Indian J. Psychiat. (1982), 24(3), 209—226

PRESENT STATE OF PSYCHOTHERAPY IN INDIA

V. K. VARMA*—M.B.B.S., M.Sc. Psychiat., D.P.M., M.R.C Psych., M.A.M.S., F.A.P.A., Diplomate, American Board of Psychiatry & Neurology

WHAT IS PSYCHOTHERAPY ? emotional or psychological nature. The "Psychotherapy is the treatment, by differences are primarily in two areas; psychological means, of problems of an namely the nature and qualifications of the emotional nature in which a trained per­ therapist, and whether and to what degree son deliberately establishes a professional the relationship must be deliberate and relationship with the patient with the structured to qualify as psychotherapy. object (1) of removing, modifying or retard­ In the Indian context, as we shall see ing existing symptoms, (2) of mediating later, a number of persons who may be disturbed patterns of behaviour, and (3) of categorised as Faith Healers or Religious promoting positive personality growth and Healers attempt to treat psychiatric patients development" (Wolberg, 1967). by what may be considered psychological The above is perhaps the most widely methods. Is this psychotherapy? We shall accepted definition of psychotherapy. Do consider this question a little later when we all people define psychotherapy in the same discuss the supposedly therapeutic activities way, or are there important differences? of such healers. Torrcy (1972a, 1972b) As this question may be highly relevant to has drawn attention to significant simi­ the question of psychotherapy in India, let larities between Western psychotherapy and us look at some of the other definitions : faith healing and has argued that in spite "For a very simple realistic definition, of apparent differences in the technique in the one can say that psychotherapy is the utili­ two cases, the therapeutically active ingre­ zation of psychological measures in the dients are remarkably similar. Wittkower treatment of sick people" (Romano, 1947). and Warncs (1974) have drawn attention to "Psychotherapy may be defined as the the similarities between psychotherapies treatment of emotional and personality practised all over the world. In spite of the problems and disorders by psychological superficial differences, they feel that such means". (Kolb 1968j. therapies around the world have got the "....psychotherapy is a form of help following important similarities : (1) There in which a trained, socially sanctioned healer is an intense emotional confiding relationship tries to relieve a sufferer's distress by facili­ between the therapist and the patient. tating certain changes in his feelings, atti­ (2) The therapist and the patient share an tudes and behaviour, through the perfor­ identical world view. mance of certain activities with him". WHAT IN PSYCHOTHERAPY HEALS ? (Frank, 1961). It is quite apparent from the above There have been several attempts to definitions that there is a wide agreement isolate the therapeutic ingredients from the amongst them that by psychotherapy are large number of inter personal and emotional meant those therapeutic manoeuvres which experiences that constitute psychotherapy. can be called psychological (as opposed to As a matter of fact, there has been a shift organic) in the treatment of problems of an in the last two decades in the studies of the

'Professor & Head, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh-160 011. 210 V. K. VARMA efficacy if psychotherapy, that is to study (1962) feels that the therapist's expectation the efficacy of each one of the various of the outcome of the psychotherapy is an techniques and factors rather than to study important factor in its outcome, "..psycho­ the efficacy of the therapy as a whole. therapist attitudes, personality characteris­ Earlier workers, since the beginning of the tics and in-therapy behavior significantly century, have been emphasising the specific influence the course and outcome of treat­ techniques peculiar to psycho-analysis or ment". Again, "Evidence was presented psycho-analytically oriented psychotherapy of a significant effect on patient improvement which purportedly heal. However, lately, of therapist prognostic expectencies". attempts have been made to bring into sharper focus the therapeutic role of the APPLICABILITY OF THE WESTERN MODEL inter personal relationship of the psycho­ PSYCHOTHERAPY TO INDIA : therapy that is perhaps common to all Comments and reservations are often psychotherapics. Frank (1968) and Abroms expressed, formally and informally, by (1968) have emphasised the role of persu­ Indian psychiatrists and other mental health asion as a therapeutic ingredient. "\Vc professionals regarding the place, the rele­ must a;sume that most, if not all, psychiatric vance for India, of psychotherapy, as it is patients are influenced to some extent by the understood in the West. For example, demand character of the therapy situation Neki (1975) feels : "Western psychotherapy, and the implicit or explicit expectation of the as it is, is hardly applicable to the multitudes therapist .... " (Frank, 1968). Abroms in India—except for a handful of Wester­ (1968) however, qualified the role of per­ nised Indians living in large cosmopolitan suasion as follows : "In a sense, persuasion cities". Commenting on the difficulties in or suggestion plays an important role in rendering Western psychotherapy suitable promoting therapeutic change. But the to the Indian context, Surya and Jayaram claim that it is the sole or primary agent (1964) comment : "Words, by their very has been shown to constitute a methodolo­ nature, arc loaded with powerful motiva­ gical assumption rather than an empirical tion and conative aspects. It is in this assertion". Torrey (1972b) has named four respect that the Western trained psychiatrist ingredient common to psycho therapies finds himself ineffective in the local setting". around world. These are (1) A shared world- Comment;ng on some of the difficulties in view, and the therapist's ability to name the this area, they say : "As compared to his offending agent (the principle of Rumpel- Western counterpart, the Indian patient stiltskin), (2) the personal qualities of the is more ready to expect and accept depen­ therapist, (3) the high expectations with dency relationships,... .less r^ady to seek which the patient approaches the apparently intrapsychic explanations,... .more ready to exalted position of the therapist, which he discard ego-bounds and involve the therapist calls the "edifice complex", and (4) the in direct role relationships; and finally his technique. He feels that the contribution ideal or idelizcd support is the good joint- of the so-called technique in the Western family elder (Indian patient) more psychotherapy towards a favourable outcome readily alludes to conceptual references like has been over-emphanscd. Bolman (1968) Karma, Dharma, and traditional figures emphasises the importance of a world-view for orientation ". shared by the patient and the therapist. The position taken by Surya and Jaya­ Snyder (1963, page 3-6) has under-scored ram, has been supported by many other the importance of understanding the role authors who have voiced reservations reg- of dependency in psychotherapy. Goldstein garding practicability of transposing psy- PRESENT STATE OF PSYCHOTHERAPY IN INDIA 211 chotherapy developed in one culture to some becuase of which the applicability of Wes­ other culture. However, Berne (1960) takes tern type psychotherapy in India is ques­ the contrary stand that the psychothera­ tioned? Let us discuss some of these. peutic methods are universally applicable. (1) Dependence : It is said that an He takes the extreme stand when he states, average Indian is more dependent "Psychhotherapeutic manoeuvres can be on other people as compared to readily transferred from one culture to an average Westerner. The grow­ another. The principles learned in the ing child is literally dependent on treatment of young women in Connecticut his parents. There is greater or California are just as effective in South amount of interdependence