Much has happened in the last two decades in India as far as the professional practice of counselling and psychotherapy is concerned. Indians today have moved from being a cautious nation that viewed mental health services as stigmatising to curious and bold consumers of psychological services, not shy of seeking psychological help for their problems.

The most significant reason for this shift is India’s emergence as a major player in the global financial and industrial marketplace in the 1990s. With liberalisation and privatisation also came multinational companies that already had experience of counselling through employee assistance programmes. Today colleagues in India report that EAP services are well used, with some providers seeing more male clients taking up these services. Globalisation has awakened the Indian psyche to the potential of psychological services as an important tool in dealing with mental health issues and improving their quality of life.

The total workforce involved in the IT and outsourcing sectors in India is staggering and all major metropolitan cities are growing exponentially, attracting heavy investments in many sectors. But with this come the unique challenges of a rapidly globalising economy, including higher rates of mental health problems. It is interesting to note that in many cities the number of family courts has risen sharply in the last 10 years and there has been a surge in the number of couples seeking divorce. There has been a 200 to 350 per cent increase in the number of petitions for divorce in India in the last few years, with 70 per cent of the applicants aged between 29 and 35.1 Marriage and couples counselling is therefore emerging as a much sought-after form of counselling in urban India, as what was once provided by the clergy, family and religious leaders is now recognised as a valuable service that can be offered by professional counsellors and therapists.

Counselling in schools

Education is another sector actively using counselling and psychotherapy services. Indian cities all have a large number of private schools, some of which use international curricula, and many Indian school boards have appointed qualified counsellors in recognition of the role of good psychological health in improving academic performance. Many counselling psychology interns are based in the school system in India, and their work reveals that children have psychological needs that require counselling intervention. A sizeable number of postgraduate students who complete their master’s education in counselling psychology or clinical psychology are employed as school counsellors across the country. Consistent with the World Health Organization’s prediction about developing countries, urban and semi-urban Indian children spend more time at school than at home, indicating schools to be an important site for the provision of counselling services.2

The changing social support structure in India is also contributing to the increasing mental health needs among children, as young people grapple with issues related to body image, substance use, relationships, sexuality, reproductive health and parental conflict. In 17 years of practice and work with schools, I am now seeing an alarming increase in the challenges faced by children and adolescents. In India 21.4 per cent of the population are adolescents and about 16 million girls aged between 15 and 19 give birth every year. Nineteen per cent of the world’s children live in India, making every fifth child in the world Indian.3 The sheer numbers indicate the challenge in providing mental health services.

The Indian Paediatric Society, in its list of top challenges faced by Indian adolescents (they include anorexia nervosa, adolescent pregnancy, behavioural problems, substance abuse, study problems, identity issues and emotional problems), cites nine out of 10 issues as being of a psychological nature.4 A recent report indicated that close to 40 per cent of 7th to 12th grade pupils (aged 13–19 years) in Indian schools use drugs of some kind or other.5 Substance use today is a major issue confronting school counsellors. A need for models of counselling and psychotherapy that can address these needs, in partnership with other mental health providers such as child and adolescent psychiatrists, is emerging.

The media has played a crucial – and positive – role in enhancing the image of counselling and psychotherapy in India over the last few years. Previously the public’s main exposure to therapy was its rather confusing depiction in popular Indian cinema. The talking therapies are now the subject of well researched and accurately written media features and columns, with high profile figures talking more openly about the benefits of psychological help. In many ways this has reduced the stigma associated with seeking mental health services. Several newspapers also provide therapeutic counselling guidance through Q&As, counsellors’ and mental health professionals’ views are sought in reporting issues of social importance and radio channels broadcast dial-in programmes where counsellors provide answers to callers’ problems. Television too has started to air programmes where counsellors discuss mental health issues.

Until recently, with few exceptions, counselling had been a practice confined to psychiatric hospitals, residential psychiatric centres and a small number of non-profit government organisations. Now, counsellors and psychotherapists in private practice make up a significant sector of the helping professions. A simple online search for ‘psychological help’ will yield a number of counselling and therapy centres in most Indian cities, staffed by professional and well-trained counsellors and therapists (many trained internationally). In my experience, counsellors in private practice report no dearth of clients seeking help, with more and more therapists having to place clients on waiting lists or refer them to colleagues. All this would indicate that public demand now is very high in urban India.

