“Yeh therapy-werapy sab bakwaas hain”
Systemic Problems with Therapy in India
82.9% of people with anxiety disorders in India are untreated. So therapy ko trust nakarna is common, and it has its reasons.
Why do we not trust therapy?: big treatment gaps, confusing/ unexplained titles - kaun kya karta hain, psychologist aur psychiatrist mein kya difference hain, kis type ki therapy mein kya hota hain, yeh CBT versus ACT versus DBT kya hain? cultural misfits with therapy, not understanding bodily distress and “tension”, not understanding family realities aur family ko kaise include ya sensitise karna chahiye, problematic medication habits, dawai se darr, uneven policies, mixed insurance rules, the list goes on.
The Mental Healthcare Act, 2017 (MHCA) guarantees confidentiality, information in a language that you understand (hindi/ english/ marathi, any other), access to your records and a formal complaints pathway.
The Digital Personal Data Protection (DPDP) Act 2023 requires clinics to provide clear consent and data handling protocol.
The gap lies in awareness. Being worried about confidentiality is perfectly normal but we don’t know our rights. Hum rights jaante nahi aur samne se clinics, doctors, government humein batate bhi nahi.
Mistrust related to confidentiality also comes from one-on-one experience with therapists who connect with family members and share details of therapy. I’ve seen this happen a lot around me. Especially jab therapist family se related ya koi friend ho. Setting confidentiality boundaries and agreeing upon certain rules, at the very beginning, is important.
The National Mental Health Survey (NMHS) shows that system mein hi problems hai, like the low availability of psychiatrists and the cost of therapy and humare own biases like choosing informal treatment,apne family physician ke paas chale jaana, asking the chemist bhaiya if they can help us, and self-medication before going to therapy. These make it hard to understand what to expect from therapy and reduce its effectiveness too.
The Ministry of Health and Family Welfare (MoHFW) has E-Sanjeevani telemedicine practice guidelines, making tele-consultation lawful and the IRDAI asks insurers to cover regular-basis tele-consults. But even when mental health coverage is compulsory and tele-consults have been recognised for billing, policies are different everywhere and OPD psychotherapy and tele-sessions ke rules set nahi hain. Just things that you always need to separately confirm in writing.
“I KNOW FOR A FACT THAT THERE ARE A LOT OF PEOPLE WHO KNOW THEY NEED TO GO TO THERAPY, BUT THEY ARE AFRAID TO APPROACH A THERAPIST. THEY ALREADY THINK IT’S GOING TO COST A LOT AND THAT THEY WON’T BE ABLE TO AFFORD IT.” -KAVITA MUNGI
There’s also a disconnect in the fact that people want bodily relief for their anxiety symptoms. When therapy does not connect mind and body, it starts feeling irrelevant. When therapy is talk-heavy and long and doesn’t solve “real” problems aise lagne lagta hai ki sirf baatein karne se kya hoga?
Some therapists may not cater to your cultural beliefs, faith, or actively say no to family involvement, yeh mismatch se naturally trust drop hota hain. Family-sensitive therapy has long roots in practice and shows benefits when it is done well. Obviously yeh person to person alag hota hai, and making your own choices is most important.
Above all else, there is something about sharing very personal details about yourself, your friends and especially your family that just feels inherently wrong. It feels shameful to talk about these things; it feels a little like bitching or betraying and there can be a sense of alarm that tells you to protect information. Whether it is because of the blurry lines of confidentiality or it is just culturally ingrained ki ghar ki baatein bahaar nahi karte, which is a constant back-and-forth battle that you need to fight yourself in.
But there’s also good news: India has strong, ongoing public conversations on mental health, including the Supreme Court’s 2025 education-sector guidelines and its recognition of mental health as a constitutional right. Large national surveys that map barriers and growing evidence for culturally adapted care are all in process.
Even with the loopholes, there are some therapists and independent organisations that do therapy well. Therapy is like Cinderella's shoe; sometimes it takes a few tries to find a perfect fit. Knowing your rights and setting boundaries can go a long way in ensuring you feel comfortable going through this process.
“ONE SIZE DOESN’T FIT ALL. NOT ALL TYPES OF THERAPIES FIT EVERYONE.” -PALAK SHAH
Good therapy should be a collective effort between the therapist, the receiver and their families (jab aap chaaho ofcourse). Good therapy should obviously recognise your concerns first, answer your questions first and review progress regularly. Conversations should feel relatable and understandable, and should contribute to a larger plan. It should connect your mind, body and spirit and encompass all aspects of your life. And most of all, it should respect your boundaries and confidentiality.
It is not “being difficult” to not trust therapy, India mein system hi thoda confused hain. We need efforts to confront problems like self-medication head-on. We need more therapists and systems that allow us to express our feelings and encourage us to put ourselves first even in a collectivist culture that doesn’t necessarily support us in doing it. Overall, the infrastructure needs to improve to make seeking help easy and we need to make the effort to support people around us to seek help and fight our own biases too.
To know more about the treatment gap for anxiety patients in India, the MHCA, the DPDP, insurance coverage for mental illness treatment, E-Sanjeevani and family-inclusive therapy in India, refer to the links below:
● Treatment gap for anxiety patients in India
● The Mental Healthcare Act, 2017 (MHCA)
● The Digital Personal Data Protection Act, 2023 (DPDP)
● Insurance coverage for mental illness