Why I can’t find the right therapist

“The first session went horribly wrong,” recalls the 26-year-old public relations professional from Bengaluru, who did not want to reveal her identity. She had sought psychotherapy—an approach to treat mental health issues by talking to a psychologist—last July. She was dealing with personal issues, which were affecting her work and her social life as well.

A friend recommended MindPeers, an app that offered online and phone therapy sessions, and with over 100 experts to choose from. She found the price “reasonable” and made an initial booking for six sessions.

After putting down the issues she was going through on the app, the woman was assigned a therapist based on those inputs. The therapist, she says, was a disappointment from the outset, even yawning as she shared her experiences. Disappointed, the PR executive chose a different therapist based on ratings and reviews on the app. While the next one was better, the woman realized she needed much more.

“The second therapist just listened and talked to me, like a friend would, but never offered any solution to address my issues and triggers,” she says. Finally, after 12 sessions over six months, she decided to discontinue the therapy with MindPeers, in January.

In February, she connected with another therapist elsewhere, and so far, it’s been going well. “My current issues could be related to my past, and she (the new therapist) kind of unknots things for me,” she says.

Experts say that the number of people who have started looking for therapy in recent years has surged. Thanks to this demand, there has also been a proliferation in the number of professionals offering therapy. Several platforms, such as MindPeers and MindTribe, have also come up to connect clients with a pool of therapists. However, the therapy seekers, especially first-timers, are unable to separate the wheat from the chaff. Indeed, some of the therapists, who lack training and experience, may be doing more harm than good.

Many lose trust in the fraternity after an unpleasant experience, and their subsequent therapists have to work harder. “People come with a broken faith in therapy, and building trust with them takes far longer than with someone who has never taken therapy,” says Vartika Modi, a clinical psychologist in Kolkata, who has over 10 years’ experience in the field.

A silent crisis

To say that India is facing a mental health crisis today would be an understatement. Almost a decade ago, in 2015-16, a National Mental Health Survey, conducted by the National Institute of Mental Health and Neuro Sciences (Nimhans), Bengaluru, estimated that 13.7% of Indians aged 18 years or above — roughly 150 million people — suffered from common to severe mental disorders at some point in their life. Roughly 83% of them did not receive any or adequate treatment. While there is no recent study readily available, it is safe to assume that the numbers have only grown since Nimhans released its report, particularly in the wake of the havoc wrought by covid.

Meanwhile, the number of people taking their own lives is also going up with each year. In 2017, there were 9.9 deaths by suicides per lakh people in India. In 2021, that had risen to 12 per lakh or 164,033 people in absolute terms.

Psychotherapists play a critical role in helping people overcome their mental issues. There are essentially two kinds of psychotherapists operating in India today: clinical psychologists (who deal with disorders, disabilities, illness and substance abuse), and counselling psychologists (who deal with everyday relationship problems, career or emotional management issues). The first lot is regulated, while the second kind, which is mushrooming today, isn’t.

Lack of regulation apart, counselling psychology has no standard curriculum and training varies from college to college. Experts say that those pursuing a master’s degree, in a few colleges, will receive practical therapy training to an extent, but there is virtually no training or supervision in a bachelor’s course.

While there is no official estimate of the number of counselling psychologists or counsellors practicing in India, it is likely several times higher than that of clinical psychologists, who are few in number.

A cut above

To practice clinical psychology, one needs to be registered with the Rehabilitation Council of India (RCI), a statutory body that is supposed to regulate and monitor services offered to persons with disabilities, standardize courses, and maintain a record of professionals.

The required qualification for clinical psychologists, according to the RCI, is a two-year master’s in philosophy (MPhil, the most common qualification among professionals); a one-year professional diploma; or a four-year doctor of psychology (PsyD) degree in clinical psychology, which ensures a certain level of practical training as part of the course.

Clinical psychologists, during their MPhil, PsyD or professional diploma coursework, receive mandatory training in therapy for a minimum number of hours or cases. They are supposed to work at clinics and hospitals on real-life cases. However, as of today, only 2,712 clinical psychologists are registered with the RCI, and only 51 institutions are licensed to offer these courses.

Thus, unlike counselling psychologists, clinical psychologists have rigorous course and supervision requirements to deal with the cases ranging from disorders to abuse. In fact, many clinical psychologists receive their initial training at psychiatry clinics or hospitals, where they closely work with psychiatrists. (Psychiatrists, whose practice is governed by the National Medical Commission, are medical doctors specializing in mental health—and can prescribe medicines to treat mental or substance use disorders.)

“Clinical psychologists, with their training, can diagnose what is going on beneath symptoms and suggest a course of treatment,” says Modi.

John Victor, a clinical psychologist with over 15 years’ experience and founder of Reevin, a mental health startup, echoes her thoughts. “If you are feeling low, it could be because of anything. We need to understand the underlying issues, and that requires expertise,” he says.

Slaves to the market

Both Modi and Victor, however, acknowledge that there is space for counselling psychologists given the demand in India. However, training and supervision are critical, but as of now, they are completely at the discretion of the market in the absence of a regulatory framework.

