A wise choice: Find right professional for your mental health

As the field of psychology is beginning to flourish in India, psychologists are facing battles in many fronts. From increasing the awareness with respect to the sheer importance of this branch of science that deals with human behavior in the nation with such an enriched cultural diversity to navigating through the battle we are facing within the field as many “mental health advocates” have risen to fame and designation over the time with the help of unsavory methods from using well-placed connection to incentives such as wealth they were born with. This brings me to a story of a well-educated parents who travelled 450km after taking the time off from their hectic lifestyle just to have their three years old toddler diagnose further after an experienced psychologist told them that the child needs neurological assessment by merely taking a glance at the child. The only symptoms being speech delay and hyperactivity. They love their child; they want to do what is best for their child like any caring parent would. They take the kid to the best neurologist in the state who also takes a mere glance at the child, does not ask any question from the parents nor he takes a moment before he says, “This is severe autism, and it might be neurological as well.” Worried parents ask, “how did you come to that conclusion so quickly?” and he assertively answers, “I have decades of experience and a degree from London.” He was not lying because he had experience for better or for worse (I only concluded worse) considering his fame and number of patients that were waiting outside and a degree, copies of which were hanging all over the building. The good parents continued to tell the neurologist how kid manages to communicate non-verbally with the help of gestures and finger pointing and the answer they get from the neurologist is how non-verbal communication only means facial expressions while finger pointing and gestures “don’t really count.” This baffling response took me back to my English teacher when I was at school and the chapter she taught high schoolers about types of non-verbal communication. Let me just assure you that there are many incredible neurologists in India but even that incredible field is not safe from some who are undeservedly licensed and continue to malpractice.

As a psychologist myself and through my numerous years of experience and travel I have always been keen to observe workings of other specialists whether they operated within my field or specialized in other fields. I acquired many common practices by psychologist and psychiatrists who are excelling in our field, and I have also witnessed events such as the one I just narrated to assure you that this story of malpractice is merely a tip of the iceberg when it comes to the unfortunate uphill battle that dignified neurologists, psychiatrists and psychologists are facing. It is to a point where many within the field feel like Sisyphus pushing the boulder as unprecedented number of so-called “professionals” are doing a disservice to the field by ignoring basic guidelines and eventually bringing ill repute to every mental health profession that is trying to make a difference, trying to give the best help to the people who seek it. This is the reason why I am writing this article because I will not resort to shaming every individual who malpractice within our field regardless of their credentials because that is a lost battle as the field working on mental health is ever expanding specially after the long physical and psychological battle everyone recently fought against Coronavirus and the repercussion our world is facing in the aftermath. Instead, through this article I want to tackle this issue by enlightening people who want to choose the right kind of help from any professional working in our field, during the time of their need. As we look back to the story I shared, no good professional will ever make diagnosis based on assumptions and first impressions even if the said professional is very experienced. First thing any practitioner is taught is to be skeptical of the first impression and any judgement that follows as they are mostly shrouded with personal biases. This is one of the many requirements that are used by a good mental health professional irrespective of the kind of achievements and acclamation they hold within the realm in psychiatry, neurology, clinical psychology, or counselling psychology or be it any specialized sub-category in the field.

The first step is always the hardest step for anyone. Recognizing the problem and accepting that help is required whether it is for you or someone who falls under your guardianship. Mental issues may go under the radar as there are no physical symptoms, they showcase when there is a dysfunction in your personal, professional, social, or spiritual lifestyle. Now as hard and humbling as this first step is, it is followed by a crucial step when you choose to seek the help of a professional in dealing with mental health. The second step becomes tricky when you are actively searching for a professional guidance, many people resort to contacts and references and often they are sent to a neurologist who diagnose and treat disorders which are related to the nerves system or a psychiatrist who treats mental illnesses through medicines. Even if you opt to go through these specialists kindly beware that conversation within the appointment should be within the realm of their specialties. If you are reading this, kindly make sure that your second step involves finding out a good psychologist. Psychologists are taught how to diagnose mental illness, create a treatment plan accordingly and refer to psychiatrists, neurologist or any other specialist if further assessment is necessary or the symptoms point that the expertise of a particular specialist is needed. There are times when patients who, for example, are diagnosed with clinical depression in a level which is not sever and can be treated counselling or therapy such as cognitive behavior therapy, jumps the gun and visit a psychiatrist directly and so they are handed anti-depressants by a psychiatrist, medication which may make them dependent or prone to relapse. Now in no way this should put question on the credential of the psychiatrist as that is what they are specialized to do and that is their general response to the situation at hand. So, it is particularly important to be aware about the kind of issue that is being faced and act accordingly.

Now we need to talk about the common practice which differentiate a good psychologist from what I like to call “other” psychologists-

Credentials: It goes without saying that researching a little bit about the credential of the psychologist that you are planning to visit helps. Individuals must complete Masters in a particular specialized field of psychology to become a psychologist. In India, Psychologists who want to practice in clinical settings with patients who have severe mental illnesses can further complete special training programs and courses under Rehabilitation Council of India (RCI) such as RCI certified M. Phil program or post graduate diploma in clinical psychology. I want to emphasize that it does not negate knowledge, ability, or skills of anyone ethically and successfully practicing psychology if they have completed their masters and opted to practice instead of doing achieving further academically. It goes without saying that any patient with severe mental illness is recommended to be supervised by a RCI registered clinical psychologist or a Psychiatrist.

Modus Operandi: The first session will always be about diagnosing the problem. The investigation must be thorough and vigorous, no-good psychologist is callous in their demeanor or hasten in understanding every aspect and detail of the issue the client is facing. They are thoroughly invested in the client, and they will never generalize the concerns. There should not be any experience bias that may affect the diagnosis. Certain aspects are commonly followed like a Mental Status Examination (MSE) of the client is generally taken. Thorough details from the first informant such as guardians of the client is evaluated.

Tools: If you are reading this article, let me tell you as a psychologist that this is the most important deduction you will make about your psychologist regardless of their credential or experience. Over the years I have learnt that even the best psychologist within my field humble themselves by keeping a manual with themselves even if they thoroughly remember every step of the psychological assessment tool they are using. There is no diagnosis without the use of psychological assessment tool. Many “other” psychologists fall for this hubris and try to diagnose problem on a whim whether they mask themselves behind the “we are too experienced” or “we are too smart” or any other thought process. You will always find numerous manuals, books, copy ICD and DSM in the office of a good psychologist and they will not hesitate to open it to verify their own knowledge as well as giving you assurance about their diagnosis. It is very important for a professional psychologist to get their diagnosis correct and for the client and/or their guardians to have the same amount as they do.

Treatment plan: Treatment plans are made after diagnosis is completed. Psychologist refer the client to other specialist whether that specialist is a psychiatrist, neurologist, microbiologist or any other expert depending on the diagnosis as such specialized treatment are beyond the realm of counselling and therapy. The treatment plans are implemented, and the progress of the client is under continuous observation with the idea that these plans can be changed if they are not being effective. There are varieties techniques for psychological interventions such as Cognitive Behavior Therapy, Dialectical behavior therapy, group therapy and they work differently to each individual. For example, a child can have speech therapy, occupational therapy, special education altogether as a treatment plan or something particular depending on the issue that child is facing and the severity of it. A good psychologist will accept if their current technique is not being effective and it is not the best one that can be provided to the client, and they will not hesitate to change it to the one which can be more productive instead.