Why Was the Joint Family Important to Indian Society? Answers

Indian J Psychiatry. 2013 January; 55(Suppl ii): S299–S309.

Indian family systems, collectivistic society and psychotherapy

Rakesh K. Chadda

Section of Psychiatry, All Republic of india Institute of Medical Sciences, New Delhi, India

Koushik Sinha Deb

Section of Psychiatry, All India Constitute of Medical Sciences, New Delhi, India

Abstract

Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the aforementioned principles of collectivism, has proved itself to be an excellent resource for the care of the mentally sick. Still, the society is changing with one of the near significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in today's changed scenario, the family forms a resources for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family unit focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally sick and information technology may pave the path for a deeper community focused handling in mental disorders. This paper elaborates the features of Indian family unit systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practise of family therapy in Bharat.

Keywords: Indian family systems, collectivistic social club, psychotherapy

INTRODUCTION

The term family is derived from the Latin word 'familia' denoting a household establishment and refers to a "group of individuals living together during of import phases of their lifetime and spring to each other by biological and/or social and psychological relationship".[one] The group likewise includes persons engaged in an ongoing socially sanctioned obviously sexual human relationship, sufficiently precise and enduring to provide for the procreation and upbringing of children.[i] Unlike the western lodge, which puts impetus on "individualism", the Indian society is "collectivistic" in that it promotes interdependence and co-operation, with the family forming the focal indicate of this social structure. The Indian and Asian families are therefore, far more involved in caring of its members, and too endure greater disease brunt than their western counterparts. Indian families are more intimate with the patient, and are capable of taking greater therapeutic participation than in the west.

In a situation where the mental health resources is a scarcity, families course a valuable support system, which could be helpful in direction of diverse stressful situations. Nevertheless, the resource is not adequately and accordingly utilized. Clinicians in India and the sub-continent do routinely take fourth dimension to educate family members of a patient nigh the illness and the importance of medication, but apart from this information exchange, the utilization of family unit in treatment is minimal. Structured family unit oriented psychotherapy is non adept in India at most places in India, except a few centers in South Bharat. Research publications on family therapy from Bharat are also few. Thereare some evidence from published "family intervention studies", simply whether all non-pharmacological interventions with family members tin can be considered as "family unit therapy" is a matter of theoretical argue.

Sholevar[2] defines family therapy as any use of a family-focused intervention to bring out behavioral and/or attitudinal changes in i or more family members" Although the "family unit" may be involved in many schools of psychotherapy, "family therapy" represents the almost direct co-operative of psychotherapy that deals with the family system as a whole.

This newspaper discusses the features of Indian family systems in the calorie-free of the Asian collectivistic culture that are pertinent in psychotherapy and family therapy as used in India, and its further scope.

Understanding THE INDIAN FAMILY FROM A PSYCHOTHERAPEUTIC STANDPOINT

Role of civilization and collectivism in shaping the family

Families do not be in isolation and family dynamics are often best interpreted in the context of their societal and cultural groundwork. Culture has been shown to determine the family structure by shaping the family blazon, size, and form[iii,four] and the family unit functioning by delineating boundaries, rules for interaction, communication patterns, acceptable practices, subject field and hierarchy in the family.[4–6] The roles of family members are determined largely past cultural factors (equally well as stages of the family life bicycle),[iv,7] and finally, civilisation also explains families' ways of defining issues and solving them.[vii]

Culture, however, is non an external passive influence on the families but families themselves serve as the master agent for transferring these cultural values to their members.[8] Parents assist children to learn, internalize, and develop understanding of culture through both covert and overt means.[9] Family members modify behaviors in themselves and others by principles of social learning. In this process, the general norms and beliefs may exist modified to adapt the needs of the family creating a set of "family unit values" – A subset of societal norms unique to the family unit.

It is imperative and then, that therapists understand the impact of culture on family functioning every bit well as in conflict resolution and trouble-solving skills of the family members.[ten] 1 such important dimension of Asian and particularly Indian culture that affects family functioning is collectivism.[eleven–thirteen] "Collectivism" refers to the philosophic, economical, or social outlook that emphasizes the interdependence amongst homo beings. It is the basic cultural chemical element for cohesion within social groups, which stresses on the priority of group goals over private goals in contrast to "individualism", which emphasizes on what makes the individual distinct, and promotes engagement in competitive tasks. "Horizontal collectivism" refers to the system of collective controlling by relatively equal individuals, for case, by the intra-generational family unit member; while "vertical collectivism" refers to hierarchical structures of power in a collectivistic family, for example, inter-generational relations in a iii generation family.

