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Clinical Psychologist; on the rare skill of healing emotional pain

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Sibongile Babusi, Clinical psychologist at Princess Marina Hospital discusses everything psychotherapy, from myths about therapy to roadblocks clients face; the challenges and triumphs of being a therapist to the menace that is rape in the society.

What has surprised you the most about being a therapist?
Clients expect us to never be sick, and that just because we are therapists we should understand all the time.

What is the biggest myth about therapy?
“It’s only for people who are mad”
“We read minds”

What seems to be the biggest obstacle for clients in therapy?
Age and gender difference. Men are mostly uncomfortable talking to female therapists. There is a shortage of psychologists in Botswana. Chances are a department may be filled with females. In departments where there are only female therapists the gender/age barrier will always be there. There is language barrier. Most psychological concepts are in English; on translating them to Setswana they somehow loose the meaning. If not translated we are not communicating and still when translating the meaning may be lost. We do not have enough resources to assist clients adequately. We also have shortage of personnel in the field.

What is the most challenging part about being a therapist?
We preach detachment, theoretically it is possible but practically it’s not as easy as theory suggests. We get to relate when hearing a client’s story. Some hit straight home, some aim straight for the heart and others alter your perception about some phenomenon. In that way we are directly or indirectly affected. With no debriefing we also have difficulty coping. Being a therapist is emotionally demanding. You have to listen to three clients at most in a day and in each case you are to relate and understand the case. At the end of the day it’s emotionally exhausting.
Just because we are therapists we are expected to never be offended. Some address us any how they wish and we are suppose to never pick offence because of the nature of our work. Other clients try to persuade friendship and some even try to offer gifts, which is unethical in our field, at the same time culture stipulates that it’s rude to refuse gifts.

What do you love about being a therapist?
I love helping people deal with problems. For physical pains we know the cure can be found in medication but when it comes to emotional pains there are no medication. So sitting down and listening to someone’s problems and helping them through the problem is one aspect of being a therapist that I love. Also the fact that by just talking we offer effective solutions makes me love therapy the most. It is those toothless smiles and heavy sighs of relief that make my day.

If there’s one thing you wished your clients or patients knew about treatment or mental illness, what would it be?
Psychotherapy is a process and not all problems are going to be fixed.
In psychotherapy we set long-term goals with clients, which mean we cannot expect to see results immediately after the first session. Yes, there are instances that one will feel better but there is no assurance that one will feel better immediately after the first session. Psychotherapy is a cooperative effort between therapist and client. It’s not all about the therapist telling a client what to do but the client being ready to make changes in his/her life. A therapist has a responsibility to help but a client also has the responsibility to ensure their healing.

What do you do personally to cope with stress in your life?
I have a counsellor, it is overwhelming to work in a referral hospital so at some point I need to debrief (that’s for occupational stress). When I have stress (personal) I first have to understand what is stressing me and why it is stressing me, then it becomes easy to address it. If it’s not working I pray. The assurance that God is listening and is working out something to save the day somehow helps me calm down. I guess staying calm when you have stress helps in thinking through the problem, it gives one time to breathe and look at the stress from a different angle.

Now on to a topic that has polarized public opinion in recent weeks, rape! It seems in many societies, the culture of rape is woven into the very fabric of society. Why do you think men rape? Is it an act of power and control?
In a manual about mental disorder there is a specific disorder that relates to rapists so the cause may be psychological. Others rape because of faulty beliefs. For instance: “when a girl child is wearing mini they deserve to be raped”. To some it’s an act of power and control and in some cases it’s an act of revenge.

Is sex a motivation?
No, they just want to hurt and there are instances of wanting gratification (happiness from hurting).

