Psychotherapy In india

The Indian journal of psychiatry was founded in 1959, a review of the articles published in the
journal from 1959 to 20007 found that there occur in three phases in relation to the theoretical
allegiance it has taken - initial phase, middle phase and the current phase. In the initial phase
there were more articles related to psychoanalytically-oriented concepts. In the middle phase the
articles were related to different theoretical concepts-psycho dynamically oriented, humanistic and
existential. In the current phase, there are articles that take more of an eclectic and integrative
stance. However, all through these phases, one finds an attempt to integrate indigenous concepts
in the application of psychotherapy.

Issues of psychotherapy in India

Psychotherapists in the Indian context face various dilemmas. Even as early as in the 1950s, Nand
acknowledged the ‘split’ of psychiatrists into biologically-oriented and analytically-oriented.

Later, many others later observed that psychotherapy, as practiced in the West, might be suitable
only for those living in cosmopolitan cities of India and not for majority of the population. It was felt
that one has to not only use a tool that is ‘alien’ to the culture, but also the socio-cultural milieu,
which at times appears contradictory to the basic tenets of psychotherapy.

Surya and Jayaram's observations highlight a significant cultural difference in how Indian patients
engage with psychotherapy compared to their Western counterparts. They noted that Indian
patients often exhibit a higher degree of dependency. This dependency is deeply rooted in the
collectivist nature of Indian society, where individuals are accustomed to relying on family and
community support for decision-making and emotional sustenance. In contrast, Western patients
typically engage in psychotherapy with a focus on integrating their intra-psychic processes—
meaning they work towards harmonizing their thoughts, feelings, and actions independently.

This dependency in Indian patients can create a dissociation between thinking, feeling, and acting. In
psychotherapy, effective treatment often relies on a patient's ability to introspect, identify, and
integrate their internal experiences and emotions. When there is a reliance on external sources of
support and validation, it can hinder this process. Patients may struggle to independently explore and
reconcile their internal conflicts, which is a crucial aspect of many psychotherapeutic approaches.

Neki discussed confidentiality and privacy in the Indian context and opined that these terms do not
even exist in Indian Languages and, in the socio-cultural context; the concepts of privacy could severe
people from interdependent society.

Therefore, he recommended family therapy or at least couple of sessions with the family members
along with dyadic therapy in order to help the progress of the psychotherapy.

Since the indian society is a collectivist sociaty, which is defined as a society which places value of
group/community needs over individual needs. Members are a part of an in-group and embrace a
group identity that obligates them to their larger family and cultural community. Group identity is
important because it increases a sense of belonging and clarifies how a person fits within the group.
Members who can identify how they fit are more interdependent and embrace group cohesion.
Psychotherapy brings with it a lot of challenges, catering to the indian population. given the in-group
vs out-groupism that is so prevalent to the roots of indian culture, the patient-doctor relationship is
often seen as being out-group, the fammily of the patient is percieved as being the in-group, and the
doctor is seen as belonging to the out-group. This leads to low levels of trust and comfort in the
therapeutic relationship between the pateint and the therapist. introducing family therapy or some
sessions of therapy with the family memebers can help mitigate this percieved devide among the
patient and the family for the healthcare provider. Having the family members educated upon the
issues of the patient and how to manage certain symptoms can increase the trust of the patient with
the therapist. The inclusion of families can also help the provider in understanding certain family
dynamics, and socio-cultural background of the patient. This information is useful in aiding the
fomrulation of well suited therapeutic plans for the patient. The therapist can also fugure out
pootential 'protective' factors that can be utilized to improve the mental health and improve
symptoms, these can be: Attending religous conventions, spending time with family, etc.

India being a collectivist culture also poses challenges such as the lack of confidentiality anf privacy.
Indian culture is intervconnected and interdependent, where the concept of privacy is less
emphasised. Without the involvement of family and community, the therapy might become futile.
Indian culture also places high value on dependency, as compared to western patients, indian
counterparts arer heavily reliant on their familues and community for decision maki, judgements and
emoyional sustenance. In psychotherapy, effective treatment often relies on a patient's ability to
introspect, identify, and integrate their internal experiences and emotions. When there is a reliance
on external sources of support and validation, it can hinder this process. Patients may struggle to
independently explore and reconcile their internal conflicts, which is a crucial aspect of many
psychotherapeutic approaches.

