Counselling and Psychotherapy

Stories, signs to notice and what to do

The Waiting Room

Priya, 26, a software tester in Pune, has avoided therapy for a year. She fears being called mad, being judged, and having to spill everything on the first day. Her friend finally lends her the courage to book an appointment.

In the first session the therapist, Dr Rao, explains that everything said is private, apart from rare safety exceptions that she will explain. She asks what brought Priya in and what she hopes will change. Priya talks about constant worry and a racing mind at night. The therapist does not give a diagnosis in the first ten minutes; she listens, asks about sleep, work and family, and suggests meeting weekly for a few sessions to see whether it feels like a good fit.

Priya leaves surprised. She expected advice, but instead felt heard. In the next sessions she learns to notice her worried thoughts, test them against evidence and try small experiments, such as sending an email without checking it five times. She practises between sessions.

After two months the worry is lighter, not gone. Priya realises that therapy is a collaboration, not a lecture, and that she is allowed to ask questions, and to change therapist if the fit is wrong.

How to recognise it

• Long-standing worry, fear of judgement and avoidance of seeking help.
• Belief that therapy is only for people who are very ill.
• Sleep and concentration affected by anxious thinking.
• Hesitation about opening up to a stranger.
• Wanting change but not knowing how.

What this story explains

Therapy is a structured, confidential conversation that builds skills such as noticing thoughts and testing them. It also shows what to expect in a first session and how to choose a good fit.

Probable root causes

• Anxiety and perfectionism.
• Stigma and myths about therapy.
• Lack of information about what happens in sessions.
• Fear of being judged by family or society.

What to do

1. Ask a doctor or trusted person for a qualified therapist.
2. Check training and ask how they work and how confidentiality is handled.
3. Go to the first session with a few notes on what troubles you.
4. Give it three or four sessions before judging the fit.
5. Do the small tasks agreed between sessions.
6. Tell the therapist honestly if something is not working.

Whom to consult

• Family doctor for a referral.
• Clinical psychologist or counsellor for talking therapy.
• Psychiatrist if symptoms are severe, long-lasting or affect daily functioning.

Do and don’t

How to behave and communicate

• Encourage a friend: "Trying therapy is a sign of strength."
• Do not push for details after sessions.
• Ask: "Do you want company to the appointment?"
• Keep conversation supportive and unhurried.

Two Kitchens, One Quarrel

Hamid and Salma have been married six years, living with his parents in Hyderabad. Every small matter becomes a fight: who cooks, how money is spent, whose mother is right. Hamid goes silent; Salma raises her voice. Their five-year-old son has started clinging to Salma at night.

Hamid's mother suggests prayer and patience, which they appreciate, but the arguments continue. Salma finally proposes that they see a couples and family therapist. Hamid is wary, saying, "Will they take her side?"

The therapist says she is not there to judge who is right. She asks each to describe the pattern rather than the blame, and notices that the problem is less each person than the cycle: Salma pursues, Hamid withdraws, and both feel unheard. Later she invites his parents for one session, to talk about roles and respect in the house.

Over several weeks they learn to speak in turns, to pause when voices rise, and to use calmer phrases like "I felt hurt when…". The therapist also respects their faith and values, and the couple brings those into their plan. The arguments do not vanish, but repair after a quarrel becomes faster, and their son sleeps better. Hamid admits later that the hardest part was listening without defending himself, and that it became easier with practice.

How to recognise it

• Repeated arguments over small matters with a pattern of pursuing and withdrawing.
• Each partner feels unheard or blamed.
• Children showing clinginess or sleep changes.
• Extended family involvement adding pressure.
• Silence or shouting that does not lead to solutions.

What this story explains

Family and couples therapy treat the relationship pattern, not one guilty person. It can include extended family and respect culture and faith.

Probable root causes

• Poor communication habits and unspoken expectations.
• Stress from sharing a house and finances.
• Different family roles and customs.
• Individual stress or unresolved hurts.

What to do

1. Agree together that you want help, without blaming.
2. Look for a therapist who works with couples and families.
3. Share your values and faith openly so they can be respected.
4. Practise speaking in turns and pausing when angry.
5. Involve elders only if everyone agrees.
6. Review progress after a few sessions.

Whom to consult

• Couples or family therapist when quarrels repeat for months.
• Counsellor or clinical psychologist if one partner is struggling with anxiety, depression or anger.
• Emergency service if anyone feels unsafe or there is any violence.

Do and don’t

How to behave and communicate

• Use "I feel" language: "I feel alone when we do not talk."
• Reflect back: "Let me check I heard you."
• Keep voices low and sentences short.
• Thank the other for trying.

When Words Alone Were Not Enough

Luca, 41, a chef in Rome, has had panic attacks for three years. His heart pounds, his chest tightens and he fears he will die. He avoids lifts, trains and even busy kitchens. He tried a few sessions of therapy and learned breathing and thought-testing, but the attacks kept coming, and his low mood deepened.

His therapist, who was honest rather than defensive, said that therapy works best when matched to the problem, and that sometimes a doctor's review is needed too. She suggested he see a psychiatrist while continuing therapy, and said that medicine and talk therapy often work well together.

Luca's mother was against it, saying only faith and strong will could help. Luca explained he was not giving up his faith, but adding a medical check. The doctor looked at his health, his sleep and his history, and discussed options with him, including how long help may take and what side effects to watch for.

Therapy continued with graded steps: he rode the lift for one floor, then three. Over several months the panic eased and his confidence returned. He later told a colleague, "Therapy taught me what to do, and treatment gave me the room to do it."

How to recognise it

• Repeated panic attacks with avoidance of places.
• Low mood or hopelessness alongside anxiety.
• Little change after several weeks of therapy.
• Daily life and work affected.
• Family disagreement about how to get help.

What this story explains

Therapy is not always enough alone; combining it with medical care, and choosing the approach to fit the problem, can help. It also shows how faith and family views can be respected.

Probable root causes

• Anxiety that builds through fear of fear and avoidance.
• Stress and sleep loss.
• Possible medical or physical factors.
• Family beliefs that delay treatment.

What to do

1. Keep attending therapy and report honestly what is and is not helping.
2. Ask the therapist or doctor whether a medical review would help.
3. Have a check-up to exclude physical causes.
4. Discuss medicine options and concerns openly with a doctor.
5. Practise gradual exposure to avoided situations as agreed.
6. Involve family by explaining the plan calmly.

Whom to consult

• Psychiatrist when symptoms are severe or not improving with therapy.
• Family doctor for a first physical check.
• Clinical psychologist for graded exposure and CBT, the thought-and-behaviour approach.

Do and don’t

How to behave and communicate

• Explain to family: "This is a health condition, like diabetes; I need proper care."
• Be honest with the therapist: "This is not helping enough."
• Listen to family worries before replying.
• Stay calm and respectful in disagreement.

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.