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Hurdles to Healing: The Struggle to Find a Therapist in Egypt

February 27, 2023

After her first experience with therapy in Egypt, Wesal Hammam, 28, nearly decided to abandon treatment altogether.

“The experience was so traumatic that I neglected the whole idea of therapy for another two and a half years,” she says.

She is not alone in this. The journey to finding a therapist in Egypt is often fraught with challenges — from financial barriers, to ethical breaches, and even mistreatment at the hands of unqualified professionals.

These obstacles can deter a patient from seeking the help they need and, in some cases, cause them further psychological harm.

Hammam first sought therapy in 2017, after experiencing a mental breakdown. Then an engineering student at Cairo University, she decided to seek help at Al Demerdash hospital. Though she had reservations about public sector facilities, Hammam says that reading a widely shared thread about the hospital’s mental health services on Twitter encouraged her to give it a try.

She arrived in the early morning to find tension reigning over a crowded waiting room.

“People had been waiting since 5 or 6 AM. There were children, teenagers, people from other governorates and from the countryside. […] The lady responsible for registration started handing out tickets, and people started hitting and stepping over each other. It was very, very disturbing to watch,” she recounts.

“I was caught between two men fighting to get to the [registration] window, and I started crying. The lady saw me crying, handed me a ticket, and told me to get out of the line,” she continues.

After receiving her number, Hammam waited another two and a half hours for her appointment, which lasted thirty minutes, and which was repeatedly interrupted by the comings and goings of nurses through the office.

“There was no privacy in the appointment. I was crying my heart out,” she says. “The doctor had kind of a poker face, he wasn’t really sympathetic. He asked questions from a sheet, and checked my answers ‘yes’ or ‘no’ or wrote them down. Then he prescribed me some medicine […]”

Hammam abided by the prescription for a month, during which she developed increasingly adverse symptoms. As a result, she decided to forego her scheduled follow-up, prescribed medication, and any further treatment for the next two years.

Despite growing acceptance, barriers persist

Today, challenges like those Hammam experienced are increasingly coming to light, as a growing number of Egyptians choose to speak up about their struggles with mental health and to seek treatment.

In recent years, the stigma around mental health in Egypt has slowly begun to wane. Both government and community initiatives have been launched to raise awareness and to spark growing conversations about mental health on and off social media networks.

“Today, there’s no one who doesn’t know what mental health is,” Marta Ashraf, who heads the mental health awareness platform Lilac, told Egyptian Streets. “There’s a lot of content out there. So people are informed to some extent, even if only in a scattered way,” she adds.

This growing acceptance alone, however, is not enough to bridge the structural barriers of access to therapy in Egypt, the first of which is its hefty cost.

“Therapy is priced like a luxury product, not like healthcare. I’m talking about private practice, of course,” says Ashraf. “Usually, public or state-sponsored therapy is not as comprehensive. It’s not as regulated either: the therapists aren’t always required to get therapy themselves, their training isn’t as comprehensive. So, I wouldn’t necessarily recommend it.”

Due to these shortfalls, Hammam’s story is a familiar one for many of those who seek treatment at public facilities.

While mental health services are freely accessible at specialized public hospitals, these facilities are concentrated in Cairo and Alexandria, with fewer resources available to citizens living in other governorates. This pressure, combined with lack of funding, can result in overcrowding, long waitlists, and inadequate care.

Confidentiality and other ethical breaches in private practice

In 2019, Hammam resumed her search for a mental healthcare provider, this time limiting her scope of inquiry to private practitioners. She cites price as one obstacle she encountered in her search, saying: “Some [professionals] in Maadi were charging four hundred pounds per session, which was a very high price at the time.”

Though her mental health challenges made it difficult to hold down a full-time job, Hammam pursued freelance work in order to gain sustainable income – efforts thanks to which she was able to afford treatment with a private psychiatrist, whom she is still seeing today.

Hammam says she is fortunate to have found a trusted practitioner from the first try; but she notes that this is not true of all those who seek help within the private sector.

Indeed, patients often have to make multiple attempts before finding someone they can safely and comfortably open up to, owing largely to fears and problems surrounding confidentiality and other ethical breaches.

