Click for a counsellor: Psychiatric counselling has gone online during the pandemic

Now that life’s gone almost fully online, people are able to access even therapy from the comfort of their homes. But does this work as well as the clinic?

Solace: Online therapy can work much the same way as in-person therapy.

When Suhasini*, 31, a copy editor from Chennai, felt herself slip into a mental health crisis a few weeks ago, teletherapy came to her rescue. She was able to tide over the challenging period with the help of her therapist online. In fact, Suhasini felt more secure talking to her therapist from her home. “Teletherapy from the comfort of my home meant that I did not have to deal with the stress of visiting a hospital. This pandemic has made me incredibly anxious about catching infections,” she says.

During the pandemic, it is precisely this freedom to schedule appointments over the telephone or video that has offered solace to many people.

And as psychiatrists and psychologists open their virtual doors to clients, social media has done its part to create awareness about therapy in a virtual setting. From crowd-sourced lists of budget-friendly therapists to inviting conversations around professional teletherapy, social media has it all. Celebrities too have pitched in, using their personal timelines to help end the stigma surrounding mental illness.

“11 things you can do if someone you love has depression”, reads a post on a popular Instagram page that covers mental health. It goes on to bust myths about depression and even offers resources where one can find help. Scroll through the page, and similar pages on social media platforms, and you will now find that access to mental health resources — especially during the lockdown — is just a click away.

Me-time

But what about those who want the security of a physical space for therapy, a face-to-face meeting with a therapist?

Durga M. Sengupta, 29, a journalist from Bengaluru, has always looked forward to the weekly sessions with her therapist. It was her me-time. No phone calls or other interruptions. “Now, the sessions feel almost diluted. Video calls leave no scope for body language. Human social cues are more or less missing in teletherapy,” says Durga. “Removing myself completely from the world and giving my full concentration seems a bit difficult in teletherapy.”

While online therapy can work much the same way as in-person therapy, “non-verbal clues are as important as verbal ones. When we work online it is not possible to capture all of this given the limitation of a screen,” says Ramya Satheesh, a psychotherapist from Chennai.

Then there are the technical glitches to cope with, which can make diagnosis difficult. “ Creating a rapport and making physical observations is crucial while diagnosing a patient. These cues can be lost if network connectivity is poor. And if the patient is going through a crisis, it is surely more reassuring if he or she is in front of you,” says Hema Tharoor, a clinical psychiatrist, who has also been conducting teletherapy for over a decade.

Teletherapy has indeed been around for some time now and professionals have used this technology to reach out to more people. But earlier, the therapist could establish a rapport through face-to-face meetings before moving online. Now with the lockdown, many are taking the teletherapy route out of necessity, sometimes for the first time.

Tech glitches

Poor internet connections, the lack of privacy at home, and finding a safe space are some of the main constraints of teletherapy. These limitations also apply to therapists and doctors whose workspace is now their homes. Your screen may freeze during a crucial moment, the doorbell might ring, and you may be interrupted by others at home.

Then there are the challenges of, say, talking to a child who needs therapy. “Or people who suffer from attention span disorders, or victims of domestic abuse; they are also vulnerable if they opt for teletherapy,” says Bengaluru-based psychologist Shrutkirti.

Experts agree that during these troubled times, any form of mental health help might go a long way, but it is crucial to exercise caution and be able to screen out quacks and unqualified hobbyists. Instances of social media influencers opening their ‘direct messages (DMs) for therapy’ are legion, and experts caution against this well-meaning but risky offer of help. While talking does help, the kind of help a non-professional gives may inadvertently lead to over-simplifying or misreading of mental health issues.

Ethics and privacy

The National Institute of Mental Health and Neuro-Sciences (NIMHANS) has published guidelines on how to handle teletherapy. The guidelines give pointers to psychologists on how to identify if a person can safely opt for teletherapy, how to get informed consent, and about data storage from a session. The Indian Psychiatry Society has also published updated guidelines on handling tele-psychiatry, including on remote prescription of medicines.

The guidelines urge psychiatrists and psychologists to be amply clear on everything from storing case records for future reference to clarifying modes of payment. With these checks and balances in place, one might be looking at teletherapy continuing in psychological interventions even beyond the pandemic.

*Name changed upon request.

The writer is a freelance journalist who writes on social and cultural issues.