Psychiatrists and psychologists involved in tele-counselling during the lockdown said the therapy was being compromised because of lack of privacy at their clients’ homes.
A person is not always comfortable opening up to the counsellor in the presence of other people. At times the person who is causing mental trauma to the client might be beside him or her during the counselling.
Therapists recounted multiple instances of clients reaching out to them through video call during the lockdown but failing to open up or answer queries in the presence of family members.
During a session with a psychiatrist, a woman who is harassed by her alcoholic husband failed to answer queries about the abuse because the husband was around.
Another psychiatrist said a teenager was on video call but could not speak freely because the parents were around her.
“There might be a lack of privacy in some homes and people might not be comfortable sharing their travails in public domain or when they know others are hearing them. Under such circumstances, counselling can get compromised. Not everyone has personal space at home,” said psychiatrist Jai Ranjan Ram.
A psychologist who wished not to be named said that in such situations, they often ask questions that could be answered in “yes” or “no”.
“This approach takes more time and is based on some assumptions. Also, during the lockdown, it is difficult to suggest solutions to problems such as domestic violence, because it is not possible now to ask the victim to move out,” the psychologist said.
Often, psychiatrists and psychologists draw inferences from postures and gestures of the persons they are talking to and through verbal communication. Video consultation provides limited opportunity for that.
“The subtle signs of non-verbal communication are not that clear in a video call. If a person is anxious, he may sweat or be fidgety, which is not always clearly visible in a video call,” said a psychiatrist.
Psychiatrist Praveen Kumar said it was advisable to talk to children above eight years of age in private and not in the presence of their parents, because parents often have the wrong impression that everything is alright in school.
“In our chamber, we can ask parents to wait outside while we talk to children and let the parents in later. But that may not happen during a video call. Tele-consultation cannot replace clinical examination,” said Kumar.
Often those who need help create opportunities by locking themselves up in washrooms or going to the terrace to ensure privacy.
Psychiatrist Sarmishtha Chakrabarti has come across situations during the lockdown where teenagers have refused virtual meetings and insisted on face-to face talks.
“Teenagers, especially those who are 18 or 19, want to talk alone. Confidentiality and counselling get compromised if that personal space is unavailable. Tele-counselling is not a replacement of face-to-face interaction, but we are trying to reach out and provide mental health support in an emergency situation,” said Chakrabarti.
Ram said it was important for those reaching out to them to be mindful of the circumstances and open other lines of communication, such as messages.