The framework regulating mental health practice in Egypt is outlined under the Mental Health Act of 2009, which sets out the rights of patients, such as the right to consent to treatment, and criteria for involuntary admission to mental health facilities. Since 2020, new legislation has also set out penalties for those practicing psychiatry without a license.

Nonetheless, beyond issues of strict legality, the ethical standards by which practitioners are bound can be murky.

Speaking to EMPWR Magazine, clinical psychologist Anne Justus expressed her shock at the poor level of doctor-patient confidentiality permeating therapy in Egypt.

“When I first started my practice here, I did not expect to be receiving a high influx of Egyptians,” she said. “My Egyptian clients tell me, ‘a main reason I’m coming to see you is because I know you don’t know my mother’.”

While noting that Egypt has no shortage of qualified therapists, Justus nonetheless recounted that “Per week, at least four clients walk into [her] office complaining about how their previous therapist breached their confidentiality. It’s a serious thing,” demonstrating the prevalence of the issue among local practitioners.

Ashraf, whose work with Lilac also involves mediating between professionals and patients, says this is a particular concern for minors, who require parental consent to pursue therapy.

“Egyptian parents are very involved in their children’s lives, so they might call a therapist and ask them what their child said during the session,” she says. “And some therapists don’t have adequate training to figure out what they should tell that person as [the child’s] guardian, and what they shouldn’t tell because [of] confidentiality.”

In addition to issues of confidentiality, misprescriptions, overstepping boundaries, and other forms of malpractice often recur within private practice. For many patients, it can take several attempts to find a trusted, reliable care provider.

Dina Hassaan, 25, tells Egyptian Streets that she first sought therapy after she was involved in a car accident in the summer of 2020, in which two of her friends lost their lives.

The therapist, whom she had found online, was widely reputable, made frequent television appearances, and had received positive reviews. Despite her many laurels, however, Hassaan quickly found her to be “super unethical, super unprofessional.”

She recounts that the session lasted only twenty five minutes, the better part of which were spent discussing the therapist’s familial issues and her own son’s involvement in a car accident.

“That was two or three months after the accident, so it was still fresh […] She opened her phone, scrolled through Facebook, and showed me pictures of the car that was wrecked in her son’s accident,” says Hassaan. “I was super triggered because to this day, two years later, I haven’t seen pictures of my own accident. I don’t want to see what the car looked like,” she explains.

This deeply troubling first experience led Hassaan to take a hiatus from treatment until April 2022, when she began seeing a new therapist with whom she shared a close mutual friend. Though she describes the experience as a positive one, the issue of their shared connection eventually became a point of discomfort for Hassaan, causing her to halt her treatment once again.

“I felt like I’m not 100 percent comfortable telling her stuff, or complaining about [our mutual friend]. Even though she’s very professional, I still thought ‘why did I put myself in this situation? I could just change therapists’,” she recounts.

Confidentiality breaches can also be of particular danger to patients whose problems are socially stigmatized, such as those struggling with self-harm or issues related to gender and sexuality.

For Salem Mamdouh*, 25, opening up about these issues culminated in threats of involuntary institutionalization.

After an unsatisfactory attempt to seek help from their university’s counseling center and an uneasy run with group therapy, Mamdouh, then a university student, sought individual private treatment with their mother’s knowledge and financial support.

“When I started seeing this therapist, I was struggling with sexual abuse and coming out of an abusive dynamic, which I hadn’t fully processed yet. I was also still exploring my gender and sexuality,” says Mamdouh.

Mamdouh, who had experienced sexual assault, says this new therapist quickly proved unequipped to help, instead leaving them emotionally much worse off than they were prior to the sessions.

“She would get really angry when I cried. [..] There was so much shame around feeling my emotions,” they recount. “And when I started telling her about the sexual assault I experienced, she said that people sometimes say ‘no’ when they actually mean to say ‘yes.’ So she thought I had actually wanted it and was now exaggerating what really happened.”

The breaking point came when Mamdouh opened up about their struggles with physical self-harm, to which the therapist’s response was drastic, prompting them to cut their treatment short.

“I understand that confidentiality is a blurred line when someone is harming themselves, but things became extreme,” they explain. “First, she said I could either tell my mother or she would. Then, it escalated into her threatening to have me institutionalized against my will. […] I sent her a sort of breakup text, telling her exactly what I thought she was doing wrong, and stopped seeing her.”

