Bad therapy: Getting scarred instead of help

11:34 PM. I glance at the clock, waiting for my therapist. My name is finally called, and I enter the room to find her sitting across from me, separated by a glass partition as this was during the pandemic. Her big black glasses stand out. The academic certificates on the wall, at least four, overlook both of us. 

She asks me to share my problems, but interrupts me repeatedly as I begin to speak. The session is over in 15 minutes, and she hands me a prescription for epilepsy medication to help me sleep better — though I do not have epilepsy.  

The process felt rushed and the chamber looked messy. 

Over the years, therapy has become a far more familiar concept than it was when I first sought help in 2019. Back then, the idea of therapy was still shrouded in secrecy, and I remember wondering if I was paying a professional for guidance or just visiting the next-door aunty for unsolicited advice.

Therapists in Bangladesh often function with a troubling level of unprofessionalism, but why is that? 

"There is a significant gap in training, and many so-called professionals in the field lack proper qualifications and degrees. Some even resort to yelling at patients when there's a disagreement or a lack of understanding," said Dr Kamruzzaman Mozumder, a professor at the Department of Clinical Psychology, Dhaka University and President of the Bangladesh Clinical Psychology Society.

He continued, "Psychologists are human too, and at times, they unintentionally project their issues onto their patients. Additionally, not all therapists adhere to ethical standards. It's also important to recognise that not every therapist will be the right fit for every patient, as their expectations and approaches may not always align."

"There is a significant gap in training, and many so-called professionals in the field lack proper qualifications and degrees. Some even resort to yelling at patients when there's a disagreement or a lack of understanding. At times, they unintentionally project their issues onto their patients. It's also important to recognise that not every therapist will be the right fit for every patient, as their expectations and approaches may not always align."

Dr M Kamruzzaman Mozumder, President, Bangladesh Clinical Psychology Society

In Dhaka, scarring therapy stories are aplenty, especially among women.

Raisa (not her real name) sat across from her therapist, trying to explain why she had lost interest in wearing makeup during a challenging emotional period in her life. 

The therapist listened and then offered an observation that caught Raisa — in her 30s and a communication manager at a development institute — off-guard: "Sometimes women wear makeup as a coping mechanism. Victims of domestic violence often use it to cover their scars or bruises."  

Raisa struggled with how her friends responded to her appearance during that time. Instead of asking if she was okay, they urged her to wear makeup. 

The therapist, hearing this, responded with an almost dismissive smile, "What's the harm in putting on some makeup then?" Raisa firmly replied, "I'm not afraid to show how I feel. Shouldn't the focus be on my feelings instead of how I look if I'm struggling?" The therapist merely smiled again.  

During Raisa's third session, the interaction became even stranger. As soon as she entered the room, the therapist casually remarked, "Why are you back? You're well now." 

In another moment of vulnerability, Raisa shared how, after getting married, she often felt a deep sense of homelessness. Her family insisted that her in-laws' house was her 'new home,' but this sentiment never settled well with her. She confided that many Bangladeshi women struggle with similar feelings. 

The therapist launched into a lecture, recounting her decades-long marriage, and concluded, "This is the reality for all Bangladeshi women, and you just have to accept it." Raisa recounted, calmly replying, "I'm sorry, but maybe that's 'your' reality, but it cannot be mine." 

In many instances, therapists fail to grasp the gravity of a situation and offer solutions that only address the issue temporarily. Each patient has specific needs, and not all approaches apply to everyone. A professional therapist is expected to thoroughly understand their patient's situation before offering any advice or opinions.

"There are two approaches therapists follow: the comfort-focused approach [advice tailored to offer comfort, make a person feel good for the time being] and the growth-focused approach [that aims to help people achieve personal growth and positive change]. Clinical therapists often prioritise growth, which can initially be painful for patients but yields better long-term benefits," said Dr Kamruzzaman Mozumder.

Sania (not her real name) sought therapy during a difficult time of separation from her now ex-husband. After two months of regular sessions, it became clear to her that she wanted a divorce. Her ex, however, was unwilling to make a decision or even work on himself to repair the relationship. To help facilitate the process, the therapist suggested that Sania, 30, invite him to one of their sessions.  

During the session, the therapist tried to help him understand Sania's need for closure and that restarting the marriage was no longer an option. Once the session ended and Sania's ex-husband left the room, the therapist turned to her and said, "I know it's unprofessional, but he seems like such a nice guy. It breaks my heart to see him so sad." 

This remark left Sania, a program coordinator at a non-profit organisation, stunned. It was also a moment when Sania knew she could no longer waste her time and money on therapy in Dhaka.  

"I would say social class plays a more important role in openness for psychotherapy than, say, gender. But within a social class, it seems women might be more open to asking for help when they need it. Psychotherapy is an expensive and inaccessible modality of treatment for most people in Dhaka. And it is almost unavailable for folks outside the capital," said Dr Mursalin Mosaddeque, a Postgraduate Trainee in Psychiatry at Dhaka Medical College Hospital.

Sanjana (not her real name), remembers meeting a dead-end when she sought therapy along with her son. They were experiencing a tumultuous home life with an alcoholic family member, Sanjana's husband. The arguments were intense at home. Against this background, the therapist's solution was, "Let him be, let him drink and avoid conflicts." 

"Resources are scarce when it comes to providing psychological interventions. Someone with a diagnosed condition might need therapy and is recommended that they go see a therapist as part of their treatment regime. On the other side, many choose to go to therapy simply as a part of overcoming everyday life," explained Dr Mursalin Mosaddeque.

Maha (not her real name) works as a client executive at a corporate office in Dhaka. She has a colleague who, after much deliberation, went to her first therapy session. She went in hopeful. However, the therapist's solution to all her problems was shockingly simple and archaic. It was "Get married."  

"Therapists like these should not be considered real professionals. There is a proper process to follow — patients need to be diagnosed first by a psychiatrist and then referred to therapy. Different types of therapy exist, and the one best suited to the patient's well-being should be recommended," said Dr Md Iftekhar Alam Siddiqui, addiction medicine specialist and mental health counsellor.

He further stressed, "Unfortunately, many individuals complete a mere 3-4 month online training programs and claim to be professionals. The real gap lies in the lack of comprehensive training after obtaining a bachelor's and master's degree in psychology." 

Therapy is "a process" and does not come with quick fixes. It also entails prescriptions of medications which, if done without professional training and expertise, can potentially set a dangerous precedent.  

While therapy has become more common and accessible, to an extent, finding the right therapist in Dhaka remains extremely challenging. And in many cases, like the cases mentioned here, it proves to be counter-productive.