Call for Participation – ENACT (Enhancing Assessment of Common Therapeutic factors) scale

Dear All,

We are looking for some participants to score the counseling sessions using the ENACT (Enhancing Assessment of Common Therapeutic factors) guidelines that helps to evaluate the set of 18 different skills often used by mental health professionals. The eligibility for participation is MA/PGDPC (psychology) with some experience in counseling practice. We need around 4-5 raters for rating the audio/video recordings. We also see the possibility of collaboration for sharing authorship on articles/papers about it.

The participants will be provided audio/video recordings of the sessions. Some financial incentive is provisioned for compensating the time used for participation in this task. The payment rate would be around Nrs 200 – 250 (tax deductible) for each recording. The average length of the recording is 10 minutes.

Kindly find attached herewith a paper and guidelines that need to be studied before participating. Interested candidates can contact directly Sauharda Rai ( who is the focal person for this study.

With Best Regards,

On behalf of the study team –
Sujen Man Maharjan

ENACT Scoring Guidelines for raters_Aug 2015_edited version.docx

Living with Ambiguity

“I wanted a perfect ending. Now I’ve learned, the hard way, that some poems don’t rhyme, and some stories don’t have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next. Delicious Ambiguity.”
Gilda Radner

mother showing a pic of her sonA mother of missing showing the photo of her son that she carries all the time hoping to find him some day.

Life surprises us with ambiguities of many sorts. Not all ambiguities are delicious in nature. Some are very painful and long lasting. Some, of course, might be exciting, temporary and teach us lessons in life. Being able to accept and live with ambiguity can be a great strength.

The ambiguity of loss is one of the most painful and difficult ones to deal with as it is unclear and ones who are facing them swing between hope and despair most of the times. Hundreds of thousands of relatives around the world are living with ambiguity about the state of their loved ones whom they have lost due to armed conflict, natural disasters, accidents, migration, etc. On International Day of the Disappeared, marked every year on August 30, missing persons are publicly remembered and solidarity is strongly expressed to the families for their right to know the fate of their loved ones.

Psychologist Pauline Boss calls the phenomenon of living with ambiguity of loss when a person is physically absent but psychologically present as ‘Leaving without Good Bye’. Family members are often hopeful of their return some day or at least finding out what actually happened to them even after decades of disappearance.

In Nepal, around 1350 people are still missing from the time of people’s war (1996-2006). Families are still searching for the answers about the fate of their loved ones. Parents hope to see their children back to support them in an old age, wives still believe themselves to be married and not-widows, and children are equally ambivalent about the status of their missing father/mother. Wives pray and do fasting for their husbands’ longevity on the occasion of teej and other religious occasions although they do not know where they are. In case of missing from other phenomenon such as natural disasters, accidents, and migration, families presume such people to be dead after certain period of time, then, they carry out certain final life-cycle rituals according to their cultures & religions and they move on with their lives. For ones missing in relation to armed conflict, there is no basis for performing the final rituals as it could be seen as betrayal and abandonment of hope so, the ambiguity is stronger and long-term. The closure is not attainable as it occurs in normal circumstances which is often expected by the society.

Families remain confused and in dilemma. People cannot make sense of what is happening and cannot find the meaning or get the sense of coherence. Without meaning and coherence, they can’t find hope to move forward in their lives. As a result, both coping mechanisms and grieving processes are immobilized. These are the effects of the ambiguous loss which cannot be judged as pathological as clinicians might view it as some of the effects look like the symptoms of PTSD, depression, and anxiety. However, the risk of developing clinical pathology must not be undermined in the long run. The impact and results of support programs for the families have shown that community-based and local approaches are better than the clinical interventions such as individual counseling/therapy. The interventions that reinforces the new relationships and social network, and that focuses on utilizing their own resilience & resources and developing tolerance for ambiguity have found out to be effective in terms of mental health and psychosocial support.

Living with ambiguity is difficult but developing tolerance can become great strength in this ever-changing world around us. Lack of closure and not knowing can be embraced gracefully.


Psychological First Aid and Art Therapy


Dear Friends,

The Art2Healing Project is coming back to Nepal soon to facilitate a Psychological First Aid and Art Therapy Program.

Please, find below the message about the training that is happening in Kathmandu on 26th August – 8th September. If you are interested to participate, then, kindly contact local project coordinator, Hira Dahal, at, for confirmation.

More details in the attached invitation letter.



Psychological First Aid Invite.pdf

3 months on: What is the status of mental health and psychosocial support in Nepal?

IMG_5546Three months ago, the mega earthquakes hit Nepal on April 25 & 26 followed by another big one on May 12. According to Nepal government official report, over 8844 people lost their lives, over 22000 were injured, over 150 went missing and hundreds of thousands lost their homes and property in the aftermath of the disaster. In addition to physical impacts, there has been invisible but significant mental health and psychosocial consequences as well. Fortunately, from worldwide research, we know that while people experience acute stress and ongoing fear and uncertainty due to recurring aftershocks, the majority of people will recover naturally over time. That said, we must not ignore others who will need longer term care and support to restore their psychological well-being. Even if only 1% of the 8 million people who experienced the earthquake have ongoing psychological distress, that means at least 80,000 people will be in need of psychosocial and mental health services.

According to the World Health Organization (WHO), during the emergencies such as natural disasters, diagnosable mental health problems increase at least temporarily. Estimates vary, but the WHO suggests that serious mental disorders (e.g. psychosis, severe depression, anxiety and trauma) may increase between 2-3% to 3-4%, whilst mild and moderate problems may increase from 10% to as much as 15-20% of the total population—an estimated 8 lakh of Nepali men, women, and children. However, such numbers need to interpreted with extreme caution because as of now, there are no published data yet regarding the incidence and prevalence of the psychosocial and mental health problems. Comprehensive data will come later as projects start with baseline assessment before their interventions.