in case Pacific." of adults. And finally when the It can be argued that people around person becomes old, he comes to the world are not alike and those of one become very much dependent upon culture differ from those of other cultures his children. Hence, we have got in many important ways which may have a beautiful system of a great direct relevance to psychotherapy, such as degree of mutual interdependency the religious philosophical background, the with everybody leaning on every­ experciential repertoire, language, modes of body else. It can be questioned affective expression, moral and social norms as to how far the Western psycho­ and mores, and the culturally determined therapy, with its high emphasis conflicts and defences. The concept of on autonomy and personal res­ modal personality is helpful here and it can ponsibility, can be prescribed for be said that the modal personalities differ such a people. from culture to culture. It is onlv reasonable (2) Psychological sophistication, verbal that psychotherapy as practised should be facility and expectations:—• consistent with it. Wittkowar and Wames Psychological sophistication, atleast (1974) have emphasised that, to be popular, to the extent of considering possible psychotherapy is to be consistent with the psychological reasons for the social-philosophical background of the people. illness and ability for introspection, Psychoanalysis became popular, in the are considered essential for psy­ U.S.A. because of emphasis on individualism, chotherapy. It is said that the rational thinking, free expression and tole­ Indian patient lacks in there attri­ rance of dissent. So became work-therapy butes. His orientation rather in the Soviet Union, autogenic training in than being psychological, is more Germany and Morita therapy in Japanj likely to be either physical and con­ in each case because it was consistent with- crete on one hand or metaphysical the respective social values. and mystic on the other. Also, Chessick (1969) has drawn the correla­ although non-verbal communica­ tion between the practice of psychotherapy tion is not irrelevant to psycho­ and the socio religious philosophical tradi­ therapy, much of the communi­ tions of the West. He feels that Western cation and interaction in the Wes­ psychotherapy is consistent with the Wes­ tern model psychotherapy takes tern philosophy of dialectics of Plato, where place at a verbal level. Does an tru th has to be reached or approached by the average Indian possess adequate debate between two enquirers or within the verbal fluency to gainfully interact heart of a single enquirer. in therapy hased on it. Also, an What then are the imporant reasons average Indian patient may expect 212 V. K. VARHA too much from therapy, a kind of some depressed patients, by the magical expectation. He may ex­ manner in which they ascribe the pect immediate and total cure, illness to sins or misdeeds committ­ as if by miracle. This would ed in a previous birth. In other again impose serious limitations on words, the guilt feeling is ascribed the efficacy of psychotherapy. not to sins committed earlier in (3) Social distance between the patient life, but those in previous births. and the doctor : It can be said that it replaces past The Indian society, at least for for present accountability for one's the la«t 2000 years or so, has been actions. It can, therefore, be that greatly class-conscious. The Varna this may have some repercussions system, although probably originat­ on the conduct of psychotherapy. ing for division of labouf, quickly However, a question may be raised, degenerated into a class system whether such a people only pay whereby people of the various lipservice to those beliefs and use Varnas, got arranged in clearly it at their convenience, or is it systematised hierarchy. Hence, the deeply in-grained in the core value patient quickly identifies the doctor system. In support of the with a superior class. He comes hypothesis that it is not deeply to assume an obsequeous and sub­ assimilated in the core value system, missive position in relation to him. it can be said that this belief is not It is quite possible that propor­ manifested in the day to-day life tionally greater number of psy­ and does not make any noticeable chiatrists and doctors in general difference in conduct of every day come from upper classes with pursuits. feudal backgrounds. Western The concept cf fatalism is closely model psychotherapy requires that related, in Hindu philosophy, to the therapist and the patient should that of re-birth. It is said that meet at a relatively equal level and not only your misdeeds of an earlier that they should jointly try to find birth make you suffer, but that out solutions to the patients' pro­ they also impair yot>r wisdom so blems. It is questioned if such that you continue to commit sins psychotherapy is applicable where even in the next birth . It is the social distances between the said, nevertheless, that in spite of patient and the doctor are so wide. this, a person can try to redeem or (4) Philosophical—religious beliefs in improve one by one's efforts. In re-biith and fatalism :— this respect, Hindu philosophy and A question is sometimes raided religious system demonstrates the if the Hindu concept of re-birth same ambivalence that all religious and re-incarnation can have impor­ system demonstrate toward": the tant implications as regards psy­ question of free will vrf. deter­ chotherapy. It is too well-known minism, perhaps of bit more so. to need a repetition here that the It is perhaps not incorrect to say belief is that one's life does not that an average Indian assumes a terminate at his death, but that he more fatalistic attitude towards life is re-born again and again in some and future, and that this can have form. One is impressed while seeing some deleterious effects on the PRESENT STATE OF PSYCHOTHERAPY IN INDIA 213 conduct of psychotherapy. How­ vance of confidentiality and the ever, it is not clear whether this strictly one-to-oiie relationship that fatalism is a part or the function are hallmark; of Western individual of the religious system or it is more psychotherapy. dependent on other factors like (7) Decision making and personal poverty, etc. responsibility :— Guilt vs. shame :— In the Western-type psychothe­ It has been said by numerous rapy, the therapist and the patient workers that the so-called primitive came together as responsible adults cultures are relatively free of guilt and each one is considered to be and that they show more of shame responsible for his own behaviour than guilt. Shame said to be and capable of making his own directly related to immediate social decision. Perhaps in the Indian disapproval whereas guilt is said netting, the patient expects more to be dependent on identification to be told by the therapist and is and on values which have become often hesitant to exercise his own deeply internalised and assimilated. choice. It is said that this is However, people are becoming mote related to greater amount of and more aware lately that this is altriciality and dependency that an over simplified conclusion, and we have earlier discussed. The that the primitive cultures also question is, if this attitude demonstrate guilt. As to the Indian makes- the Indian patient unsuitable context, in study after study on the forpsychotherapy or if it requires psycho-pathology of depression, modification in the technique where­ authors have found that the Indian by the therapist has to assume a patients also demonstrate a signi­ more directive attitude. In a study, ficant amount of guilt (Venkoba Varma and Ghosh (1975) found Rao 1973, Teja et al., 1971). It that the Indian psychotherapist may be perhaps true that in case led a relatively more active role of the Indian patient, the guilt than that the Western counterpart, feeling may be related to certain suggesting, sympathising, manipu­ values other than those important lating the environment, teaching in the Western culture and may be and reassuring. The Indian psy­ thought to be