New Delhi: A 36-year-old hospital administrator from Guwahati had her marriage called off a month before the wedding date. She blamed herself for it. She needed someone to guide her through this difficult period. Faced with the taboo surrounding mental health, she turned to therapy through an online platform. She connected with a ‘therapist’ anonymously through a mobile app.
But the free chat session only worsened her condition. The so-called counsellor started spilling stories of his own break-up. The therapy industry is booming in India. But this absolutely inappropriate behaviour by the counsellor highlights the utter and alarming lack of regulation, qualifications, training, and standards in the sector.
“He said he wanted to commit suicide and end his life after his relationship ended,” the woman recalled the therapist saying. She immediately wanted to end the session. “In these times, you would not want to hear any trigger words. I guess he didn’t know that words like ‘suicide’ don’t work on someone who is already dealing with so much in life,” she added.
What’s worse, two days later, she received a message from the app asking if she would like to become a counsellor herself.
Therapy is now more accessible and acceptable in a society that has long avoided public discussions about mental health. Online sessions have seen the biggest growth, offering stigma-free anonymity. Numerous phone apps, platforms like Instagram, Facebook, YouTube, personal websites, and clinics offer counselling services. Even influencers are posing as therapists.
The counselling business, where pseudo-therapists use terms like talk sessions, listening, or life coaching, is expanding and evolving. The demand for these services has increased due to heightened awareness of mental illnesses. But unlike the medical profession, the counselling field is right now dangerously ad hoc and lacks proper regulation. Almost anyone with just a Master’s degree or a short bridge course can become a therapist, leading to the entry of unqualified individuals who call themselves counsellors.
Even for those with undergraduate and postgraduate degrees in psychology, there is currently no mechanism to assess whether they have received practical training to work with real patients. The quality of education in psychology lacks standardisation, and most young counsellors receive minimal training beyond textbooks, according to experts interviewed by ThePrint.
“The system is quite broken. Earlier, there was a lag, but now, because of Instagram and social media, every other person is claiming to be a therapist. That’s even worse. I know people who have gone to unqualified or incompetent therapists and now don’t want to go back to therapy at all,” says Akanksha Chandele, psychotherapist and founder of the I Am Wellbeing organisation, which operates centres in Noida and Delhi.
In 2021, the health ministry passed The National Commission for Allied and Healthcare Professions Act to regulate the sector. The Act intends to establish standards of education in counselling psychology, assess institutions, and maintain a central register of professionals after assessing their skill and competencies.
However, the Act is yet to be implemented. In the meantime, the lack of oversight means mental health patients are left in the hands of unqualified and untrained counsellors who may cause more harm and hamper their path to recovery.
This trend is taking the sector back by many years, warn experts.
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Everyone’s a therapist
After the first Covid-19 lockdown, Krishna Kumar Nair, the founder of MeetCounsellor, an online platform connecting people with qualified psychologists, noticed a spike of 400 per cent in the number of individuals seeking help from his organisation. The pandemic was a turning point for the mental healthcare industry, he says, as it compelled people to acknowledge the importance of seeking professional assistance.
“People are now coming forward to say that yes, I am depressed. I need help,” says Nair.
The demand for therapy skyrocketed, and the shift to a work-from-home lifestyle eliminated geographical barriers in accessing counsellors. Individuals could now find psychologists online through various aggregator websites (like Practo, Clinic Spots, Lybrate), social media platforms, and mobile apps, allowing them to book sessions without having to disclose to anyone they were seeking therapy.
However, this surge in demand and the increased accessibility of counselling services for urban populations also gave rise to an influx of unqualified and untrained psychologists. On social media platforms, numerous profiles of life coaches, listeners, meditation and yoga therapists, and influencers emerged, offering guidance on social anxiety, stress, and depression for a fee.
Although many of these individuals do not call themselves as counselling psychologists, the services they provide are similar to those of professional counsellors. In October last year, a complaint of cheating was filed against an Instagram influencer for allegedly posing as a wellness therapist. In response, the Karnataka High Court instructed the government to regulate the proliferation of pseudo-therapists on Instagram.
“People who call themselves ‘life coaches’ or ‘listeners’ often lack the qualifications to be a counsellor,” says Pratik Shetty, a counselling psychologist and co-founder of Fettle Counselling.
These individuals typically have a large following and try to sell positivity. Then there are websites where people share personal stories and, at the bottom, indicate that they “deal with depression” or “deal with breakups”. For the general public, these individuals are often more approachable compared to licensed therapists, according to Shetty.
Nair points out that when listeners begin to offer advice and solutions to problems, they enter a delicate territory. “If a person is just sitting and listening like a priest in a confession box, then there is no issue. But problems arise when they start interacting with the person and respond with triggering words. Nowhere is it mentioned that listening is a mental health service,” he says.
Shetty says that in his practice, he encounters many patients who have had negative experiences with such Instagram influencers, which causes these patients to retract into their shells. For instance, a patient who had suffered childhood abuse shared his trauma with an influencer who also claimed to be a listener on Instagram. Instead of providing appropriate support, the influencer started crying. When the patient further described engaging in socially unacceptable behaviour as a coping mechanism, the listener abruptly ended the call.
“Her crying made the patient uncomfortable. When people share these things, they are already uncomfortable. And if you respond like that, you are shaming them. When you cut a call, it indicates that you can’t deal with this,” explains Shetty. For the patient, this experience may mean undoing months of progress from the point where they mustered the courage to share their struggles.