Discuss Rape Trauma Syndrome (RTS) and what determines how a person responds to rape?
RTS is a group of reactions reported by victims of attempted or completed rape. The reactions are categorised in three being emotional, physical, and behavioural. The clusters of reactions have two stages being an acute (mostly emotional and physical reactions), immediate phase of disruptions and disorganisation and a long-term of reorganisation (emotional and behavioural reactions). The length of each stage can vary and there is a high chance of people to move back and forth between the stages. There is no determining factor as to how a person responds to rape. Different people react differently to rape as the context; nature of assault and the gender of assailant differs in each case.

We seem to be a culture of victim blaming. What do you think is at the core of such mentality?
Transfer of responsibility. As a community we do not want to take responsibility for allowing some things to happen. As a mother, a father or a relative what role did you play in raising a rapist or in ensuring that your son/daughter can never do that? As a community what did we do to prevent this? If the community is unable to account on that, we tend to blame the victim as we cannot blame ourselves.

What are the psychological impacts of victim blaming on the victim?
Most people who have been assaulted or there was an attempt are prone to present with the following psychological symptoms; Depression
Suicidal ideations
Social phobia
Identity crisis

Doesn’t it boil down to respect though? How do you teach respect especially to the boy child?
It does boil down to respect. The family is a powerful teacher of character. If the boy child is taught from home to respect the girl child and understand that the boy child and the girl child are equal a lot of social ills can be reduced.

At societal level, what do you think can be done to prevent abuse and/or better support those who have been abused in their recovery?
Most people are not aware of the recent statistics of rape so the society takes the matter lightly. If there were awareness campaigns that the society can be aware that indeed rape is worrisome in Botswana then the society could have already been mobilising preventative measures.

What is the best advice you can offer to readers on leading a meaningful life?
Challenges are not meant to destroy us but to build us. Being your true self is the only way to live life to the fullest.

Where does one find a therapist?
In each and every region in the country there is a therapist and the service is offered for free in government hospitals. There are also therapists in the private sector who charge a consultation fee.

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‘Cancer took away my boobs, not my life’

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Sun Health: What events led up to your diagnosis, or, how did you discover that you were suffering from cancer?

Mpho Kgaodi:My journey with Breast cancer started in 2012. Around April I felt a lump on my right breast. It was not painful at all, just slightly itchy. It was on the upper part of my breast. I ignored it for about three days but it kept nagging me and then I decided to go see my doctor. He also confirmed that there was a lump on my breast He sent me for mammogram that confirmed an abnormality on the structure of my right breast. I then went to see him with the results and he informed me that there are two ways to test that lump – Biopsy, which meant that he will be taking a piece of that lump to send it to the laboratory for examination and the other option was to totally remove the lump, Lumpectomy. I decided that he removes the whole lump, because I really didn’t want that Lump on my breast.

SH: We know that about 10% of all breast cancers are hereditary. Are there other women affected in your family?
MK: I don’t know of any other woman or even man in my family who has had cancer, though it is hereditary.

SH: What were your first thoughts when you received the diagnosis?
MK: I cried for a brief moment. I was overwhelmed with emotions, fear of death. I quickly recovered from that dreadful thought and remembered that I have a great husband and three boys. I felt that I had so much to live for.The doctor informed me about the options I had regarding treatment and he gave me time to think about it. I drove back home to Lobatse and by the time I arrived at my house, I had already made up my mind that I am going for total removal of the breast. I broke the news to my family and they were just as shocked as I was when the doctor broke the news to me. I explained to them my decision to go for surgery and they were very supportive. Few weeks later, I went for a mystectomy.

SH: How long were you in treatment

MK: The surgery was followed by Chemotherapy. The first time I walked into the oncology centre, I found so many people there already. I then realised that I am not the only person with cancer, it is so many of us. It gave me strength and courage. I had heard that the side effects of chemo are brutal, seeing those people made me realise that if others can do it so can I. I decided to go for it as I had so much will and spirit to stay alive and raise my kids. After the second session of chemo, I started losing my hair, nail beds turned black. I was never discouraged though, despite my aching body and the constant nausea after chemo. I had six cycles of it. In 2013 around April again, I experienced severe pain on my left breast, but with no Lump. My doctor again recommended I go for a mammogram. It confirmed cancer which was still at stage 1. I then insisted that they remove the breast. I would lose both my breasts but I knew staying alive for my boys was more important. Other people thought the pain was psychological, and I knew what I felt and my mind was made up. I had the second mastectomy and had to go through another cycle of chemo which I completed. I am now on oral medication. I take my tablet daily. It is recommended that I take it for ten years. I have just started on my year 6 on the tablet. I do go for regular check ups, to establish if the cancer is not back.

