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Psychotherapy in Traditional Society: Context Concepts and Practice
Vijoy K Varma, Nitin Gupta
SECTION ONE: TRANSCULTURAL PSYCHOTHERAPY (THEORETICAL BASIS)
CHAPTER 1:
Introduction to Western Psychotherapy
INTRODUCTION
PSYCHOTHERAPY: DEFINITIONS AND COMMON CONCEPTS
WESTERN MODEL OF DOCTOR-PATIENT RELATIONSHIP
1. It is a professional relationship
2. Thus, it is addressed to identified, specific needs
3. It is a formal relationship
4. Psychotherapy is a contractual relationship
5. The relationship is based on defined boundaries around individuals
6. It is based on the concepts of individual rights and prerogatives
7. It is a confidential and confiding relationship
HOW PSYCHOTHERAPY HEALS
WHAT IN PSYCHOTHERAPY HEALS
PSYCHOANALYTIC OUTCOME CRITERIA
CHAPTER 2:
Classical Western Versus Traditional Therapies
BASIC TENETS OF PSYCHOTHERAPY ARE BEING CHALLENGED: DEMANDING, NEW DEFINITIONS, THEORY, TECHNIQUES AND GOALS
TRANSCULTURAL RESEARCH AND EXPERIENCE ADDING TO THIS ATTACK
APPLICABILITY OF THE WESTERN MODEL PSYCHOTHERAPY TO TRADITIONAL/DEVELOPING SOCIETIES
TRADITIONAL MODEL OF DOCTOR-PATIENT RELATIONSHIP
1. The Nature of Doctor-Patient Relationship
2. “Technique” Versus Relationship Dimension
3. The Social Definition of Healer
4. The Rule of Abstinence
5. The Deliberateness of Therapeutic Interchange
6. Psychotherapy for Self-actualization
7. Psychological Sophistication, Introspective and Verbal Abilities and Religious Belief-System
8. Decision Making and Personal Responsibility
9. Manpower Constraints
10. Doctor as a Guru, a Teacher and a Specialist of Life Itself
CONCLUSION
CHAPTER 3:
Socio-Cultural Variables Relevant to Psychotherapy
DEPENDENCE VERSUS AUTONOMY
PSYCHOLOGICAL SOPHISTICATION
INTROSPECTIVE AND VERBAL ABILITY
NEED FOR CONFIDENTIALITY AND THE NATURE OF DYADIC RELATIONSHIP
PERSONAL RESPONSIBILITY AND DECISION-MAKING
NATURE OF GUILT AND SHAME
RELIGIOUS AND SOCIO-CULTURAL BELIEF SYSTEM
Cultural and Religious Ethos in Hinduism
PATIENT'S EXPECTATIONS
SOCIAL DISTANCE BETWEEN THE PATIENT AND THE THERAPIST
UTILIZATION OF MYTHOLOGY FOR THERAPEUTIC GOALS, E.G. HANUMAN COMPLEX
ROLE OF THE FAMILY
CHAPTER 4:
Psychotherapy in Traditional Societies
INDIAN CONCEPTS OF MIND AND MENTAL HEALTH
Introduction
Psyche and Soma
INDIAN CONCEPTS OF EXTERNAL REALITY AND CAUSALITY
THE PSYCHIC STRUCTURE
Humoral Theory
Aetiology of Mental Illness
Causes of Loss of Peace of Mind
THE HUMAN PERSONALITY
Development of the Personality
Instinct Theory
The Concept of Sreya (Good) and Preya (pleasant)
Transmigration of the Soul
ANCIENT HISTORY OF PSYCHOTHERAPY
MEDITATION AND MENTAL HEALTH
THE PRESENT STATE OF PSYCHOTHERAPY IN INDIA
Religious and Faith Healers
Exorcists
Religious/Faith Healing and Exorcism versus Modern Psychotherapy
Psychotherapy as Practised by Indian Psychiatrists
General Practitioners, Indigenous Doctors, and Lay Therapists (Varma, 1982)
CHAPTER 5:
Models of Psychotherapy of the Future
SOCIAL CHANGE
The Advent of Human Civilization
Progression from Agricultural to Industrial Societies
Problems of Industrialization
The Advent of the Post-industrial Society and Information Explosion
MENTAL HEALTH STRAINS OF THE FUTURE
Breakdown of Family and Other Primary Groups