based sometimes on chotherapists, in suggesting depar­ misdeeds of an earlier birth. tures from the Western model, Confidentiality and the dyadic pleaded for greater flexibility, grea­ relationship :— ter activity on the part of psycho­ therapist and greater use of sugges­ Some authors have suggested that tions and reassurance. confidentiality in psychotherapy is not so important to the Indian patient, and that he does not HISTORY OF PSYCHOTHERAPY IN INDIA mind discussing bis illness with the If psychotherapy which can be deter­ psychiatrist in front of friends and mined as "the interpersonal method of family members. The friends and mitigating suffering," has had a long his­ family members may actually be tory in India. In response to a question perceived as therapeutic allies. This by a mendicant Potthapada, Lord Buddha raises questions regarding the rele­ replied, "I have expounded, Potthapada, 214 V. K. VARMA what is suffering; I have expounded what accepted by the patient/client. is the origin of suffering; I have expounded (4) Not everybody was considered fit what is the cessation of suffering; I have for such psychotherapeutic relation­ expounded what is the method by which ship. "Another common feature one may reach the cessation of suffering." of these ancient therapeutic systems In this regard, the Exalted One can be said is their esoteric nature—their tenets really to have concerned himself with pro­ and practices have been considered pounding a psychotherapeutic system (Neki, mysteries of the highest order that 1975). Further history of psychotherapy, cannot be made accessible to any however, till the early days of this century, except the most worthy [adhikarin). are not documented in any detail. This is Thus they have remained the ex­ not surprising, as perhaps even in the clusive domain of the spiritual elite Western countries, psychotherapy did not and the people in general have come to be identified as a specific science remained bereft of their benefits" till around the turn of the century. (Neki, 1975). It is, therefore, not possible to say as to A historical account of psychotherapy what course psychotherapy, as expounded since the second decade of this century by Lord Buddha and various others, took in has been given by Sinha (1956). India. If one were to conjecture, perhaps Girindrashekhar Bose, the founder of the Indian brand of psychotherapy over the the Indian Psychoanalytic Society, centuries differed from the modern Western can be considered to have brought modern concept in a number of ways : psychotherapy to India. In addition to- (1) Psychotherapy practised in India stimulating other people in psychoana­ was not limited in its applicability lysis, Bose also propounded a theory of only to the sick, but was also per­ "opposite wishes", and published a book, ceived as much, if not more so, ''The Concept of Repression." He en­ to be useful in inculcating insight tered into a lengthy correspondence with in those not afflicted by mental Sigraund Freud which lasted from 1921 illness and thus effecting fulfilment almost to the time of Freud's death in and self-realization. 1939. Freud must have been delighted (2) The giver of such ameliotative and with this relationship and the support enriching experience assumed a that it represented. However, going highly exalted and reversed posiiion through the correspondence, one gets the in the society. In such a situation, feeling that Freud's attitu.de was that of it was neither possible nor consi­ benevolent indulgence, but he was never dered desirable for the therapist greatly impressed by Bose's idea and for­ and the patient or client to meet mulations, and he never gave anything and interact as equal;-. The rela­ resembling a clear seal of approval to them. tionship was perhaps akin to 'he The Indian Psychoanalytic Society teacher-disciple relationship. still continues, although its membership (3) Psychotherapy was, therefore, not has never been large, partly, no doubt, a dialectical process where truth due to their own stringent requirements. was reached or approached by a It is based in Calcutta does accept doctors debate between the two or within as well as non-doctors for training analysis, the heart of the recipient, but was and publishes a journal, called Samiksha. more of a situation where truth was Another aspect of history of psycho­ revealed by the therapist and therapy in India is the resurgence of in- PRESENT STATE OF PSYCHOTHERAPY IN INDIA 215

terest in a types of therapy of great If by psychotherapy we mean a deliberate antiquity, Yoga and T.M. In addition relationship between a professionally trained to numerous lay groups trying to promote person and a patient (Wolberg, 1967), it in the various parts of the country, there naturally we shall have to direct our have been scientific attempts to define enquiry to those psychiatrists who possess and interpret it, and to test its value a basic degree in modern medicine and as a therapeutic tool. Vahia and co­ have nad further training/qualification in workers have been, perhaps, most active psychiatry, and to perhaps a few psycho­ of all in this modern analysis of Yoga. In logists who are engaged in therapy. Ob­ numerous publications, they have presented viously, our scope will be rather limited. Yoga to the professional and especially to On the oiher hand, if we take psycho­ the Western workers, and using relatively therapy to mean "(he treatment of emo­ stringent and scientific methods, have attem­ tional and personality problems and dis­ pted to test its therapeutic efficacy in psy­ orders by psychological means" (Kolb, chiatric disorders (Vahia et al., 1966 ; 1968), it may be assumed to include many Vahia, 1969 ; Vahia et al. 1972, 1973). other therapeutic activities, e.g. the psy­ The results, so far, indicate that, for cases chological element of presumed therapeutic of of psychoneuroses, Yoga is superior to value in the casual contact between a doctor "pseudo-treatment", i.e. where they "were and his patient, the treatment activities of asked to relax and do some postures re­ non-medical professionals such as psycho­ sembling Asnas, and breathing practices logists and social workers, and the activities resembling Pranayama" and to "write of faith healers and religious healers. all the thoughts that came to their mind For the purpose of this section, we during the treatment (similar to Dharana shall adopt a more liberal definition of and Dhyana)". psychotherapy, meaning thereby, "the Finally a word about transcendental treatment of emotional and pesrsonality meditation. This therapeutic modality problems and disorders by psychological which possibly was derived from the Vedan- means" (Kolb, 1968), and would review all tic Psychotherapy of ancient India and ex­ therapeutic activities going on in India istentialism of modern-day Europe, gradua­ which seem to operate through psycholo­ lly started to be noticed in late 1950's ; and gical means. Such activities can be best considerably reinforced by neurophysiolo- described in terms of the therapists involved. gical research, quickly gathered momentum Although precise and detailed information in so much so that by early 1970's it become this area is glaringly inadequate. The follow­ a phenomenon of incredible popularity ing general comments can be made. The and global impact. This 'phenomenon' therapist involved can be roughly classified which almost defies attempts at its inter­ as follows : pretation is too recent to be analysed and understood yet. (1) Religious and faithhealers : Such healers are quite widespread all THE PRESENT STATUS OF PRACTICE OF over the country, although it is impossible PSYCHOTHERAPY IN INDIA : to be sure of their number or affiliations. Reliable objective data on types and A strong faith in the tenets of religion extent of psychotherapy conducted in and supernatural phenomena and powers, India are extremely scarce and hard to on part of both the therapist and clients, come by. Part of the difficulty lies in the is a necessary prerequisite for the success definition of psychotherapy