Interview with Kirandeep Chohan, Cognitive Behavioural Psychotherapist

Tell us about your background and how you came to train as a CBT therapist

After I left university, I struggled to understand what I wanted to do. I didn't have the finances to fund a master's course, so I sort of fell into a community development worker role, in mental health and community work, at an IAPT  service. At the time, I had no idea what IAPT was, but it wasn't far from my house and sounded exciting! Our job was to go out into the community, to talk about mental health and improve access. My male colleague had done some amazing work building relationships and connecting with local communities, but I noticed that women who were reluctant to come forward to him began to reach out to me. I soon set up a focus group with an interpreter for women from the Kurdish community to talk about mental health. They shared their thoughts and feelings about the cultural aspects of mental health. When the interpreter shared that I had similar experiences, I could see how powerful it was; I think it helped us connect, and everything grew from there.

Five months into that role, my manager convinced me to apply for a low-intensity trainee position. At that point, I wasn't sure if I wanted to return to studying, but my team encouraged me to have a go. Reassured that my position in community development would stay open, I applied. I did low-intensity work for about two years, then realised my dream; my end goal was to become a CBT therapist. After several attempts to get on to training, I accepted a place at my first choice, Kings College.

My journey has been so profound. I have learned so much about myself, other people, communities, and the therapy I deliver. It has been a process I could never have even imagined. Even now, sometimes I have to pinch myself!

What do you enjoy most about the role?

 There are so many things that I enjoy! I think the first thing is that I can be curious, ask questions, learn more about people's lives, and understand what is special and valuable to them. I love building trust with people; I enter their lives as a complete stranger for only 50 minutes or 60 minutes a week, and suddenly, they're telling me things they've never mentioned to anyone. Through listening and hearing their own words, they feel understood and heard. I think that's the most powerful thing.

The other thing that I love is the difference it makes. We are very focused as CBT therapists. The sessions start with an agenda; you go through a process or a protocol, 'Have we discussed this? Have we discussed that?' On paper, it looks very business-like, but to do that in a conversation takes a lot of skill, and I think it's very powerful for both parties to know what you want to achieve and to walk away feeling happy that you've achieved it. I particularly love the last few sessions of relapse prevention, seeing that road to recovery when the client reflects on their journey back to me.

 'I was here, and now I'm here. And 'I've met my goal' or 'I'm on target to meet my goal'.

Of course, it doesn't always work like that, CBT isn't for everyone, and that's OK. Even when you haven't entirely stuck to your plan, it can be very powerful because it helps you learn to improve and move on.

Tell us about your experience and the impact it has had

I have worked in IAPT for over ten years in many different trusts, some a lot more diverse regarding clients than others. People often think it's more challenging to work with a diverse group of clients or that it has to be different. I don't believe that at all!

Everybody is an individual; everybody has difficulties they bring to the therapy room. I mentioned at the beginning that I love being curious. I'm really trying to share and promote the importance of being curious. As a woman of colour, I have certain cultures and practices, but I don't assume they are the same as somebody else. I think sometimes we forget that.

 I am consciously open and curious, asking people about their experiences. It doesn't matter what colour we are; the micro-cultures within our homes, our family systems, and our friendships make and shape us. During peer supervision and talking to my colleagues, I've noticed that when we go through longitudinal formulations, early experiences and recognition of someone's race and culture are often lost or not taken into account. Therapists sometimes say,

 ' I've gone too far in my treatment with somebody to even talk about race.'

It's never too late to talk about race. I've been in Sessions 8 to 9 and learned something completely new about someone, so it's never too late. We will never understand and know everything about a person in 12 to 16 sessions, but we can continue to be curious. I don't know if that really makes me different, but I'd like to think that that's something that stands out for me as an individual. Having that curiosity and the eagerness to want to know more and to understand that this person may not fit into a model because, as I said, it's not for everyone. But we can make it work….

You've just evoked a memory that I've never really talked about….

Going back to my early work, specifically with the Kurdish women, I remember being in the Community Centre; the women knew I was there to talk about mental health. We made it clear that they could leave at any point; there was lots of other stuff within the centre that they could go to. I immediately noticed that nobody wanted to sit down. My impression was that they wanted to run. But within 30 minutes of me talking, I saw women finding chairs. I've never really reflected on this until now. What they needed was somebody they could connect with. Six of those nine women stayed afterward to talk to me individually with an interpreter. The issues and difficulties they were having were cultural. But they didn't realise they were affecting their mental health because they had no idea what mental health was. They assumed that these things were a part of life. In the West, we have much more access to information on social media and TV regarding mental health, but it's still closed off in certain cultures. I think we this for granted. And In therapy, we don't talk about it enough.

In my new role as an EDI lead, my colleague and I are in the middle of developing clinical skills training. The most important message is, don't be afraid to ask.

There are many cultural ideas and feelings around health and wellbeing. But if you're not asking, 'how do your beliefs impact your mood, anxiety, worry, or stress?' Clients won't feel safe enough to tell you. As therapists, we understand how to step foot into difficult situations, but if these conversations feel difficult for us, imagine what it feels like for the other person.

