In early May, Mani S*, a Chennai-based writer and journalist, found himself talking to an empty chair. ‘Imagine a friend seated there, going through your emotional crisis, and talk to him,’ said his therapist’s calming voice over a WhatsApp call from Bengaluru. Though initially awkward with the exercise — especially now in our socially-distanced reality — Mani soon found that the new perspective helped him deal with his anxiety. “I thought in-person sessions were better, but I’ve had no trouble [with teletherapy] because my psychologist is aware of the medium’s limitations and helps me with specific instructions,” says the 32-year-old, who first got help last October to cope with his divorce. “During the lockdown, I realised that medicines alone were not helping my depression, so I turned to teletherapy.”
In New Delhi, the fortnight after the first lockdown saw a spike in Covid-related phone calls at IWill Therapy, the online specialist therapy company. The first week was spent addressing anxiety from both first-timers and existing clients. “With lay-offs, pay cuts, and mounting bills, everyone is facing some issue now. But our callers have been triggered to a point where their depression or anxiety is painful,” says Nayamat Bawa, 32, head psychologist, adding that they’ve seen a 65% jump in sessions between May and June. Corporates are stepping up too. I will has signed up with nine (big and small start-ups) in the last month, including home services start-up Urban Company (UC) and food delivery platform Swiggy. “UC has made this a part of their health policy, wherein employees can book unlimited sessions on our app and the expenses are borne by the company,” says Bawa.
Even social media platforms are upping their game. This week, Snapchat rolled out its Here For You’ feature. While there are no teletherapists, its content covers a range of topics including eating disorders, anxiety, and how to identify distress in a loved one.
(left) Shipra Dawar, Founder and CEO, IWill Therapy & ePsyClinic and (right Nayamat Bawa, head psychologist
Help’s just a tap away
Though teletherapy has been around for years, the pandemic has most certainly brought the psychotherapist home. Teenagers, millennials, and people in their 40s are reaching out the most, to address concerns such as job insecurity, couple discord, behaviour issues with children, sleep disorders, and loneliness. “Anxiety and depression as clinical conditions have seen a strong spike. This is because the pandemic has created stressful conditions for people with no pre-existing issues as well as those with an existing risk for burnout,” says Bawa, adding that since April, over 80,000 people have reached out on IWill’s free therapy platform, ePsyClinic. “Around 44% are in the 42-45 age group, followed by 31% between 22 and 42 years,” says Bawa, adding that the platform is seeing month-on-month growth of 80% direct or self-referred clients. One of her first sessions, she recalls, was with a client in his 40s whom she’d been seeing for a couple of years. “His business was overseas and he had to shut shop. He was experiencing suicidal thoughts. I had to use positive coping mechanisms and cognitive behaviour therapy, such as thought restructuring, to help him,” she says.
- The rise of the social media therapist is troubling. Many, especially teenagers, are replacing therapy with licensed experts with unsolicited advice from influencers and celebrities.
- “In the offline world, we maintain social control over our expression. Social media’s anonymous environment allows for uncontrolled expressions of personal thoughts, fears, and even easy denial if an issue crops up. We need social media literacy (through awareness programmes on offensive content, etc) especially among teenage users, to help them evaluate a post or interaction in a constructive manner,” says Dr. Manoj Kumar Sharma, Professor of Clinical Psychology at NIMHANS.
In Chennai, psychiatrist Dr. Vijay Nagaswami, 62, has also noticed a much higher incidence of anxiety and irritability over the last four months. “Many couples haven’t spent as much time in direct contact with each other as they have now. So the cracks that were once papered over are now opening and people are realising that they can’t delay addressing the issues any longer,” he says.
During this lockdown, more than 60,000 people have been counselled on mental issues related to the Covid-19 pandemic and lockdown, through the teletherapy helpline set up by the National Institute of Mental Health and Neuro-Sciences (NIMHANS). In addition, Practo’s Online Consult has registered a 240% growth in overall psychiatry teleconsultations (comprising 74% men and 26% women).
Need for privacy
For those who’ve never had therapy, teletherapy is an easy introduction. “Many first-timers find video sessions more comforting as they remain in their own environment,” says Nagaswami, who has been taking online sessions since 2013. Moreover, taking 50 minutes out of one’s day is far easier than travelling a couple of hours to get to a therapist’s office. “Virtual sessions are more convenient for someone with anxiety as the smallest of things, such as traffic or bad roads, can seem impossible to handle,” says Mani.