STRAINS OF GENETIC ENGINEERING AND ORGAN TRANSPLANT ON PERSONAL IDENTITY AND RESPONSIBILITY
Erosion of Privacy and Autonomy on Account of Information Technology
Ecological Changes Resulting from Plunder, Waste and Pollution
Changes in Social Values Leading to the “Death of Childhood” and “Death of Old Age”
CHANGING PATTERNS OF HUMAN NEEDS AND CONCERNS
Instincts
Drive
MODELS OF PSYCHOTHERAPY OF THE FUTURE
Development of Alternative Models of Mental Health Care
Psychotherapy for Nurturance, Personality Development and Self-Actualization
Development of Self-help and Helping Situations, Including Meditation
Making Psychotherapy more Flexible and Pragmatic and Less Bound by a Dogma
Post-Freudians and Neo-Freudians Rejected the Following Freudian Concepts
As a Group, they paid more attention to
However, they can be said to tacitly agree to the basic psychodynamic principles, i.e.
CONCLUSION
CHAPTER 6:
Cultural Psychodynamics in Health and Illness*
THE DYNAMICS OF CULTURE AND MENTAL HEALTH
THE THEORY OF CULTURAL DEFENCES
TRANSCULTURAL DIFFERENCES IN PSYCHOPATHOLOGY
Schizophrenia
Depression
Mania
Neuroses
Acute/Reactive Psychosis
Personality Disorders and Sexual Deviation
DYNAMIC AND FORMAL EXPLANATIONS TO THE TRANSCULTURAL DIFFERENCES
NATIONAL CHARACTER/MODAL PERSONALITY
AGES OF MANKIND
LINGUISTIC COMPETENCE
COGNITIVE STYLES
SOCIAL SUPPORT SYSTEM
MATERIAL CULTURE
PSYCHOLOGICAL SOPHISTICATION
PERSONALITY, COPING MECHANISMS AND ILLNESS
CULTURE AND PSYCHOTHERAPY
CONCLUSION
SECTION TWO: PRACTICE OF INDIVIDUAL PSYCHOTHERAPY IN A TRADITIONAL SETTING
CHAPTER 7:
Selection of Patients for Individual Dynamically Oriented Psychotherapy: General Principles
GENERAL SELECTION CRITERIA
Age of the Patient (16–18 to 45 years)
Duration of the Illness (5 years as the cut-off point)
Severity of the Illness
Diagnosis
Intelligence
Motivation
Low Motivation
Wrong Motivation
Depth of Insight
Secondary Gain
Ego Strength
Hereditary Influences
Constitutional Factors
Early Developmental Influences
Developmental History
Current Interpersonal Relations
Methods of Handling Stress - Predominant Mental Mechanisms used
Ability to Gratify Basic Needs
Symptoms
Precipitating Environmental Factors
Previous Adjustment
Level of Social Maturity
Current Environmental Situation
Past Therapeutic Failures
Responses to the Present Therapeutic Effort
CONTRAINDICATIONS FOR PSYCHOTHERAPY
Freedom from Neuroticism
Triviality of Neurosis
Fear of Change
Pride; Dependence too Humiliating
Fear of Self-revelation
Passivity
Magical Thinking
Common Beliefs that Create Resistance to Psychotherapy
Overwhelming Anxiety
Previous Acquaintance with the Therapist
CHAPTER 8:
The Process of Case Selection and Psychotherapy
INDIVIDUAL PSYCHOTHERAPY SUPERVISION
PROCESS OF CASE SELECTION AND CONDUCT OF PSYCHOTHERAPY SESSIONS
Rules of Psychotherapy
Regularity and Punctuality
Fee
What to Talk
What to Expect from the Therapist
Confidentiality
Abstinence
Important Decisions
Recording of Psychotherapy Sessions
PSYCHOTHERAPY CASE CONFERENCE
CHAPTER 9:
Selected Case Vignettes
CASE 1
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Course of Psychotherapy
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Termination of Psychotherapy
CASE 2
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Session 10
Session 11
Session 12
Session 13
Session 14
Termination
