Indians Test The Patience Of Psychologists: From Requests For Freebies To 2am Texts

This happens a lot to me. First, they text you, via a trusted referral. They ask to speak with you briefly to explain why they need your help. You then make yourself available for that ‘brief’ call, and it’s as if a torrent has been unleashed. They are frantic, in crisis. You deploy your active-listening skills, and they feel better after they pour out all their troubles. And then? They carry on with their lives, making no changes—not even an appointment with you. When it feels difficult again, they look for another psychologist with whom to have that cathartic initial conversation. These non-clients are pretty much the crank callers of psychologists. They simply discharge their anxiety and dump their issues on us during the first call, but never actually show up for a session. Understandably then, many psychologists are quite firm during first calls: “I am not their ponchha,” said Delhi-based clinical psychologist and author Nupur Dhingra, echoing what many mental health professionals feel.

This, of course, just scratches the surface of what psychologists in India must contend with. 

In India, the norms of when and how to access psychotherapeutic interventions are still in the ‘storming’ stage. This means that we are still awaiting a social consensus on the acceptable limits of approaching a psychologist or psychotherapist. There is also a general lack of what clinical psychologist Sujata Chatterjee calls “psycho-education”. Indeed, many people are unclear about the difference between psychologists, psychotherapists and psychiatrists.  

Here’s a quick primer: both psychologists and psychotherapists offer the talking-cure. Psychotherapists may or may not be psychologists first but have undertaken professional training, including often their own therapy prior to working with others. 

Both of these are different from psychiatrists, who are medical doctors specialising in mental health. In this article, for ease of reading, I’m using the term psychologists to refer to psychotherapists as well. All three categories of mental health professionals in India, however, frequently encounter similar issues not just in their offices but in the personal sphere as well.

Crossed boundaries

Some friends may treat you as a psychologist and some clients may treat you as a friend. Friends often think they can seek professional input one-to-one, in a café, bar, party, or restaurant. Once while attending a wedding, I was led to a table where I was abruptly asked for professional intervention. Some friends I do not regularly speak with call every time there is a life event that they want a deep debrief on, but they think of it only as a chat. “Friends often ask me, ‘If you can forget I’m your friend for a moment, could you work with me?’” says Shubhanjali Mukherjee, a psychotherapist in New Delhi.

It can get so awkward that some psychologists prefer to not tell casual acquaintances what they do for a living. Some even make up another profession just to avoid being drawn into an impromptu consultation in the middle of a social setting.

Another tricky area is when clients assume too much familiarity with their psychologist, and use terms such as ‘aunty’ or ‘didi’ to address them.  Clients may also send friend requests on social media, which again blurs boundaries between a therapeutic and a personal relationship. Gloria Burrett, a child psychotherapist in New Delhi, told me that she ensures that there are at least six degrees of separation between her and her clients when accepting friend requests. Still,  despite such precautions, some clients may stalk their psychologist on social media to satiate their curiosity about their lives.

It can get even more intrusive. Shobhika Jaju, a psychologist in Margao said that some clients think nothing of calling or texting at all hours and may have an unhealthy ‘dependency’ on their psychologist. Meischa Cholera, a Psychologist in Vasco, recalled how she had clients threaten self-harm if their calls and texts outside session hours were not responded to immediately.  

Role confusion

Here’s some truth: the responsibility for change lies with the client. The psychologists I interviewed were very clear that choosing to visit a psychologist is about taking charge of your own life. It is not about passing on the responsibility to fix things to the therapist, even when the client is a child. 

The person who is going to change needs to commit to the work, or else it is futile. However, many people see psychologists as professional fixers. This attitude can take two forms: exalting psychologists as god-like figures, or viewing them as glorified mechanics. Several psychologists I spoke with mentioned this aspect. “In the Indian context, people tend to put doctors on a pedestal,” said Yun Pang, a psychodynamic and systemic psychotherapist in New Delhi, highlighting that this can cause a power differential that is problematic for the therapeutic alliance.  