Classically, the cultures of Western Europe and North America with their circuitous, stratified societies, where independence and differences are emphasized, are said to be individualistic, whereas in Asia, Africa, parts of Europe and Latin America where agreeing on social norms is important and jobs are interdependent, collectivism is idea to be preponderant.[14,15] Studies comparison Caucasians or Americans with people from Asian cultures, such as Vietnamese or Filipino[13,16] do show that individualistic societies value self-reliance, independence, autonomy and personal achievement,[16] and a definition of self apart from the group.[xiii] On the other mitt, collectivistic societies value family cohesion, cooperation, solidarity, and conformity.[16]

Such cultural differences mean that people in different cultures have fundamentally different constructs of the cocky and others. For more than collectivistic societies like ours, the cocky is defined relative to others, is concerned with belongingness, dependency, empathy, and reciprocity, and is focused on small-scale, selective in-groups at the expense of out-groups. Relationships with others are emphasized, while personal autonomy, space and privacy are considered secondary.[17] Application of western psychotherapy, primarily focused on dynamic models, ego structure and individuals, therefore, becomes difficult in the Indian collectivistic context. The point has been well discussed by Indian psychiatrists in the past. Every bit early as in 1982, Varma expressed limitations to the applicability of the Western type of psychotherapy in India,[xviii] and cited dependence/interdependence (a marker of collectivism) in Indian patients with other family members as foremost of the vii difficulties in conveying out dynamic and individual oriented psychotherapy. Surya and Jayaram take also pointed out that the Indian patients are more dependent than their western counterparts.[19] Neki, while discussing the concepts of confidentiality and privacy in the Indian context opined that these terms do not even exist in Indian socio-cultural setting, as the privacy can isolate people in interdependent society.[twenty] Neki recommended a center ground with family therapy or at least couple of sessions with the family members along with dyadic therapy in guild to help the progress of the psychotherapy.[21] Family, therefore, forms an important focus for change in collectivistic societies, and understanding the Indian family becomes an essential prerequisite for involving them in therapy.

The traditional Indian family

Whatsoever generalizations about the Indian family unit suffer from oversimplification, given the pluralistic nature of the Indian civilisation. Nevertheless, in most sociological studies, Asian and Indian families are considered classically as big, patriarchal, collectivistic, joint families, harboring three or more generations vertically and kith and kin horizontally. Such traditional families course the oldest social institution that has survived through ages and functions as a dominant influence in the life of its private members. Indian joint families are considered to be strong, stable, shut, resilient and enduring with focus on family integrity, family unit loyalty, and family unity at expense of individuality, freedom of choice, privacy and personal space.[22]

Structurally, the Indian joint family unit includes three to four living generations, including grandparents, parents, uncles, aunts, nieces and nephews, all living together in the same household, utilizing a common kitchen and often spending from a common purse, contributed by all. Change in such family structure is wearisome, and loss of family units afterwards the demise of elderly parents is balanced by new members inbound the family as children, and new members (wives) inbound by matrimonial alliances, and their offsprings. The daughters of the family would get out following marriage. Functionally, majority of joint families adhere to a patriarchal ideology, follow the patrilineal rule of descent, and are patrilocal; although matrilocal and matriarchal families are quite prevalent in some southern parts of the country. The lines of hierarchy and authority are clearly drawn, with each hierarchical strata operation within the primary of "collective responsibility". Rules of conduct are aimed at creating and maintaining family harmony and for greater readiness to cooperate with family unit members on decisions affecting almost all aspects of life, including career choice, mate selection, and marriage. While women are expected to accept a position subservient to males, and to subordinate their personal preferences to the needs of other, males are expected to have responsibility for meeting the needs of others. The earning males are expected to back up the old; take care of widows, never-married adults and the disabled; assist members during periods of unemployment and disease; and provide security to women and children.[i,23] Psychologically, family unit members feel an intense emotional interdependence, empathy, closeness, and loyalty to each other.

The changing Indian family unit

The socio-cultural milieu of India is undergoing change at a tremendous stride, leaving key alterations in family structure in its wake. The last decade has not merely witnessed rapid and cluttered changes in social, economic, political, religious and occupational spheres; but also saw familial changes in power distribution, marital norms and role of women. A review of the national demography data and the National Family unit Health Survey (NFHS) data suggests that, gradually, nuclear families are becoming the predominant form of Indian family establishment, at least in urban areas. The 1991 census, for the commencement time reported household growth to be college than the population growth, suggesting household fragmentation; a tendency that gathered further momentum in the 2001 and the 2010 demography. A comparison of the three NFHS information [Table 1] also shows that over the years in that location has been a progressive increment in nuclear families, more in urban areas, with an associated progressive decrease in the number of household members.[24–26] Other important trends include a subtract in age of the firm-head, reflecting change in power structure and an increase in households headed by females, suggesting a alter in traditional gender roles.

Table 1

Summary information from the National Family Health Survey

However, though traditional joint families have been significantly replaced by urban "new society" nuclear families, it would be wrong to look at present Indian families in such simple bimodal groups. The family systems presently have become highly differentiated and heterogeneous social entities in terms of structure, design, role relationships, obligations and values. Articulation families that stay under same roof, just with carve up kitchen, separate pocketbook and with considerable autonomy and reduced responsibleness for extended family members are mutual and represent "transitional families".[27] Others may stay in separate households but cluster around in the same community. Such transitional families though structurally nuclear, may still continue to function as joint families. Sethi, back in 1989 pointed out the strong networks of kinship ties in Indian "extended families", and observed that even when relatives cannot really alive in close proximity, they typically maintain potent bonds and attempt to provide each other with economic help and emotional support.[1]

Effects of societal and familial change on mental health

Social and cultural changes take altered entire lifestyles, interpersonal relationship patterns, power structures and familial relationship arrangements in current times. These changes, which include a shift from joint/extended to nuclear family unit, along with bug of urbanization, changes of role, status and power with increased employment of women, migratory movements amid the younger generation, and loss of the feel reward of elderly members in the family unit, have increased the stress and pressure on such families, leading to an increased vulnerability to emotional problems and disorders. The families are frequently discipline to these pressures.

