I had been working as a therapist on and off for almost 30 years when the trajectory of my life and work abruptly shifted. I’ve worked in a variety of mental health settings through the years and spent a fair bit of time training and supervising therapists in various countries, but most of my clinical work has been in private practice, mostly with affluent professionals.

It isn’t that I haven’t found my work as a therapist satisfying and fulfilling; rather, that I feel replaceable. Many others could do my job with equal (or superior) effectiveness. Sometimes, listening to my privileged clients complain about their troubles, I’ve found it hard to remain compassionate. During other periods, those complaints began to sound like incessant whining and the critical voice inside my head would scream: ‘You’ve got everything anyone would want in life, and still it is not enough for you!’ It took me a while to figure out I was speaking to myself, as much as to my clients.

I stopped practising therapy altogether for a time, concentrating instead on my teaching, research and supervision. I had become burned out and found it difficult to listen to my clients any more. They all began to sound the same. I found it more and more challenging to remain present with them. I became bored not only with them, but also with myself – I was tired of listening to my own stories.

Feeling like a hypocrite, teaching and writing about a profession that I was no longer actively practising, I gradually began selecting new clients very carefully, choosing only to work with those who presented novel or interesting challenges. With a very small practice, I once again found myself energised and intrigued with my work, yet something was still missing.

It had always been one of my life’s dreams to travel to Nepal and trek in the Himalayas. I am an avid hiker, climber, cyclist and adventurer who has used travel as stimulation when my work felt stale and repetitive. None of my experiences of therapy as a client, supervision, workshops or books have ever been able to affect me nearly so dramatically as some of my adventures abroad.1,2 I’ve spent months working in Australia, New Zealand, Iceland, Peru and on Semester at Sea [a shipboard global study programme], and have always returned a profoundly different person from the one who departed. Yet even these experiences did not prepare me for my first visit to South Asia.

One of my doctoral students, Kiran, was an obstetrician in Nepal who was researching childbirth experiences in remote regions. She wanted to learn qualitative research methodology to investigate why her country’s maternal mortality rate is among the highest in the world. Kiran invited me to follow her on her rounds to isolated villages to teach her qualitative interviewing and grounded theory analysis. What a perfect excuse to do some trekking!

The disappeared girls

It was during our visit to a remote village along the Indian border that I first learned about the ‘disappeared’ girls. While Kiran was examining her patients, as the only doctor who ever visited that district a few times each year, I spent time in the school working with the children and teachers. I kept hearing rumours about certain girls who were ‘disappeared’, but couldn’t quite get a handle on what that meant. I asked the school principal, who pointed to a girl of about 12 years old talking with some friends: ‘Do you see that girl? She will be disappeared next.’

I learned that ‘disappeared’ meant that this girl was likely not be around much longer because her family was too poor to keep her in school. All families have to pay for their children to attend public school, and when they have many children and limited resources, they often allow the boys to attend school and keep the girls at home. Since they can’t afford to feed them all, the girls end up being married off as early as age 12; the unfortunate ones are sold and smuggled across the border, where they end up as sex slaves in brothels.

On further investigation, I learned that each year 12,000 Nepali girls end up stolen, kidnapped, or sold into slavery – some as young as eight years old. This was just about the most horrifying thing I’d ever heard.

Imagine standing on the school grounds, staring at a vibrant young girl with tremendous academic potential who lives in such poverty that she has no future other than as a child sex slave. In addition, some Indian men who frequent the brothels of Mumbai are HIV positive and believe that having sex with a virgin will cure their disease. That is why young virgins are in such demand, especially innocent Nepali girls who have no rights or recourse.

I asked the principal how much it would cost to keep this girl in school for a year. He did the mental calculations in his head. ‘Oh, sir, it is very, very expensive. I’d say about 3,000 rupees.’ Three thousand rupees? That’s 50 dollars! The thought that for $50 I could save a girl’s life was irresistible. Without considering the consequences of my action, I reached in my pocket and pulled out some money and put it in the principal’s hand. ‘This is for her. She stays in school. And I’m coming back next year to make sure that she’s OK.’

Walking away from that encounter, it felt like the single most meaningful and important thing I’d ever done in my life. I’d spent the previous decades doing all kinds of things to be helpful to others: volunteering my time to causes, working pro bono for clients who couldn’t afford my services, and working for universities in which the vast majority of my students were minority and first generation immigrants. Yet it always seemed to me that, if I weren’t there, somebody else would be, and could do the job just as well. But in this case, if I didn’t intervene, then nobody else would. Forget the books I’d written and the other lives I’d touched – this was what mattered most. I couldn’t believe that for $50, for the cost of a good meal, I’d just saved a girl’s life.