Training standards

Training in counselling and psychotherapy in India has also seen considerable development. The first master’s programme in counselling psychology was started by Sampurna Monfort College and subsequently a few other universities and colleges began to offer similar programmes. Well-respected training programmes today focus on the personal development of the counsellor, require personal and group therapy, provide supervision and enlist counselling and psychotherapy practitioners as trainers. In a survey conducted by the co-author of this article, postgraduate students of counselling psychology indicated that their own experiences self-growth and awareness in response to therapy had been enlightening for their families. Counsellors and therapists have established their presence in meeting the growing demands of the Indian public while at the same time maintaining ethical standards. (See www.talkitover.in and www.mindvidya.com for examples of initiatives started by peers and alumni of leading institutes that provide postgraduate training in counselling and psychotherapy.)

Postgraduate training in counselling offers trainees a variety of models to work with, and intensive internships and supervision help them to integrate their learning into practice. Employers of counsellors and psychotherapists prefer counsellors trained at this level. A few notable diploma programmes are also offered. I say notable because the field of counselling and psychotherapy has also seen a proliferation of short-term, poorly conceptualised training programmes with weak theoretical orientation that produce counsellors who are not competent, often leading to poor outcomes and infringement of ethical standards. An example of an effective training programme at diploma level is the one offered by Parivarthan (www.parivarthan.org). Similar programmes can be found in other cities and states.

Training has also benefited from the input of trainers from other parts of the world. For example, at the university where I work training by trainers from the UK in cognitive analytic therapy (CAT) as an integrative model has been offered for the past four years to master’s students of counselling and clinical psychology (www.iacat.in). These programmes provide an opportunity for cross-fertilisation of ideas, practice concerns and models of care between countries and cultures and have improved the competence of counsellor interns significantly.

The emerging models of counselling and psychotherapy today in India appear to be moving towards more integrative models. Practitioners and trainees are finding the blending of Eastern and Western approaches useful in dealing with their multicultural, multi-ethnic and rapidly globalising Indian clientele, and the inclusion of traditional healing and spirituality into counselling and psychotherapy training is now gaining an impetus in counsellor education programmes. Collaborative programmes with many partners across the world through conferences and writing (see www.iccp2012.weebly.com) have proved to be effective ways of internationalising counselling and psychotherapy in India.

Psychotherapy in India is an emerging professional field facing many challenges6 posed by a rapidly evolving society that constantly stretches the social fabric of the community. Counselling and psychotherapy is increasingly addressing this need in India through greater public awareness and well-rounded training programmes, sharing of practice models internationally and the integration of cultural elements into practice. However, the magnitude of mental health needs in India is staggering and much still needs to be done to make services accessible and affordable to everyone.

Tony Sam George is Associate Professor and Head of the Department of Psychology, Christ University, Bangalore.

Elizabeth Thomas is Assistant Professor and PhD Scholar at the Department of Psychology, Christ University, Bangalore.

References

1. Jain G. The rearranged marriage. Tehelka Magazine 2009; 6 (43). http://archive.tehelka.com/story_main43.asp?filename=hub311009the_rearranged.asp
2. Hendesen R, Weisen RB, Orley J. Mental health programs in schools. Geneva: Division of Mental Health, World Health Organization; 1994.
3. UNFPA for UN System in India. Adolescents in India – a profile. New York: United Nations Population Fund (undated). http://web.unfpa.org/focus/india/facetoface/docs/adolescentsprofile.pdf
4. Gupta VM, Sen P. Adolescent Health. Indian Journal of Public Health 2001; 45(1): 3–7.
5. Qadri SS, Goel R, Singh J, Ahluwalia SK, Pathak R, Bashir H. Prevalence and pattern of substance abuse among school childern in nothern India: a rapid assesment study. International Journal of Medical Science and Public Health 2013; 2(2): 273–282. DOI: 10.5455/ijmsph.2013.2.271-280.
6. George TS, Pothan P. Counseling and psychotherapy in India: professionalism amidst changing times. In: Moodley R, Gielen UP, Wu R (eds). Handbook of counseling and psychotherapy in an international context. New York: Routledge; 2013.