Countries within the developing world are impatient and intend to achieve inside a generation, what countries in the adult world took centuries. Hence societal changes hither are not step by step or gradual, but rapid, the process inevitably involving "temporal compression". Additionally, the sequences of these societal changes are haphazard or "Cacophonic",[28] producing a condition that is highly unsettling and stressful. For example, in a household where a woman is the chief breadwinner but has minimal standing in decision making, the situation leads to role resentment and disorganized power structure in the family. Indeed, studies do show that nuclear family construction is more than decumbent to mental disorders than joint families.[29] Fewer patients with mental illness from rural families take been reported to exist hospitalized when compared to urban families because of the existing joint family structure, which apparently provides additional support.[30] Children from large families have been institute to report significantly lower behavioral problems like eating and sleeping disorders, aggressiveness, dissocial behavior and delinquency than those from nuclear families.[31] Even the big scale international collaborative studies conducted by WHO – the International Pilot Study on Schizophrenia, the Determinants of Outcome of Severe Mental Disorders and the International Study of Schizophrenia – reported that persons with schizophrenia did better in India and other developing countries, when compared to their Western counterparts largely due to the increased family unit support and integration they received in the developing world.[32]

Although a bulk of Indian studies indicates that the traditional family is a ameliorate source for psychological support and is more resilient to stress, ane should not, however, universalize. The "unchanging, nurturant and benevolent" family core is frequently a sentimentalization of an altruistic society.[33] In reality, arrangements in large traditional families are frequently unjust in its distribution of income and allocation of resources to different members. Exploitation of family unit resources by a coterie of members shut to the "Karta" (the head of family) and subjugation of women are the common malaise of traditional Indian family. Indian ethos of maintaining "family unit harmony" and absolute "obedience to elderly" are often used to suppress the younger members. The resentment, however, passive and silent it may be, simmers, and in the absence of harmonious resolution often manifests every bit psychiatric disorders. Somatoform and dissociative disorders, which prove a definite increased prevalence in our society compared to the w, may exist viewed every bit manifestations of such unexpressed stress.

Therefore, rather than lamenting on the change in societal structure and loss of the joint family, the therapist should exist enlightened of the unique dynamics of each family he treats, and should endeavor to find and utilize the strengths therein, while providing ways to cope with stress within the limits of the bachelor resource.

UNDERSTANDING PSYCHOTHERAPY FROM THE Family unit PERSPECTIVE

Family oriented psychotherapy: History and scope in Republic of india

Social interventions with families to assistance them cope with problems have ever been a office of all cultures in form of a variety of rituals, for example, the rituals surrounding expiry of family members. The roots of the formal development of family therapy, notwithstanding, dates back to the early on 1940s, when pioneers like John Bowlby in the Us; John Elderkin Bell, Nathan Ackerman, Theodore Lidz, Lyman Wynne, Murray Bowen and Carl Whitaker in United Kingdom; and D.L.P. Liebermann in Hungary began seeing and observing family members in therapy sessions.[34] The initial potent influence from psychoanalysis before long gave way to concepts from social psychiatry, learning theory and behavior therapy, and the early concepts of theoretical framework for family unit therapy were formed.[two] In the mid-1950s, Gregory Bateson and colleagues at Palo Alto in the United States, introduced ideas from cybernetics and general systems theory in psychotherapy.[35] The systems approach did non focus on the linear causation model of private psychology, and instead emphasized on feedback and homeostatic mechanisms that operate in family systems. The famous "round causation and process" model was forwarded and here-and-now interactions between family members started being viewed as a major factor in maintaining or exacerbating problems, whatever be the original cause.[36] Simultaneously, Murray Bowen at the National Plant of Mental Health, worked on his hypothesis on family systems, based on his observations on the father-female parent-child triad. Bowen's observations on triadic relationship, fusion and distancing, nuclear family emotional procedure, multi-generational transmission processes and family constellation forms the basis of the family systems theory, which later came to be known as the Bowen'due south theory.

Past the mid-1960s, a big number of singled-out schools of family therapy had emerged, some of which included brief therapy, strategic therapy, structural family therapy, and the Milan systems model. Meantime and somewhat interdependently with the systems theory, intergenerational therapies emerged, which theorized the intergenerational transmission of health and dysfunction and usually dealt with at least three generations of a family. After the late-1970s, the field of family therapy saw many applied modifications of the earlier rigid theoretical frameworks, specially in the light of accumulated clinical experience in treatment of serious mental disorders. In the past few decades, at that place has been a full general motility towards integration and eclecticism, with practitioners using techniques from several areas, depending upon their own inclinations and/or the needs of the clients.