adopted, of this kind of therapy. It will perhaps 216 V. K. VARMA not be incorrect to say, that most of the supernatural genesis of maladies, and the practitioners and patients are Hindus, how­ beneficial values of faith, reverence and ever, many Muslims are thought to be rituals. Thus, the therapeutic situation endowed with great healing properties. contains three important ingredients, i.e. The usual method of operation is that the a shared world view, personal qualities of patient seeks the therapist, and comes to the therapist, and the h:gh exceptations of him for help. The latter in turn gives him the patient described by Torry (1972b). a sympathetic hearing, involves greater What is the extent of this type of religious faith and reverence in hi.m and therapy ? Again, very little information jointly invokes the mercy of God on is available on this point. If the general him. In the process, he may give the impression that one gets in his practice of patient some sacred ash (Bhabhuti), ask psychiatry while elucidating history of him to make certain offerings at the altar, previous treatments of his patients, and the and give him verbal reassurance and sugges­ overall picture of pshychotherapeutic ac­ tion that the problem would be over. Cer­ tivities in a general and especially rural tain other religious rituals, like periodic population that one is familiar with, is offerings and worships over long periods any guide, such faith-healing activities of time, observation of fasts and other must go on a very large scale. It is perhaps restrictions may be prescribed. Sometimes safe to assume that a great many patients the therapist names some offending spirit or who do not or who can not avail of modern the patient's sins or misdeeds (including psychiatric facilities utilize the services those ascribed to an earlier birth) and pres­ of faith healers to a large degree. Their cribes the remedial measures as earlier services must be solicited quite frequently noted). for conditions like hysterical neurosis, epi­ lepsy, mental retardation and even many The healer generally enjoys very high cases of frank psychosis. reputation in the local area as a holy man ; good-intentioned, helpful, compassionate Can we call this type of activity as and possessive of extraordinary powers. psychotherapy? One can say that these Although, we have given him the generic healers cannot be called ''professionally name, here, of faith healer or religious trained", and that the relationship is more healer, he is not conceived of as such by haphazard than "deliberate", hence this the population but as a learned and wise activity does not qualify as psychotherapy man. The vernacular name for him varies according to Wolberg's definition. On the from one part of the country to another, other hand, one can argue that, although but some typical examples are Peer, these, "healers" did not receive any train­ Sayana, Babajee and Ojha, literally ing in formal psychology, or psycho-ana­ meaning a divine, a learned man, an elder lysis, they have had methodice training respected man and a Brahmin respectively. under their Gurus for this kind of treatment, In most cases, he is also the village priest hence they can be considered to be "pro­ (although not all priests are conceived of fessionally trained". as healers). Does this type of therapy help? It The patient who seeks his help generally may seem that since this therapy does not comes to him with high hopes and expec­ conduct itself along the lines of modern tations. Both he and his family have heard psychotherapy, and does not utilize certain a great deal about him and hold him in "techniques" of it, it may not be able to high esteem and reverence. He shares effect ameliorative change. However, the with the therapist his views about the evidence, though patchy and inadequate, PRESENT STATE OF PSYCHOTHERAPY IN INDIA 217

strongly suggests that this therapy almost impossible to make any reasonable guess certainly helps those suffering from certain about the number of such healers or the types of neurotic problems, especially extent of therapy practiced by them, but it hysterical neurosis ; and possibly those must be considerable. with many other types of neurotic prob­ Typically the patient suffering from a lems. Psychiatrists often comes across psychatric illness, which may range from in their practice, hysterical patients who hysterical neurosis, to depression, to schizo­ had earlier been treated by a faith-healer phrenia, comes or is brought to the healer, with satisfactory remission of symptoms, who typically is a middle-aged or old wo­ the reoccurrence of which has brought man, and his problem is stated to the exor­ him to a psychiatrist this time. It is quite cist. She then names a particular offending likely, that the faith healer may also have spirit or influence. The therapy primarily adversely harmed certain patient, both consits of a trance induced by the thera­ by using unsatisfactory techniques and by pist through magical dancing and chan­ delaying proper medical treatment. There ting, in which both the therapist and the is not much doubt that mary patients patient participate. The exorcist, thus, are unaffected, one way or the other, attempts to drive away the offending spirit by their intervention. Incidentally and or influence. Producing noxious and un­ fortunately, however, there is a growing pleasant smoke and gases, beating or awareness amongst the religious and faith- branding the patient, engaging into franzied healers, especially the ones who treat psy­ dancing, and many similar techniqus may chiatric patients fairly regularly and some­ be adopted in the process. times commercially, that their competence The same arguments as advanced in is limited to certain types of mental abe­ case of faith-healers would apply to the rrations. They classify mental illnesses question whether this activity qualifies to into two groups ; first, that they can help, be categorized as psychotherapy. As with and the second, where medical (psychiatric) faith-healing, it will be unfair to say that intervention is needed. They have been there are no differences between this and known to refer certain patients, considered conventional psychotherapy conducted by to be belonging to the second category, to psychiatrists, but at the same time, it must psychiatrists. be conceded that it has several characte­ (2) Exorcists—The group named as ''ex­ ristics of psychotherapy. orcists" here have got important similarities Does it help ? Here, again, it will be with the group of faith healers and religious hard to sustain that it never helps. We healers described above. However, there come across many cases of hysterical neurosis are important differences between the two earlier treated by exorcists, as by faith- groups, because of which it may be more healers, with good remission. The fact convenient and useful to consider them that many of these patients relapse subse­ separately. For one thing, although quently is another thing. Perhaps, we the exorcists share the religious halo and reve­ modern psychiatrists also are not more rence with the faith-healers, they are generally effective in many such cases. not considered to be holy or religious people, However, it must be kept in mind that tubare thought of as possessing supernatural or the exorcists also inflict harm to a number magical powers which may both be benevolent of patients. I have earlier referred to the and melevolent. They are looked upon by the fact that they often beat up or even brand general population more with fear than with their patients with hot iron. Such dis­ reverence. As with religious healers, it is figured patients are often seen by us subse- 218 V. K. VARMA quently. The psychological effects of such total patient sample. However, 8.3% were physical torture and punishment can be unemployed, 16.7% students, 17.4 % house­ catastrophic. Attempts must be made wives, 15.1 % had not completed high school to stop such undesirable incidents. and 28.0% had a monthly income not ex­ ceeding Rs. 300/- per month. As