Chandele, a trauma therapist, has also encountered numerous cases similar to this in her practice. She emphasises the need for therapists to undergo rigorous training that is constantly updated and supervised.
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Qualified but untrained
One of the most common diagnoses that clients approach Chandele with is personality disorders. However, she often finds that their problems stem from underlying trauma rather than the diagnosed condition.
“Many clients say they are on medication for borderline personality disorder. What was actually happening was there’s a lot of trauma and their bodies were coping up. The whole point of medication is to support therapy. But the opposite is happening,” she says.
According to Chandele, the entire system of producing psychologists in India needs an overhaul, starting with colleges. Recognising the increasing demand for psychology, colleges have begun offering more courses and increasing the number of seats. In India, psychology for mental illnesses is mainly divided into two streams: clinical psychology and counselling psychology. Clinical psychologists focus on diagnosing mental illnesses and conduct tests, often working alongside psychiatrists in hospitals. On the other hand, counselling psychologists can establish their own practice or work under senior counselling psychologists, counselling patients through talking or therapy sessions.
A quick online search reveals profiles of individuals with degrees in dentistry, homeopathic medicine, and certification as life coaches or experts in breathing and aerobic techniques who have also obtained an MA or MSc in psychology from open universities or unknown private colleges. They claim to treat depression, insomnia, phobias, addictions, and other serious mental illnesses. Some even offer help with financial, spiritual, and emotional well-being, as well as academic and career counselling. Then there are self-proclaimed therapists who mention having degrees in counselling psychology without specifying the university or college they attended.
However, merely learning theory and obtaining a master’s degree in psychology does not prepare students to become competent counsellors, says Shalmalee Gadgil, a counsellor and co-founder at Wisdom Matters, a member of Psychology Association of India. According to Gadgil, rigorous training under professionals and continuous upgrading of skills are essential for becoming a good counsellor.
“Practising psychology is a different ballgame. Most Indian universities and courses do not equip counselling psychologists for practice. The theoretical understanding is still based on Western theories that were given many years ago. There is no Indian context. Despite this, students start practising immediately after completing their master’s degree,” says Chandele.
To gain practical training, graduate students need to be supervised by senior psychologists and undergo therapy. Moreover, specialised courses are necessary to provide therapy for trauma or depression.
In the US and the UK, counselling psychologists or therapists must be registered and obtain their licence after rigorous mock therapy sessions and tests before seeing real patients. In countries with more structured health systems, degree courses typically span around four years, and short term-diploma or certificate courses are insufficient for practising as a counsellor.
In the US, mental illnesses are also covered by insurance, which helps filter out unqualified or unregistered therapists from the market. “The insurance companies will not reimburse you if you go to an unregistered therapist,” says Soumitra Pathare, director of Centre for Mental Health, Law and Policy, a think tank. However, in India, where 80 per cent of healthcare expenditure is out-of-pocket, the insurance model does not work, he adds.
Even the formula of considering years of experience and charging high fees per session does not always guarantee quality, according to experts.
Roshini* shared her experience with ThePrint, where the counsellor she visited appeared distracted and “kept fiddling with things in the room”. “She spilled water and then started cleaning it. I asked if I should stop talking but she asked me to continue anyway. I was sharing personal details and she couldn’t even give me her full attention.”
Roshini decided not to continue with that counsellor. A few days later, she received a text for a follow-up session and the suggestion that marriage would be the solution to all her problems.
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The Act of hope
Psychologists express concern about the damaging effects of bad therapy. The say that the Allied and Healthcare Professions Act 2021 holds hope for cleaning up the industry.
The Act stipulates a fine of Rs 50,000 for individuals practising without registration. Currently, there is no mechanism for reporting a therapist to a medical council, as is the case with reporting medical negligence by doctors.
“Allied healthcare professionals are currently unregulated. This Act will bring some regulation to the non-doctor part of the healthcare professional ecosystem. Once implemented, it will clearly lay down who can become a therapist,” says Pathare.
The lack of regulation and registration means there is no available information on the number of counsellors practising in the country. Currently, only clinical psychologists are registered under the Rehabilitation Council of India (RCI).
“We definitely need restructuring. The RCI structure is limited and does not account for alternative forms of therapy such as dance therapy or art therapy,” says Gadgil.
ThePrint contacted the health ministry through calls and emails for comments, but there was no response from officials.
The ministry’s own assessment in 2016 revealed that 13 crore people in India require mental health services. It also highlighted a massive treatment gap for mental disorders, ranging from 70 per cent to 92 per cent across different disorders. The treatment gap refers to the percentage of individuals with mental illness who are not receiving treatment.
Whose responsibility?
Due to the lack of registration in the counselling sector, the responsibility falls on the clients to verify the credentials of the professionals they seek therapy from, says Pathare. Experts suggest that checking reviews and seeking references can serve as effective filters.
However, for individuals like Riya, discussing therapy with their peers can still carry a stigma. Although therapy had previously helped Riya, she had to convince her mother to allow her to visit a clinic.
“I assured her that the counsellor would only talk to me and do nothing else,” Riya said. “I went [to the session] wearing a mask, sunglasses, and a cap to hide my identity.”
On the mobile app, though, she could seek help without disclosing it to anyone. It didn’t occur to her that the person posing as a therapist might be unqualified to assist emotionally vulnerable people.
“He suggested that I watch south Indian movies to feel better,” Riya said.
(Edited by Prashant)