Verma raised objections to the applicability of the Western type of psychotherapy in India.[19] He
pointed out seven distinct features of the Indian population, which may not help psychotherapy work
in the Indian context in comparison to the western population. They are as follows:

 Dependence/interdependence.
 Lack of psychological sophistication.
 Social distance between the doctor and the patient.
 Religious belief in rebirth and fatalism.
 Guilt attributed to misdeeds in past life.
 Confidentiality.
 Personal responsibility in decision making.

He also viewed that the history of psychotherapy in India shows that it differed from the West in the
following lines:

 It was not meant only for the sick.

 The patient and the therapist cannot be considered equals and hence dyadic relationship is
not possible.
 The patient has to accept what the therapist considers as ‘truth’.
 Everyone is not considered fit for psychotherapeutic relationship.

However, with globalization, increasing levels of education, higher sense of awareness on human
rights and the wider use of electronic media even among the rural population, whether these
observations stand today is a pertinent question. Varma and Ghosh,[23] in a study, of the practice of
psychotherapy, on 32 Fellows of the Indian Psychiatric Society, found that short-term supportive
therapy was used by majority of them. Some practiced other forms of psychotherapy including
psychodrama.

Intergrating religion into psychotherapy.

Psychiatrists practicing psychotherapy in India have recognized the significant influence of religion as
an integral component of therapy since the early days. Nand, for instance, compared scientific
psychotherapy with what he termed ‘Religious Psychotherapy.’ He identified the ‘Shivite symbol’
as a central symbol within Indian culture, drawing parallels between the symbols found in Hindu
religious practices and those used in Western psychoanalysis. Specifically, he compared the phallic
symbols present in temples at Banaras with similar symbols used by Freud, who integrated
elements from his religious and cultural background into psychoanalysis. By doing so, Nand
suggested that there is a need to strengthen religious therapy and also consider 'race therapy,' which
involves understanding the cultural and racial context of the patient. He also highlighted the
importance of exploring the psychopharmacology of change agents in psychotherapy, suggesting a
combined approach that incorporates cultural and pharmacological elements.

Hosseini described how Islamic principles could be effectively used in psychotherapy, indicating
that religious frameworks from different faiths can be beneficial in therapeutic settings. Hoch
examined the roles of Pirs and Faquirs, who serve as traditional healers or therapists within their
communities, particularly among illiterate populations. Hoch interpreted the practices of these
indigenous therapists, noting that they provide culturally relevant therapeutic interventions that
resonate with the local populace.

Mythology in Psychotherapy

Each concept mentioned here draws from Indian mythology, philosophy, or cultural traditions to
provide a framework for understanding and practicing psychotherapy:

1. **Legend of Savitri**: Surya and Jayaram observed that the legend of Savitri provides a
framework for psychotherapy. Savitri, a mythological figure from Indian epics, exemplifies strength,
determination, and resilience in the face of adversity. Therapists may draw inspiration from Savitri's
story to guide patients through their own struggles and challenges, emphasizing themes of courage,
perseverance, and empowerment.

2. **Buddhist Communication and Concepts of Karma and Dharma**: Verma viewed psychotherapy
as an interpersonal method of mitigating suffering, rooted in the communication techniques taught
by Buddha. He emphasized the use of concepts such as Karma (the law of cause and effect) and
Dharma (duty or righteousness) in psychotherapy. These concepts can help individuals understand
their actions, motivations, and responsibilities, facilitating personal growth and healing.

3. **Concept of Sahaja**: Neki introduced the concept of Sahaja, which refers to a state of positive
mental health characterized by illumination, equipoise, spontaneity, freedom, and harmony. He
viewed Sahaja as the pinnacle of mental well-being, embodying qualities of balance and authenticity.
By striving towards Sahaja, individuals can cultivate a sense of inner peace and fulfillment.

