Response to Letter to the Editor “Psychotherapy belongs to whom?”

Sir,

The field of psychotherapy has grown in depth and breadth over the years through significant contributions from varied disciplines. “Psychotherapy belongs to whom?”[¹] is a question that resonates with the current ethos of mental health care in which a consumer needs to be clear about what services a professional can be expected to deliver.[²] It also resonates with a seemingly basic query of what belongs to the self (in this case a discipline) and what belongs to the other.

During the pandemic, a number of tele-practice guidelines were formulated in India to support mental health practitioners in providing ethical and competent mental health care, during this sudden and challenging transition. The Guidelines for Tele-Psychotherapy Services,[³] released on April 17, 2020, by the Department of Clinical Psychology, NIMHANS, were developed after extensive internal consultations and external independent reviews for practicing clinical psychologists in the country. A careful reading of page one of the guidelines would indicate that the statement in question, in response to ”Who can offer these services?,”[³] was about the applicability of the guidelines for qualified clinical psychologists who are eligible to practice according to the Rehabilitation Council of India (RCI) guidelines and Mental Health Care Act.[²] These guidelines are also for trainee clinical psychologists, from RCI recognized training institutes, receiving documented supervision from qualified clinical psychologists.

It is unfortunate that the authors have understood the choice of words used in the first version of the tele-psychotherapy guidelines[³] to imply that ”only” (emphasis added) clinical psychologists can offer these services in the sense that clinical psychologists are claiming propriety of psychotherapy. However, these guidelines are not about eligibility to practice psychotherapy or tele-psychotherapy. As the authors themselves mention, “...the guideline mentions it's applicability to CP only.” and that is essentially to honor our professional boundaries and limit the applicability of these guidelines to clinical psychologists, and not to indicate that professionals from other disciplines are prohibited from practicing tele-psychotherapy. While generic guidelines are useful across disciplines, it may be useful for each discipline that offers psychotherapy to develop specific guidelines that highlight the specific expertise and unique worldview of that discipline. Declaring the guidelines[³] as applicable for all disciplines that provide psychotherapy would have had ethical implications. Some of the other guidelines prepared during this time include Best Practice Guidelines for Telepsychology during Disasters (COVID-19 Pandemic),[⁴] Telepsychiatry Guidelines,[⁵] and Guidelines for Tele-Psychiatric Social Work Practice.[⁶]

The letter[¹] is an illustration of how the choice of words may be viewed diversely by people from various backgrounds. This perspective may be useful specifically when further versions of these guidelines[³] are developed and generally when guidelines are being developed to be available in the public domain. We sincerely hope that, as a nation that needs concerted efforts to meet the mental health needs of its occupants now more than ever, individual professionals from various disciplines and systems alike would work, learn, and grow together.

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Nil.

Conflicts of interest

There are no conflicts of interest.