15.8 — Choosing Someone, and What to Expect

Check the qualification, because the title means nothing

In India, as in many countries, "counsellor" and "therapist" are not protected titles. Anybody can use them.

What to look for.

A clinical psychologist in India should hold an MPhil in Clinical Psychology from a recognised institution and be registered with the Rehabilitation Council of India. You can ask for the registration number and you should.

A psychiatrist is a medical doctor with a postgraduate qualification in psychiatry, registered with a state medical council.

A counselling psychologist will typically hold a postgraduate degree in psychology with counselling training.

And for anybody else calling themselves a therapist: ask what their qualification is, from where, and how long it took. A weekend certification in a branded method is not a training.

The question to ask, plainly: "What is your qualification and are you registered anywhere?" A competent practitioner answers this without any difficulty. Discomfort at the question is itself the answer.

Match the approach to the problem

From 15.2. Ask for the specific thing by name.

"I'm looking for CBT for panic.""I need exposure and response prevention for OCD.""I'm looking for trauma-focused therapy.""I want CBT for insomnia."

This matters most for OCD, PTSD and insomnia, where the specific protocols are considerably better than general talking therapy and where general counselling can waste a year.

The first session

It is a two-way assessment. You are deciding as well.

What a good first session includes: what brought you, some history, what you want out of it, an explanation of how they work, and a rough sense of how long.

What to ask:

"How do you work, and what would we actually do?""How many sessions would you expect?""How will we know if it is working?""What if it isn't?"

A competent therapist welcomes these.

Signs of a good one

They explain what they are doing and why.

You feel heard, and also slightly challenged. Only comfortable is not therapy; only challenged is not either.

They set goals with you and review them.

They give you something to do between sessions, in the structured therapies.

They tolerate disagreement. Say "I don't think that's right" once and watch what happens — this is the most informative test available.

They keep boundaries. Time, role, no dual relationships.

And they are willing to refer you elsewhere if they are not the right fit.

Signs to leave

No explanation of method, or a proprietary technique that cannot be described in plain language.

Promises of rapid transformation or of curing something in a fixed number of sessions.

Talking about themselves at length.

Making you feel judged, or telling you what you should do with your life.

Pushing a belief system — religious, political or otherwise.

Any boundary violation. Contact outside sessions beyond the practical, socialising, financial entanglement, and anything sexual, which is a serious ethical violation and grounds for a complaint.

Dismissing your concerns about the therapy itself.

And no improvement after a reasonable period with no discussion about it. A competent therapist raises this before you do.

How long, and how to tell if it is working

Structured therapies: typically eight to twenty sessions. Depth work is longer.

Some worsening early is normal, particularly in trauma work, because avoided material is being approached.

By around six to eight sessions there should be something — a change in the numbers (15.7), a behaviour that has changed, or a clear sense of direction.

And say it if there is not. "I don't feel like we're getting anywhere — can we talk about that?" A good therapist treats that as useful information rather than as criticism, and the conversation frequently unblocks the work.

Cost, and the options in India

Private therapy is expensive and the price varies enormously by city and by practitioner.

Cheaper routes that exist.

Government hospitals and medical colleges with psychiatry departments, at low or no cost.

District Mental Health Programme services.

Tele-MANAS on 14416 — free, 24 hours, and it can provide ongoing support and referral, not only crisis response.

University psychology departments, where trainees see clients under supervision at low cost. Supervised trainees are frequently very good — closely monitored and highly motivated.

Non-governmental organisations, several of which offer sliding-scale counselling.

And employer schemes, which many people have and do not know about.

Online and app-based therapy is cheaper and has reasonable evidence for mild to moderate difficulty. Check the therapist's qualification, which platforms do not always make visible.

Fit matters more than method

From 15.1: the relationship is one of the most consistent predictors of outcome.

Which means it is legitimate to change therapists if the fit is wrong, and it is not rude. Say so directly — "I don't think we're the right fit" — rather than disappearing, and ask for a referral.

And give it three or four sessions before deciding, unless something on the leave-list applies. The first session is frequently awkward for everybody.

What to do

Ask the qualification question, and ask for the registration number.

Name the approach you want, particularly for OCD, PTSD and insomnia.

Bring your numbers (15.7).

Test one disagreement early and watch how it is handled.

And if the cost is the obstacle, call 14416. It is free, it is staffed by trained people, and it is the single most under-used mental health resource in the country.

Next: Part 16 turns from repair to construction — what actually makes a life go better, and how to become somebody you would respect.