Earlier this year, Neeta Sethia, a media professional, was battling marital issues and sought professional help. However, after six sessions with her therapist, she realized that her issues were only aggravating as old wounds were being ripped open during the sessions, leaving her irate and hopeless. What was worse was that the therapist was unable to help her deal with the wounds and simply asked her to “let it go” and focus on matters at hand. “When you are seeing a therapist, you are bound to revisit your unresolved issues, which will bring back the hurt and anger that was repressed. Not knowing how to channelize it or letting it go pushes the person deeper into depression and self-criticism,” she says.
Sethia’s case isn’t the only one where someone has regretted their choice of therapist. Saket Doshi, an engineer who is dealing with borderline personality disorder, approached a therapist recommended by an acquaintance but stopped going for sessions after experiencing unprofessionalism on the therapist’s part. “The therapist was rude and would not entertain me for a minute beyond the stipulated time. She would also not address the issue seriously, she would be a passive listener without giving much insight into the problem being discussed," says Doshi. He also says there was typically no follow-up on the client’s well-being, even if they missed sessions.
While mental health awareness is on the rise, leading to an increasing demand for mental health professionals, the supply isn’t enough, leading to a dearth of good, qualified therapists. This has led to the space being occupied by shamans, soothsayers, "life coaches" and self-declared therapists—all of whom are not mental health workers and are not qualified to deal with mental health problems.
While there is no set standard for a client-therapist match, there are some basic points and tell-tale signs of a good therapist that one can look out for or assess.
Understand Who To Approach For Your Problems
A psychiatrist is a doctor who specializes in the diagnosis and treatment of mental health issues. They have a medical licence and can prescribe medication. A psychologist, however, does not have a medical degree and is not a “doctor”. They may hold a doctoral degree in psychology and are trained in counselling, psychotherapy (“talk” therapy) and psychological assessment/testing.
It may always be best practice to approach a psychiatrist first as they are trained to provide both diagnosis and medication. Shefali Batra, senior consultant psychiatrist and therapist and founder of Mindframes, a mental health practice, explains: “The reason why I suggest approaching a psychiatrist to begin with is for a definite initial evaluation to rule out medical causes of the symptoms too. Common conditions like sleep deprivation, caffeine intake, food allergies, or medical conditions like diabetes, hypertension, thyroid states, imminent immunology concerns, any and everything in the body can give rise to associated psychological turmoil and have biological predispositions too.” The treatment plan could involve medication, therapy, lifestyle change, social intervention, work-life balance and a holistic approach that you could work on once you know what you are dealing with.
A psychiatrist will then refer you to a psychologist or a counsellor depending on your diagnosis for regular counselling and therapy sessions.
On the other hand, for non-clinical issues such as relationship problems, family issues, marital issues or career counselling, one can directly approach a therapist without meeting a psychiatrist first.
Search The Right Resource Pools
Panna Rele, a psychologist with the Institute For Psychological Health (IPH), believes that finding a therapist takes some research, patience as well as intuition. She adds, “A referral coming from a reliable source is better; helps to build some level of trust even before the first session.” Sayli Agashe, a clinical psychologist and lecturer at Sassoon General Hospital and Maharashtra Institute of Mental Health, recommends looking up legitimate websites such as that of the Rehabilitation Council of India (RCI), which has a list of registered clinical psychologists. “The website of the Indian Association Of Clinical Psychologists has a comprehensive list of clinical psychologists and therapists as well,” she says. When it comes to psychiatrists, hospitals usually have a psychiatric ward/department with qualified professionals who can be approached.
Double-check The Qualifications
The bare minimum qualification that any therapist must have is a master’s in psychology, accompanied by a diploma or a certification in the therapy technique they practise. In the case of a clinical psychologist, the practitioner must have an MA in psychology along with an M.Phil and RCI expand recognition. A psychiatrist has a medical background with an MBBS and MD in psychiatry.
Make Sure Their Working Style Is Professional
Rajendra Barve, a psychiatrist with over three decades of experience, throws light on the process of therapy and the working style of a therapist. “A good therapist will draw up a clear road map, give regular assignments/homework and have pre-determined markers to gauge progress. Timelines are given and things are put on paper. They will ask the patient to be involved in the process and create milestones. Primarily, a good therapist will help you help yourself better.” A therapist does not just treat the current symptoms but delves into the root cause and helps you heal from within, therefore looking at a long-term solution.
Mind you, your therapist is not your friend. The conversations should not just be chit-chat or venting sessions. There needs to be a working alliance between the therapist and the client where, after one or two sessions, goals need to be set. “Also, the process of therapy should have quick resolution timelines and not just prolong for years. In cases which are severe, therapy may go on for a year or so. However, in other cases, it should end in a few months,” says Deepali Godse, counselling psychologist and wellness coach at Cognizant Technology Solutions, Pune.
“One can have a three-session contract with the therapist to figure out if the proposed treatment plan is something you are comfortable with and if a rapport has been built with the therapist,” Godse suggests.
Work Towards Building Symbiosis
Like any other relationship, a therapeutic alliance is a two-way street. So, there could be factors in you or your therapist which make the relationship succeed or fail. Dr Batra illustrates the point with an example: “If you are not trusting, there’s a likelihood that you will not trust any therapist, no matter how empathic, how much of a good listener, and how concerned they are for you. On the other hand, if you are trusting, and in fact you are giving your therapist a fair chance to help you; and in turn the therapist is judgemental, non-empathic or not genuine, then again, the relationship will not work.”
So, in order to think whether the therapeutic relationship is working or not, sit back and introspect on all the factors. Ask yourself whether you are not being open, you are not compliant, you are not trusting, and you are not following the guidelines your therapist is giving. And then assess whether your therapist is giving you sufficient time, engaging with you, seems qualified, seems experienced, and is giving you the kind of suggestions that are working for you—then you know you've struck gold.
Ask Your Therapist
How long have they been in practice?
Have they dealt with clients who have had similar issues as you?
Do they specialize in a particular age group?
The therapy and treatment plan they will be using.
Fees? (This is a pertinent question—therapy is a long-term process and involves time, energy and money. Lack of money should not be the reason that one drops out of therapy halfway.)
Do I feel reasonably okay with this person? (This is the intuitive part of choosing a therapist.)
Too comfortable? Still a problem because it shouldn’t feel like just chit-chat. Both should be moving towards a goal.
Is the therapist listening to me?
Is the person seeming genuine?
Does he or she really care about how I feel?
Am I getting supportive direction?
Is the therapist actually helping me change?
Is this just a venting session and I feel good for the moment but nothing changes?
Keep in mind that eventually, the success of the therapeutic relationship is dependent on your efforts as much as your therapists’ and the choice you make is influenced by the goals you want to achieve through therapy.
Divya Naik is a psychotherapist and Rational Emotive Behavior Therapy (REBT) and Cognitive Behaviour Therapy (CBT) counsellor