The perils of being a psychotherapist in a country that barely understands us.

I feel an immense degree of admiration and deep seated respect, for the courage with which my clients willingly bare their stark naked souls and embark on this journey of self-discovery/ recovery, considering how difficult it is, to even open up to your partner/parent sometimes.

And it’s an add on when I see, over the course of time, when a client(s) improve and grow in front of my very eyes. Honestly, I sometimes wonder if this is how parents feel when they see their kid walking for the first time. And trust me, despite the years of practice, with each new client, am hit with the same degree of awe. It never grows old.

Inspite of the aforementioned, just like there are two sides to a coin, a dark side to the moon, there is a dark side to practicing psychotherapy in a country that barely understands the concept of mental health and psychotherapy.

This write up is for people who wish to understand the ‘human being’ that’s their therapist, at least a few essentials aspects, so that you have an understanding of their very human struggles pertaining to the choice of this profession specifically in a country like India (when licensure, sound regulatory bodies to ensure quality control, healthy practices, mental health insurance is a distant dream at the moment)

It is for beginner psychotherapists, who often think private practice is cool and a cakewalk. (spoiler alert- it’s definitely not a cakewalk!) So here goes a few pointers, breaking the misconceptions that people have of a psychotherapist who is practicing in our country.

1.Therapy is just talk –

For clients- I have written multiple pieces before on this. Yet for the sake of the reader, talk is the primary (there are other mediums) medium with which a therapist conducts therapy.  There is great degree of finesse and technique underlying the talk, that’s based on years of research in the field. Please do not undermine the same. You may talk to a friend, or a parent or a mentor even, but being in therapy isn’t the same as talking to someone.

Your therapist trains for years to attain a degree of mastery over this, and constantly has to attend a lot of workshops/seminars to keep updating his/her skills and is under supervision for this.

For beginner therapists- Please do not approach it casually and ensure you engage in the aforesaid to ensure you are doing quality work.

2. Therapy is costly-

For clients- Unfortunately, In India there aren’t many government agencies that take on mental health as a priority, there are very few NGO’s as well.  There are a lot of policy level issues that aren’t discussed enough. At present, India spends around 0.06 per cent of its health budget on mental health. According to a 2011 World Health Organisation (WHO) report, most developed nations spend over 4 per cent of their budgets on mental-health research, infrastructure, frameworks and talent pool.  Then there is the matter of numbers and ratios- there are few well trained mental health professionals. For example – According to the 12th five-year plan there is a demand of 3232 clinical psychologists, yet there are only presently 852 Clinical psychologists’ (As per Indian Association of Clinical Psychologists, Membership Directory). They may be or may not be associated with Rehabilitation Council of India. So you can probably add a few 100 ‘s to that stock. But a number of studies show that about 25% of trained professionals are going abroad due to better remunerations, service condition and job future prospects (as per the article- Status of Clinical Psychology in India – (A Retrospective Analysis of Review) Shatrughan Singh, 2015) So the numbers fall down again.  According to the Union ministry of health and family welfare, the country needs 11,500 psychiatrists but has just 3,500. In a country where one student commits suicide every hour, according to National Crime Records Bureau, 2015, the entire mental health workforce, comprising clinical psychiatrists, psychologists, psychiatric social workers and psychiatric nurses stands at 7,000, while the actual requirement is 54,750.

Bridging this gap is near impossible. So most of us are overworked and under-payed actually.

Then the matter of time and effort– each session is an hour of technique individualised to the client.

Then there’s the matter of quality– we are witnessing a trend of misrepresentation as today, many claim after barely any training to be psychologists. They don’t have the adequate qualification to be one. For more read – Real Versus Quacks!

A crude analogy might help here to explain just the pricing of a session, a simple dish at a dhaba will cost you much lesser than a complicated unique dish at a Michelin /5 star restaurant. You simply pay for the quality and the experience. I assume I do not have to explain any analogies to explain the matter of quality. After all, It’s your mind  that we are working with, surely quality is of the upmost essence there.

For beginner therapists- The first few years are going to be real hard. Be prepared for low pay, long hours, despite which commit yourself to add to your skill set and quality.