CASE 3
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Session 10
Termination
CASE 4
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Termination
CASE 5
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Termination
CASE 6
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Termination
CASE 7
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Termination
CASE 8
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Termination
CASE 9
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Unscheduled appearance in OPD (5 days after first session)
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Session 10
Session 11
Session 12 (Last Session)
Termination
CASE 10
Provisional Treatment Plan
Assessment for Psychotherapy
Provisional Psychodynamic Formulation
Final Treatment Plan
Psychotherapy Sessions
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Termination
SECTION THREE: OTHER (NON-DYNAMIC) PSYCHOTHERAPEUTIC TECHNIQUES
CHAPTER 10:
Non-Dynamic Psychotherapeutic Techniques (Meditation and Relaxation)
ESSENTIAL INGREDIENTS IN ALL MEDITATIVE TECHNIQUES
YOGA
TRANSCENDENTAL MEDITATION (TM)
AUTOGENIC TRAINING (AT)
BREATHING RELAXATION
VIPASSANA
POPULAR MISCONCEPTIONS ABOUT YOGA AND MEDITATION
CHAPTER 11:
Yoga
DEFINITION AND CONCEPT
SYSTEMS OF YOGA
REVIEW OF LITERATURE
Critique
CONCEPTUAL FRAMEWORKS
Cultivation of the Correct Psychological Attitude
Asanas or Postural Patterns
The rationale of asanas – A scientific perspective
Effect of ‘asanas’ on the other body systems
Pranayama
Rationale of Pranayama
EEG Studies on Pranayama
The Psychological Effect of Pranayama
Pratyahara, Dharana, Dhyana and Samadhi
Process of Meditation
Scientific Viewpoint
Relaxation Response
A De-automatisation of Experience
De-conditioning and Development of Insight
Flow Experience
CONCLUSION
CHAPTER 12:
Vipassana Meditation: A Consciousness Approach to Healing
INTRODUCTION
THE DOMAINS OF PSYCHE
THE IMPORTANCE OF SENSATIONS
Sensations as the Substrate of Consciousness
Sensations as the Roots of Experiences
Sensations as the Links between the Psyche and Soma
MINDFULNESS MEDITATION
VIPASSANA MEDITATION
The Atheoretical Stance
The Ten-Day Course
Embodiment
EXPLAINING THE BEHAVIOR CHANGE PROCESS
Semantic Network Models
Reprocessing of Past Experiences
THE CONSCIOUSNESS THERAPY APPROACHES
Integrative Attempts – A Move towards Consciousness Approaches
RELATIONSHIP BETWEEN MENTAL EVENTS AND CONSCIOUSNESS
The Levels of Consciousness
PHENOMENOLOGY OF CONSCIOUSNESS
Therapy Work: Getting Connected to the Background Consciousness
STAGES OF CHANGE IN VIPASSANA
Early Stages
Middle Stages
Advanced Stages
CONCLUSION
CHAPTER 13:
Transcendental Meditation: Current Status
INTRODUCTION
ORIGIN AND SPREAD
PROCEDURE
Advanced Techniques
Cost of Learning
THEORETICAL BASIS
The Maharshi Effect
BENEFITS AND INDICATIONS
DIFFICULTY IN MEDITATION RESEARCH: METHODOLOGICAL CHALLENGES
EFFECTS ON THE PHYSIOLOGY
EFFECTS ON COGNITIVE FUNCTIONS
THERAPEUTIC EFFECTS IN PSYCHIATRIC DISORDERS
Anxiety Disorders
Other Psychiatric Disorders
Smoking Cessation
Marijuana Abuse
Alcohol Dependence
THERAPEUTIC EFFECTS IN PHYSICAL DISORDERS
Cancer
Seizure Disorders
ILL-EFFECTS OF TM
CONTROVERSIES RELATED TO ‘TM’ PROGRAM
CONCLUSION
CHAPTER 14:
Autogenic Training
HISTORICAL BACKGROUND
WHAT IS ‘AUTOGENIC TRAINING’?