SH: What helped keep your spirits up and gave you support during this period?

MK: A good friend of mine and colleague told me about Journey of Hope Botswana. He introduced me to them, and I had tremendous support from them. I also went to Cancer Association Botswana to introduce myself. My family has also been my backbone, supporting me through it all. I am so greatful. On days that my spirits are low, I always take my mind to positive thoughts. I try to remind myself of the good times, sometimes I even find myself laughing out loud.

SH: How has this affected you at a psychological level?

MK: My life has not really changed for the worst. Like the saying “when life gives you lemons, make lemon aid out of them”. I lost my job after the second diagnosis of cancer. While this affected my family financially I never got discouraged, as this gave me time to take care of my family. I am a full time stay home mom. I walk this journey with my family. My boys understand that I had Cancer but now I am okay. They sometimes check if I have taken my medication, and they would even ask about my next appointment. I am blessed to have them.

SH: Facing the diagnosis of breast cancer is one of the most feared experiences in our society. What has been your experience as you worked with communities through Cancer Association of Botswana (CAB)?

MK: Working with CAB has been eye opening. Through motivational talks and other actives like the annual stiletto walk, the message has been positively received. There is still a lot to be done though, especially to make people understand that breast cancer is NOT a death sentence. So many lives can be saved.

SH: Amongst raising awareness, cancer awareness month is about celebrating individuals like yourself and their triumphs over cancer. Is there anything you would like to say to the community of cancer survivors and women in general?

MK: I have learnt so much from being diagnosed with cancer. I appreciate life more. I never used go and see a doctor without any pains or any thing “wrong” with my body. Now I do it regularly and so far I always get a clean bill of health. I encourage everybody to do regular self -breast examination. It is easy, convenient, cost-effective and can really help with early detection. I believe there is a lot to be done as far as breast cancer awareness. Remember men can also have breast cancer.

To all those who are going through cancer at the moment, remember you are not alone. Let’s walk this journey together. Let’s walk with Hope, Courage and Strength. There is life after cancer. Cancer took away my boobs it did not take my life. As October is breast cancer awareness, let’s support those affected, honour the survivors and remember the fallen.
PINK RIBBON ALWAYS

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Caroline Gartland speaks on Children and Mental Health

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Tell us about yourself and your background
I’m originally from the UK but have been in Botswana for eight years so this is now home! I have a Combined Honours degree in Psychology an MSc in Mental Health and have had a pretty varied career.
I started off working with offenders doing rehabilitation programmes; went on to support the victims of domestic violence then ended up working in Child and Adolescent Mental Health Services for the National Health Service.
I’ve done a lot of work, mainly voluntary, in different fields since being in Botswana but my passion is now Early Childhood Mental Health.

What does your work entail?
Early childhood mental health is mainly working with parents, caregivers and teachers to help them understand how children develop and the best ways to support their mental health and brain development as they grow. It’s about providing training and opportunities for families to bond with their children and introducing new ways of playing and interacting.

What sparked your interest in early childhood mental health?
Quite simply, having my own children! My daughter was born five years ago and I was fascinated watching her develop and grow. It occurred to me that the younger you begin to consider mental health and provide tools for resilience against life’s adversities, the better outcomes you are likely to have.
I began reading everything I could get my hands on, and completed a diploma in Infant Mental Health. I’ve worked down the lifespan but I feel I’m now where I belong, working with babies and young children.