In India, work in family therapy started in the late 1950s, coinciding with the menstruum of increased interest in psychotherapy in Bharat. Vidya Sagar, who worked with families at the Amritsar Mental Infirmary in the 1950s, is credited as the begetter of family therapy in India. His ain writings on the topic are thin, merely he was able to involve families of patients in agreement and taking care of their patients with psychiatric illness, and to support each other through grouping participation.[37] Vidya Sagar constitute that involving the family unit significantly reduced the hospital stay, increased credence of the patient by the family, and enhanced family unit coping skills.[38] In a like effort most the aforementioned time, the Mental Health Center at Vellore[39] started albeit all psychiatric patients along with their families to unit family rooms. Mental Health Center, Vellore tried to focus on family education and family counseling on how to bargain with the index patient and showed promising results of the family interventions. 1960s was likewise the time of beginning of the full general hospital psychiatric units (GHPUs) with inpatient facilities, where patients were admitted mandatorily with a family member with focus on family unit education and counseling. The similar practice has been followed at all the GHPUs, which have been established in India over the concluding 5 decades. These units, though may not be conducing family unit therapy, are working with family involvement in treatment of the persons with mental illness.

Some other major boost to family unit therapy in India occurred in the tardily 1970s and early 1980s, when the National Found of Mental Health and Neuro-Sciences (NIMHANS), Bangalore started working actively on family unit members of patients with psychiatric disorders, which ultimately resulted in the formation of a formal Family unit Psychiatry Middle in 1977. Early work from the center showed that families could be taught to cope with their brunt through education, counseling and group support in an effective manner.[40] Subsequent work by researchers[41–43] showed the usefulness of involving families in the management of a variety of psychiatric disorders including marital discord, hysteria and psychosis. In the late 1980s, the eye developed Indian tools for working in the field of family therapy, notable amongst which are the Family Interaction Pattern Scale, the Family Topology Calibration[44,45] and the Marital Quality Scale.[46] In the late 1980s and 1990s the eye started training post graduates in psychiatry in concepts and schools of family therapy and started orienting itself to structured rather than generic family therapy. At the turn of this century, it became the simply middle in Republic of india to offering formal preparation and diploma course in family therapy.[47] Though the center in past had practiced various dynamic and behavioral models, currently information technology follows primarily a systemic model of family therapy.[48]

In the not-government sector, though in that location are family therapy practitioners, particularly in the cities of Delhi, Bombay and Bangalore, they are mostly scattered and oftentimes suffer from the lack of preparation and resource facilities. The Schizophrenia Inquiry Foundation at Chennai, which works with long-term care and rehabilitation of the chronically mentally ill patients, conducts a family intervention plan, focused on education and coping of family members with the illness of the index patient. The Indian Association for Family Therapy, founded since 1991, has too been working in the field to provide a platform for private therapists.

Effectiveness of family oriented psychotherapy in India

Although a meaning number of therapists practice family therapy in India in government and private settings, the published literature on the discipline is surprisingly sparse. Most publications are event based experiential accounts of the practitioners, rather than testify based claim of particular therapy modalities. Fifty-fifty and then, most intervention studies report significant benefits whenever family take been involved in management of psychiatric disorders. Tabular array 2 summarizes the findings of major family intervention studies from Bharat.

Table two

Summary of the findings of family intervention studies from India

A large body of published work in family therapy in India comes from the Family unit Therapy Heart, at NIMHANS.[49] In one of the primeval studies from the center, it was establish that staying with a preferred family member reduced duration of hospital stay in psychiatric inpatients.[42] In some other definitive study on the effectiveness of family therapy in Indian setting, Prabhu et al. in 1988 followed-up 60 families over 2 years, who had received brief integrative inpatient family therapy. Ii tertiary of the grouping did very well or moderately well.[50] Subsequently studies accept reported comeback with family therapy in patients with a broad range of psychiatric problems, including schizophrenia,[51] booze dependence,[52] eating disorders,[53] epileptic psychosis,[54] adolescent conduct disorder,[55] marital issues,[56–59] family unit violence[60,61] and in families coping with people living with HIV AIDS.[62]

In improver to the interventional studies, experiential accounts and reflective writings past therapists working with families in India aid u.s. to sympathize issues, practical difficulties and unique advantages of the Indian setting. Table three summarizes the major points of various published studies on family therapy by Indian practitioners in final xv years, that throw light on the process issues rather than the result.

Table iii

Summary of experiential and reflective journal articles on family therapy in India

Family oriented psychotherapy: Procedure and issues in practice

Ideally, any psychotherapy would include intake process, therapy proper and a termination phase. In family therapy, aim of the intake phase is to understand the families' perception of the trouble, their motivation to undergo therapy, and the therapist's assessment of the suitability and type of family therapy to exist applied. Assessment of the family forms an of import part of the intake phase and different therapists utilize different techniques for the purpose like the iii generation genogram; life cycle chart, structural map or the circular hypothesis. The three generation genogram diagrammatically lists out the patient's generation and ii more related generations and helps to empathize trans-generational patterns of interaction. The life bike nautical chart explores the functions of the family unit and roles of unlike family members. A structural map shows the different subsystems in the family, the ability structure and the relations between the family members. This can testify if relations are normal, overinvolved, conflictual or distant. The circular hypothesis generally used in systemic therapy helps to understand the significant of the symptoms for the patient and the office of the family members in maintaining them.