INDICATIONS AND CONTRAINDICATIONS
EFFICACY
CULTURE-SPECIFIC ISSUES
PROCEDURE
CONCLUSION
CHAPTER 15:
Role of Eclecticism, Integration, and Common Factors in Psychotherapy Practice in India
I. INTRODUCTION: ECLECTIC / INTEGRATIVE PSYCHOTHERAPIES
DEFINITION OF TERMS
TYPES OF ECLECTIC/INTEGRATIVE THERAPIES
II. CULTURAL ISSUES IN PSYCHOTHERAPY
CULTURAL ISSUES RELATED TO PRACTICE OF PSYCHOTHERAPY IN INDIA
CURRENTLY POPULAR INDIAN SCHOOLS
III. APPLICATION OF THE COMMON FACTOR APPROACH IN INDIA
COMMON FACTORS APPROACH: UTILITY IN INDIA
THE COMMON FACTORS
PRACTICING WITH THE COMMON FACTOR APPROACH
IV. CONCLUSION
SECTION FOUR: EPILOGUE
CHAPTER 16:
Development of an Indian Model of Psychotherapy: Thoughts and Directions for the Future
I. THE NEED FOR PSYCHOTHERAPY
II. THE PRACTICE OF PSYCHOTHERAPY IN INDIA
Pre-colonial
Colonial
Professionalization of Mental Health
Post-colonial
III. WHAT IS PSYCHOTHERAPY?
Nature of Influence Exerted by the Healer/Therapist: the Place of Spirituality
Therapy: Social Sanction and Professionalism
Evidence
Ethics
Training of Psychotherapists
Ethical Responsibility for Service Provision: Psychotherapy Training of Non-Psychotherapists (Other Mental Health and Health Professionals and Health Workers)
Focus of the Healing/Therapeutic Effort
Nature of Contact/Working Together
Use of Psychotherapy for Prevention of Illness and Promotion of Mental Health
Psychotherapy as a Consistent Body of Knowledge with Theoretical Models of Psychopathology, Proposed Mediators/Moderators of Change, and Specified Techniques
IV. PLACE OF PSYCHOTHERAPY IN PUBLIC MENTAL HEALTH
Challenges and Prospects
Systems of Psychotherapy
Training of Psychotherapists—Some Pragmatic Issues
V. ADAPTING WESTERN PSYCHOTHERAPY FOR INDIA
Use of Lesser-trained Professionals
Greater Activity on Part of the Therapist
Making Therapy Briefer, Flexible, Eclectic, Less Psychodynamic, and Socially-Relevant
Using Psychological Sophistication (or Lack of It)
Appropriate Incorporation of Patient's Introspective and Verbal Ability
Use of Religious and Philosophical Belief Systems
Rule of Abstinence
Confidentiality and Involvement of Family (or near ones)
IV. CONCLUSION
1. Psychotherapy should Relate to Psychodynamics
2. It should Relate to Socio-cultural Dynamics
3. It should Relate to the Social System, an Open Social System
4. It should Underplay Confidentiality, Anonymity and Social Distance
5. It should Underplay Dogma
6. It should Use an Eclectic Approach
7. Psychotherapy should remain Cognizant of the Strains of the Future and should Act to Absorb the Future Shock
8. Psychotherapy should not Lose Sight of What it can do for the Development of the Personality to Its Human Potential
9. Psychotherapy should be Based on Empathy, on Compassion
References
INDEX
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