Absolutely Hellish to Actually Helpful: 7 Obstacles to Therapy

The mere thought of trying to find someone else defeats me. Navigating the hell that is mental healthcare worldwide is not something I'm prepared to do right now.

Also Read: Psychologist vs. Psychiatrist: What's the Difference? 

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It is often discouraging to find that, now that you've made up your mind to get help, help is nowhere to be found. 

Gearing up to see someone about your mental health is in itself a massive ordeal. And this is someone who's already fighting their own mind on a daily basis. So when you add into the mix the difficulties that stand in the way of finding good help, it's a recipe for disaster. Most people are absolutely crushed right at the outset, and lose all faith in the concept of mental healthcare. Just one more in a series of battles lost before they are begun. 

Finding a good therapist or psychiatrist is not easy. There, that's the bad news. So I find it's better to be prepared right from the start. This way, you can remind yourself that just because these obstacles exist, doesn't mean you can't find help.

The Obstacles to Good Therapy

We cannot allow these factors to get in the way of getting help; simply because of how important it is to pay attention to your mental health.

1. Financial Barriers  
2. Geographical Barriers 
3. Language Barriers 
4. Prejudices and Biases 
5. Inexperienced Therapists 
6. Inflexible Therapists 
7. Your own mental health, i.e. the very thing you're trying to fix to begin with. 

Financial Barriers 

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In India, the current going-rate for "affordable" therapy is around Rs. 850/- a session. This is mainly courtesy of "therapy sites" and clinics who have a larger number of therapists on their payroll.

Experienced individual therapists typically charge way higher per session - in the Rs. 1200-1600 range at least. 

Depending on your earning capacity, 850 bucks four times a month may already be out of your reach. Even 850 bucks once a month is a pretty big deal for me. And for most people - especially those who are  just starting out - monthly sessions probably won't cut it. You may need weekly, or even bi-weekly sessions at the get-go. So how in the world are you supposed to shell out Rs. 6,800/- a month just to stay sane? 

Of course, there are cheaper alternatives. Psychology students give free counselling as one of the requirements of their degree. Non-profit organizations try to mobilize resources and offer free counselling, as do hospitals. 

But students are typically inexperienced, and non-profits are few in number. Their resources are already overtaxed to the limit. And a hospital is hardly the kind of calm, one-on-one environment you're looking for when you want to discuss your problems privately.

Geographical Barriers 

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Where you live matters. In Kerala, I've known people who have had to travel hundreds of kilometres to get to a competent mental health provider. Travelling a distance of even 45 minutes on a regular basis proved next to impossible for me in my chronically depressed state. So how is someone supposed to travel hundreds of kilometres, and cross several districts on a weekly, or even a monthly basis? If you're dependent on someone else taking you, then you're also at the mercy of their moods and energy levels. It's a double whammy. 

Language Barriers

Are adequate mental health facilities available in the dozens of regional languages spoken in India? No, of course not. Again, I've seen some non-profit organizations make the effort. But free or low cost counselling in a regional language - we're already at a difficult intersection. 

Prejudices and Biases

Which brings me to Whammy No. 3. I visited a psychiatrist in Thrissur once, many years ago. My goal was to get a medical certificate for my depression, in the hopes that it would help excuse my absences in college. 

The meds she prescribed included a mood stabilizer - one that, after taking only a single dose, instantly killed my libido. The medicine such that it took more than a week for the effect of that single tablet to wear off. And at no point did she warn me of such a side-effect. 

[A simple google search of the medicine's name will take you to hundreds of such complaints about it. In most of those cases, regardless of gender, patients were not warned of the effects.] 

The following week, I asked her whether any of the medicines she had prescribed would have had such an effect. She admitted that it did, but that it didn't matter, because I wasn't married. 

I can't say this exchange did much to help my mental state. Nor did it do anything for my faith in the system. 

Another doctor spent absolutely no time whatsoever speaking to me - his prospective patient. Instead, he spoke to my dad without me present, and carelessly wrote me a prescription. Interestingly, the prescription he gave me had the same medicine on it. Needless to say, that piece of paper did not make it past a hospital trashcan. And not only did I avoid that doctor, but also the entire hospital after that.

Therapists who are Inexperienced, Inflexible, or Just Plain Bad

A bad therapist or doctor can do so much harm. A patient going to see them is in an incredibly vulnerable position. There's a power dynamic here - one that, if exploited, can have damning consequences. Because a patient is looking to trust, and is likely to believe what their therapist or doctor tells them. 

Using judgmental language, being indifferent or callous, or just plain wrong: these are all things I've come across. There are also therapists who are incapable of adapting their methods according to what works for a patient. Even the doctor I currently am seeing has a habit of blurting out stupidity:

• "You shouldn't be putting on weight. You're too young to look like an aunty."
• "You can stop taking meds when you have a job and a stable boyfriend."
• "You're definitely a borderline."

[A borderline what? Lol.]

(In his defence, he's a very old man. He keeps forgetting when he's seen me last, and also that I've been employed since I left college.)

Thankfully, by the time I met him, I'd developed a bit of a thick skin. Making your way through the options available in three different states (in two different countries) have to offer can do that to you. So now I know to let these comments roll off my back. In fact, I go in expecting to hear them. And he's not actively malicious, indifferent or damaging, so I stick with him. Because the mere thought of trying to find someone else defeats me. Because navigating the hell that is mental healthcare worldwide is not something I'm prepared to do right now. But we cannot allow these factors to get in the way of getting help. Simply because of how important it is to pay attention to your mental health. In my next post, I write about some of the things that help me navigate this obstacle course; and what signs to look for in a good therapist.