4. **Guru-Chela Relationship**: Neki also discussed the Guru-chela relationship as a therapeutic

paradigm. In Indian tradition, the Guru (teacher) imparts wisdom and guidance to the Chela
(disciple), fostering personal and spiritual growth. In psychotherapy, therapists may adopt a similar
role, providing support, mentorship, and insight to their clients as they navigate their psychological
journey.

5. **Patanjali Yoga Therapy**: Patanjali's Yoga Sutras, ancient texts outlining the philosophy and
practice of yoga, have been utilized as a therapeutic modality. Yoga therapy integrates physical
postures, breathing techniques, meditation, and philosophical principles to promote holistic well-
being. By incorporating yoga into psychotherapy, individuals can enhance their self-awareness,
reduce stress, and cultivate mental clarity.

6. **Hanuman Complex and Mythological Framework**: Wig introduced the term Hanuman
complex, drawing from the mythological character Hanuman, known for his unwavering devotion
and strength. By referencing Hanuman's story, therapists can help patients understand and navigate
their own psychological processes, drawing parallels between mythological narratives and personal
experiences.

Overall, these concepts provide rich cultural and philosophical foundations for psychotherapy in
India, offering practitioners diverse frameworks for understanding, treating, and promoting mental
health and well-being.

Two of the earliest studies are those of Balakrishna et al.[40] and

Vahia.[46,47] Balkrishna and his associates studied the effect
of Patanjali yoga on ‘psycho neuroses’ and found it useful in stress
induced psychological disorders

Hanuman Complex
The story of Hanuman, the revered figure in Hindu mythology, is rich with symbolism and moral
lessons. Born to the monkey King Kesari and the princess Anjana, Hanuman's divine birth was the
result of a union between Anjana and the God of wind, known as Pawan, Vayu, or Marut.

Hanuman inherited his father's ability to fly and traverse any part of the earth. As an infant, he once
attempted to catch the sun, which angered the king of heavens, Indra. Indra threw his thunderbolt at
Hanuman, breaking his jaw, hence the name "Hanuman" which means "prominent jaw" in Sanskrit.

In response to Indra's action, the God of wind, Vayu, became upset and stopped the wind from
blowing, causing life on earth to come to a standstill. Indra and other gods eventually apologized and
bestowed many boons upon Hanuman.
Despite his divine origins, Hanuman was mischievous as a child. He would play pranks on holy men
(Rishis) during their prayers, causing them annoyance. In retaliation, the Rishis cursed Hanuman,
decreeing that he would lose his power to fly. However, upon pleading from his mother Anjana, the
curse was modified so that Hanuman would not lose his ability to fly but would forget about his
powers until reminded by a wise man at an appropriate time.

The story of Hanuman's heroic deeds truly unfolds in the epic Ramayana. When a mission is sent to
search for Lord Rama's kidnapped wife, Sita, Hanuman joins the expedition. Standing at the edge of
the sea that separates them from the island of Lanka, where Sita is held captive, the group despairs
at the seemingly insurmountable obstacle. It is then that Jambavan, an aged bear and wise member
of the party, reminds Hanuman of his true identity as the son of the God of wind. With this
revelation, Hanuman regains his powers and confidence, enabling him to fly across the sea and meet
Sita.

Throughout the Ramayana, Hanuman performs numerous heroic feats, including bringing the
Sanjivini herbs from the Himalayas to revive Lakshmana. However, it is Jambavan's intervention and
reminder of Hanuman's true potential that transforms him into a great hero for the remainder of the
epic.

The story of Hanuman serves as a powerful allegory, illustrating the importance of self-awareness,
courage, and the realization of one's innate abilities. It highlights the transformative power of
guidance and wisdom from wise mentors, as well as the significance of perseverance and loyalty in
the face of adversity.

The "Hanuman Complex" as described in the context of psychotherapy draws parallels between
Hanuman's journey in Hindu mythology and the psychological struggles faced by individuals in
therapy. There are two key implications of this complex:

1. **Empowering Patients**: Patients who have lost confidence and feel incapable of facing life's
challenges are encouraged to reflect on the story of Hanuman. The therapist relates how, like
Hanuman, the patient may have temporarily forgotten their own inner strength and potential due to
their struggles or illness. By shaking off this sense of diffidence and realizing their true abilities,
patients can overcome obstacles and achieve their goals. The therapist highlights that the power to
change lies within the patient themselves, and therapy serves as a means to rediscover and harness
that power.

