Seeing a Counselling Psychologist: What the First Session Involves, and What Stays Confidential

A first counselling appointment is a conversation, not a test. What you say in it is protected by a legal duty of confidentiality under section 23 of the Mental Healthcare Act, 2017, a duty limited by the exceptions written into section 23(2) of that Act, plus the separate mandatory-reporting duty under the Protection of Children from Sexual Offences Act, 2012. Those exceptions are listed in full further down, along with what actually happens in the room.

Two boundaries before anything else, because they decide whether AJSMC is the right place at all. AJSMC is an outpatient and day-care centre on Police Commissioner Office Road, Egmore, Chennai, open Monday to Saturday, 10am to 9pm. It has no emergency department and no critical care — its ten beds are for planned, stable admissions, with a nurse on site overnight and no doctor on the premises. And what the Psychology department at AJSMC provides is psychological counselling, not psychiatric care, not medication. There is no psychiatrist on the AJSMC roster, and a counselling psychologist cannot prescribe anything, here or anywhere in India.

If someone is at risk of ending their life right now, this article is not the next step and neither is a clinic appointment. Call 112, the single national emergency number, or 108 for an ambulance in Tamil Nadu, or go to the nearest hospital with a 24-hour emergency department. If you need to talk to someone this minute rather than this week, Tele-MANAS on 14416 is free, government-run and answers 24 hours a day, every day (Ministry of Health and Family Welfare, launched 10 October 2022). In Chennai, SNEHA in R.A. Puram runs a 24-hour helpline on +91 44 2464 0050 and +91 44 2464 0060. All three are open at 3am on a Sunday. AJSMC is not.

What happens in a first counselling session?

You talk, and the psychologist listens and asks. There is no examination, no injection, no scan and no test you can fail. A first counselling session is history-taking in your own words — what has been happening, since when, what it is affecting, what you have already tried, and what you want to be different.

Indian law puts one specific thing at the start of that conversation. The Mental Healthcare Act, 2017 defines informed consent at section 2(i) as consent given for a specific intervention, without force, undue influence, fraud, threat, mistake or misrepresentation. Consent given without knowing the limits of confidentiality is not informed consent, which means the limits set out in the next section belong at the beginning of the conversation rather than after it. Two consequences follow, and both are in your favour. You can ask, before you say anything, what is written down and where it goes. And you can decline to answer any question; consent that is pressured is not consent under section 2(i).

What a first session cannot produce is worth stating with the same plainness. It cannot produce a prescription, because only a registered medical practitioner may prescribe. It cannot produce a psychiatric diagnosis that requires a medical practitioner. It cannot arrange a psychiatric admission — AJSMC's ten beds are for planned, stable admissions, with a nurse on site overnight and no doctor on the premises. And it is not a substitute for emergency services where there is active risk to life.

How long a session runs, how often you come back and when the plan is reviewed are decided between you and the psychologist rather than fixed by any guideline, and they differ from person to person. Ask on the phone before you travel: 044 2532 2021.

Is counselling confidential in India, and who can be told?

Yes, subject to a defined set of exceptions, and they are written into the statute rather than left to the practitioner's judgement. Section 23(2) of the Mental Healthcare Act, 2017 places a duty on all health professionals to keep confidential everything obtained during care or treatment, and then lists the circumstances in which information may be released. Outside that list, and outside the separate reporting duty under the POCSO Act, 2012 set out further down, there is no lawful reason to tell anyone anything.

Section 23(2)(d) is the clause most worth reading twice, and it is the one that answers the fear that actually keeps people out of a counselling room in Chennai. Even in the situations where confidentiality can be broken, only such information that is necessary to protect against the harm identified shall be released. Breaking confidentiality is not a switch that opens the whole file. It releases the one fact that has to be released, to the one person who has to hear it.

Can I come without telling my family?

If you are 18 or over, yes. Nothing in the Mental Healthcare Act, 2017 requires a spouse, a parent or an employer to be informed that you attended, and none of the exceptions in section 23(2) is "a family member asked". A husband, a wife, a parent or an in-law who telephones AJSMC in Chennai to ask what was said is not on that list.

What the exceptions do cover is risk. If there is a threat to life, or a risk of harm or violence to someone else, the Act permits release — narrowly, and limited to what is necessary. So the honest answer is not "nothing ever leaves this room". It is: nothing leaves this room because someone outside it is curious, and if something does have to leave, it is the minimum the law allows and you are told.

Whether you bring someone with you into the appointment is your choice to make at the door. If you would rather come alone, come alone.

What if the person coming is under 18?

The position changes, and it changes by statute rather than by clinic policy, so it is better known in advance than discovered halfway through a session. A minor is anyone who has not completed 18 years (Mental Healthcare Act, 2017, s.2(t)).

The POCSO duty sits outside the Mental Healthcare Act's list of exceptions altogether. It is not something a counsellor in Chennai can agree to set aside, and no promise of secrecy given to a child or to a parent can override it. It is stated here because a family is entitled to know the rules before the first sentence is spoken, not after.

Is this a psychologist or a psychiatrist, and what is the difference?

A psychiatrist is a doctor. A psychologist is not. That single distinction decides who can prescribe, who can admit, and which of the two you are actually looking for.

