True Stories:
This Book:
Story 3

Family counseling
in resource poor settings:
Case study from Pune
Bharti Misal

success story :
the outcome of Community Service Program| SEHER

Family counseling
in resource poor settings:
Case study from Pune
Bharti Misal

Bapu Trust, Pune, has been working in the slums of Pune since 2004, and intensively, using an integrated community development model, since 2009. In this model, a batch of support workers from low income communities of Pune, who are very well trained in a variety of verbal and non-verbal therapies, deliver ‘Psychosocial care and Inclusion services’ at the doorstep..

Family Counselling is based on the theory that family is a system, it is a a unit in which the members keep acting and reacting to one another.

Now imagine your automobile engine. If one part is not functioning properly, other parts in the engine will be affected.

But, if all parts are working well, the engine will be at optimum performance.

The goal of family therapy is to establish healthy boundaries, improve functioning, change negative patterns of interaction, and build positive relationships among family members.

Because the family system is interrelated and mutually influential,as family therapists I don't focus on

an individual family member during treatment, instead, I address problems within the family system.

In other words, family therapists first assess what is going on in the family that is causing or contributing to the problem.

Some problems could be very old and habitual to families.

Old and habitual problems become very hard to break, as the family is not even aware of such ‘relationship habits’.

As a family counselor in Bapu Trust, I take the following actions. This is my role as community based family counselor. I have worked with a number of people with severe disturbance, in each case there are chronic family issues

1. Develop rapport with the family

2. Identify a primary caregiver for our client, and a secondary care giver within the family

3. If a family caregiver is not available, I try to support to the client by finding neighbors who can be caregivers, from neighborhood

4. After identifying a caregiver, the second step in the intervention, is to do psycho- education to the caregiver, ensure daily basic needs are met at the least, understand medicine if any, and suggest what changes can be made.

5. Try to develop caring and loving attitude towards the client within the family.

6. Regularization of medicine, if any

7. Arrange for comprehensive health care

8. Provide information regarding getting medical care, several health schemes of govt, papers require to access the facility etc. is informed

9. Sometimes family also need livelihood or other supports. We enable those also.

There are certain issues of clients with psychosocial problems, like, if client have phobias or severe depression or OCD, the clients do not adjust anywhere and everywhere. They need their own ‘spaces’, that is, space within the caregiver’s heart and also availability of safe physical space.

I always suggest to the caregiver to remember that,

“They are people like us, and they can exercise all rights which we do. It’s the present need of their mind and body, that’s all”.

Family should make them comfortable not a subject for people to talk.

He/she needs attention, someone to understand and listen, someone who has time for them.

In severe disturbance, people do get very angry. We don’t know if it is because of the ‘problem’ or because of ‘environment’, manje ‘family’

Family has to see that client should not get provoked, excited, or very disturbed, due to certain behavior of others or place or smell or voice or other triggers. Families must have firsthand knowledge what is the causation and also, immediately what should the family do, or should not do, if client become very disturbed or very angry.

As in physical illness we do care for the wound and bandage it and make sure that the person should feel ok.

This is a wound to emotion which also needs the bandage of love, acceptance, care and bliss.

The family also deals with stigma due to the client.

In that case, the family needs support from the neighborhood, relatives; and even from the other family members, they should feel care and support of each other.

In my work, I was dealing with a family, there are three brothers and a sister. A sister is hearing voices.

She needs acceptance, care and support from her brothers. If the relation between brothers is not healthy, they do not accept the responsibility of my client. My client Vimala is 46 years of age does beedi rolling work in Lohiyanagar. She is a pensioner the elder brother who is a primary care giver. Not knowing what to do, he admitted her every now and then in the mental hospital.

After six months when he finds her “NORMAL” (manje, ‘manageable’) brings her back home.Vimala stays with her elder brother in a separate room upstairs and his brother stays with his family on the ground floor. Vimala told me that her Sister in law does not like her; Whatever she prepares for food, she do not like that; and always say to her, ‘Don’t prepare food’.

“… blah… whatever I prepare you eat that, don’t go out,don’t meet/bring any friends of you,stay inside a room, be quiet don’t make any sort of noice at home, don’t speak loudly… blah…” .…”

In this way Vimala had too many restrictions.

She requested my intervention with her sister in law. In Marathi she say ”mala pan anandi rahawasa watata, bolawa,

gappa marawya asa watata pan mazyashi koni bolatach nahi”

I talk to the family to sensitize the issue.When I asked, ‘Who is Vimala to you’?, she said “She is my husband’s ‘Crack mind’ sister”.

I realized the distance in relation, stigma in word, seen as an unwanted person at home, a burden, the dependency of my client, her helplessness.

My second question, ‘Tumhi tichya kon ahat?’ just as an introduction, “ Tichya bhawachi baiko”.