expected, (3) Psychotherapy as practised by the Indian a vast majority of patients (65.2%) were psychiatrists : suffering from psychoneuroses. Strangely, An attempt in the direction of compiling however, 15.9% were diagnosed to be objective information on the extent and suffering from schizophrenia. In most nature of psychotherapy practised in India cases, therapy was not what can be termed was undertaken by Varma and Ghosh in long-termed, intensive psychotherapy. How­ 1974. (Varma and Ghosh, 1975), in which ever 15.2% of the patients had been re­ they set out to ascertain the nature and ceiving psychotherapy oftener than twice extent of psychotherapy practised by the a week, 9.1 % had been in psychotherapy for Indian psychiatrists. Wolberg's (1967) over two years, and 6.8% had had over definition of psychotherapy was accepted 100 sessions each. The finding regarding for the purpose of this study, and psycho­ the seating arrangements was also consis­ therapy was further specified to mean a tent with the above, in that the majority deliberate contract with structured and (80.3%) of patients sat in chair facing the scheduled therapeutic sessions whereby therapists, and that couch was used in case the patient was seen at least once a week, of only 10.6% of them. each session was of a minimum duration of 20 The therapist was found to play a rather minutes, and the total time deovted to the active role in psychotherapy, perhaps more patient was at least 30 minutes per week. so than what goes on, on an average, in psy­ This survey was conducted amongst the chotherapy in the West ; suggesting, sym­ Fellows of the Indian Psychiatric Society, pathising, manipulating the environment, resident in India (A fellow generally has teaching and reassuring. However, in fully had at least 4 to 5 years of training and/or 38.6% of cases, psychotherapy was consi­ experience in psychiatry with or without a dered to be of reconstructive variety. In postgraduate qualification in psychiatry). addition to the psychodynamic and eclec­ Out of a total of 182 psychiatrists available tic approaches, rarer techniques like psy- for this survey, 48 (26.4 %) responded to chodrama, play thereapy, milieu therapy, the questionnaire. 16 of them were not Pavlovian therapy, hypnosis and Yoga the­ treating any patients with psychotherapy rapy were also reported as being used. at the time of the study. The remaining 28.0% of patients were receiving psy­ 32 years treating 180 patients at the time chotherapy as the sole treatment. Psycho­ of the study. However, they provided therapy was considered to be the primary complete information on only 153 of their treatment in 60.6% of patiets and ancillary patients of which 132 fulfilled the criteria in the rest. for psychotherapy adopted for the study. The attitude of the participating psy­ Out of these 132 patients, males outnum­ chiatrists were also explored through the bered females (58:42). The findings did questionnaire. All felt that psychotherapy not, furthermore, support the notion of a is a useful mode of treatment. A large young (and ? attractive) female as the majority, however, recommended depar­ prototype of psychotherapy patients. As tures from the We. tern model. The expected, the higher socio-economic bra­ various modifications suggested were that it ckets seemed to be over-represented in the should be briefer, crisis-oriented, supportive, PRESENT STATE OF PSYCHOTHERAPY IN INDIA 219 flexible, eclectic, and tuned to be cultural answer the above question. Briefly, these and social conditions. Greater activity or, difficulties can be summarised as those of part of the therapist, greater use of sugges­ defining and identifying the population (of tion and reassurance, lesser use of dynamic psychotheraphists), of drawing out a re­ interpretation, religious blending and en­ presentative sample thereof, and of adopting tering into a Guru-Chela relationship were an operationally sound and at the same the other departures from the classical model time conceptually meaningful definition of suggested. However, no comprehensive psychotherapy (where do we draw the line ? and well-crystallized model of psychotherapy How casual can the interactions get and still suited for this country was suggested. be called psychotherapy?) The above study, although perhaps Hence, the expected data that may representing a significant addition to our merge from such an enquiry are likely to factual knowledge as regards the state of be more 'soft' and difficult to interpret. psychotherapy in our country, and being Such a research may even degenerate into the first study of its kind reported ; must impressionistic and highly biased accounts be viewed as encompassing perhaps a rela­ of psychotherapy in India as visualised by tively small fraction of all psychotherapeutic the author. activities in the country, using the term in Going back to Varma and Ghosh's its widest sense. The authors, themselves, study, 32 psythiatrists reported that they have correctly pointed out these limitations were doing psychotherapy at the time of of the study. Firstly, the study pertains to the study. This represented 17.6% of the "psychiatrists", namely those people who 182 psychiatrists who were available for the are doctors (thus excluding "lay" thera­ study, and 66.7% of the 48 psychiatrists who pists) possessing as a medical degree in responded to the questionnaire. Thus, it "modern" or a"allopathic" medicine (thus can be said that psychotherapy is practised excluding Vaids, Hakims, and other prac­ to a significant, but a somewhat limited titioners of the indigenous systems of medi­ degree by the Indian psychiatrists. Consi­ cine), with formal training o/ certification in dering the findings that the lower socio­ psychiatry (thus excluding general practi­ economic brackets were also well represen­ tioners of "modern" medicine). Of course, ted amongst the patients and that explora­ faith-healers and religious healers of the tory and reconstructive techniques were various sorts are also excluded. At the also used quite often ; serious questions are same time, the definition of psychotherapy raised as to the relevance and applicability adopted for the purpose of the study should of the limitations hypothesised earlier as be kept in mind in assessing the significance regards psychotherapy in the Indian se­ of the data gathered. The definition chosen tting. The study, however, was neither was a relatively specific one, and included designed nor expected to answer this ques­ only those therapeutic manoeuvers of psy­ tion, for which different strategies must be chological nature which were deliberate employed. and structured, as opposed to casual con­ How do the findings of this study tacts of presumably therapeutic effectiveness. compare with the situation in the West. The question may be asked, what about Wing and Wing (1970) reported on the quantifying the other psychotherapeutic characteristics of patient seem in 'speciali­ activities in the country r.ot covered sed' (at least once a week) for at least six by Varma and Ghosh's study ? Several months by a psychiatrist mainly or exclu­ great, possibly insurmountable, difficulties sively doing psychotherapy) and 'suppor­ come to mind at the prospect of a study to tive' (anyone seen 20 or more times in 220 V. K. VARMA one to two years) psychotherapy. They By the term, "indigenous doctors" is comm­ found clear differences in the demographic only meant those who practise other system and clinical characteristics of the two of medicine prevalent in India, e.g. homeo­ groups. Older age-groups (35% vrs. 5% pathic, Unani or Ayurvedic medicine and above 45 years), and females were clearly they are generally referred to as homeo­ over-represented in the supportive psy­ paths, Hakims and Vaids, respectively. chotherapy group, and single patients Some such practitioners have had a formal 26% vrs. 57%) and social classes I course of training and credentials in the and II (4% vrs. 41%) underrepresented. respective discipline, but the overwhelming As regards the diagnostic labels, perso­ majority have picked up the skills infor­ nality disorders (25% vrs. 6%) and sexual mally. Although no reliable estimate of disorders (17% vrs. 2%) were over-re­ the total number cf indigenous practitioners presented in the specialised psychotherapy is available, it is guessed that it is several group, and psychoses (3% vrs. 32%) under- times the number of those practising allo­ represented. In Varma and Ghosh's study, pathic or modern system of medicine. by comparison, 4.5% of patients were above As regards psychotherapy practised by 49 years of age, males out numbered females these practitioners, perhaps very few, if in the ratio of 58.42 and 18.2% were psy­ any, practise a formal, structured psycho­ chotic. These figures more closely appro­ therapy based on a deliberate contract. ximate Wing and Wing's figures for the However, it can be safely guessed that a specialized psychotherapy patients. sizeable proportion engage in what can be In another study, Mowbray and termed as "helping situations". The effec­ Timbury (1966) collected the opinion of tiveness of any practitioner in such therapy Scottish psychatrists on certain aspects depends upon his personal qualities of of psychotherapy. 