Equally well-nigh of these assessment tools were originally adult in the west, they need to be suitably modified for employ in the eastern culture. In the last few decades attempts take been to develop culturally sensitive tools to appraise Indian family unit in handling. The Family unit Topology Scale[52] is a 28 detail scale that measures family types, and groups them into the five subtypes of normal, cohesive, egoistic, donating and anoxic. Another tool, the Family Interaction Pattern calibration,[44] looks into the developmental phases of the family unit. The scale has half-dozen subscales looking into leadership, communication, part, reinforcement, cohesiveness and social back up. For assessing marital problems in Indian couples 2 tools are bachelor: Marital Aligning Questionnaire[92] and Marital Quality Scale.[46] Marital Adjustment Questionnaire[92] attempts to assess marital aligning in Indian couples, and measures seven aspects of family unit functioning, including personality, emotional factors, sexual satisfaction, marital role and responsibleness, human relationship to in laws, attitudes to children and family planning, and interpersonal relationships. Marital Quality Calibration[46] is a more comprehensive instrument for assessing marital problems and looks into 12 dimensions of understanding, rejection, satisfaction, affection, despair, conclusion making, discontent, dissolution potential, authority, disclosure, trust and office operation. Such emic assessment tools are invaluable in understanding the unique problems of the family in our culture.

The therapy proper is the stage, where major piece of work on the family unit is carried out. The schoolhouse of therapy used depends on various factors. For example, the degree of psychological sophistication in the family unit will determine if psychodynamic techniques tin be used. The nature of the disorder will likewise decide the therapy, similar the employ of behavioral techniques in chronic psychotic illness. Therapist's comfort and preparation, and the time the family unit tin spare for therapy are other determining factors. Dynamic approaches generally take months to years, where as focused strategic techniques can bring benefits over a few sessions.

Endo-cultural problems may crop up at the initial phases, which threaten to jeopardize the therapy issue. The therapist needs to be aware of them and exist sensitive and considerate. Although Indian families are more encouraging and supporting of their mentally ill fellow member, the rigid hierarchical structure of Indian families oft hinders gratuitous communication of thoughts and feelings. Therefore, the therapist may encounter difficulties in improving family communication blueprint. The "karta" (head) of the family unit may resist attempts of family members to usurp his authorisation and and then may non allow other family unit members to express feelings. The therapist may come to an impasse, if he attempts to claiming the authority of the begetter or sides with the wife rather than with the husband in couple's therapy. Additionally, given the diverse cultural and social background, the therapy needs to be tailored to the needs of private family, keeping factors such as socio-economic status, educational level and family structure (nuclear, transitional, joint, traditional) into business relationship. Directive approaches may be more suitable for traditional families, as the therapist is often looked upon as charismatic, disciplinarian and in control of the session.[93]

New and unexpected bug arising out of the rapid changing social scenario besides need to exist addressed. Family and couple'southward conflict arising out of factors such as conflicts in families over dowry, or related to inter-caste marriage; sexual problems arising out of concrete separation of couples due to job timing or placement; disagreement virtually child rearing practices (both within couples and intergenerational); conflicts related to husband'south role in sharing in domestic chores for working couples; problems with unsupervised children, and loss or displacement of role or function of the elderly are only a few of the problems unique to modern Indian families.[xc] In family therapy focusing on adolescent and children, substance abuse, juvenile delinquency, school dropout or low schoolhouse attendance are mutual amongst the lower socioeconomic classes. Parent-child conflict from increased autonomy and individuation of the child are common in nuclear families. In recent times, increased demands on children or adolescents for academic achievements from parents, the civilisation clash with children going for night-outs, parties, raves and adolescent sexual experimentation have been reported past Indian therapists every bit common issues while dealing with adolescents.[86] Although most of these issues are the same that troubled the westward in the 1960s and the 1970s, our cultural differences make the therapist look and treat these problems every bit new.

It might be benign for the therapist to sympathise that in India and other like collectivistic societies, the concepts of self, attitudes, values and boundaries are defined differently from those of the western globe. In collectivistic societies the self is largely defined through the collective identity with family identity forming a pregnant component of the self-identity.[94] Therefore, individuals from such societies, when they stand up for their individual rights are termed rebellious, disobedient, or disrespectful. In therapy, if the person resists the solutions proposed past family unit members, the person may often be accused of not respecting of import members of the family and/or customs.[xv] Attitudinal differences in collectivistic societies hamper treatment seeking too. People from collectivist societies ofttimes tend to go along their personal issues to themselves, peculiarly if their own opinions and experiences are inconsistent with the conventional wisdom and mores of the family unit. Typically, only in severe cases, the people seek support from outsiders, and even then at the price of significant resistance from other family unit members, who may perceive help seeking from the therapist equally a measure of failure of the family to solve the problem of their fellow member.[95] Additionally, involvement of outside strangers in resolving personal issues may be perceived by members of the commonage society every bit intruding in the family'due south private affairs, undermining the family's harmony, and/or as a potential threat to their reputation. Collectivist values make each member of the family responsible for the beliefs and the life conditions of every other family unit fellow member, even to the extent of denial of individual needs and aspirations. In therapy, this often leads to over involvement, lack of privacy and space for the client. Indeed, negative expressed emotions that might hamper therapy and positive expressed emotions that assist, have both been constitute to be more meaning predictors of result in our country compared to the west.[96]

