In India, Getting Online Therapy for Mental Health Can Be Challenging

From lack of privacy to technical issues, interacting with a therapist online may be difficult, but it’s worth the effort.

A 40-year-old software engineer based in Hyderabad, had already been dealing with anxiety due to work-related issues when he was diagnosed with early symptoms of obsessive-compulsive disorder (OCD) in March. The psychiatrist prescribed him a course of medicines, after which it was recommended that he start therapy with a psychologist.

But before he could book an appointment, the coronavirus pandemic hit India, and the government imposed a strict lockdown. As a result, most private offices, including counselling centres, were either shut down or working with restricted schedules. Many therapists switched to online consulting, and the client decided against arranging the meeting for now.

“I didn’t know the therapist, and I was not sure if online is the best way to establish a new relationship with a therapist”, he said.

24-year-old Sri Laxmi had similar doubts. She was going tough times last year after losing her job in Mumbai and dealing with delayed salaries. While she did find a job in her hometown Vijayawada, the shift triggered anxiety and depression in her.

“I was not able to adapt to this change easily. I started having sleepless nights, breathing difficulties and a feeling of utter loneliness. That’s when I decided to consult a therapist to help me cope with this,” she said.

However, she has decided to postpone this for now, as she feels uncomfortable talking into a screen.

While the shift to online therapy was inevitable during the COVID 19 scenario, many Indians—both clients as well as the therapists on the other side of the screen—are struggling to adjust to the new ways of expressing their thoughts, fears, assessments and advice without being in the same room. With mental health still not being the priority, it deserves in the country. The sudden change has been a roadblock to those who were planning to seek help.

Those who have tried online therapy report other challenges, like the lack of space and privacy in their homes. Some clients don’t want to disclose to their families that they are in therapy. Reliable Internet connectivity is also an issue for some.

The right setting

Many therapists and clients feel that nothing can replace the experience of face-to-face sessions. A therapist’s office is a neutral space. It may be associated with feelings that have been shared, and a feel-good factor permeates the environment.

Sometimes when one associates one’s home with uncomfortable memories or trauma, it isn’t easy to feel comfortable while expressing feelings about it when you’re there.

Therapists also miss the physical cues, such as body language of subtle hand and feet gestures, which are crucial in human connection and communication. How the other person is reacting physically while sharing emotions can communicate a lot about how they’re feeling and thinking. Clients need affirmation that their therapist has understood what they’re trying to communicate; therapists need to observe the physical reactions of clients. The limited space of a screen may restrict this.

“These tiny bits of biofeedback make a significant difference in the therapeutic process. Doing this online is sometimes difficult because you don’t get the input as quickly and clearly. You are only seeing the person from the neck up most of the time”, says Dr. Vidyasagar, a therapist at Hope Trust.

He said that a patient’s hygiene and appearance could also be an indicator of their mental health.

And for those who have psychotic disorders and need constant guidance, interacting online can be a challenge. Psychiatrists at Hope Trust often meet the clients face-to-face for the first couple of times for accurate assessments and establishing rapport, followed by continued therapy online.

Is online therapy worth it?  

Not at all. While there are difficulties in adjusting to a new normal, mental health is an essential aspect of healthcare. If you can, it’s definitely worth continuing with online sessions and focusing on the upside of this process.

While there are difficulties in adjusting to a new normal, mental health is an essential aspect of healthcare. If you can, it’s definitely worth continuing with online sessions.

There are other moments of joy, as well. Housewife Sudha, who lives an hour away from her therapist’s office, says she can concentrate more on her thoughts because she doesn’t have to go through the hassle of travel in traffic.

“I’m more focused on what I want to say, and not concerned about travelling back through rush hour traffic”, she said.  Therapist Rajeshwari has observed that her clients can express themselves better in online sessions because they’re not conscious that someone is watching every word and gesture.

“With some clients, things have actually improved because they are less aware of my presence and can express themselves better about what they are going through because they are in their own familiar spaces,” she said.

Another unexpected benefit is that the therapist and patient get a glimpse of each other’s world – the client’s bedroom can offer insights into the client’s lifestyle, and the therapist’s virtual room can become as comforting and familiar as their physical office.

Adapting to the new reality will have its challenges, as any change always does. Overall, teletherapy is now the new frontier in psychological and psychiatric care. Mental healthcare is innovating – and both the patient and the therapist are happy about it.

Hope Trust has reported nearly 80% increase in online therapy appointments. It is proving to be an effective, safe and convenient alternative to physical consultations.

The bottom line is, it works. And it’s worth it!