Modern Trends of Psychotherapy in India
Psychotherapy or talk therapy, is a way to help people with a broad variety of mental illnesses d emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.
In a research conducted by Verma objections to the applicability of the Western type of psychotherapy in India were identified. 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:
1. Dependence/interdependence.
2. Lack of psychological sophistication.
3. Social distance between the doctor and the patient.
4. Religious belief in rebirth and fatalism.
5. Guilt attributed to misdeeds in past life.
6. Confidentiality.
7. Personal responsibility in decision making.
As pointed out by Singer in 2007 Compartmentalization was to be adopted. It means the ability to function with newer skill sets or values in one area of life and retain the older values in another area, serves well as an adaptation to modernization. This could be a great solution to some problems faced while psychotherapy is being practiced by therapists in India.
In another research, it was found that using the process of Glocalisation which means counselors adjusting their practice to the local context if they have been trained in the western approaches would be useful. It was found that it is hard for many residents of India to participate in exploration of feelings, which is called “cultural de- fence”. Having cultural preparedness is the key.
Use of Transactional Analysis is still prevalent in India: Transactional analysis was developed by Berne (1957), who was trained as a Freudian psychoanalyst and psychiatrist. Eric Berne first developed theory of personality including theories of child development and psychopathology, which form the basis of a theory of psychotherapy, and also a theory of communication for understanding groups and organisations (Berne, 1963, 1966). Ordinary interactions was popularized by Berne(1957), Harries(1969), and Jongeward (1971). Berne, E. (1964) postulated instead three “ego states”, the Parent (P), Adult (A) and Child [C] go states, which were largely shaped through childhood experiences. It is used primarily as a therapeutic tool though it also has relevance for facilitating a deeper understanding of behaviours which affect relationships in a wide range of settings (Heyer, 1979). Shaskan, Moran and Moran (1981) and Shaskan and Moran (1986) provide a perspective which is historically interesting to Transactional Analysts, although limited from a research perspective. Transactional analysis helps the patients to change their immature and inappropriate ways of communicating with others (Sdorow, 1998). The emotional understanding for the final change is achieved with personality states after logically accepting it(Alton, 2007).Transactional analysis is a way of inquiring into what goes on between people and inside people in order to help them make change (Singh and Jain, 2014). (Bhatt) (Singhand & Singh, 2017) (Thunissen)
EMDR training is also introduced to counselors and therapists. Eye Movement Desensitization and Reprocessing (EMDR) is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches. (Bhatt)
DPCCQ-I: Development of Psychotherapists Common Core Questionnaire-India. It measures learning and professional development of therapists. It revealed experiences in therapy with clients, reading books and journals, therapists’ personal life experiences, and case discussions were perceived as having the most positive impact on development as a therapist. The most frequently reported negative influences were institutional conditions, experiences with clients, and personal life experiences.
Neuroimaging: It has been established for a long time that psychological interventions can markedly alter patients’ thinking patterns, beliefs, attitudes, emotional states, and behaviors. The neural mechanisms mediating such alterations were poorly understood before the advent of functional neuroimaging techniques (eg, single-photon emission computed tomography [SPECT], positron emission tomography [PET], and functional magnetic resonance imaging [fMRI]). Since the turn of the new millennium, a number of functional neuroimaging studies have been conducted to elucidate this important issue. Studies have explored the neural impact of various forms of psychotherapy in individuals with major depressive disorder (MDD). Other neuroimaging studies have investigated the effects of psychological interventions for anxiety disorders (obsessive-compulsive disorder [OCD], panic disorder [PD], post-traumatic stress disorder [PTSD], social phobia, and spider phobia. This technique now helps in building treatment plan for many psychological illnesses. (Beauregard)
Dialectical Behaviour Therapy- Dialectcal behavior therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders. As such, DBT is a transdiagnostic modular treatment.
“Diabolical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change to reach their goals. In addition, the skills and strategies taught in DBT are balanced in terms of acceptance and change. The four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness). (Washington) (Landes & Chugani)
Mindfulness-based cognitive therapy: Mindfulness-based cognitive therapy (MBCT) was developed as a psychological intervention for individuals at risk of depressive relapse. Mindfulness is defined as nonevaluative present-moment awareness, and is used within MBCT to help individuals disengage from their ruminative thoughts and to promote detachment and decentering from depression-related thoughts and feelings. MBCT was developed from a model of cognitive vulnerability that stated that individuals who experience depressive relapses have different patterns of negative thinking from those who do not experience relapses. According to the model, for those who have previously experienced relapses, small negative mood shifts may produce recurrence, because they can activate patterns of depressive thinking that are similar to the thoughts experienced in previous depressive episodes. (Kocovski & MacKenzie)
Mobile phone technology: Smartphones are mobile phones with the functionality of computers. There has been a recent increase in smartphone usage, especially in India. There is almost a 54% increase in smartphone ownership in 2014, which is expected to rise by 4–5 times by next 5 years. Recently, use of smartphone has been extended to mental health which includes screening of illness, monitoring of illness and symptoms, enhancement of medication compliance, psychoeducation, skills training, tracking of treatment progress, management of sub-threshold illnesses by using self-help strategies as well as for the promotion of mental health. (sharma & parmar) (menon, rajan, & sarkar)
End-of-Life Care and Psychiatry- Although 80% of the deaths worldwide occur in middle- and low-income countries such as India, there is less awareness of end-of-life care (EOLC) for people with chronic, serious, progressive, or advanced life-limiting illnesses, including dementia. EOLC involves good communication, clinical decision-making, liaison with medical teams and families, comprehensive assessment of and specialized interventions for physical, psychological, spiritual, and social needs of patients and their caregivers. The psychiatrist and psychotherapists can play a significant role in each of the above domains in EOLC. The current trends in India are examined, including ambiguities between EOLC and euthanasia. Future directions include formulating a national EOLC policy, providing appropriate services and training. The psychiatrist should get involved in this process, with major responsibilities in providing good quality EOLC for patients with both life-limiting physical illnesses and severe mental disorders, supporting their caregivers, and ensuring dignity in death. (Deodhar)
Neuroimaging techniques, alternative healing techniques, end of life care and m-health is being widely growing in its use. On the other hand transactional analysis is reducing its importance and stance as a scientific method. It can be observed that in India, we are progressing towards a more scientific and objective ways of diagnosing, psychotherapy and treatment of mental disorders and problems. This gradual transition happened over a period of time and people are adopting methods that are more result driven than methodological. It is also observed that the importance on the mental health of the psychotherapists themselves is seen as important and efforts are being made to take care of their mental health as well. The APA is also making huge efforts and contribution to it.