3. Therapists have bills to pay! –

For clients-  Yes, they have bills, taxes just like everyone else, and they aren’t covered by insurance or any schemes in India. Usually therapists charge you by the hour, and its one hour of ‘technique’ wrapped in the garb of ‘talk’- please do not berate years of research and training (a min of 7 years in our country) to just talk.

Your therapist is trying the best despite the aforesaid issues in the previous point, also if your therapist is in private practice, he/she is paying a huge percentage of his/her income towards renting space and infrastructure and admin support. For eg. Nearly half of my fees go into this.

Please atleast respect the effort by not bargaining, atleast after agreeing upon the fees before therapy starts. There have been times when some of my clients, after agreeing to a set fee, later had issues with the same, and kept bargaining to reduce fees. We can empathize with your financial constraints, and some therapists even offer a sliding scale (fees as per income), but please respect with ours too.

For beginner therapists-  For those in private practice, Let’s charge nominal fees to begin with, try working with a sliding scale format, if your institute is okay with it.  Your income is going to be scanty in the beginning, and unpredictable. Best, try and work in other spaces for a while before starting off on your own, to build experience, besides it also ensures a stable income.

4. Therapy is a time consuming process for both the client and the therapist-

For clients – Sessions are usually hourly, however the formats change depending on the school of thought, number of clients (couple/family). And since therapy is often long term– (one session rarely does the job) sessions are often by appointment. Please try and respect the time your therapist is investing in you and inform well in advance of any cancellations. In the beginning of my practice there were times when there were nearly 15 cancellations in a week that were last minute and unpaid for!

For beginner therapists-

Patience will be your best friend in those initial days. Cancellation policy is a thing in the west, and you could incorporate it in your practice here. However, It’s quite the trick to manage a healthy balance, since India is new to therapy, let alone policies that come along with it. Clients often drop out; some may refuse to pay for cancelled sessions. Plan ahead for times when your clients cancel last minute, and maybe you finish up some much needed reading, and documentation.

5. Therapists are human and have a personal life, separate from the profession-

For clients – They have very human lives. Personal lives. With actual problems. Which they keep from you, because of ethical and professional reasons. Some of you may be plain curious, which is natural, you can consider discussing the why’s with your therapist, some may feel insecure, finding that the relationship is one sided, wherein you find yourself opening up your darkest parts whereas here lies this ‘perfect’ therapist in front of you, not sharing theirs. (in short, they aren’t, it’s just the job, in fact- to protect the clients) Just cause they are therapists’ doesn’t mean they are immune to life and the problems that come with, well living it. They then have to consult a therapist. Yes. Therapists can also go for therapy and should also take care of their mental health.

So please respect these boundaries for both your sakes and if there’s an emergency try and schedule an earlier appointment, than call your therapist at 2am, and expecting them to be there for you then. And don’t worry they aren’t perfect. But don’t worry if they are imperfect either, or in therapy themselves, like I mentioned before it’s merely human. In fact, if you have a therapist who acknowledges he/she has problems, and addresses it beforehand, it’s good for you. A healthy therapist, means a healthy client.

For beginner therapists-

Most clients understand and respect your boundaries of their own accord. However, it may be in both your best interests to discuss this out at the very beginning and establish the same. There are times when boundaries will be tested, work through it as professionally as possible.  If you are facing problems yourself in your personal lives, don’t avoid seeing a therapist yourself, its best in fact if you have a therapist even otherwise, since being a mental health professional often brings along an experience of vicarious trauma, and with the other issues- financial, stigma, security, a lack of understanding which we already discussed. It’s also good if you are in supervision with a senior therapist, and constantly keep updating yourself, by attending workshops, seminars, training programs. Yes, more expenses indeed. But that is what you are signing up for.

Postscript-

Ever since I began my journey as a private practitioner it has been a roller coaster. Long unusual hours, sheer exhaustion –both emotional and physical, unpredictable pay, a significant step back from social life. (My friends and family miss me, and I them)

It’s been a learning curve, and I’m discovering new ways to cope, heal and prioritize me and my mental health. It’s going to take some time.

Despite all that,

To each client I have worked with in the last year, I must say, thank you for letting me be a part of your journey, you made all the sacrifices worth it.