2. **Guidance for Therapists**: For therapists in training, the story of Hanuman serves as a reminder
not to assume that the power to change resides solely within themselves. Instead, therapists are
encouraged to adopt the role of Jambavan, the wise mentor in the story, who helps restore
Hanuman's awareness of his own capabilities. Similarly, therapists should facilitate the process of
self-discovery and empowerment in their patients, guiding them to recognize and utilize their
inherent strengths and resources. Therapists act as facilitators in the patient's journey towards self-
awareness and positive change, rather than imposing solutions or assuming control over the
therapeutic process.

In essence, the "Hanuman Complex" underscores the importance of self-discovery, resilience, and
empowerment in the therapeutic journey. It encourages patients to recognize their own potential
and therapists to foster a supportive environment where patients can rediscover and utilize their
inner strength.

One notable aspect of the concept of the 'Hanuman Complex' is its nuanced portrayal. Unlike
many psychological complexes in Western psychotherapy, it is not solely perceived in
negative terms. In Hanuman's story, there is not only a depiction of psychological challenges
but also a pathway to resolution, as exemplified by the wise mentorship of Jambavan.

The fame of Hanuman extends far beyond India's borders. Dr. Antti Pakaslahti, a
psychotherapist and Associate Professor of Psychiatry at the University of Oulu in Finland,
interprets Hanuman's story as an allegory for psychological and social growth. He sees
Hanuman's daring feats, such as reaching for the sun, as symbolic of asserting one's rights
and innate potential, even in the face of adversity. The severe chastisement by Indra, leading
to Hanuman's temporary loss of his powers, reflects the challenges and setbacks encountered
during adolescence. However, through wise guidance from mentors, symbolized by
Jambavan, Hanuman rediscovers his true abilities and assumes adult responsibilities, such as
embarking on the perilous journey to rescue Sita.

Dr. Pakaslahti suggests that Hanuman's celibacy and devotion to Sita represent the
sublimation of primal instincts into service of higher ideals and values. This interpretation
reflects the complex interplay between instinctual drives and cultural norms, highlighting the
transformative potential of channeling personal energies towards noble endeavors.

In essence, Hanuman's story serves as a timeless allegory for personal growth, resilience, and
the pursuit of noble ideals—a narrative that resonates across cultures and generations,
offering profound insights into the human condition and the journey towards self-realization.

Ayurveda and Psychotherapy

Ayurveda, the ancient Indian system of medicine, describes the mind as having three primary
qualities or gunas: Satwa (Balance), Raja (Arrogance), and Tama (Indolence). These qualities
are believed to influence mental states and emotions, and an imbalance in these gunas can
lead to psychological disturbances.

Satwa represents a state of balance, clarity, and harmony in the mind. When Satwa
predominates, the mind is calm, focused, and free from negative emotions.

Raja is associated with qualities of activity, ambition, and restlessness. An excess of Raja can
lead to arrogance, agitation, and impulsiveness, disrupting mental equilibrium.

Tama is characterized by inertia, lethargy, and darkness of the mind. When Tama
predominates, there may be feelings of depression, apathy, and laziness, hindering mental
clarity and vitality.
According to Ayurveda, imbalances in Raja and Tama, referred to as "Doshas of mind," can
lead to emotional disturbances and psychological disorders. These imbalances are akin to
toxins or impurities in the mind, which if not addressed, can give rise to chronic mental
health issues.

Ayurvedic texts categorize various mental disorders under the umbrella of "Manas roga" or
disorders of the mind. These disorders include anxiety, neurosis, depression, insomnia,
hysteria, and epilepsy (known as Apasmara).

In addition to the gunas, Ayurveda also identifies specific behavioral alterations known as
"Vrittis" or sets of behavioral patterns. These include Kama (desire), Krodha (anger), Lobha
(greed), Bhrama (confusion), Tandra (drowsiness), Murchha (fainting), Sanyasa
(forgetfulness), and Maddattaya (intoxication), among others. These behavioral patterns can
contribute to imbalances in the mind and exacerbate mental health issues if not managed
effectively.

