Lahore is a city that is often joked about as being somewhat bigger than a village. It’s a city where everyone knows everyone. You see this in the way rumours spread across the city—especially unpleasant ones. Maybe it is a byproduct of the difficult times the country has seen that we have become so desensitized to the problems of others that most people wouldn’t think twice before repeating them to acquaintances, even complete strangers. While nobody voluntarily washes their dirty linen in public – it is snatched and displayed for the city to see regardless.

This remains problematic in all spheres of life – whether it is family politics, romantic relationships or workplace gossip. But this becomes not only problematic and highly unethical but also dangerous when the one spreading someone’s private information is a trusted therapist. Recently a friend of mine mentioned to me how a therapist in Lahore who works with another senior therapist mentioned to 10 people at lunch how most women in the city are depressed – while taking at least eight names there and then. Recently another incident circulated all over social media where a teenager went to a famous psychologist and spoke about his sexual orientation to her after which the psychologist called his parents to let them know, as well.

I am surprised at myself that these events blew my mind because I’ve been hearing similar stories forever. I believe the biggest issue in all this is why these professionals feel so comfortable breaking all client-therapist confidentiality guidelines on a whim and why they don’t fear any legal repercussions of such a massive breach in their code of conduct.

Globally, therapists and psychologists are regulated through a body made just for this purpose. Professionals who meet the requirements of the body are then registered and provided licenses to begin working in the field. These regulatory bodies ensure that anyone working as a therapist and a psychologist meest the minimum requirements and is qualified. This also assures clients that they cannot be conned in anyway. Secondly if there were a breach of conduct, there is a body that can be notified, which would result in strict action taking place against the professional.

I spoke to Jasmyn Khwaja, a psychotherapist and clinical supervisor, based in Lahore to better understand the rules and regulations governing the industry in Pakistan as well as in other countries. She explained that everywhere in the world it is compulsory for all therapists to have a supervisor. This applies even to those with 30 years of experience. The therapists are required to report how many hours of supervision they have done in a year. Secondly, it is also compulsory for therapists to do CPD (constant professional development) courses every year and also report those hours to a regulatory body. “This is the case for every therapist, psychotherapist, clinical psychologist in the world,” says Khwaja. “If you fail to do CPD and complete your required supervision hours, you can’t stay registered with the body.” Secondly, these bodies also provide a platform for clients to complain against a therapist in case of ethical misconduct.

In the United States, there is a body called Association of State and Provincial Psychology Boards (ASPPB), which is responsible for the licensure and certification of psychologists throughout the United States and Canada. The body ensures that applicants meet all requirements before they are issued a license, which includes education, examination and supervised experience. According to their website, “Licensure for the independent practice of psychology requires a doctoral degree in psychology in most states, provinces, and territories of the US and Canada. About half the states, provinces and territories also have a category of licensure for the practice of psychology under the supervision of a doctoral level licensed psychologist, often called psychological associate, which usually requires at least a master’s degree in psychology. Degrees must be obtained from programmes that meet specific criteria, such as regional accreditation and certain course work requirements, set out in laws and regulations.”

While there are some bodies like Pakistan Psychology Association, which working therapists and psychologists can become a member of, they are not mandatory and do not equate to a license nor can they hold members accountable for any breach in ethics or code of conduct.

Once a candidate meets this requirement, they have to appear for an exam called the Examination for Professional Practice in Psychology (EPPP). “Many states and provinces require a jurisprudence examination (i.e., an examination covering the laws and rules governing the practice of psychology in that jurisdiction) and/or an oral examination in addition to the EPPP,” states their website. Through the ASPPB, clients can verify a license, file a complaint, and also follow what actions were taken after filing a complaint.

The United Kingdom (UK) has a similar body called The British Association for Counseling and Psychotherapy (BACP). While the regulations to become a therapist or a psychologist may vary across countries, these bodies ensure that registered members meet the minimum requirements, hold them accountable to ethical standards and ensure that the public has a way of knowing that whichever professional they choose has the necessary qualifications or else they would not have been registered with the said regulatory body.

Currently, there is no government-regulated licensure system for psychologists in Pakistan. While there are some bodies like Pakistan Psychology Association, which working therapists and psychologists can become a member of, the membership is not mandatory and they cannot hold members accountable for any breach in ethics or code of conduct. According to a therapist who spoke on the condition of anonymity, it is generally expected that you will have a master’s degree in clinical or counseling psychology to practice after a four-year degree, which is also generally in the same field. Practice should only begin after the degree has included a strong practical component, which usually includes 5-6 months of interning as a trainee psychologist working with clients. But because there is no strict licensing system, practice comes down to each individual’s own ethics.

“There are people practicing with only brief courses, bachelors’ degree or with only an academic master’s,” says the psychologist. “But technically, there’s nothing stopping them from setting up practice.” Recently, Rameeza Ahmed, who works in research at FC College’s Cognitive Psychology Laboratory, took to her social media accounts to warn people that there is a growing trend of people with only a BA/BSs degree in psychology claiming to be therapists and starting their own practice. “Pakistan has next to no legal framework or official licensing authority for psychologists or mental health workers and the gap in this law is being exploited by these opportunists,” Ahmed wrote.

“There are a handful of very ethical therapists and we make sure we do this thing called peer supervision where we supervise each other,” says Khwaja. “And, we all have a supervisor in the UK and we all go for supervision as well as CPD or we do online courses.” She explained that while they try to follow the global code of conduct, there is not regulation and nobody is checking. So, if they were to not do any of it, there would be no way to hold them accountable.

There is a dire need for Pakistan to officially recognize this field, to have laws governing this industry and also a regulatory body that holds professionals accountable at every stage of their career, ensuring that educational requirements, ethical guidelines are being met for every therapist in the country. While such a regulatory authority does not exist and there is no official licensing system, citizens themselves should be very careful while choosing a therapist by asking and double-checking their credentials as well as the reputation they hold in the city.

The author is a writer based in Lahore and can be reached at n.sukhera@columbia.edu