While scrolling on social media recently, I came across a post by a psychiatrist explaining attachment styles using Taylor Swift songs. I liked it, which led my Instagram algorithm to suggest similar content by other creators, making me cognisant of just how many “therapy” accounts exist and leaving me wondering if everyone who claims to be a psychotherapist has the required credentials.
A series of studies by McKinsey across the United States indicate that mental health concerns have worsened through the pandemic years, especially for young people between the ages of 16-24. Recent studies in India too, indicate a similar pattern. This upward trend, coupled with the discourse on social media, has led to a surge in demand for mental health practitioners. However, the difference between psychotherapy and counselling is also not well-understood.
Psychiatrist vs Clinical psychologist vs Counselling psychologist
As in the rest of the world, there are three kinds of people involved in mental healthcare in India. A psychiatrist undergoes medical training, is a doctor, and can prescribe medication; a clinical psychologist holds an M Phil in psychology, which entails mandatory supervised internships in clinical setups; and a counsellor or a counselling psychologist has a Master’s degree in psychology with varying specialisations, depending on their training.
Drishti Jaisingh, a clinical psychologist licensed by the Rehabilitation Council of India (RCI), explains: “A clinical psychologist is trained at a hospital set-up, can use diagnostic tools and make assessments and diagnosis, and often collaborates with psychiatrists, but they cannot prescribe medication. Counsellors can only offer support and help navigate emotional and behavioural problems; they cannot prescribe medicines or offer diagnosis.”
Alisha Arora, an RCI-licensed clinical psychologist for 10 years who works with the National Tele Mental Health Program (Tele MANAS, Jharkhand), says that people use the terms ‘therapist’ and ‘counsellor’ interchangeably. “Psychotherapy, using professional treatment methods with clients who have serious mental health concerns, should only be done by people who have the training to do so, that is those who have an M Phil degree in clinical psychology because that provides practitioners with more than 400 hours of supervised training.” However, with poor mental health literacy in the country, many are unaware of this distinction.
Even the nature of the postgraduate courses for obtaining a Master’s degree is not universal across the country. Some training institutions at the postgraduate-level mandate conducting supervised pro-bono therapy sessions before granting a Master’s degree in clinical and counselling psychology, and others include extensive fieldwork and training within their psychology postgraduate courses. Some, however, do not have such requirements. Somya Jain, an RCI-licensed clinical psychologist at VIMHANS, explains, “The problem (in service-delivery) arises when individuals who have only theoretical knowledge start to practice, because they often lack the skill that is required to facilitate a therapeutic dialogue between a therapist and a client.”
Seeking friendly therapists
Given the state of therapy, what are people looking for when seeking a therapist? The vocabulary around mental health is changing with terms like ghosting, bread crumbing, caspering being consistently referenced. Therefore, while choosing a therapist, “some clients need more professionalism, whereas others prioritise relatability with their therapist, so the language the therapist speaks (literally and metaphorically) is often an important criterion,” says Jaisingh. Warmth and empathy are desirable traits in a therapist, and are also stereotypically associated with women, thus making gender another metric for choice.
Divija Bhasin, a counselling psychologist reiterates this idea. “Female therapists who are younger and friendly, with some social media presence, are perceived as being more open-minded and are sought after,” says Bhasin.
Dr. Bhumika Kapoor, an assistant professor of psychology at Delhi University, notes that “social media presence can legitimise a person’s work, even when they are claiming to be practitioners without the right credentials. The quality of service being provided by the professional, therefore, cannot be determined based on social media activity.” She added that there have been “instances of untrained professionals causing more harm and increasing the trauma of an already vulnerable individual, which further disincentivises them from seeking help”.
Priyanka Sharma, a 23-year-old psychology graduate from Delhi University (who is not currently a practitioner), emphasises that it is ideal if therapists publicise the approach they use, instead of stating the issues they deal with, as the latter categorises mental health concerns into buckets, which are not always something individuals the patient can identify for themselves. Tanya Antony, (24, from Delhi) pursuing her doctorate in psychology in Ireland, reiterates this idea and adds that different modalities work for different people, depending on how they want to be understood and perceived.
A shortage of therapists
The demand-supply gap has become more pronounced after the pandemic, but this demand is still more from urban pockets. Dr. Kapoor adds that “sometimes people’s families are not on board (with them seeking therapy), and a lot of times, marginalised groups cannot access services because of financial and social barriers, and so the demand might be even higher (than currently anticipated).”
Arora estimates that India has less than one clinical psychologist for about one lakh people. “No large-scale study or investigation since 2016-17 has comprehensively mapped the existing ratio. But the number of institutes offering M Phil are increasing so in about 6-10 years, we should be able to fill 50-60% of the gap,” she says.
There is no centralised supervising body that oversees the practice of or provides standardisation for all mental health practitioners, though clinical psychologists in India are bound by the Mental Healthcare Act, 2017. The RCI is the commonly known statutory body. However, in case of malpractice, it can only revoke the registrations of people who have been registered in the first place. “A regulatory body can help fix some gaps in the system. A common portal where licensing requirements and credentials of professionals are mentioned not only helps improve accountability but also helps potential therapy seekers get all the required information in one place,” says Dr. Kapoor.
“It is the relationship that heals,” writes renowned therapist Irvin Yalom in his book Love's Executioner. This sentiment is echoed by Raksha Rajesh, an RCI-licensed clinical psychologist. “It is the component of safety within therapeutic relationship that helps clients and therapists build an alliance that facilitates healing. Having a common supervising body then helps practitioners be more accountable,” she adds.
A sense of accountability towards clients helps respect boundaries, and ensure that the therapy or counselling provided is structured in the best interest of the client. In this ecosystem, ensuring therapy seekers are better informed can increase their chances of finding the suitable professional who has the required expertise to help them, and doesn’t just have life experience to offer.
Devika Oberai is a psychology graduate from Delhi University who currently works in the development sector.