Misprescriptions and undefined boundaries

Hassaan, who is now seeing a psychiatrist and taking medication for anxiety, says she was initially unclear about the distinction between therapists and psychiatrists.

“When I first started seeing the psychiatrist, I didn’t know if a psychiatrist is also your therapist or just your doctor. […] Then I realized she doesn’t talk to me about [my feelings], she talks about my brain chemicals,” Hassaan explains, noting that the realization also prompted her to start searching for a new therapist.

Therapists and psychiatrists fulfill very different functions. While the former are trained to listen and provide counsel to their patients; the latter’s role is to diagnose and prescribe medication as needed.

Confusion about the difference between the two professions prevails among patients, but “therapists and professionals themselves sometimes don’t even know their own scope,” says Ashraf.

Mamdouh’s therapist, for instance, had also prescribed them what they now realize was an abnormally large amount of medication, including a mood stabilizer and sleeping pills which were causing them night terrors and severely disturbed sleep.

In an attempt to rectify this, Mamdouh sought help from a university psychiatrist, who changed their prescription — leading to even more harmful results.

“I would become exhausted, feel my heart rate go up, and get frequent panic attacks. I threw up all the time, to the point where I couldn’t eat,” they explain. “When I googled it, I realized that the meds he prescribed me couldn’t be taken together. […] When I told him this and explained my symptoms, [the psychiatrist] brushed it off as ‘placebo effect’.”

At this point, Mamdouh started seeing a new psychiatrist with the sole aim of going off their medication, which they eventually did. After several more run-ins with ill-qualified practitioners, Mamdouh halted their search efforts in the wake of the COVID-19 pandemic. The outcome of the lockdown was vast deterioration in their mental health.

“My body really was collapsing,” they recount. “I had a serious leg injury and was on bed rest for a while. I wasn’t taking any medication, I wasn’t eating, and I was smoking up a lot. For those few months, nothing was right.”

Overcoming barriers through community

Those seeking mental healthcare in Egypt are likely to come across a multitude of obstacles, and there seems to be no surefire way to avoid these pitfalls. Nonetheless, growing acceptance and awareness surrounding mental health means that more community initiatives can work to bridge existing barriers.

“Over the years, Lilac’s mission has changed,” says Ashraf. “It used to be more about raising awareness. Now, our mission is more of mediating between professionals and the public. […] Another thing would be making [a] community, holding workshops, internships, recruiting people to come to events and connect with other people, etc…”

The former is something which Lilac does by keeping a database of existing therapy centers and interviewing practitioners to make sure that they abide by basic regulations. Additionally, Lilac also sometimes relays patient feedback to centers, and tries to set in place discounts for those unable to afford sessions at their full price.

Though Ashraf notes those efforts cannot guarantee quality services or eradicate challenges, they are still a step toward implementing accountability structures in a largely unruly landscape.

The latter element, forming a community, is perhaps just as key in mending present fractures, as feeling supported and empowered to share their feelings about treatment is critical to those struggling with mental health issues.

After recovering from their leg injury and taking some time to themselves, Mamdouh eventually sought the help of a friend in finding a new therapist.

“As much as I was isolating myself, I knew my support system was there for me. I asked my best friend for recommendations. She gave me a list of names and we went through them together to determine who I would be most comfortable with. I called this therapist, and she’s the person I’m seeing now,” they recount.

Hammam recounts that in the process of finding her current practitioner, she relied on two friends who had previously sought treatment to help her get a sense of what to expect.

“My friends really prepared me, because people always think they’ll go for two sessions and the doctor will diagnose them immediately, then heal them with a magic wand. […] but they told me the hard truth, that this would take time and effort,” she says.

Ultimately, both Hammam and Mamdouh affirm that seeking treatment has had widely positive impacts on their professional, social, and personal lives, allowing them to navigate their symptoms with greater ease and independence.

Despite the challenges she faced, Hassaan too says she has derived benefits from her second experience with therapy, including “tips and tricks” to navigate life and a firmer grasp on and understanding of her emotions.

For the past month, Hassaan has been actively seeking to resume therapy and vocally encourages others to do the same; “I think everyone needs therapy and I like to shout it out loud as much as I can.”

*Names were changed due to safety concerns.

If you are looking for mental health support, click here for a list of places where you can find it.

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