Ayurveda emphasizes the importance of maintaining balance in the mind-body system

through lifestyle practices, dietary habits, herbal remedies, and therapeutic techniques such as
yoga and meditation. By addressing imbalances in the gunas and behavioral patterns,
Ayurveda aims to promote mental well-being and prevent the onset of mental disorders.

Meditation
Meditation is an English term with Latin roots (meditari; to think, reflect or
contemplate) and indicate ‘deep exploration of mind’ (Goleman & Davidson, 2017).
It is considered a ‘technique to control the mind’(Rao & Paranjpe, 2016)by
controlling our attention and awareness(Walsh & Shapiro, 2006). The process of
meditation goes from attending to an object (Dharana), sustaining this attention in an
unbroken manner (Dhyana) to complete absorption into it (Samadhi). Another term
Bhavana is also used in Patanjali Yogasutra for cultivating maitri, mudita, karuna and
upeksha. Meditation aims towards a higher state of consciousness. As by-products
of this process, healing and developing special powers are noted. The various
definitions of meditation may not fully capture its essence due to the limitations of
language. The US Department of Health and Human Services reached a similar
conclusion regarding challenges in developing a taxonomy of meditation. Using expert
consensus, (Cardoso, deSouza, Camano, & Leite, 2004)tried to capture the meaning
of meditation through five core criteria based upon its process and outcomes, to
overcome some of these limitations. These were - it is done by oneself, using a
technique, by relaxing the body, and the analytic mind, while focusing on oneself.
Other relevant aspects of meditation were found to be - a spiritual-philosophical
context, mental silence and possibility of an altered consciousness.
Many of the currently popular meditation techniques originated in the Indian civilization
thousands of years back. It was introduced to the West in 1920 when Indian monk
ParamahansaYogananda travelled to USA. Around the 1970s, meditation got scientific
attention when another Indian monk from the Himalayan tradition Swami Rama
demonstrated voluntary control over multiple bodily organs in USA. Within a lab setting,
he changed brain waves, heart functioning and skin temperature, which were known to
be entirely automatic processes. Subsequently, American Psychological Association
(1977) issued a statement noting that “meditation may facilitate the psychotherapeutic
process” and also encouraging further research “to evaluate its possible usefulness”
(as cited by Kutz, Borysenko and Benson, 1985).
16.9 BROAD CATEGORIES OF MEDITATION
For ease of research and understanding, a broad categorization that is often used lately
has been mindfulness and concentration meditation, based on the differences in the
attention process (Thomas & Cohen, 2014; Lippelt, Hommel, & Colzato, 2014).
a) Focused Attention/ ConcentrativeMeditation: In this category of
meditation, we focus all attention on a single point / object / idea/ image /
sound. This meditation process is described in Dharana-Dhyana stages of
Patanjali’s ashtanga yoga, where we develop an unbroken flow of attention
towards a single point.The process also includes removing attention from other
distractions, as done in pratyahara stage. It also includes noticing when one
has got distracted internally, by one’s own thoughts and bringing attention
back to the focus of attention. This process of meditation is also known as
Samatha meditation in Buddhism. This type of meditation further travelled in
Asia and developed regional variations and names in interaction with local
culture and spirituality.
378
Positive Psychology
Interventions
b) Mindfulness / Open Awareness / Open Monitoring Meditation: This
ancient meditation from India was rediscovered and popularised through his
teachings by Buddha. It is called Vipashyana, a unique way of seeing, and
gaining insight and Sakshi bhava, which means the cultivation of being a witness.
In this category of meditation, we try to keep an open and curious attitude
towards whatever is happening in the body or mind. We remain aware of our
thoughts, feelings and sensations in the present moment. When we notice
these without any judgment or need for control, we can then let them go. In
recent times the most popular way of learning the traditional form of Vipashyana
around the world is through the lineage of Shri S.N. Goenka. Apart from upto
11 hours of daily meditation these retreats have video lectures on Buddhist
philosophy related to suffering and release from the same. The aim is to develop
an experiential insight into the non-permanent nature of our self and identity.
c) Transcendental Meditation: It is sometimes considered the third category
of meditation. Maharshi Mahesh Yogi is acknowledged to be the founder of
this meditation technique, who developed it in 1958. Here we may start with
silently reciting a mantra, which is usually a short, monosyllabic sound. Often
though not always, these sounds are sacred beej-mantra. However, in the
process of meditating, we are supposed to transcend it or go beyond it. Here
the mantra recitation process is connected with the state of mind, with increase
in mantra recitation, when we encounter more distracting thoughts.
d) Interpersonally Oriented Meditations: These were a recently added
category, and find their roots in Maitri or Metta meditation which is present in
multiple traditions from ancient India (Agrawal & Sahota, 2021). Here we try
to cultivate loving-kindness, friendliness, goodwill and compassion for others.
These qualities are supposed to be cultivated in a limitless manner, without
personal preferences or aversion and thus are called the four Immeasurable.
The process includes focusing on an idea, and seems to be a combination of
concentration and mindfulness meditation practices.