I bring down the distance between their relations to “0”.

The counselor has to be a good observer and can develop a habit to hear the heart and mind of a person, should be able to read in between lines, listen to the silence, the gesture.

I usually begin and end my talk always keeping my client in centre and then hear the family issues.It is understood that family has to give extra attention, but if as a unit you divide your responsibilities and make the client independent (to train him in certain daily easy tasks) he/she will improve and you as family can also feel better and reduce your burden.It helps everybody. It also helps to build self confidence in the client.

In the case of Vimala, I did very close work with the family. Then she attended the depression support group run by Bapu Trust. She also came for ABT sessions, did drumming but she don’t like loudness. She beat the drum slowly and in very low pitch. But sometimes, she beat the drum as if she wants to tear the skin of the drum away.

She now does Beedi rolling work with her friend Radhakka at her friends home, mix-up with her friends family, and sometimes they go together for marketing.

It is important to know that her elder brother has moved to another place in the city. He had invited my client to stay with him in the new house.

Her social capital increased. She has a habit, that, whatever she prepares (food), she give it to her neighbors and ask them how it is. She needs and gets that appreciation from her neighbours.

Even if I go for home visit she gives me something new that she has tried and prepared.

While I did sensitization I suggested to her brothers to divide the work amongst them; and whatever pension vimala gets get some nutritious food for her every month.

This is followed by all three brothers. Now they visit her every week and see what she needs

In another case of mine, a client was referred to Bapu Trust through awareness activities.

The neighbour of the client reported about the clients’ symptoms. She takes off her clothes and runs naked on roads and in Wada.

Neighbour said we are ashamed of her,

she shows her Menstruation pads to her son and other males in the Wada and if we try to communicate with her she use fights with us.

She mutters to herself and speak bad words to us.

She also has a habit of Tobacco chewing and Tadi (a drink).

She has an alcoholic husband and two sons.

One stay away from the family in other city and the younger one stays with his parents.He has stopped going to school as mother use to send her to bring Tadi and ask him to do gambling and bring money. If he did not bring money at home she used to beat him.

She also has two married daughters and they stay in Gujarat state They can’t come every now and then. I decided to find a primary care giver in the neighborhood. We conducted a corner meet with the Wada people, and did sensitization, made them aware about her mental condition and shared that she need help from all of you.

I taught them how to talk with her, understand her and not to stare at her when she looks at you or tries to speak with you.

Speak normally and don’t show any excitement or show that you see something odd.

Ask her about her food and sleep or if you know anything that she likes to do.

Tell her that she look beautiful when she wear that saree. Say that she looks very thin and weak. Is there anything that is troubling her, any issues that she wants to talk about.

Like this, I give them words, and they start dialogues with her. In the beginning they were afraid of her.

Later she listened, they took her to the Mental Hospital for treatment. They got her admitted. Soon, the staff said we want to send her back as there are no any symptoms.

The staff described that she use to get up early in the morning, bathe every day, swipe the floor, and change clothes.

She don’t show any other problem that she needs psychiatric treatment.Please take her back home, she need proper food intake as she is anemic. So now I came to know that because of anemia all symptoms appeared. It is because of her addiction to tadi she do not feel hungry. Her needs are not addressed in the family.

She had irregular menstruation some gynecological problems which needed immediate treatment. When people around gave her love and attention she started eating slowly. Gradually she left tadi did all house hold work, regularize her intake. More nutritional supplement was provided.

The primary caregiver talked with her husband to ask him to give egg and milk every day. The neighbor also encouraged him to reduce alcohol for himself and his son, using moral pressure: “Otherwise you have to leave this place as you are staying here as tenant; We all neighbors will complain to the owner”.

The husband stopped his addiction gradually. He started working on ‘Wada pav’ selling business. My client started stitching and tailoring work with a nearby shop. Whatever she earned, she saves the money as she wants to go to Gujarat to meet her daughter.

One of her daughters will come for first delivery to her parental house here in Wada. So my client started stitching small clothes for her grand children. When I go for home visit I see the sea change as grandma. I can’t express the happiness in words……

Family as an important unit in the recovery of our client….accept the person as it is, don’t think what others are thinking about you. Forgive others. It will be easier for you and the client. In this case, I work closely with neighbors in this case. In communities, ‘family’ is not just one’s own family, but also includes

neighbours, extended family, and other care givers!

In the end I want to mention as family counselor I have to build a hope in the family that client can recover and be independent earn for his livelihood for that we have to take a joint efforts to see that he/she become independent.

In the end I want to mention as family counselor I have to build a hope in the family that client can recover and be independent earn for his livelihood for that we have to take a joint efforts to see that he/she become independent.

This was story 3.
It is a true story.

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