Finally, the therapist should be aware of the psychotherapeutic concepts derived from Indian philosophy and religion, as they have been found to be effective and culturally more than acceptable in certain cases. The concept of "Shivite" stemming from the Hindu mythology of God Shiva and representing a phallic symbol can exist used in dynamic psychotherapy.[97] The fable of Savitri has been used every bit a framework for psychotherapy by Surya and Jayaram.[98] Wig has used the term Hanuman complex[99] for the mythological story of Lord Hanuman needing external assist being reminded almost his forgotten powers. The concept can exist used to assist patients empathize the procedure of psychotherapy and identifying one'southward hidden strengths. Varma used principles from the advice of Buddha in psychotherapy, which he viewed equally an 'interpersonal method of mitigating suffering'. He has also emphasized on the utilise of concepts of Karma and Dharma in psychotherapy.[xviii] Neki used the concept of "Sahaja" and the role of "nirvana" in psychotherapy. He also propounded on the directive interaction between the therapist and the patient using the "Guru-Chela" paradigm.[100] Although such concepts may not be universally applicable, particularly in the changed urban modernistic scenario, they can be effectively used especially in traditional systems to brand therapy more adequate and effective.

The termination phase summarizes the original trouble, reviews the beneficial changes and patterns of interaction that have emerged through therapy, and stresses on the need for sustaining the improvements achieved. The follow-up sessions may be continued over the adjacent half dozen months to a twelvemonth to ensure that the client therapist bond is not severed besides quickly.

Decision

Indian families are capable of fulfilling the physical, spiritual and emotional needs of its members; initiate and maintain growth, and exist a source of support, security and encouragement to the patient. These fundamental characteristics of the Indian family remain valid even now despite the changes in the social scenario. In a land, where the arrears in mental health professionals amounts to greater than 90% in about parts of the country, the family is an invaluable resource in mental health treatment. From a psycho-therapeutic viewpoint, in collectivistic societies similar ours, the family may be a source of the trouble as well as a support during trouble. Information technology is therefore, plausible that the family might also provide solutions of the trouble and indeed, interventions focusing on the whole family unit rather that the individual often results in more gratifying and lasting effect. Sadly, the progress made in the terminal few decades has been minimal and restricted to few centers only and family therapy has not found popularity amidst the mental wellness community. Lack of integration of psychotherapy in postgraduate curriculum, lack of training centers for clinical psychologists, and lack of a practiced model of family therapy that can be followed in the diverse Indian setting are the 3 cardinal reasons for the aloofness. This does not atone the mental health professionals from the responsibility of providing solutions for the issues of the family, which seems to have multiplied during the same fourth dimension. The Indian family, which often feels bewildered in these times of changed values, changed roles, changed morality and changed expectations is in need of support and is ready for family unit therapy. If developed enthusiastically, family unit therapy might be the right tool to non just help the families in need but too to develop a huge resource in customs-centered treatment of mental-health problems.

Footnotes

Source of Support: Null

Disharmonize of Involvement: None declared

REFERENCES

two. Sholevar PG. Introduction: Family theory and therapy. In: Sholevar PG, Schwoeri L D, editors. Textbook of Family unit and Couples Therapy: Clinical Applications. Rockville, MD: Aspen; 2003. pp. 3–25. Function ane; Chap ane. [Google Scholar]

3. McGill D. Cultural concepts for family therapy. In: Hansen J, Falicov C, editors. Cultural Perspectives in Family unit Therapy: The Family unit Therapy Collections. Rockville Dr.: Aspen; 1983. pp. 108–21. [Google Scholar]

4. McGoldrick Chiliad, Giordano J, Pearce J, editors. Ethnicity and Family Therapy. 2nd ed. The Guilford Press; 1996. [Google Scholar]

5. Falicov C, Brudner-White Fifty. Shifting the family unit triangle: The issue of cultural and contextual relativity. In: Hansen J, Falicov C, editors. Cultural Perspectives in Family Therapy: The Family Therapy Collections. Rockville Doc: Aspen; 1983. pp. 51–67. [Google Scholar]

6. McGill DW. The cultural story in multicultural family therapy. Fam Soc. 1992;73:339–49. [Google Scholar]

7. Schwartzman J. Family ethnography: A tool for clinicians. In: Hansen J, Falicov C, editors. Cultural Perspectives in Family Therapy: The Family Therapy Collections. Rockville MD: Aspen; 1983. pp. 122–35. [Google Scholar]

8. Johnson Ac. Resiliency mechanisms in culturally diverse families. The Family Journal: Counseling and Therapy for Couples and Families. 1995;iii:316–324. [Google Scholar]

