• FACE-TO-FACE
Mental hygiene is equally important as personal hygiene. In recent times, many people - irrespective of their social status, class, gender or age - are opening up about their poignant stories of struggles, heartbreaks and unresolved psychological conflicts in the midst of topsy-turvy life situations. In this context, Sanjog Karki of The Himalayan Times had a tête-à-tête with Pooja Panth, a pharmacist and mental health practitioner as the latter shared her insights on the matters related to mental health. Excerpts:
Q. With the meteroic rise in technological advencements, telecounselling has become an alternative medium to provide mental health services to clients dealing with a myriad of mental health conditions. Do you think 'in-person meeting' is essential for building rapport between mental health practitioners and clients?
A. Counselling works best when there is trust between the therapist and the client. Various theories like Carl Rogers' approach remind us that empathy, genuineness, and a safe environment are at the heart of good counselling. These factors help build a strong 'therapeutic alliance,' which is one of the biggest predictors of positive outcomes. With today's technology, telecounselling has become very popular of late. It has opened avenues for people who live far away, have busy schedules, or feel shy about visiting a counselling centre. But when it comes to building rapport, face-to-face meetings can still play an important role. In-person meeting helps both the counsellor and the client read body language, understand emotions more clearly, and create a natural sense of comfort. For someone who is very anxious, dealing with trauma, or not familiar with using online platforms, being in the same room can make a big difference.
In Nepal, for example, many people from rural areas feel more confident when they meet the counsellor directly, whether in a health camp or during outreach programmes. In our culture, personal contact often builds trust faster, and families also feel reassured when they see the professional in person. Having said that, telecounselling is extremely valuable too. Young people in cities like Kathmandu or Pokhara, or Nepalis living abroad, often find it easier to open up online.
With clear communication and a warm attitude, rapport can be built effectively even through a screen. So, in-person meetings are not always necessary, but they can be very helpful. The most important thing is to choose what works best for the client's comfort, culture, and situation.
Q. In a country like Nepal, there's still a stigma attached with mental health. Needless to say, a large section of people have started opening up about their emotional upheavals and mental chaos, particularly in the aftermath of the COVID-19 pandemic in late January, 2020. In your experience, has Nepali youths taken a significant leap forward when it comes to breaking their prolonged silence regarding their mental health issues?
A. Yes, I do believe Nepali youth have taken a significant step forward in breaking the silence around mental health, especially after the COVID-19 pandemic. The pandemic acted like a turning point. People were isolated, stressed and uncertain, and this pushed many to reflect on their emotional wellbeing. As a result, young people started speaking more openly about anxiety, stress, relationship issues and career pressure. We can see this shift in many everyday examples in Nepal. For instance, more students in colleges are now reaching out to counselling units or seeking help from psychologists. Social media platforms like TikTok and Instagram have also played a big role in this regard. Many Nepali youths now follow mental health pages, share posts about selfcare, and talk openly about therapy. Even celebrities and influencers have started sharing their own mental health struggles, which makes young people feel less alone and more comfortable seeking support.
Another example is the increase in youth participation in mental health awareness programmes. During and after the pandemic, several organisations in Nepal conducted webinars, support groups, and online counselling sessions. Majority of participants were young people. They asked questions, shared their feelings, and encouraged their friends to join in such programmes as well. We can also see changes in family conversations. Young people are now telling their parents when they feel overwhelmed or emotionally low - something that used to be rare due to fear of judgment. In urban areas like Kathmandu, Pokhara, Butwal, and Dharan, many youths even encourage their friends to 'visit a counsellor' just like they would suggest visiting a doctor.
So yes, although stigma still exists, the progress among Nepali youth has been remarkable in recent times. Their openness, willingness to learn, and courage to talk about mental health shows that we are moving in a positive direction as a society.
Q. Phone addiction has been the scourge of today's generation. The surge in the internet use in recent times corroborates this claim. Moreover, easy internet access to people from all walks of life has paved the way for the proliferation of its dark side, exacerbating the quality of life of a large section of the society. With the number of individuals dealing with a myriad of psychological issues on the rise of late, how effective can psychotherapy be when it comes to obliterating the underlining psychological issues of individuals struggling with the obsessive use of smart phones?
A. Psychotherapy can be very effective in addressing the deeper psychological issues behind excessive smartphone use. What we often see is that phone addiction is not just about the device itself, it's connected to unmet emotional needs, stress, loneliness, or underlying mental health conditions like anxiety and depression.
