Do therapists also come with red flags?

While the benefits of seeking mental health care have gained significant momentum in mainstream conversations, why are the perils of therapy gone wrong not that widely talked about?

It was 2018 when a then 22-year-old Meera Patel (name changed on request) started hearing voices in her head. It made her believe that telepathy was real. She was in London pursuing her masters, when she confided in one of her closest friends—a mental health professional—about it, who broke it to her that she might just have psychosis. Patel refused to accept what she heard, and instead, convinced herself that her friend was a “non-believer” (of telepathy and magical thinking). The seed of doubt, however, had been planted in her head. Upon her return to her hometown Mumbai in January 2019, Patel decided to visit a psychiatrist. The experience, unfortunately, left much to be desired. “She was terrible, so I stopped going. A couple of months later I started working my first job as a journalist. Through my entire time at my first workplace, I had voices in my head with symptoms getting worse each day. I was essentially in survival mode the entire time,” Patel, now 27, says, remembering how her psychiatrist would make her feel unsafe and judged. She would even get angry every time Patel expressed vulnerability around her.

“When I told her I smoke she would be like, ‘Yeah, your voice is so nasal—of course you do.’ When I opened up about not being comfortable taking medicine, she asked how else I thought I would get better. Essentially, she was being logical, but I needed a more sensitive approach,” says Patel. Soon after, the exhaustion and disappointment from this experience made her hit the brakes on seeking mental health care for a while, until she could gather enough courage and faith to rekindle her search. Patel knew she needed professional care, and the presence of friends practising in the field reminded her that all hope was not lost. “It didn't necessarily shake my confidence in mental health professionals, but in myself. I said to myself that I'm sure there are good ones too, but I don't have the energy to go looking.”

Is no therapy better than bad therapy?

In the book Premature Termination in Psychotherapy: Strategies for Engaging Clients and Improving Outcomes (2015), Joshua K. Swift, a practising psychologist and associate professor in the Department of Psychology at the University of Alaska Anchorage, and Roger P. Greenberg, director of the psychology division at the Department of Psychiatry and Behavioral Sciences in the State University of New York Upstate Medical University, talk about premature termination of mental health care being a significant yet oft-neglected problem in the field. According to some estimates, “as many as 20 per cent of adult clients terminate psychotherapy prematurely,” the study mentions, allowing a peek into the prevalence of an issue that is not as regularly spoken about as the need for dialogue on mental health is.

According to 26-year-old Disha Wadekar (name changed on request), “No therapy is better than bad therapy.” The Pune-based researcher decided to speak with a counselor in March 2022, after struggling for years to cope with unresolved emotions from her childhood. Wadekar lost her mother at the age of 14, a phase she vividly remembers being gruelling to navigate. It was also the first time she encountered a mental health professional—another counselor—in school, with whom a compulsory meeting was arranged to gauge her preparedness to return to school after going through a life-altering personal loss. That solitary session was unremarkable; 12 years later, Wadekar’s second tryst with a mental health professional was even worse, and mostly, disturbing. “She lacked empathy. Because I am a researcher and writer, she was convinced that I could articulate my feelings well so our sessions would only be about me talking. They were freewheeling and I’d end up feeling like I was only venting, something I could do with even a friend and did not have to necessarily spend 750 rupees on each time,” Wadekar says.

She stuck to the routine for eight months, in which the first few days were spent simply “venting”. Wadekar, however, admits that those initial sessions did allow her to acknowledge suppressed emotions she didn't even know existed. But eventually, a sense of stagnation set in, besides the fact that she could also no longer ignore some glaring red flags in her therapist who would yawn during sessions, and keep checking her watch. “It’s these little things that struck me. For example, I preferred in-person meetings because I live in a joint family, so privacy during online sessions is an issue. My therapist went on a trip in between, during which she conducted the sessions online. However, once she was back in town, she didn’t inform me, and continued with online sessions despite knowing I preferred them offline. I actually found out about her return accidentally,” Wadekar sighs.

Such incidents reveal more than just fundamental incompatibility between the mental health professional and their client—it marks the absence of a feeling of safety and a space where one hopes to not be judged for their thoughts and actions that continue to weigh them down. “She would disapprove of me crying. This one time, I told her that I did not believe in marriage because of the patriarchal nature of the system. In response, she asked me if I don’t trust my education and upbringing and the decisions I make as a result of them. She also said that if I did not get along with someone, I should try and maybe understand them and resolve their issues, when I already have my own emotions to deal with,” shares Wadekar.

Evidently, a gradual degeneration of faith in her counselor and, consequently, in the institution of mental health care, deterred Wadekar from continuing beyond those eight months. Soon after, she tried Vipassana—a form of mindfulness meditation—which brought her better results and equipped her with tools to cope with her intrusive thoughts more efficiently.

The repercussions of losing faith in the process

People like Patel and Wadekar—in their attempts at alleviating themselves of painful symptoms and thoughts that are, more often than not, rooted in neurochemical changes in the brain’s physiology—end up feeling implicated for their predicament due to such harrowing experiences. These episodes then lead to a sense of greater despair than what one started with before seeking professional help, as a result of which rebuilding trust in the process becomes a daunting task. This is especially true for a society where stigmas attached to mental health continue to be a thorny reality, agrees Dr. Nilanjana Chatterjee Chakraborty, practising psychologist and psychotherapist, and founder of Anusharan Mental Health and Wellness Clinic in Kolkata.