9. Preli R, Bernard JM. Making multiculturalism relevant for majority culture graduate students. J Mar Fam Ther. 1993;xix:five–16. [Google Scholar]

10. Thomas AJ. Understanding civilization and worldview in family systems: Use of the multicultural genogram. Fam J: Couns Ther Couples Fam. 1998;6:24–32. [Google Scholar]

12. Avasthi A. Preserve and strengthen family unit to promote mental health. Indian J Psychiatry. 2010;52:113–26. [PMC gratuitous article] [PubMed] [Google Scholar]

13. Desai J. Intergenerational conflict within Asian American families: The role of acculturation, ethnic identity, individualism, and collectivism. Diss Abstr Int. 2007;67:7369. [Google Scholar]

14. Nelson G, Fivush R. The emergence of autobiographical memory: A social cultural developmental theory. Psychol Rev. 2004;111:486–511. [PubMed] [Google Scholar]

15. Triandis HC. Collectivism and individualism as cultural syndromes. Cross Cult Res. 1993;27:155–eighty. [Google Scholar]

16. Skillman Yard. Intergenerational conflict within the family context: A comparative assay of collectivism and individualism within Vietnamese, filipino, and caucasian families. Diss Abstr Int. 2000;sixty:4910. [Google Scholar]

17. Markus H, Kitayama S. Culture and the self: Implications for knowledge, emotion, and motivation. Psychol Rev. 1991;98:224–53. [Google Scholar]

nineteen. Surya Due north, Jayaram S. Some basic considerations in the practice of psychotherapy in the Indian setting. Indian J Psychiatry. 1964;6:153. [PMC complimentary commodity] [PubMed] [Google Scholar]

xx. Neki JS. Confidentiality, secrecy, and privacy in psychotherapy: Sociodynamic considerations. Indian J Psychiatry. 1992;34:171–3. [PMC free article] [PubMed] [Google Scholar]

22. Mullatti Fifty. Families in India: Beliefs and realities. J Comp Fam Stud. 1995;26:11–25. [Google Scholar]

23. Chekki D. Family values and family change. Indian J Soc Piece of work. 1996;69:338–48. [Google Scholar]

24. Bhat PN, Arnold F, Gupta 1000, Kishor S, Parasuraman S, Arokiasamy, Singh SK, Lhungdim H. International Institute for Population Sciences (IIPS) and Macro International. I. Mumbai India: National Family Wellness Survey (NFHS-3), Ministry of Wellness and Family Welfare, Authorities of Bharat 2005–06; 2007. Household Population and Housing Characteristics; pp. 21–52. Chap 2. [Google Scholar]

25. National Family Wellness Survey (NFHS-two), Ministry of Wellness and Family Welfare, Government of India 1998-99. Republic of india Mumbai: 2000. International Constitute for Population Sciences (IIPS) and ORC Macro. [Google Scholar]

26. National Family Wellness Survey (NFHS-1), Ministry of Health and Family Welfare, Government of Republic of india 1992-93. India Bombay: 1995. International Establish for Population Sciences (IIPS) and ORC Macro. [Google Scholar]

27. Sinha D. Some contempo changes in Indian family and their impications for socialization. Indian J Soc Work. 1984;45:271–86. [Google Scholar]

28. Myrdal Yard. Asian Drama: An Inquiry into the Poverty of Nations. Allen Lane: The Penguin Printing; 1968. [Google Scholar]

29. Sethi B, Chaturvedi P. A review and office of family studies and mental health. Indian J Soc Psychiatry. 1985;1:216–thirty. [Google Scholar]

30. Chandrashekhar C, Rao N, Murthy R. The chronic mentally ill and their families. In: Bharat Due south, editor. Research on Families with Problems in Bharat: Bug and Implications. Mumbai: Tata Institute of Social Sciences; 1991. pp. 113–20. [Google Scholar]

31. Murlidharan R. Size of family and its human relationship with behavior difficulties in children. J Psychol Res. 1969;thirteen:94–100. [Google Scholar]

32. Kulhara P, Chakrabarti Due south. Culture and schizophrenia and other psychotic disorders. Psychiatr Clin North Am. 2001;24:449–64. [PubMed] [Google Scholar]

33. Bennett L. The Role of Women in Income Production and Intrahousehold Allocation of Resources as a Determinant of Kid Wellness and Nutrition. Geneva: WHO/UNICEF; 1983. [Google Scholar]

34. Broderick C, Schrader S. The history of professional marriage and family unit therapy. In: Gurman A, Kniskern D, editors. Handbook of Family Therapy. New York: Brunner/Mazel; 1991. [Google Scholar]

35. Guttman H. Systems theory, cybernetics, and epistemology. In: Gurman A, Kniskern D, editors. Handbook of Family unit Therapy. New York: Brunner/Mazel; 1991. [Google Scholar]

36. Becvar D, Becvar R. Family Therapy: A Systemic Integration. 7th ed. Pearson; 2008. [Google Scholar]

37. Vidyasagar . Innovations in Psychiatric Treatment at Amritsar Mental Hospital. New Delhi: WHO. Sea/Ment; 1971. [Google Scholar]

