The Next Big Challenge for Psychology in India
Access and Affordability Remain Major Challenges, But Another Unseen Challenge Is Brewing Silently
“You probably don’t want kids because you are selfish.”
A therapist somewhere in India
When a person walks into the therapist’s office for the first time, they are expecting a place where they won’t be judged and will be given some space to express themselves freely. What they don’t expect are statements/advice which draw on the therapist’s own preconceived notions. The statements above were said by a therapist in session with a vulnerable client.
Since the COVID pandemic hit the world in 2020, mental health awareness has risen quite a lot across the world. India has not been any different. More and more people have come to realize the importance of mental wellness and, naturally, the demand for psychologists has increased as well.
Sadly, this has brought to the fore an issue that had been plaguing mental healthcare for ages but went under the radar - the issue of quality control.
Unprofessional Professionals
Over the past 3 months, here are some disturbing instances of professional overreach, misconduct, and negligence I have come across.
A young girl visits a therapist for the first time and is bullied and guilt-tripped as a test of “assertiveness” before being told, “You are not a good client anyway.”
A man visits the psychiatrist with his wife complaining about perceived alcohol dependence and is immediately labeled an alcoholic with a long list of prescriptions. This diagnosis was based on intuition alone and not psychometric assessments
A child being bullied in school shares her suicidal ideation with the school counselor. She is told, “Don’t joke around with me.” before being asked to leave abruptly.
These people are not quacks. I checked each of their qualifications. They have all the qualifications needed to practice as an MHP. They clearly don’t have the skills, even the most basic ones.
I am pretty sure if I asked them about Beck’s CBT or Ellis’ REBT, they would tell me all they mugged up during exams but they cannot put it into practice.
Too many psychology graduates and current students see the things they learn as mere “knowledge”. Not as something they are supposed to inculcate in themselves while practicing.
They know the virtues of a non-judgemental space which allows people to be themselves and explore their own identity but they don’t know how to not judge, or how to let a client have space in the therapy room.
They know they shouldn’t be giving you advice on how to change your life but they will do it anyway because who is checking? Then there are some mavericks who take media portrayal of therapists too seriously and think they can heal anyone with a bit of “tough love” and “harsh truths”.
There are impostors among us, not just one, but many.
So What?
Economists believe that when the quality of a product or service is bad, customers simply choose whoever offers a better quality of the same service. Sadly, that will not be the case with mental healthcare.
Many people who visit a psychologist today, are probably the first ones in their family to do so…ever. They aren’t sure what therapy should be like and what it should feel like.
This makes the situation ripe for an impostor to wreak more havoc on an already vulnerable client. The client may not know what is happening is wrong. If they eventually stop, the client might be turned away from the concept of therapy altogether.
The journey for a client into the therapy room is tough and arduous. They have to overcome social norms, worries over affordability, and the fear of the unknown before stepping inside. It is shameful for someone who has overcome so much to be turned away by an impostor.
What Can We Do?
Unfortunately, in India, there is not a lot one can do if they have the misfortune of coming across an impostor therapist.
There is no one they can report to. There is no regulatory body overseeing the delicate work that therapists do. A person who has been wronged by their therapist is quite literally helpless.
The best one can do is complain to an employer (if there is one) and hope they take your word for it.
Doctors, those who take care of our physical health, can be prosecuted legally for negligence in India but psychologists, those who take care of our mental health, cannot. You just have to hope that you find a “real” psychologist and not an impostor.
Things only change here when something goes horribly wrong. I am afraid it will take a tragic event before psychologists (esp. counseling psychologists) get regulated. Because until something goes wrong, why worry? Right?
Until we have a regulatory body in place, my advice to the Indian folks reading this would be to only visit the therapists you trust/those that have been recommended by someone you trust.
I genuinely hope we don’t have to rely on the referral system for too long and an actual regulation comes in to reign us in.
The best we can do is keep our fingers crossed.
And that is it for this week! How would you solve the quality control issue psychology has in India? You can let me know your ideas and thoughts in the comments or by replying to this email.
I would also love to know the situation in other countries. Does your country have quality control measures for psychologists? What happens when they mess up?
Looking forward to your thoughts.
Until next time,
Arjun
A few black moles change the experience of mental health.
One of the way to monitor MHP’s would be to have disguised sessions. A person appointed goes to the MHP as a client. That gives a good perspective on where the MHP stands.
One more way would be to have an exam. Various cases will be give where they would have to answer on how they would approach that particular case. It is important that no theory questions are asked. The exam can be conducted every 2 years. A strict valuation is necessary, there is only ‘pass’ and ‘fail’, nothing in between.
It is so important for people to read this, especially who are being wronged by their therapist. That first bitter experience kills all your leftover hope and makes you even more vulnerable. The problem is not in the concept of therapy but in an unskilled therapist.