In an article published in national daily, Dr. Brandon Kohrt emphasizes that earthquake survivors who maintain and strengthen social bonds are less likely to develop PTSD contrary to widespread assumption that the majority of the population who experienced the disaster will be traumatised. It was concerning how the media and even some professionals were expressing the views that most survivors will develop PTSD and psychologists from other countries took interest for the PTSD treatment based on such reports.

Psychologist Alessandra Pigni from the University of Oxford wrote “Psychologists stay home: Nepal doesn’t need you” based on her experiences in humanitarian aid and reminded Western experts/well-wishers that affected populations are resilient and pathologising suffering and immediate reactions after a traumatic event will hinder the process of healing and recovery. Well-aware of that fact, she decided to stay back home and turned down the offer to go to Haiti mission following the earthquakes in 2010. Research has shown that forced counseling, specifically Critical Incident Stress Debriefing, will help little and may even be harmful because survivors need to go through the natural grieving process and the vast majority will not develop PTSD, nor any other psychological disorder. Psychological first aid and community based psychosocial support are suggested to be more helpful because they build on existing social support and positive coping mechanisms without forcing survivors to recount their traumatic experiences. IMG_6102

American Psychological Association (APA) made their position clear on what could be the role of the US psychologists in response to the international disasters. “The statement cautioned U.S. psychologists against travelling to a disaster-affected country unless they were invited, experienced, worked from a public health or community perspective, and were prepared to provide program support, not direct interventions. The statement also cautioned psychologists to know about and follow internationally-developed guidelines and standards for disaster relief”, Merry Bullock, senior director of APA’s Office of International Affairs said. It gave important messages for psychologists from other countries as well who are interested to come to Nepal to support earthquake survivors. As she mentions, psychologists can contribute to sustainable recovery through research on disaster response, recovery and preparation by lending their expertise to training/educational efforts, and not being involved in interventions without adequate information about context and needs of the people. Meaningful participation of local partners, community and beneficiaries is crucial for sustained psychosocial recovery process. Professor Jamie Hacker Hughes, President of the British Psychological Society, also made a statement following the second earthquake in Nepal and emphasized that support for basic needs come first and a need for more MHPSS support for individuals and groups come later.

In order to better organize the disaster relief efforts at district and national level, the UN cluster approach came into effect and two clusters are active in the MHPSS response: the Psychosocial Support sub-cluster under the Protection cluster and the Mental Health sub-cluster under Health cluster. The Psychosocial Support Technical Working Group has been formed to coordinate and share the information among organizations and professionals. This group has created and shared the draft work plan for mental health and psychosocial support (MHPSS) projects for better coordination and to prevent duplication by following Inter-Agency Standing Committee (IASC) guidelines which has been contextualized and implemented locally. It has targeted for five major outputs: coordination among project partners, provision of psychological first aid, provision of counseling services to vulnerable groups, provision of specialized mental health & psychological services and awareness raising on psychosocial support through mass media by implementing various activities.

Two documents were produced rapidly after the earthquakes to help guide MHPSS services. The International Medical Corps (IMC) produced a rapid MHPSS situational assessment. A desk review of research on culture, context, and care for MHPSS in Nepal was completed on behalf of the Inter Agency Standing Committee (IASC) Reference Group for MHPSS in Emergency Settings. These tools help humanitarian actors in proper needs assessment and understanding the local context and culture to carry out the support programs. As of latest update available online, over 20 organizations are actively working in the 14 most affected districts of Nepal and over 86 psychosocial counselors and psychologists have been deployed in field to assist the affected people at local level. The Ministry of Health and PopulatioIMG_6006n in coordination with WHO and Transcultural Psychosocial Organization Nepal (TPO Nepal) conducted an mhGAP Humanitarian Intervention Guide (mhGAP-HIG) training of trainers and supervisors for Nepali psychiatrists who will be deployed for trainings in the most affected districts. They will train MBBS doctors and other primary care workers in diagnosing, treating and referring the people with psychosocial problems and mental illness. One major goal of this program is to prevent inappropriate use of medications that may hamper social recovery processes.

Nepali psychologists have created online groups to share information, organize events for trainings and workshops and provide professional support. Nepalese Psychology Network (NEPsychNet) was also active in sharing messages online and linking up psychologists from NATAN (Israeli Humanitarian organization) to CPSSC (academic institute) to organize two workshops for professionals. NEPsychNet in collaboration with Claudia Van Zuiden organized solution-focused supervision workshops to support counselors who are helping survivors to maintain and to support their own mental health and well-being while being involved in their work. In addition, a telephone hotline for psychosocial support and referrals has been established for toll-free telephone calls within Nepal (phone number: 16600102005). Several websites, blogs, articles, TV interviews, media messages have also helped the public to understand the psychological impact of the disaster and how to cope with it.

Three months on, Nepalese are getting back to their regular business. No doubt the earthquake left behind much damages and ruins but Nepalese are optimistic that it is also an opportunity to rebuild better.  Now, the people are paying close attention to the new constitution that the political parties have promised to promulgate soon that will hopefully end the structural inequalities and discrimination and prevent people from being more vulnerable when such disasters hit.

Note: I would like to thank Dr. Brandon Kohrt for reviewing this post. Please, follow the links for attached reference materials and readings. IMG_5997-0