76% agreed that the warmth and concern and on his psycholo­ term psychotherapy should be used only for gical sophistication and sensitivity. Many a "deliberate undertaking". 20% followed- general practitioners, many family doctors "a classical or recognised school". 88% and many Vaids and Hakims demonstrate of psychiatrists combined psychotherapy these qualities to a commendable degree, with other forms of treatment ; 86% with and their effectiveness and involvement is, drugs and 53% with ECT (of 64.4% and no doubt, greatly enhanced and facilitated 7.6% respectively of patients in Varma and by their personal knowledge of and involve­ Ghosh's study). ment with the patients. By the term 'lay therapist', here, is (4) General practitioners, indigenous doctors meant a non-medical professional like a clini­ and lay therapists : cal psychologist, a psychiatric social worker, Almost nothing is known regarding the or a psychiatric nurse engaged in psycho­ characteristics and the quantum of psycho­ therapy. A lot of debate has been going therapy that may have been practised by on regarding the role of a psychologist in a these categories of people. By the expres­ clinical setting, that is, whether he is pri­ sion, "general practitioners", here, is meant marily to help the psychiatrist by adminis­ those with a qualification in modern medicine tering psychological tests, or is to be mostly (allopathic medicine) who are engaged in utilised in research activities, or is to act general or family practice. Perhaps the as a psychotherapist. Similar, though not modern doctors who are specialists in some ?o intense, discussion goes on regarding the branch of medicine other than psychiatry role of a social worker and how he or she can also be considered in the same category. should apportion his or her time and efforts PRESENT STATE OF PSYCHOTHERAPY IN INTJIA 221

between writing a social history, exploring confusion within their own ranks regarding social and financial support for patients and their role. clients, and doing psychotherapy of some THE FUTURE OF PSYCHOTHERAPY sort or the other. As regards the nature and extent of As regards the future of psychotherapy psychotherapy practised by tr e lay therapists, in India, at least three trends can be considerably more is known regarding the expected. clinical psychologists than the other non­ (1) It is inconceiveable that the further medical professionals. There are many development of psychotherapy in India will clinical psychologists engaged in the work be in isolation of the trends and innovations of psychotherapy. In a recent survey in the West. The practice of psychotherapy (Sharma et al., 1975), it is reported that has undergone numerous changes in the approximately 80% of the clinical psycholo­ United States and Western Europe since the gists practise counselling and guidance, about beginning of this century, since the advent 3/4 of them supportive and electic therapies, of psychoanalysis, with new schools being others are engaged in behaviour therapy, propounded, new orientations suggested, psych odynamic psychotherapy and play and gradual but important changes in the therapy. Approximately l/3rd of their technique of psychoanalysis effected. The time i? taken up by this type of therapy. following are some of the trends currently Sen (1974, 1975a, 1975b) advocates be­ important in the West : haviour therapy and therapies based on (1) There is not much doubt that the learning therapy and other psychological classical "Freudian" psychoanalysis is under­ approaches also for the clinical psychologists going significant changes. Marmor (1973), of the eightees. Sharma (1970) mentions a noted psychoanalyst and the present that projective tests could be used thera­ President of the American Psychiatric Asso­ peutically and feels the trend nowadays is ciation, commenting on the future of the to go from brief to "briefer" psychotherapies psychoanalytic therapy, predicted that psy­ to "first aid" and "emergency" and "crises" choanalysis will move increasingly towards therapies. Dhairyam (1975) advocates an open-system biosocial perspective, in­ "Guru psychotherapy" and ''Karma yoga corporating aspects of field theory, communi­ psychotherapy" based mainly on the "Guru- cations and information theory and general kula" and "Grru-Sisbya" systems. Naue systems theory. Pointing out serious limi­ (1975), Majumder (1975a, 1975b) etc., tations to the purely dyadic free-associational have also reported case studies where yoga and other forms of psychotherapy have been method, he has underscored changes that the successfully carried out. In fact, therapies technique of psychoanalysis has been under­ from almost all schools of psychology are going for the last few decades, in that it being practised by the clinical psychologists has been gradually moving towards a thera­ in India. peutic relationship in which the therapist assumes a more active and intervening role, It can be said that, by and large, in and predicted that "....as time goes on, actual practice, at present, the other non­ this (classical) approach will be relegated medical professionals do very little psycho­ primarily to investigative and training pur­ therapy. This is partly due to the role suits and that it will be used less and less expected of them by the psychiatrist, who frequently for therapeutic purposes". Marks usually assumes the position of group leader (1971) feels that there are trends towards or administrator, and partly due to their unification between the various approaches. own lack of initiative, and on account of Priest (1972), however, answers in negative 222 V. k. VARMA to the question , "is a glorious unity of feels that an awareness of one's own falli­ disparate therapeutic approaches taking bility and limitations is the most important place?" that he himself posed, and warns trainir g experience for a therapist. Brenneis against simplistic eclecticism, and combi­ and Laub (1973) see the surging interest nation therapies. Marks (1971), in the and emphasis on the activist, social system same paper, enumerates other trends in approach as fulfilling narcissistic needs of psychotherapy as : the therapists so interested. The conflict (a) use of meditation, biofeedback, between the "new" radical psychiatry and (b) use of less highly trained personnel "old" professionalism is seen as a conflict (c) a pragmatic approach involving between action and reflection; a choice bet­ cost effectiveness analysis ween being a good human being which is (d) use of each type of psychotherapy seen as fashionable and being a good thera­ more specifically for limited indi­ pist which is outdated. They feel that a cations "crucial aspect of becoming a psychothera­ (e) greater attention being paid to the pist is the positive acceptance of one's finite active ingredient of each type of and fallible means for effecting