In other cases, psychologists are seen as replacements for carers. Nitasha Borah, a clinical psychologist and arts-based therapist in Panjim, shared that many years ago she was working with a single, male client whose schizophrenia symptoms had shown significant improvement. “He was functioning well and becoming more engaged socially. Suddenly, his mother, his primary source of support, passed away. His sister who was based abroad thought it might be a good idea if I married him so that he would have a therapist for life,” said Borah.

Unwarranted ‘advice’

Psychologists are experts in their field. Yet, many professionals from other fields believe that it is appropriate for them to ‘guide’ a psychologist on how to go about their job. Some of them bring their relatives (especially children, but also adults) for treatment, but also issue advice on how the process should go.

This kind of behaviour not only undermines the authority of the psychologist being consulted, but also signals disrespect for the field of psychology.

Transactional therapy

Many psychologists offer sliding scales to make their services more inclusive, but many clients across the board try to negotiate for ‘discounts’ in India. Neha Gupta, a child and adolescent psychotherapist in Delhi, refers to such clients as “flea-market shoppers” because they come in ready to haggle over the consultation fee. Most such people would not dream of acting this way when they visit their GP, she said. “What makes us so different? What makes us look like we are selling vegetables?”

Shaina Vasundhara Bhatia, a psychotherapist and counselling psychologist in Gurgaon, said bargaining is especially problematic when the real client is a child/adolescent and the payment is being done by a parent. On top of this are delays in payment, or fees not being given at all. “Holding back payment for a completed session can especially cause ethical difficulties for the psychologist”, she said.

Gupta also pointed out another category of clients who treat going to a therapist like a shopping trip. “The ‘therapist shoppers’ are here to test me after having visited 22736783 therapists. Their focus is on ‘can you handle me?’ rather than ‘how can you support me to better manage myself’,” she said.

Such problems are less pronounced in hospital or other institutional settings but rampant in private practices, said Nisha Sachdeva, a clinical psychologist and psychotherapist who works in a hospital setting and has her private practice. There are many ways in which the therapeutic alliance required for the work can be compromised. Many of these become the content of the therapeutic process also and cannot be weeded out in entirety. They may be the ‘stuff’ of the changes that the client needs to eventually work through.

What psychologists need

The question now is, how can we facilitate mutually respectful and productive relationships between clients and therapists? How can we be more sensitive to therapists if we happen to be part of their family or social circle?

Some key things that may be done differently are:

If you are friends with or related to a psychologist, recognise that they are not professionally engaging with you and acknowledge that you have a different mutuality and reciprocity with them.

Respect the personal time and boundaries of psychologists. Instead of creating a dependence on them and stalking them on social media, focus on taking responsibility for your own life.

Be conscious of when you are interfering in a psychologist’s professional intervention with your child or another relative. Remember that they have ethical commitments to the client first.

Be mindful of that first call you make to psychologists. Be brief and ask for an initial session that you pay for. 

Treat the payment system in the same way that you would any consultation with a professional. The sliding scale is to ensure that opportunities for mental health are available to those who may need it when they cannot afford the regular fee. Use this only if you are truly eligible.

If you recognise yourself in any of the descriptions above, take note and have a laugh! Spelling out these aspects is something I have done with the intention to educate and inspire people to be responsible toward their mental wellbeing. It is not to place blame or deride those who do not know the ‘rules’ of engagement with a mental health professional. 

All the psychologists I spoke to are deeply committed to their work and to the work that their clients are doing for themselves. This psychoeducation is to further cement their commitment to their important role in our society.

To conclude on a positive note, there is a growing number of clients and collaborators in India who understand the role of psychologists and also inform and educate others. People are coming more comfortable with acknowledging their emotional wellbeing and mental health needs.  What used to be a fledgling profession is gaining ground and becoming an acceptable channel for easing distress and finding tools to become the best version of yourself. It can only get better when we help the helper to get the best possible results. 

Dr. Rachana Patni is a Panjim based psychologist.