Educating women

I had no idea when I reached in my pocket and pulled out a bit of money how this would change my life, my commitments, my priorities, my very life path. I went home soon after and resumed my usual duties – teaching students, seeing a few clients, writing more books about therapy – but I frequently found myself thinking about the girl and wondering how she was doing. Since she lived in a place without electricity, without even an address that could receive mail, the only way I could check on her was to return to her village. I immediately made plans to do so, and discussed with Kiran ways we might identify other academically gifted girls who were at greatest risk of being sold.

Kiran’s research study was groundbreaking; it revolutionised obstetric care in Southern Nepal.3 She discovered from her interviews that so many women were dying in childbirth not only because 90 per cent of the country had no access to healthcare whatsoever, but also because, even when it was available, women refused to avail themselves of the services. One reason was that lower-caste women were treated like animals by the male doctors, who humiliated them, touched their private parts and put ‘snakes in their arms’. The latter refers to inserting intravenous tubes without explaining what they were for – or, for that matter, without talking to the patients at all. The few women who did go to the hospital for complicated pregnancies returned to their villages and warned their neighbours never to go to that place where they were treated so poorly.

Kiran and I decided to pool our own funds to support more girls in school. For a few hundred dollars each year, we could provide scholarships for a handful of other girls. I began thinking about all the superfluous indulgences on which I fritter away money: $50 for a good meal – that’s the cost of a girl’s life; $150 for a pair of shoes I don’t really need – that’s three girls who could be saved; $500 for a new chair – that’s 10 girls! It wasn’t so much guilt that was motivating me as a new-found understanding of ways I could spend my own money and time.

The next year, I returned to Nepal to check on the girl and distribute scholarships to three other girls in her village. The year after that we expanded to another village, then another, then another, each in a different district. Before we knew it, we were supporting dozens of lower-caste girls, all of whom had great potential but few resources. Kiran and I had this audacious vision that we might grow the next generation of women doctors who could save other women at risk.

So far we had funded our project solely from our own pockets; we had no paperwork to keep track of and no bureaucracy. We knew each of our girls personally and could monitor their progress carefully, and make sure that all funds were spent solely to support them. In a region where corruption was so rampant, we wanted to be as careful as possible with how our money was spent.

Friends, colleagues, family members and students learned about what I was doing and asked if they could help. I began to collect donations that made it possible to double, then triple the number of girls we were helping – 20 the next year, then 60, and now well over 300 children in nine villages around the country. It became necessary to register as a charitable organisation in the US, as well as in Nepal. But I was still determined that we would remain solely volunteers. We would have minimal overheads, no office, no paid staff, so that almost all of the donations would go directly to support the girls.

Around this time, someone who had been thinking about making a donation said, ‘How do I know what happens to this money? I’ve never heard of you. How do I know that the money goes where you said it will?’ I suppose there is a theme of impulsivity that runs throughout my story, because my immediate response was: ‘Why don’t you come with us on the next trip and see for yourself? Why don’t you meet the girls and their families yourself and see what is happening? That way, you can act as a witness for anyone else who wonders about what is really going on.’ That’s how the next stage of this project evolved into a kind of reciprocal exchange process, in which our volunteers have been affected almost as much as our girls.

Helping and being helped

As a psychologist, I’ve long been frustrated by how long it sometimes takes therapy to work, and how the effects are often short-lived. I’ve long had fantasies of being a travel agent, planning trips for people that would transform them dramatically in a relatively short period of time – with enduring effects. As I mentioned earlier, such travel experiences have been the most powerful change experiences in my own life. I wanted to design experiences for our volunteers that not only maximised their commitment to our cause but also exposed them to the kinds of things that have been so influential in my life.

It is just amazing to spend time with people who, even though they have so little (most don’t even have shoes and eat one meal a day), are so spectacularly happy. I don’t mean to over-idealise their plight, but so many Nepalese people we meet along the way greet us with ‘Namaste’ and the most glorious smiles you can imagine. They have nothing except the clothes on their backs, but their Buddhist/Hindu beliefs guide them to appreciate whatever small gifts life might offer them. It is both exhilarating and disturbing to encounter people who have so little and yet appear so content, especially for those of us who have so much and always hunger for more. Team members often return from our visits completely disoriented about what they have discovered and determined to put into practice what they have learned from our children. I have long been a fan of the idea that our clients are our best teachers, and so it has been with our scholarship children and their families: they help us as much as we help them.