change in therapy. patients", and that, "one way out of this In addition to greater emphasis being dilemma is to abandon psychotherapy as a given to group therapies and behaviour relevant activity and to pursue the narcissis­ therapies in general, interest has been gene­ tic goal in some other clinical area." rated in newer therapeutic models like encounter groups, transactional analysis, II. Adapting western psychotherapy to suit the transcendental meditation, Yoga, and local needs : Morita therapy. Numerous changes and adaptation may (2) Several authors have elaborated have to be made to suit psychotherapy to on the conflict, espe;ially in the contem­ the Indian setting. As already mentioned porary America, between the traditional, most of the Indian psychiatrists surveyed by dyadic, individual psychotherapeutic models Varma and Ghosh (1975) recommended and the activist, social system psychotherapy. departures from the Western model. If Social system psychotherapeutic model has that is any guide, it can be predicted that been elucidated by Pattison (1973) as a psychotherapy in India will gradually move multiple-person, multirelational interaction, towards briefer contacts for specific crisis an "open" model" psychotherapy, rather and problems, in which the psychiatiist than a one-tc-one interaction. Patient seeks will play more of active, directive, interven­ to return to the social system which is the ing and nurturing roles. Then, there is venue of the psychotherapy, and on which also the question of professional manpower. it is focussed. Dicks (1969), Kubie (1971), The total number of psychiatrists is so small and Brenneis & Laub (1973) however, raise in relation to the population that it is in- important doubts regarding the relevance conceiveable that they will come anywhere and utility of the activist model. Defining near being adequate for all psychothera­ psychotherapy as ". .not only a set of skills peutic needs. Certain strategies may be but especially an attitude toward sick or evolved to tackle this problem. Persons suffering persons....", and psychodynamic other than those designated as psychiatrists viewpoint as "... .an attitude of mind rather may have to be recruited. This may include than a mere technique", Dicks (1969) sees non-medical professionals like clinical psy­ psychotherapy as essentially a way of handl­ chologists and social workers; general practi­ ing the experience of illness. Kubie (1971) tioner?, practitioneis of indigenous systems PRESENT STATE OF PSYCHOTHERAPY IN INDIA m of medicine, and perhaps even the faith- psychotherapy in particular to better carrv healers and religious healers. Serious im­ out their work. A few, rather feeble, pediments with regard to utilizing the attempts have been made in the country to services of each category may have to be provide this orientation. Fortunately, be­ overcome. As legard : clinical psychologists cause of professional bond and association and social workers, there is widespread between the psychiatrists and the general reluctance to use them for therapeutic pur­ practitioners, it may be relatively easier to poses. The arguments against using them achieve a significant piogreis in this area. for therapy by and large, are too well known Many prominent psychiatrists ftel that it to .stand repetition hsic. There is a growing is possible to impart a practical, working dissatisfaction however with the value of knowledge of psychiatry to general practi­ psychological testing, the traditional job of tioners is a brief period of time, training clinical psychologists, and a feeling that they them in recognition of common psychiatric should be better utilized in some other illnesses and use of certain drugs. Short fashion. As regards social workers, because courses in this direction have also been of differences in social systems (especially suggested and tried out. It may not be all with very few financial and social support that difficult to teach them the basic prin­ systems available in India) the traditional ciples and practical aspects of supportive Western model of utilizing their services psychotherapy and "helping" situation. for tapping financial resources for patients' Here, again, it may be added that general support is not applicable here. Hence, practiuoners and "family physicians" quickly tney alsj can be more profitably utilized develop a more understanding and em- in therapeutic activities. pathic attitude towards their patients, per­ haps more than the specialists do. This As regards the othe. categories men­ can be nuitured and further developed and tioned above, there is not much doubt that crystallized into more acceptable thera­ they are engaged in a great amount of peutic skills- therapeutic work. How well they do it is another matte:. General practitioners who When we consider the situation regard­ are pi acti doners possessing degrees in modern ing the indigenous practitioners, things are (allopathic) medicine, are, bv the nature considerably different. It will be more of their job required to see a lot of patients difficult for psychiatrists to establish rela­ with emotional problems. It has been tionship with them because of lack of a variously estimated that, of the patients common professional bond and difficulty who report to general practitioners for help, on our part to understand their methods at least one-fourth to one-third are not and philosophy. However, the conclusions suffering from an^ organic illness, but from is inescapable that they treat a large bulk a primarily psychiatric disorder; and p;r- of the population, especially in the rural haps an equal number, though suffering areas and that rightly or wrongly, they from an organic disorder do show significant exercise their psychotherapeutic skills. It amount of psychcpathclcgy independent of will be impossible to stop this. Then, why or secondary to the physical illness. It is not collaborate with them to increase then inevitable that, knowingly or unknowingly, effectiveness and to decrease any possible the general practitioners will attempt to harm that they might be doing? Unfor­ render psychotherapeutic help to these tunately, we know so very little about them patients. However, the general practitioners that it may be foolhardy to jump into any will be required to be given proper orien­ such programme without knowing the level tation towards psychiatry in general and of cooperation expected from them and our 224 V. K. VARMA effectiveness in enlarging their orientation. unbiased research in Yoga. Transcendental Finally, the faith-healers, religious meditation (TM) although having originated healers and exorcisis. Here, again, there is here, has now reached much wider clientele. not much doubt that they are engaged in The future of TM is likely to be decided not large-scale supposedly therapeutic activities; on the Indian scene, but at the international and that it will be impossible to check or arena. Part of this battle will, no doubt, be contain it. Then, why not at least establish fought in neuroph/siological laboratories, some liaison with them so as to limit harm but the ma in de terminan t of the final ou tcome done by them and perhaps to increase their will be the attitudes, beliefs and philosophy effectiveness ? The task is much too enor­ of trie people at large, which again are mous to feel very optimistic about it at this perhaps functions of a large number of time, and a lot of research and experience socio-political variables. will be needed to know the various problems Neki (1974), discussing the Guru-Chela that may be encountered in such an effort. relationsnip has concluded that ''the Guru- For one thing, it is not clear if, and to what Chela relationship as a therapeutic paradigm extent, they would cooperate with the appears to be particularly tenable where modern doctors and psychitrists in any pro- self-discipline rather than self-expression is giamme where they can be guided and re­ to be inculcated among the clients and oriented as regards psychotherapy. Many where a creative harmony is sought be­ of them would, doubtless, feel threatened tween the individual and the society." It is that they may lose the financial and prestige impossible to predict at this time, with any gains that their present vocation gives them. amount of certainty if and to what extent Guru-Chela relationship, or psychotherapy III. Evolving and developing indigenous systems patterned after such a relationship would of Psychotherapy : enjoy popularity in the future. If the Another trend that can be predicted attitudes of psychiatrists as gathered by for the future, would be the development Varma and Ghosh (1975) is any glide, it is and propagation of the indigenous psycho­ likely that some concepts and technique of therapeutic approaches, like Yoga, transcen­ Guru-Chela relationship, e.g. more activity dental meditation, Guru-Chela relationship and direct guidance and advice by the and faith-healing. therapist, may influence and adapt Western As mentioned earlier, some professionals psychotherapy for India; although it is have been actively scientifically studying unlikely that a new school of psychotherapy Toga as a therapeutic modality. Unfor­ along these lines will be propagated. tunately, however, it is unusual to find an Whether or not faith-healing will receive Indian psychiatrist who would have an scientific sanction and be accepted as a open and unbiased attitude towards Yoga. separate approach to psychotherapy is not Majority of them are perhaps negatively very clear. It is quite unlikely that it will. biased against Yoga which they try to What is more likely to happen, not only in reject, consciously or subconsciously, deli­ India but on the world scene at large, is berately or otherwise, as they reject much that an analysis of faith-healing vrs. psy­ of the ancient cultural heritage and phi­ chotherapy may help us develop a moie losophy. Some, on the other hand, over­ scientific, realistic and objective attitude value Yoga and many even look upon it towards these, help us see the common as some sort of panacea for all maladies— grounds between them, and to adopt some mental as well as physical. Such attitudinal principles and practices of faith-healing for problems are likely to retard objective and psychotherapy, especially for hysterical and PRESENT STATE OF PSYCHOTHERAPY IN INDIA 225

other simple neuroses. unanticipated penalty of the full-time system. Arch. Gen. Psychiat., 24, 98. To conclude, we may say that a formal, MAJUMDAR, S. K. (1975a) A case study on pedago- "Western Type" psychotherapy is practised phobia psychotherapeutic approach to behaviour to a small but significant extent in India. modification. Indian J. Clin. Psychol., Other therapeutic interpeisonal relation­ 2,91. ship, operating through psychological means, MAJUMDAR, S. K. (1975b) Psychotherapy ofpedago- are much more widespread. There are phobia by reciprocal inhibition—a mechanical technique. Indian J. Clin. Psychol., 2, serious limitations to directly implanting 191. Western psychotherapy into India on account MARKS, I. (1971) The future of the psychotherapies. of differences in psycho-socio economic vari­ Br. J. Psychiat., 118, 69. ables and philosophical tradition. "The MARMOR, J. (1973) The future of psychoanalytic future of psychotherapy in India, though therapy. Am. J. Psychiat., 130, 1197. hard to predict, can be seen to lie in dis­ MOWBRAY, R. M. AND TIMBURY, G. C. (1966) Opin­ ions on psychotherapy : An enquiry. Brit. J. covering the strengths (and weaknesses) of Psychiat., 112, 351. her traditional psychotherapeutic techniques NAUG, R. N. (1975) Yoga therapy in neurotic and elaborating them more scientifically disorders. Indian J. Clin. Psychol. 2, 87. into clinically serviceable therapeutic sys­ NEKI, J. S. )1974) A reappraisal of the Guru-Chela tems" (Neki, 1975). relationship as a therapeutic paradigm. Int. Ment. Health Res. Newsletter, 16, 2. NEKI, J. S. (1975) Psychotherapy in India ; Past, REFERENCES present and future. Amer. J. Psychother., 29, 92. ABROMS, G. M. Persuasion in Psychotherapy. (1968) PETTISON, E. M. (1973) Social system psychotherapy. Am. J. Psychiat. 124, 1212. Am. J. Psychother, 27, 396. BERNE, E. (1960) The cultural problem: Psychotherapy PRIEST, P. N. (1972) The destiny of psychological in Tahiti. Am. J. Psychiat. 116, 1076. therapies : Convergence or divergence. Br. J. BOLMAN, W. M. Cross-cultural psychotherapy. Am. J. Med. Psychol., 45, 209. « Psychiat. 124 : 1237-44, 1968. BRENNEIS, C. B. & LAUB, D. (1973) Current strains for ROMANO, John. (1947) Psychotherapy in Witmer, H. mental health trainees. Am. J. Psychiat. L. (ed.) Teaching Psychotherapeutic Medicine. 130, 41. New York ; The Commonwealth Fund and CHESSICK, R. D. (1969) How Psychotherapy Heals : Cambridge, Massachusettes, Harvard Univ., The Process of Intensive Psychotherapy. New p. 122. York: Science House, P. 107-22, 193, 199. SEN, N. N- (1974) Behaviour therapy in depression DHAIRYAM, D. Presidential address to the V All- 1. An experimental analysis. Indian J. Clini. India Convention of Clinical Psychologists. Psychol., 1, 53. (1975) Indian J. Clini Psychol. 2, 1. SEN, N. N., (1975a) Behaviour therapy in depres­ iir'DiCKS, H. V. (1969) The state of psychotherapy in sion II, Plan and procedure of case analysis British psychiatry. Am. .J. Psychiat. 125, and treatment. Indian J. Clini. Psychol., 1232. 2, 77. FRANK, J. D. (1961) Persuasion and Healing : A Com­ SEN, N. N., (1975b) Clinical Psychology of eighties: parative Study of Psychotherapy. Baltimore: Editorial. Indian J. Clin. Psychol., 2, i-iv. Johns Hopkins, p. 114. SHARMA, V. P., (1970) Psychodiagnostic tests and FRANK, J. D. (1968) Recent American research in psychotherapy. Brit. J. Proj. Psychol. & Pers. psychotherapy. Brit. J. Med. Psychol., Stud., 15, 13. 41, 5. SHARMA, V. P., OJHA, K. N. AND VAGRECHA, Y. S. GOLDSTEIN, ARNOLD, P. (1962) Therapist-Patient (1975) Clinical psychologists in India II. Indian Expectations in Psychotherapy. Oxford, Lond., J. Clini. Psychol., 2, 73. New York, Paris: Pergamon Press, pp. 111- SINHA, T. C, (1956) Development of psychoanalysis in 121. India. Indian J. Psychoanal., 47, 427. KOLB, L. C. (1968) Noyes' Modern Clinical Psy­ SNYDER, W. U. (1963) Dependency in Psychotherapy : chiatry. Philadelphia : Saunders, (Indian edition A Casebook. New York : Macmillan, p. by Oxford and IBH, 1970, p. 546). 3 & 6. KUBIE, L. (1971) The retreat from patients: an SURYA, N- C. AND JAYARAM, S. S. (1964) Some basic 226 V. K. VARMA

considerations in the practice of psychotherapy VAHIA, N. S., DOONGAJI, D. R., JESTE, D. V., KAPOOR, in the Indian setting. Indian. J. Psychiat., S. N., ARDHAPURKAR, I. AND NATH, S. R. 6, 153. (1973) Further experience in the therapy based TEJA, J. S., NARANG, R. L. AND AGARWAL, A. K. upon the concepts of Patanjali in the treat­ (1971) Depression across cultures. British J. ment of psychiatric disorders. Indian J. Psychiat., 119, 253. Psychiat. 15, 32. TORREY, E. F. (1972a) What Western psychotherapists VARMA, V. K. AND GHOSH, A. (1975) Psychotherapy can learn from witchdoctors. Am. J. Orthopsy- as practised by the Indian psychiatrists. Paper chiat., 42, 69. presented at the 27th annual conference of the TORREY, E. F. (1972b) The Mind Game: Witchdoctors Indian Psychiatric Society. and Psychiatrists. New York : Emerson Hall. VENKOBA RAO, A. (1973) Depressive illness and guilt VAHIA, N. S., VINEKAR, S. L. AND DOONOAJI, D. R. in Indian culture. Indian J. Psychiat., 15, (1966) Some ancient Indian concepts in the 231. treatment of psychiatric disorders. Brit, J. WING, J. K. AND WINO, LORNA. (1970) Psychotherapy Psychiat., 112, 1089. and the National Health Service : an opera­ VAHIA, N. S. (1969) A therapy based upon some tional study. Brit. J. Psychiat., 116, 51. concepts prevalent in India. Indian J. Psychiat., WrrTKOwER, E. D. AND WARNES, H. (1974) Cultural 11, 7. aspects of psychotherapy. Am. J. Psychother., VAHIA, N- S. it at. (1972) A deconditioning therapy 28, 566. based upon concepts of Patanjali. Int. J. Soc. WOLBERG, L. R. (1967) The Technique of Psycho­ Psychiat., 18, 61. therapy. New York : Grune & Stratton, p. 3.