In therapy, we first try to understand why the person is turning to their phone. For some, it may be a way to escape difficult emotions; for others, it could be a habit formed from boredom or lack of meaningful social connection. Approaches like Cognitive Behavioral Therapy (CBT) help clients identify the thoughts and feelings that trigger their compulsive phone use and replace them with healthier coping strategies. Motivational Interviewing (MI) can also be helpful, especially when clients feel ambivalent about changing their habits. From the Nepali context, I've seen many young people who use their phones excessively due to academic pressure, limited family communication, or the fear of missing out on social media. For example, I once worked with a college student from Kathmandu who spent most of his day scrolling because it helped him avoid thinking about his board exam results. Through therapy, he learned to manage his anxiety, set digital boundaries, and gradually regained control over his routine.
Psychotherapy doesn't focus on removing phones from people's lives. Instead, it helps individuals build self-awareness, strengthen emotional regulation, and develop a healthier balance. When clients understand their triggers and learn practical tools such as screen-time planning, grounding techniques, or alternative coping skills, they often see a significant improvement not just in their phone use but in their overall quality of life. Moreover, psychotherapy can be highly effective. It helps individuals address not just the symptoms but the root cause of their behaviour, and empowers them to build healthier, more fulfilling daily habits.
Q. Political bickering has forced many Nepali youths to leave their motherland and reside overseas merely to make their ends meet. In a pyramid of Maslow's mativational theory of hierarchy of human needs, where do majority of them belong? Can 'tele services' be effective in order to obliterate the psychosocial issues facing these youths?
A. In Maslow's hierarchy of needs, many Nepali youths who have left the country due to political and economic challenges facing the country are primarily operating at the safety and physiological levels, their basic needs for security, stable income, and living conditions take precedence over higher-level needs like self-actualization or social belonging. When basic survival is uncertain, psychological well-being can be significantly affected, leading to stress, anxiety, and feelings of isolation.
In this context, telecounselling can be very effective. It allows these youths - even while overseas - to access mental health support without the barriers of distance or unfamiliar local services. For instance, a Nepali student working in Australia or UK can connect with a counsellor back home to discuss stress, homesickness, or career pressure. Tele services provide continuity of care, culturally sensitive support, and guidance for coping with psychosocial challenges, which helps address emotional distress even when they are far from their support networks.
In short, while telecounselling may not replace the value of in-person community support, it serves as a practical and effective way to address the psychosocial issues of Nepali youths abroad.
Q. How affordable is psychotherapy and counselling in the context of Nepal?
A. In Nepal, private therapy sessions in Kathmandu usually cost between Rs 1,500 and Rs 3,500, while some NGOs and online platforms offer more affordable rates starting from Rs 700 to Rs 2,500. Although cheaper than in many high-income countries, therapy is still expensive for many Nepali families because multiple sessions are often required. Affordability remains a challenge due to urban-centred services, limited availability of services in rural areas, added travel costs, and extremely low government investment in mental health, which restricts subsidised services. While NGO-based counselling and tele mental health options help reduce costs, their reach is still limited.
To improve accessibility, Nepal needs stronger public-sector integration of mental health, more low-cost and subsidised services, and wider adoption of tele-counselling to serve remote communities effectively.
Q. There hasn't been a noticeable steps on the part of the government when it comes to obliterating the situation of individuals dealing with mental health issues, notwithstanding the fact that the claims of malpractices of some pseudo-psychologists are rampant in Nepal owing to dearth of genuine and trained clinical psychologists. Can you briefly elaborate on this issue?
A. In Nepal, mental health continues to receive minimal governmental priority, with less than 1 per cent of the national health budget allocated to this sector. As a result, services remain limited, infrastructure is weak, and structured mental health programmes are scarce, especially outside urban areas. The workforce crisis is even more pressing these days.
At present, only four seats are allocated for MPhil in Clinical Psychology programme as of the fiscal year 2024/25, which is the only pathway in Nepal that leads to becoming a registered clinical psychologist. Since the number of available seats is extremely limited, many aspiring students have no choice but to go abroad for advanced clinical training. This creates a persistent dearth of qualified professionals in the country. Due to this gap, the field has become vulnerable to pseudo-psychologists and untrained individuals who offer 'counselling' or 'therapy' without proper education, supervised training, or ethical standards. Such practices risk harming clients, spreading mis/disinformation, and undermining trust in legitimate mental health professionals. In some cases, these issues also raise concerns about malpractices in the psychotherapy setting.
Overall, the core problem lies in insufficient government involvement and low public awareness, which together make the system easily exploited. Nepal needs stronger policies, expansion of postgraduate seats in clinical psychology, a robust licensing and regulatory mechanism, and nationwide awareness initiatives. These steps are essential to protect the prospective clients as well as to ensure that the public can differentiate between well-trained, registered clinical psychologists and unqualified service providers.