can keep a journal or use a mood-log application on your phone to mindfully monitor your thoughts, feelings, and symptoms. There are also plenty of videos and helpful guides for learning breathing skills, grounding techniques, and mindfulness-based exercises (try the apps “Calm” and “Headspace”).

With depression, it can be hard to find the motivation to even look for any of these fancy tools. So it’s important to start slow and aim for motivational “baby steps”, even if they seem as simple as taking a shower or getting out of bed today. Remember: one baby step at a time.

What is your advice for people who want to embark on the field of therapy/counselling?

Start within. To empathize with someone else, you need to be connected to your own vulnerability first. Seek therapy yourselves and know your own biases, blind spots, and limitations.

What’s your advice to someone who wishes to start therapy but is reluctant because of the stigma attached to it?

It’s okay to hold some shame around seeking therapy because the stigma is deep-rooted indeed. However, when a part of our body is hurting for too long, we seek a professional, a doctor, without any shame. Then why treat our mental health any differently from our physical health?

Contrary to what the stigma tells you, you are not broken for seeking help. In fact, it requires immense courage and vulnerability. And alongside the reluctance, there’s a part within you that wants to feel better. Connect with that part and embrace the compassion that it holds for you; you deserve every bit of it.