It has now been 13 years since we began our project. Our very first girl is the first in her village to pursue higher education. She received a full scholarship to attend an elite university, and has been followed by dozens of others. It just amazes me what is possible with such (relatively) little money and effort. Yet if I’ve made this enterprise sound like an easy, fun adventure, I’ve left a lot out. What began as a lark, an impulsive gesture, has now taken over my life.

It’s easy to launch a service project: it really is as simple as finding somewhere to make a difference. But, alas, the follow-through is the killer. All these lives now hang in the balance of my being able to continue raising money and recruiting volunteers. There are so many other girls who need help, and I sometimes feel so frustrated that I can’t do nearly as much as I want.

I face many other problems that are so overwhelming and dispiriting. I’ve taken more than 100 team members with me over the years, but less than a handful have stuck with the project after they return. Most carry on with their lives, perhaps haunted by what they’ve seen but not enough to keep them involved. Meanwhile, all those girls who once cost $50 per year to support in school now cost $125; those entering university or medical school cost several thousand dollars each per year. Where will I find the money to support so many children? How can I recruit more help as we continue to expand?

Then there are the logistical and physical problems with which I must frequently contend. It takes three planes, a bus trip and several days’ walk in the Himalayas to get to some of our villages. Last year it took me seven weeks just to visit all our girls, who are spread across the country. In some cases, it took me a week to get to a village and return.

The cultural misunderstandings and political shenanigans I experience are exhausting. After all, we are attempting to change the culture of the country so that girls become more valued and are afforded opportunities that are ordinarily closed to them. I have to rely on my Nepalese partners to implement our strategies, but often a lot is lost in translation. We are constantly battling an entrenched system in which the village elders, all men, resent the fact that we are assisting lower-caste ‘untouchable’ girls. Why aren’t we helping the Brahman boys, the highest caste? Many of them need help too.

Exhilarating and exhausting

The money our organisation provides to support the education of at-risk girls in Nepal is crucial to their survival and welfare, but the relationships we develop with each of the girls and their families are just as important. Most of the girls never dreamed that they could ever do anything other than be a wife and mother until they met professional women from around the world, who showed them what was possible. Most of our volunteers and team members never dreamed it was possible to be so happy and content with life while having so little. We come home from our visits to Nepal determined to devote ourselves to things that matter so much more than mere ambition and achievement – friendships, family, creative pursuits and, yes, service to others.

Although I still do therapy on a small scale, and continue my work as a professor, supervisor and researcher, I now think of my main job as advocating for girls in Nepal. I still find the visits there to be exhilarating, but also exhausting and overwhelming. I make time to go trekking each trip – I’m still in love with the mountains. And one of my favourite things in life is to bring friends and colleagues with me to meet the wonderful children and experience the Himalayas up close.

It has been fascinating to use my skills as a therapist to make a difference on a larger (or at least a different) scale, and I am aware that throwing money at causes is not nearly enough without adequate and ongoing support, outcome evaluation and personal contact. Based on what we know and understand about systemic change, our teams visit the homes of every one of our girls to honour them in front of their families and neighbours. We’ve been concerned that, once we leave, our financial support alone won’t be enough to sustain the children in an environment that is less than encouraging. Our public ceremonies mean that the families would lose too much face if they married off or sold their daughters: even though they are at the bottom of the caste system, being selected as scholars with great potential gives the girls a certain status. Many of the places we visit have never had visitors from abroad before, and our donors and volunteers come from all over the world.

All of this began with just one girl who needed help. It is truly amazing what you can do once you get out into your own community – or to other parts of the world. There is an ancient Jewish saying: by saving one life, you save the world. I truly believe that’s also how we save ourselves.

Jeffrey Kottler, PhD, is Professor of Counselling at California State University, Fullerton, and the author of over 80 books. He is the founder and CEO of the Empower Nepali Girls Foundation. For further details, visit www.empowernepaligirls.org

© Copyright (2013). Abridged from ‘The power of transcendent empathy: empowering lower-caste girls in Nepal’, by Jeffrey A Kottler, in: Helping beyond the 50-minute hour: therapists involved in meaningful social action, edited by Jeffrey A Kottler, Matt Englar-Carlson, and Jon Carlson. Reproduced by permission of Routledge, Taylor and Francis Group, LLC, a division of Informa plc.


1. Kottler JA. Travel that can change your life. San Francisco: Jossey-Bass; 1997.
2. Kottler JA, Marriner M. Changing people’s lives while transforming your own: paths to social justice and global human rights. New York: Wiley; 2009.
3. Regmi K, Kottler J. An epidemiologist learns grounded theory. In: Minichiello V, Kottler K (eds). Qualitative journeys: student and mentor experiences with research. Thousand Oaks, CA: Sage; 2009 (pp71–88).