What mental health issues have you observed in children in Botswana?
Mental Health is still stigmatised around the world and Botswana is no exception. Most people immediately think of mental illness, but mental health is about so much more; we all have mental health and some days we are fine and able to deal with life’s challenges and some days we need more support and tools under our belt to help us cope.

Young children can experience mental health problems. Anxiety is a common one, but we are more likely to focus on the behaviour we see rather than how the child is feeling. An anxious child who refuses to go to school may be labelled as ‘difficult’ or ‘naughty’ but what they are expressing is a painful emotion that they need help dealing with.

Describe one thing you find fulfilling and challenging about working in this industry.
Working with children and families is a pleasure and a privilege. To make life a little bit easier for someone is all that matters, you don’t have to be out there saving the world to make a difference.
My major challenge is time. I would love to do more, I’d love to do an MSc in play therapy and a couple of other therapeutic techniques I’ve come across in Europe but that gets put on hold as I focus on my own family and business.

Can you share an anecdote about how mental health consultation works?
I think that education, understanding and connection are the three keys to giving a child the best start in life. Led by that, SensoBaby provides classes in the community for parents and caregivers to connect with their infants.

We offer workshops on parenting and play to foster understanding of child development and wellbeing and we are available to troubleshoot specific problems an individual or agency has with the young children in their care or the systems they have in place. When it comes to individual parents, mostly what they need is to feel heard, supported and guided in their parenting choices.
You can read all the baby books in the world but they won’t give you the answers you need for your child, through responsive parenting and connection, you’ll find you have the solutions you need.

What advice do you have for child-care providers or early childhood teachers who are at their wits’ end over a child’s challenging behaviour but don’t have access to a consultant?
Empathy is an important and undervalued skill – the ability to consider another’s viewpoint. What is that child feeling? Their behaviour might be challenging and hard to deal with but often the root cause is an unmet need. There’s a famous quote from an American Clinical Psychologist, “The children who need love the most, will ask for it in the most unloving ways.”

Does a mother’s mental health affect her foetus? How important would you say is paying attention to women’s well being during pregnancy as with their physical well being?
100% yes. It is so important to support a woman’s wellbeing during pregnancy. As an example, if the mother experiences significant stress and rising levels of cortisol (the stress hormone) during pregnancy, the foetus will be affected and in some cases will be more sensitive to stress in childhood or later in life.

Pregnant women and new families (Dads as well!) deserve nurturing care themselves and shouldn’t be afraid to ask for support. SensoBaby run FREE monthly coffee mornings to support pregnant and new mothers because we understand the importance of maternal wellbeing.

Do smart phones and television make our children mentally ill as is often purported?
I don’t think technology is always the villain it’s made out to be. The key is in the relationship with that technology. Moderate use of TV’s and smart phones are fine, as long as they aren’t a substitute for outdoor play, imaginative play and meaningful interactions. If a child is crying or upset and we hand them a device to keep them quiet then we have missed an important opportunity for connection, helping them process what is going on and supporting them to calm down and settle themselves.

Now, I know you are involved in an exciting programme that helps caregivers and children to bond and get the children off to the best start in life through play. Can you say a little bit about that work and just how you are seeing it play out?
SensoBaby is our baby; a project born from passion and a desire to support families in Botswana. We offer play-based classes for children and their caregivers that are underpinned by the principles of child wellness as well as early foundations for learning.

When you provide developmentally appropriate opportunities to play, you learn so much about your child. That understanding and observation builds strong connections, which will form the basis of that child’s future relationships and self esteem. Play is so much more than ‘a fun activity.’

We offer a number of trainings and workshops for parents, nannies and community stakeholders and hope to increase our offerings this year. Our community partnerships and voluntary programmes have been successful so far and we hope to see more impact in 2018.

We currently serve the Gaborone community but would like to expand throughout Botswana as opportunities arise. The response to SensoBaby has been fantastic so far and we can’t wait to see how far we can go with the concept!

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