Dr. Vijay Nagaswami
But convenience and flexibility aside, there are challenges too. Therapists have to be alert for non-verbal cues. They also have to judge the baseline for a new client’s anxiety. “I talk this through at length with patients, but mostly we go by how long the problem has been persisting and how badly it affects their daily life,” says Jessica Gold, Assistant Professor at Washington University’s Department of Psychiatry (St Louis), who has authored articles on issues faced by therapists. “Where I need to check their heart rate or blood pressure [for those on stimulants for ADHD, etc], I’ve been asking them to use Fitbit or other ways to get their own measurements,” she adds. It is also particularly hard for people with symptoms of paranoia around technology. Gold explains how, if you thought someone was following/monitoring you, and then you had to communicate with a therapist using technology (which isn’t 100% secure), it could be quite frightening.
Another constraint: the lack of a ‘safe space’. When you pay for therapy, you pay for the psychotherapist’s knowledge and the space — where you can open up without the risk of interruption or being overheard. Nagaswami believes teletherapy won’t completely replace face-to-face sessions in the future. “For those living with large families, privacy is a concern. They will prefer to wait for in-person sessions unless their issues are too compelling and require urgent intervention,” he says. This explains why many opt for sessions on WhatsApp or the chat platform on IWill’s app. Poornima Bhola, faculty at the Department of Clinical Psychology at NIMHANS, recalls a 19-year-old who found it challenging to speak to a psychologist because his family didn’t know he was in therapy.
- When the first lockdown was announced in March, the Indian Psychiatric Society (IPS), along with Bengaluru’s National Institute of Mental Health and Neuro-Sciences (NIMHANS), brought out the Telepsychiatry Operational Guidelines 2020 because, according to IPS president PK Dalal, “this is the first time we’ve gone fully digital with our sessions”.
- In April, IPS reached out to over 1,600 people across India for a Covid-linked online survey. The anonymous study revealed that two out of five people had symptoms of depression and anxiety. “Nearly 70% were stressed and behavioural changes were cropping up,” says Dalal, who is now planning to conduct another survey to check if awareness and advocacy about the crisis have helped lower stress and anxiety levels.
Let’s talk money
Price is a concern, too. Especially since no insurance company covers therapy (though the 2017 Mental Health Act provides for the inclusion of mental illness cover). Last month, Delhi-based feminist researcher Radhika Radhakrishnan, 26, tweeted about the exorbitant cost of therapy in India. With over 2,000 retweets and 10,000 likes, it resonated with many. “A session with a psychologist costs between ₹1,500 and ₹2,000 for an hour, and psychiatrists cost more, close to ₹3,000. This, added with the cost of medicines, is a high expense every month,” she says.
Finding the right specialist takes time too, says Radhakrishnan, who has consulted four psychologists and two psychiatrists in the last five years. Then there are the bad experiences no one talks about. “I once had a psychologist who disagreed with me during a session, stopped midway, and then blocked me on WhatsApp!” Unfortunately, at the moment, such cases can’t be reported. “There is no governing body that regulates psychotherapists and counsellors in the manner that the Indian Medical Council regulates doctors,” says Nagaswami.
Meanwhile, Shipra Dawar, founder-CEO of IWill Therapy, is working on regulations to report such cases. “It works both ways: whether a therapist is harassed by a client or the other way around. Therapists are trained to handle such situations — we never block them, but a disengagement message goes out to the client mentioning sessions will no longer be available,” she says.
- What is this practitioner’s training, qualifications, and license?
- Does the practitioner’s area of expertise match your current needs (e.g. children’s issues, addictions)
- What are the session’s charges and accessibility?
- Have you heard any positive feedback about the practitioner you are considering?
- Do you feel comfortable in the initial interactions with this practitioner?
Expert speak
Of course, teletherapy has been a learning curve for therapists too. Gold says making the virtual switch in March wasn’t easy. “It can be really exhausting to go from person to person on Zoom or Skype all day,” she says, adding that some things simply can’t be done over video or phone, like handing someone “a tissue if they are crying”. But what they all agree on is that teletherapy will be the new normal in tackling the mental health crisis — albeit as a hybrid version. “It will not replace traditional sessions entirely; there will be a mix of the two. It will give us the opportunity to reach out to more people, especially those in rural and semi-urban areas,” says Bhola. As more glitches get fixed and more experts join the expanding roster of online resources, this will mean help at hand for anyone, anywhere.
*name changed
Sneha suicide prevention helpline: 044-24640060 (8 am to 10 pm); 044-24640050 (24/7)