We must also be mindful of how we, as therapists, bring ourselves. What might I, as a therapist with an Asian background, be bringing into the therapeutic space? How might my accent and how I speak impact how people feel about me? These conversations are incredibly powerful, and I would really encourage therapists to be open.

Our training also highlights the importance of language. We often refer to 'mental health; however, the word 'mental' has negative connotations for some communities and cultures, which may lead someone to shut off or disengage with therapy. We have to be mindful of the words we use.

Most of all, we need to consider people's identities. When we see people as individuals and try to understand their role in the world, I think that is when true magic happens.

Equality, diversity, and inclusion are clearly important to you; tell us more

Absolutely. We all have a responsibility to educate ourselves, especially in our jobs. When there is a new book or article about things relevant to our clients, we read; we attend training. Why are we not doing that regarding culture and diversity? It often feels like a last-minute thing; half a day of training that ends,

 'We have emailed you some slides on EDI. Read them.'

 It's just not good enough. Equality, diversity, and inclusion training cannot be tokenistic; there needs to be continuation and longevity. Therapists must make it their job to be informed, to come to the therapy room with the knowledge. Why are we not taking responsibility and empowering ourselves to be the best therapists we can be?

We must all play our part and do much more, regardless of our role, and we shouldn't be afraid to talk about these issues in supervision or with our clients.

As a trainee, I worked in a very diverse trust; one of my training cases, a textbook social anxiety client was an African Caribbean gentleman who described himself as very big and tall.

 'I'm big and tall, so I stand out.'

His social anxiety was only a problem at work, and he often referred to his difficulties with sweating,

'I'm sweating around my face. It glistens; you can see it.'

Now I think about the colour of his skin and the way the sweat might have appeared more noticeably, but I never asked,

'How many people are you seeing like yourself? Not just 'big and tall', 'what about the colour of your skin?'

How did I not ask that question?! I am Asian, Indian, and Punjabi. It means something to me; it's part of my identity. How did I miss a huge part of his cultural identity?!

He didn't mention it because I didn't ask.

What disappoints me is that I didn't ask those questions and that my supervisor never asked anything about his cultural background. I wish I could go back; I would do things so differently. My work would have been much more powerful if I had asked the right questions. It taught me so much about my responsibility as a therapist.

How do your experiences and reflections continue to shape and guide your work?

It is really hard because I feel there's a responsibility placed upon me, that because I'm a woman of colour, developing EDI training, I have all the answers, but I don't. It's really difficult and feels heavy because I know how much people suffer from racial trauma.

I have had my own experience of racism. I remember walking to the sixth form with my folders in my hand. My bag was so full. I remember two men passing me saying,

 "I don't know why you're bothering with your education; we're going to bomb you."

That has stayed with me for a very long time. I often think if they had hurt me, I would not have helped hundreds of people to recover and live fulfilled lives. I know not everybody from the white community wanted to destroy me, but those men represent a part of the community I serve to the best of my ability every single day. It has taken me a long time to realise my worth.              

When I deliver training sessions, I often encounter resistance and witness people who disagree or invalidate people's racial experiences. That's really difficult because even if you have not experienced or felt the same thing, you can still sympathise with those emotions of sadness, anger, or frustration. If this is how therapists treat one another, what are we doing or not doing to our clients?

The importance of a diverse and culturally sensitive workforce

I'm working with someone at the moment, and we speak in her mother tongue to do the therapy at the moment, which is difficult but really valuable. She was referred to me because she wanted somebody from an Asian background, and I'm the only Asian therapist. She had previously had three assessments with white colleagues before coming to me, and in each of those assessments, she'd said similar things to all three of them. But when she spoke to me, it was completely different. She talked about the cultural aspects of her mental health; black magic and superstition. When I asked  why she had never mentioned it to anyone else, She said,

 'I didn't think they'd understand.'

But I wonder if they asked the questions that I asked?

So it comes back to the same thing, a sense of weight and responsibility. Why am I supposed to know? We must increase representation across all modalities in IAPT to give people a choice. CBT is absolutely fantastic, but It's not going to work for everyone, we need to encourage our diverse staff groups to take up specialised training in other evidence-based treatments like EMDR and couples therapy for depression, so we have a more varied group of therapists available to work with our diverse clients.

Final thoughts?

I've got my little piece of paper here; I was having a cup of coffee, thinking, and writing some notes this morning in preparation for our interview. My first little scribble on this piece of paper is

'We have all had the experience of being' other.' Consciously or not. How we understand and bring that experience into the therapy room ultimately shapes our work.'

It's really important that we, as therapists, find space to bring ourselves.

I am very privileged to have worked in such amazing teams, met some great people, and had such fantastic training. I am continuously working very hard to be the best therapist I can be.

We cannot understand the clinical experience of a client without first understanding the human experience.

Kirandeep Chohan, Cognitive Behavioural Psychotherapist.