Why it's crucial that you choose the right mental health practitioner

Till about a year ago, Shweta Gupta, a 28-year-old consultant, would not have considered seeing a therapist because she felt equipped to deal with the issues in her marriage on her own. But a few months ago, Gupta and her partner decided that their increasingly fractious relationship needed some unbiased inputs. They zeroed in on a psychoanalyst and marriage counsellor based in Noida. His consultation fees were steep, but the couple took that as a measure of his credibility. Two sessions in, Gupta realised their choice had been disastrous.

The counsellor was sure that Gupta would someday want kids (“all women do”), that she must put her “feminism aside” if she “wanted to keep her man happy”, that she shouldn’t be a grouch when her husband came home and that he wouldn’t be addressing the “elephant in the room” if he didn’t remark on how “simple” she looked in front of her “obviously better looking” husband. To many it is astonishing that in 2019, in the age of Twitter and Facebook and Google, a highly regarded counsellor in an elite space in a cosmopolitan city could make sweeping gender generalisations — and get away with it. His reviews on aggregator platforms are spotless to the point of being identical; they are clearly not genuine. But no one is suing him.

With the conversation around mental health cracked wide open, there are greater  numbers of people who feel comfortable reaching out for help. But finding the right mental health practitioner, even in urban centres where access is far easier than in smaller towns and villages in India, can itself be an emotional rollercoaster. Even if you were to find a therapist’s details on the internet, how do you know you can trust this person to help you responsibly? It might seem like feeling one’s way through the dark but there are ways to find a mental health practitioner who is right for you.

Before he offers any guidelines for this, Akashdeep Ghoshal, a clinical psychologist who practises at New Delhi’s Moolchand Hospital, wants to distinguish between the various kinds of mental health practitioners. “There are vast differences between a psychiatrist, a clinical psychologist, a social psychologist and a counsellor. Technically, counselling is not a recognised term in mental health and quite unscientific,” he says. “A clinical psychologist will, for instance, use objective tools such as analytical tests to diagnose his or her patient and arrive at a specific psychotherapeutic module,” he explains. A counsellor, he says, will only offer “advice”, which invariably comes loaded with the therapist’s own social context and biases.

Naina Patnaik’s parents chose a therapist for her when she was 15. The moment she settled into the room, the therapist talked to her about her previous patient, a young boy Patnaik had seen leaving when she entered the room. “He’s gay. We’ll cure him,” the therapist told her. Patnaik never went back to that therapist. 

“Psychology students are taught how to behave with patients and how to maintain objectivity at the MPhil level. So one way of determining credibility could be through the education filter,” says Ghoshal. 

But Patnaik, like countless young men and women, now relies on crowd-sourced lists of mental health practitioners. Two of these lists — one curated by mental health organisation iCall and the other by Mahima Kukreja, a Delhi-based writer — have become go-to resources for those seeking therapy, featuring every kind of practitioner from the exclusive and expensive to virtually free organisations such as Delhi’s Sanjivini Society for Mental Health. 

Kunal Singh, a Delhi-based publishing consultant, found two therapists through the iCall list. But before that, he went to a leading hospital in Delhi to seek therapy. “I was told I could consult anyone there and see how it works. That was very bad advice because you don’t see a hospital or their services, you see a specific person who needs to be specially skilled,” says Singh. He chose a therapist from the hospital’s list of psychotherapists. It was entirely unfruitful. “She’d talk over me, check her phone between sessions and sometimes show up with a burger and a soft drink, which she’d eat as if she was in a movie theatre,” he says. She also charged him per 30-minute session. “Thirty-minute sessions are a scam. People take that much time to open up and before you know it, it’s over.” Eventually it led him to Ambedkar University’s Ehsaas, a mental health clinic where fees are based on one’s ability to pay (a regular session costs Rs 250). He found a therapist there, with whom he consulted for several months before his personal context changed.

Singh was able to see that his psychotherapist was unable to handle the changed situation, and decided to switch. “No therapist can solve all problems and most only specialise in some limited issues. Before you begin therapy full-time, you need to have an honest conversation with your therapist about their strengths and work history,” says Singh. This is a safeguard that Singh swears by. 

Be mindful
 

•  Do basic background checks before consulting a mental health practitioner
•  Remember that you may need to consult several therapists before settling on one
• Choose your therapists through a reference,
• if possible
• Check iCALL’s crowd-sourced list of ‘Mental Health Professionals We Can Trust’ and Mahima Kukreja’s list of LGBTQ-friendly mental health professionals for young adults on her Twitter account, @AGirlOfHerWords

Rashi Sinha, psychotherapist at Mind Piper, a mental health practitioners’ collective in Delhi, agrees. “I often feel that therapy is akin to match-making. There are a few filters one can apply, based on the age, the kind of concern, the school of therapy. However, a substantial part of this decision-making lies in the ‘feeling’ — how well the therapeutic relationship is built in the first few sessions,” she says. “If at the end of the first session, the client feels comfortable in the therapeutic space and if I feel competent supporting them, I guess that is where we commit to our alliance,” she adds.

But this openness to change and understanding of nuance has so far been limited 

to a younger, upper-class demographic. “In the urban middle- or upper-middle class, the tendency to see a psychologist first [and not a psychiatrist] is high, and this is the social group that has seen the maximum change in mindset,” observes Archana Sharma, a Delhi-based clinical psychologist. “Your comfort level with your therapist matters greatly, but should not come at the cost of basic qualifications.” For this, the Government of India’s Rehabilitation Council of India (RCI) gives out certifications to trained mental health practitioners. Currently, an MPhil is a requirement for an RCI tag, which excludes an entire gamut of mental health professionals. There is also no regulatory body that oversees the work of mental health professionals, barring those who have the RCI tag.

In such cases, referrals in crowd-sourced lists play a significant role. Kukreja’s list, for instance, is often personally vetted by her and specifically looks at LGBTQ-friendly psychotherapists. “If I hear that someone’s experience with a counsellor was damaging, I immediately take that professional off my list,” she explains. This list was a consequence of her own struggle with clinical depression, which she wrote about on Twitter. “I started getting a lot of messages asking me for referrals and I realised this was a huge need among young adults.” 

Gupta eventually found a therapist who worked for her and her partner. And till there can be better regulatory checks to weed out bad practitioners, the path to therapy is paved with cautious hope.

Some names have been changed on request