Authored by Shabari Bhattacharyya, this post provides insights on how one can find a good therapist. Shabari has worked as a mental health practitioner since 2008 in both India and the US. Her expertise lies in counseling and clinical supervision in mental health issues, couples’ counseling and family therapy.

What to Look for in a Mental Health Provider, when Nothing is Clearly Defined

Finding the right therapist/ counselor/ psychiatrist/ psychologist is complicated anywhere, but in India this process becomes even more complicated when mental health practitioners themselves use these terms inconsistently. This particularly becomes a problem as although talk therapy is “just talk”, bad therapy can cause genuine harm. To prevent this harm, the American Counseling Association (ACA) and the American Psychological Association (APA) in the US have very rigid rules for practice that take out much of the guesswork both for mental health practitioners and their clients. Both practitioner and clients understand what to expect and what to do if the rules are not followed.

Common Challenges

Looking for a practitioner in India then takes some luck, which in itself may seem scary. How can we be vulnerable with someone else when we know nothing about them, their training or how they practice? That too, in this scary space which seems murky and opaque in popular media and culture. Most often people looking for help go by word of mouth, and this can work mostly because we tend to interact with people similar to ourselves, and if the practitioner worked for someone we like and trust, perhaps they could work for us as well. As a culture we tend to trust those who are familiar and “known”.  This is coupled with the options in mental health providers who are trained in different aspects of mental health, but there are no clear guidelines on who to go to if we have a genuine problem.

Who are these people who call themselves mental health professionals?

The words therapist, counselor, psychiatrist and psychologist need some definition. In recent news in India, mental health has become a hot button topic. Googling Sushant Singh Rajput’s unfortunate death leads us to understand the confusion about these terms. His therapist spoke out about his mental illness, and this created an uproar on social media. The first question that came up was- what is mental illness and who can diagnose and treat it? The words therapist or counselor are not legally defined in India, they are used loosely to describe anyone who conducts talk therapy, or often anyone who gives advice. Talk therapy may involve some forms of advice, but it is not defined by this. It is a process that is hard to define, by which two people meet as equals and through this process, change can be explored. The process itself starts the therapeutic journey- and does not involve a magic wand or voodoo.

The problem is the process takes time, effort and lots of training to learn. Who has this training? Sushant Singh Rajput’s therapist had a Masters in psychology from the University of London. Did that train her to diagnose and treat him? It’s hard to say without understanding the training program she went through and the kind of supervision she had. This information generally for foreign universities is public record. Anyone can look it up, and understand the training the professional went through. With Indian therapists we have to ask a few more questions, where did they train, and what experience does the person have? Also, what ethical guidelines does the professional follow- in case of dispute (which happens more often than we know) – is the conflict resolution process transparent. Foreign professional organisations can be very prescriptive about what constitutes good therapy- in India there being no professional organisations yet to self-govern, the rules of engagement are left up to the conscience of the individual therapist. 

The term clinical psychologist is legally defined as someone who has at least the equivalent of an MPhil in Clinical psychology in training and is registered with the RCI or Rehabilitation Council of India. A non-clinical psychologist is again not defined clearly. This may change once the Mental Health Act of 2017 is implemented, but as of now mental health practitioners tend to generally use the term “psychologist” but it doesn’t really mean anything without more information.

Out of all of these, psychiatrists seem to be the most clearly defined. They must actually have an MD in psychiatry and be a practicing doctor, but this is where clarity ends. Some psychiatrists do practice talk therapy and some do not. Most will refer patients out for counseling, because they don’t really have time to give each patient the time that counseling takes, but this is not consistent. 

Navigating the system and the rules

Looking for testimonials online can also be difficult. We also have to take into account most therapists feel uncomfortable soliciting testimonials, indeed the ACA prohibits it, so really without an external body establishing minimum guidelines we’re often stuck trusting our friends for referrals, but this is often hit or miss.

During this journey to find help, here are some general rules of engagement in therapy:

1. Your therapist is not there to be your friend, counselling works, but the relationship is quite different. In fact, being both a friend and therapist most often causes harm. Professional boundaries exist for a reason.
2. Rules should be defined before the counseling process begins, including rules regarding confidentiality and payment. 
3. The therapist has a responsibility to be transparent about his or her training and experience, and how that plays out in the therapy process. The therapist is not a magician, there is a science to the process that needs to be explained and that the client has a right to know.

The general reason these rules are followed is to make sure that as practitioners we do not harm our clients, and the client has a right to give informed consent. Within the appropriate therapeutic setting, what happens can sometimes feel like magic.