Chakraborty believes that therapy is where there can be no space for judgements, and where everything happens with explicit consent. She also states the importance of feedback regarding what the client is comfortable with, and how it’s imperative for that to align with the professional’s areas of expertise for their relationship and the treatment to thrive. “I have been trained in a way where I believe in delegation, and this method foregrounds the client’s well-being. You often realise that you cannot continue treating someone because you have nothing to study before your sessions with them, so you advise them to move on to a different professional who may be better suited to handle their case. I myself give them their contacts,” Chakraborty says.

Therapy is, in fact, a form of learning, according to the psychologist, in which we pick up cues from our environment to train our minds to absorb the good and the bad it has to offer. “When you step into a therapist’s room for a session, in that moment your mind forms associations and learns certain things about the environment you are in vis-a-vis the experiences in that room. For someone who anyway has been in a negative headspace when they first went to therapy, and then experiences something unpleasant in therapy, their brain chemistry changes because it confirms their fears that therapists are, perhaps, mean. This form of learning is very difficult to undo,” she says, adding that such encounters end up altering brain patterns that might even evoke a fight-or-flight response in individuals when they think of mental health care going forth.

The struggles of finding the right therapist

Barshana Basu, a 26-year-old research scholar from Kolkata, was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in February this year. It took them five years and five mental health professionals to arrive at a point where they could finally feel comfortable in therapy. “Back in 2018, my mother took me to a therapist because I was going through a really traumatic break up. I had stopped eating, sleeping, and being functional, so she realised I needed help even though we don’t speak openly about mental health at home,” they say. That was, however, Basu’s first and last session with the professional. “She (the therapist) did not seem to think my breakup was anything out of the ordinary and blew it off as something every teenager goes through,” they recall.

*Trigger Warning: Rape, Victim Blaming, Sexual Assault*

In 2019, an acquaintance of Basu’s raped her, following which they decided to seek help as a form of SOS. This time, it proved to be a tougher endeavour as they were in acute physical pain from the assault, besides being met with disbelief from the mental health professional they went to three days after the incident. “I did not go to a gynecologist or a general physician because they would be obliged to file a police report, and I did not want to go to the cops. When I went to the therapist, she kept asking me as to how I was sure that I was raped, even after I told her that not only were my clothes torn and I was in pain after the incident, but I even had the perpetrator admitting it to me on record,” they say. The therapist kept quizzing them about their whereabouts, implying that if they had indeed been drinking on the night of the incident, and were in the kind of excruciating pain they said they were in, then it would’ve been impossible for them to return home in the first place. “She victim-blamed me continuously. I told her that my alcohol was laced, which is why I felt the pain much less in the first few hours and could manage to drag myself up the stairs back home. The moment the effects of the alcohol and the drug wore off, my body was falling apart in pain. I showed her all the marks on my body from the assault and even then she refused to believe me.”

*End of Trigger Warning*

Luckily, they say, these alarming encounters with professionals in the field did not deter them from keeping faith in the discipline entirely. They carried on with their search and eventually found therapists who were kinder and more empathetic. “As someone who identifies as gender non-binary and bisexual, I have also often been asked in therapy whether I am sure of my gender and sexuality. These weren’t necessarily skeptical questions, but they came more from a place of genuine curiosity. However, I think I got lucky in this regard and that isn’t always the case,” Basu points out.

In India, where conversations around gender and sexuality continue to be riddled with prejudice—or even resistance—therapy assumes paramount importance as an institutional safe space that can offer counsel and relief to queer individuals, as a lot of times their families pose the toughest challenges. Mohit Ranadip, a psychiatric social worker and counselor based in West Bengal’s Serampore city, has come across several such cases through his career of over three decades. The 56-year-old practitioner works across the length and breadth of Bengal, including rural and suburban pockets, where he often meets young queer individuals whose families ask him to find a “cure” for their children. “In fact, around 15 years ago, one of my colleagues, a senior psychiatrist, had asked me to treat a queer person using Cognitive Behavioural Therapy. I told him I don’t know how to do that, so I can’t,” he recalls. However, thankfully, said psychiatrist has revised his views and believes differently today, Ranadip adds.

“As a mental health professional, my job is to mostly listen, and not speak much. I need to strengthen my client’s belief in themselves, and with members of such marginalised communities, it is even more important to encourage them to acknowledge what they are feeling, instead of asking them to live in denial,” he says.

But professionals like Ranadip are difficult to come by even today, and one has to go through multiple practitioners to finally find the right fit. This process is not just emotionally exhausting, but also makes mental health care less affordable to many. “I did my Vipassana course for free, whereas I spent 750 rupees for each session nearly thrice a month, for eight months with my counselor, and nothing came out of it,” Wadekar says. Basu echoes her thoughts by saying that every time they have to work with a new therapist, it essentially means spending the first few sessions explaining their history all over again from scratch. This not only feels like a financial drain because you shell out money to repeat a process you have already paid for in the past, but revisiting the traumas can be immensely triggering as well.

For 32-year-old Bedbyas Datta, it’s been a rather expensive and tedious journey through nine therapists and five psychiatrists in the span of roughly 17 years. Today, he feels an urgent need for professionals who are open to deviating from “conventional paradigms”, especially as someone who identifies as gender queer. “I wish one’s relationship status and job status weren't life markers, much like those dreaded words, 'How have you been doing'?” he says. In 2018, he remembers visiting a psychiatrist who left him feeling upset and admonished for his life choices at a time when he was struggling with his career. During this time, he also faced a fall out with one of his close friends, while struggling with family dynamics simultaneously. Had it not been for this dispiriting experience, Datta wonders if his life at that time would have turned out differently, and perhaps, better even.

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