In the US, a counselling psychologist needs to acquire a licence to practice. Licensure requires a doctorate in most states, and a master’s with extensive supervised experience in others. In India, a vast number of counsellors are fresh master’s degree holders or at times have a bachelor’s degree, without any significant supervised therapy experience.

MindPeers, for instance, has several counselling psychologists who were hired right after their master’s, going by their LinkedIn profiles. The website shows “one-two years of experience” for all such hires. However, it’s not clear what kind of supervision they went through before offering therapy on their own. MindPeers did not respond to Mint’s queries on its process of training and supervision.

MindTribe has at least two therapists hired after their bachelor’s or post-graduate diploma. Asked if a bachelor’s degree was sufficient to start offering therapy, the company responded, “In our experience, to be a successful therapist, one requires a combination of knowledge, skills, and personal qualities such as communication, critical thinking, empathy, and so on. Each individual is hired based on their skills, and exceptional candidates meeting these criteria are hired even if they only have a bachelor’s degree.”

Carmiline Rebello, one such therapist with MindTribe, says that when she started at MindTribe, she was given training for almost two months by experienced psychologists on a daily basis. “In addition, I have daily meetings for almost one hour with the co-founder to discuss and work on new research presentations, workshop activities, group therapy, and case discussions with the entire team to generate an idea pool with actionable steps,” she adds.

At Reevin, Victor hires therapists with a master’s in psychology for training. “They first go through 55 days of classroom training in counselling skills, cognitive behavioural therapy, positive psychology interventions, and so on. We then make them go through practice sessions, recording sessions, or simple cases with no psychopathology,” he says. In each batch, out of 20-30 people who are trained, only one-two are hired, he claims.

“Even after they are hired, they continue to work under supervision. Every week, we organize a three-hour session, where all the counselling psychologists anonymously present their cases, and are provided guidance on their approach. Senior psychologists at times work with them on specific cases. If a case is too difficult, we even take over from them,” he adds.

The cost factor

Demand only partly explains the proliferation of counselling psychologists. The other reason is their low cost.

“Employing a clinical psychologist is quite costly. They will not work with you unless you pay ₹1 lakh a month,” says Victor. Master’s students, on the other hand, can be hired for ₹15,000-20,000. At Reevin, they are not paid salaries but earn through their sessions, he clarifies.

An experienced clinical psychologist would typically charge anywhere between ₹1,500 to ₹3,500 for a session of 45 to 60 minutes. But a young counselling psychologist can be as cheap as ₹350-500 per session. The PR executive cited at the beginning paid ₹350- ₹400 per session with MindPeers, whereas her new therapist charges ₹1,300 per session. While she is feeling the pinch, her prior experience has made her wary of cheap options.

Yash Batra, a 27-year-old entrepreneur based in Gwalior, says he, too, had a “strange” interaction with a therapist at MindPeers last September. He went for it because it was cheap, at around ₹300 per session. The therapist, he says, was dining while talking to him, and her mother could be heard shouting from another part of the room. At one point, the therapist even enquired about his caste, and whether he was a Punjabi. “That’s when I realized why good therapists charge more,” he says.

But that is not to say that expensive therapy will necessarily be good. Satvik Bhasin, an undergraduate student at Drexel University in the US, started seeking therapy towards the end of 2020. He was in the middle of therapy with a PsyD from the campus—which, he says, was a great experience—but had to return to India in December 2020 amid the pandemic. Unfortunately, he could not continue the therapy in the US because of jurisdiction issues.

Among many therapists he tried in India, there was one at a “big” hospital in Gurugram who charged ₹3,500. Bhasin had to wait for two hours. “The therapist was sitting there wearing a white coat, with a sheet of paper. She kept writing throughout the session while I talked. All I got at the end was a summary of what I had spoken.” With the travel, wait time and cost, it did not feel useful at all, he adds.

Malpractices galore

Bhasin matched with one more therapist during his stay in India, who offered logotherapy (a form of psychotherapy that focuses on helping clients find meaning in life) online. “It seemed like he was reading off something during our hour-long Zoom session.” He wanted to know all about my sexual experiences, in detail, even if it was not relevant to what was causing my distress,” he adds. At the end of the session, the therapist became transactional and offered to “solve” his problems in certain number of sessions. Of course, for a price.

Promises of solving a mental health problem in a fixed number of sessions are mis-selling, say experts. “Many people with just a diploma or a certificate are picking up a niche, say, anxiety disorders. They claim that they can cure your anxiety in 20 days, which is impossible,” says Modi.

Batra narrates a “funny” encounter he had with a “renowned” senior therapist in Gurugram in 2019. When he walked into the room, there was one more person, apart from the therapist, sitting there. He was not informed about this in advance and felt uncomfortable revealing his issues. The therapist reminded him that “he has come far in his life” and advised him to “stay positive and motivated”.

Whether it is clinical or counselling psychologists, there is clearly room for improvement on both sides. Qualification and experience are no guarantee of appropriate etiquette or desirable outcomes.