Two words in that table are legal terms rather than descriptions, and are commonly misused in Chennai listings. "Psychiatrist" and "clinical psychologist" are both defined in the Mental Healthcare Act, 2017 — sections 2(y) and 2(g) respectively, and neither describes counselling psychology. AJSMC publishes the Psychology department as counselling, and that is precisely what it is.

Which one you need usually sorts itself out in the first conversation. Counselling is talking work: stress, low mood, sleep difficulty, exam pressure, relationship problems, behavioural concerns in children and adults. Where the picture points towards something that needs a doctor, medication or admission, the right move is a referral, and saying so is part of the job rather than a failure of it.

Will I be given medicines at a counselling appointment?

No, and not by anyone in this department. Only a Registered Medical Practitioner may prescribe a Schedule H drug under the Drugs and Cosmetics Rules, 1945. A psychologist of any kind — counselling, clinical or otherwise — is not a medical practitioner and cannot write, change, continue or stop a prescription.

If you are already on medication prescribed by a psychiatrist elsewhere, do not stop it, reduce it or skip a dose because you have booked counselling at AJSMC in Chennai. Bring the prescription with you and keep taking it exactly as the prescribing doctor directed until that doctor says otherwise.

Is it a crime to have attempted suicide in India?

No, and this is worth saying loudly because the belief that it is a crime keeps people and their families silent. Section 115(1) of the Mental Healthcare Act, 2017 provides that notwithstanding section 309 of the Indian Penal Code, any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress, and shall not be tried and punished under that Code. The Indian Penal Code named in that section has since been replaced by the Bharatiya Nyaya Sanhita, 2023, in force from 1 July 2024, which does not re-enact a general offence of attempting suicide; attempted suicide is therefore not an offence under the penal code now in force, and section 115 of the Mental Healthcare Act continues to require care rather than punishment. Section 115(2) goes further and places a duty on the appropriate Government to provide care, treatment and rehabilitation to reduce the risk of a further attempt.

Nobody is taken to a police station for this. The law's own starting assumption is severe stress, and its own instruction is care.

What follows an attempt, or active risk of one, is emergency medical assessment rather than an outpatient appointment. Section 94 of the same Act allows a registered medical practitioner to give treatment that is immediately necessary to prevent death, irreversible harm, or a person inflicting serious harm on themselves or others, and the Explanation to that section makes clear it includes transporting the person to the nearest mental health establishment for assessment. Note who acts there: a registered medical practitioner, in an emergency setting. Not a counselling psychologist, and not a centre in Egmore that closes at 9pm.

Where do I call if I need help right now?

One clarification about an older number that is still circulating. KIRAN, 1800-599-0019, launched in 2020 under the Department of Empowerment of Persons with Disabilities, has been integrated into Tele-MANAS, with its calls redirected there. Dial 14416 first.

A helpline is not a lesser option than an appointment. At 2am on a Sunday in Chennai it is the better one, because it is answered and AJSMC is closed.

What is not offered at AJSMC, and where does a referral go?

Being precise about this is more useful than a list of what is available. AJSMC in Egmore, Chennai provides outpatient psychological counselling within Monday to Saturday, 10am to 9pm. It does not provide psychiatric care or prescribing, because there is no psychiatrist on the roster. It does not admit anyone in crisis: its ten beds are for planned, stable admissions, with a nurse on site overnight and no doctor on the premises. It has no emergency department and no critical care. It offers no consultation at all outside those hours or on a Sunday.

So the referrals go outward, and they go outward early rather than after several appointments have been used up. Anyone who needs prescribing goes to a psychiatrist. Anyone who needs unplanned admission, or observation with a doctor on the premises through the night, goes to a hospital equipped to provide it. Anyone at active risk to life goes to emergency services on 112 or 108, or to the nearest hospital with a 24-hour emergency department, not to a booking form, not to a callback, not to a helpline alone, and not to a waiting list.

How do I book, and what are the hours?

Telephone 044 2532 2021, 9150615999 or 9150642999. The Psychology department at AJSMC runs within the centre's outpatient hours, Monday to Saturday, 10am to 9pm, at Police Commissioner Office Road, Egmore, Chennai 600008.

If you are already under a psychiatrist or another clinician, bring that information with you; it makes the first session shorter and more useful.

When should you see a counselling psychologist?

When something has been going on long enough that you have started arranging your life around it — sleep that will not come, a mood that has not lifted, an exam or a workplace you cannot face, a relationship that is running the same argument every week, a child whose behaviour has changed and stayed changed. You do not have to be in crisis to be entitled to the appointment, and waiting until you are does not make you more deserving of it.

See someone sooner if daily functioning has slipped — work, studies, eating, or caring for a child, or if you find yourself thinking that people would be better off without you. That last thought is common, it is a reason to talk to someone the same day, and it is not a reason to be ashamed or to be punished.

And if the risk is immediate, do not book. Call 112 or 108, or go to the nearest hospital with a 24-hour emergency department. Tele-MANAS on 14416 and SNEHA in Chennai on +91 44 2464 0050 answer round the clock. Counselling at AJSMC is for the conversation that comes after safety, not instead of it.