BENEFITS OF MEDITATION
There has been an explosion of research on meditation since 1970, using both
psychological and physiological measures. These studies have been done in advanced
meditations with many years of practice and novice, beginner meditators. Similarly, it
has been explored both in healthy populations and those suffering from mental or physical
illnesses.
In a review of the research (Hussain & Bhushan, 2010), meditation leads to multiple
effects on the autonomic nervous system, slowing heart rate, decreased oxygen use,
and lowered blood pressure. Other common findings related to meditation are increased
alpha waves in the brain correlated with deep relaxation and theta waves associated
with peace and blissful feeling, along with reduced activity in the brain’s emotional
centres. Improved attention, perceptual abilities, learning, memory, emotional maturity,
and resilience also seem to be present.
Other reviews (Goyal, et al., 2014) focusing on meditation studies in the clinical
population have reported a decrease in stress and anxiety, rumination, trauma symptoms,
depression, de-addiction, and improvement in sleep, quality of life, well-being,
selfcompassion, and psychological flexibility. Studies on meditation’s effect on physical
health have commonly found improvement in hypertension, cardiovascular disorders,
respiratory disorders, musculoskeletal diseases, better management of pain, headache,
skin issues and improved immune response (Hussain & Bhushan, 2010).
Need for caution: It is also essential to take a cautious approach (Fjorback & Walach,
2012). Some studies have indicated specific adverse effects, often related to distress
due to the resurfacing of old traumatic memories or unpleasant thoughts. Further, with
those diagnosed with psychotic disorders, one needs a clinician’s judgement before
introducing meditation. A thoughtful choice needs to be made. There may also be
individual responses to meditation, and personal guidance from a trained mentor is
desirable.

MODERN PSYCHOLOGICAL
INTERVENTIONS INTEGRATING
MEDITATION
Due to various benefits, meditation has increasingly been integrated with counselling
and psychotherapy over the last few decades. It began with Benson’s relaxation
response and became popular with Jon Kabat-Zinn’s Mindfulness-Based Stress
Reduction Program. Subsequently, an entire trend of integrating meditation with modern
psychology started, with examples like Mindfulness-Based Cognitive Therapy,
Mindfulness-Based Relapse Prevention etc. (Fjorback & Walach, 2012). The classic
Mindfulness-Based Stress Reduction Program is conducted in a group format across
eight weeks. One needs to engage in daily individual meditation and other homework
for at least 30 minutes and a weekly group meeting of 2.5 hours.
In India too there has been a lot of research and application of yoga and meditation in
the health setting(Kumar, Bhide, Arasappa, Varambally, & Gangadhar, 2021). Given
the variety of meditation-contemplation and philosophical systems available in the country
with both experts in these systems as well as a population open to these systems, one
may find rich literature in this area. Sattva Enhancement Therapy and Sattva Cultivation
Program is one such module developed at National Institute of Mental Health and
NeuroSciences, Bengaluru which integrated yoga psychology and meditation for
improving mental health (Agrawal, 2021).
It is also important to remember that at the core of these traditions lies the belief that
one can live a life with inner freedom, and it needs to be experienced first-hand and
personally. Therefore, a global movement is happening now where psychologists
themselves are engaging in yoga and meditation to experience its benefits before teaching
it to others.