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The key role of therapy is to create a holding environment, functioning as a ‘container’ for clients’ thoughts and feelings, and reflecting them back in a comprehensible and constructive way. A healthy holding environment relies on appropriate relational boundaries, which help maintain a professional therapeutic space, avoiding personal entanglements and ensuring clarity in group settings. Therapists spend years in supervision to master these boundary-setting skills.
This leads to the important question: Can we establish a robust holding environment within mental health programs in low- and middle-income countries (LMICs)?
Given the scarcity of professionally trained therapists, creating strong holding environments in LMICs is challenging. The consensus is that expanding mental health programs will involve task-shifting responsibilities to local healthcare providers. The World Health Organization (WHO) has published various manuals highlighting the significance of task-shifting, including Group IPT and Self-Help+. However, these methods often neglect exercises that foster group cohesion, essential for evolving a supportive holding environment.
Incorporating task-shifting effectively will require training local staff to facilitate group dynamics, ensuring they can create a space that reflects and nurtures client experiences. This necessitates a shift in focus toward developing skills that help build group cohesiveness and emotional safety, which are critical elements of a holding environment.
While task-shifting presents potential benefits, it also poses significant challenges. Local providers may lack the extensive training of professional therapists, which can hinder their ability to manage complex group dynamics and maintain the necessary boundaries. To mitigate these issues, targeted training programs should be developed to enhance the skills of local staff in fostering a safe and cohesive therapeutic environment. L2T’s platform and protocol supports local therapists by giving them tools to create audio instructions that explains how to follow three simple steps, giving them space to build skills in leading groups.
Moreover, community involvement can strengthen the effectiveness of mental health programs. By engaging community members in the creation of supportive networks, mental health services can tap into existing social structures, facilitating acceptance and reducing stigma around mental health.
In summary, while establishing a robust holding environment within LMIC mental health programs presents challenges due to the scarcity of trained therapists, embracing task-shifting and focusing on community involvement can enhance the development of effective support systems. Through targeted training and fostering group cohesion, programs can create environments that nurture clients’ emotional and psychological needs, ultimately leading to better outcomes in mental health care.