38. Bhatti R, Varghese M. Family Therapy in India. Indian Soc Psychiatry. 1995;11:30–4. [Google Scholar]

39. Verghese A. Involvement of families in mental health care. J Christ Med Assoc India. 1971;46:247. [Google Scholar]

40. Narayanan HS. Experiences with group and family therapy in India. Int J Grouping Psychother. 1977;27:517–nine. [PubMed] [Google Scholar]

41. Bhatti R, Channabasavanna Southward. Social system approach to understand family disharmony. Indian J Soc Piece of work. 1979;40:70–fourscore. [Google Scholar]

42. Bhatti RS, Janakiramaiah Due north, Channabasavanna SM. Family psychiatric ward handling in India. Fam Procedure. 1980;19:193–200. [PubMed] [Google Scholar]

43. Geetha PR, Channabasavanna SM, Bhatti RS. The written report of efficacy of family ward treatment in hysteria in comparison with the open ward and the outpatient treatment. Indian J Psychiatry. 1980;22:317–23. [PMC gratuitous article] [PubMed] [Google Scholar]

44. Bhatti RS, Subba Krishna DK, Ageira BL. Validation of family unit interaction patterns calibration. Indian J Psychiatry. 1986;28:211–6. [PMC free article] [PubMed] [Google Scholar]

45. Bhatti R, Channabasavanna SM, Prabhu Fifty, Subha Krishna D, Shivaji R. A manual on family typology scale. Bangalore: Eastern Press; 1985. [Google Scholar]

46. Shah A. Assessment of Marital Life. 1991 [Google Scholar]

47. Varghese Grand, Bhatti R, Raghuram A, Chandra P, Uday Kumar 1000, Shah A. Training in Family Therapy at NIMHANS. In: Kapur M, Shama Sundar C, Bhatti R, editors. Psychotherapy Training in Bharat. Bangalore: NIMHANS; 2001. pp. 112–5. [Google Scholar]

48. Verghese M, Uday Kumar 1000. An integrative systemic model of family unit therapy at NIMHANS. In: Bhatti R, Verghese K, Raghuram A, editors. Changing Marital and Family unit Systems, Challenges to Conventional Model in Mental Health. Bangalore: NIMHANS; 2003. [Google Scholar]

49. National Institute of Mental Health and Neuro Sciences. NIMHANS: Family Psychiatry Centre: Publications [Internet] 2012. [Last cited 2012 Dec 14]. Available from: http://www.nimhans.kar.nic.in/fpc/publication.htm .

fifty. Prabhu LR, Desai NG, Raghuram A, Channabasavanna SM. Issue of family therapy: Two year follow-up. Int J Soc Psychiatry. 1988;34:112–vii. [PubMed] [Google Scholar]

51. Chandra P, Varghese M, Anantharaman Z, Channabasavanna S. Family therapy in poor outcome schizophrenia and the need to await across psychoeducation. Fam Ther. 1994;21:47. [Google Scholar]

52. Channabasavanna S, Bhatti R. Family unit therapy of alcohol addicts. In: Ramachandran V, Palaniappan V, Shaw L, editors. Standing Medical Teaching Plan. Madras: Indian Psychiatric Club; 1982. pp. 17–23. [Google Scholar]

53. Chandra PS, Shah A, Shenoy J, Kumar U, Varghese Grand, Bhatti RS, et al. Family pathology and anorexia in the Indian context. Int J Soc Psychiatry. 1995;41:292–viii. [PubMed] [Google Scholar]

54. Swamy HS, Mallikarjunaiah M, Bhatti RS, Kaliaperumal VG. A study of epileptic psychoses-150 cases. Indian J Psychiatry. 1986;28:231–six. [PMC free commodity] [PubMed] [Google Scholar]

55. Anant S, Raguram A. Marital conflict among parents: Implications for family unit therapy with adolescent conduct disorder. Contemp Fam Ther. 2005;27:473–82. [Google Scholar]

56. Bhatti R, Sobhana H. A model for enhancing marital and family relationships. Indian J Soc Psychiatry. 2000;xvi:47–52. [Google Scholar]

57. Channabasavanna S, Bhatti R. Utility of "Function Expectation Model" in treatment of marital problems. Indian J Soc Psychiatry. 1985;2:105–20. [Google Scholar]

58. Isaac R, Shah A. Sex roles and marital adjustment in Indian couples. Int J Soc Psychiatry. 2004;50:129–41. [PubMed] [Google Scholar]

59. Shah A, Gaur S, Gaonkar Chiliad, Raguram A. Human relationship attributions and marital quality in women with depression. Eastern J Psychiatry. 2003;7:62–70. [Google Scholar]

60. Bhatti R, Beig A. Family violence: A systemic model. Indian J Soc Psychiatry. 1985;1:174–85. [Google Scholar]

61. Shah A. Violence and abuse in therapy with couples: Guidelines and concerns of a therapist-cum-trainer. Eastern J Psychiatry. 2002;6:13–8. [Google Scholar]

62. Krishna VA, Bhatti RS, Chandra PS, Juvva S. Unheard voices: Experiences of families living with HIV/AIDS in Bharat^*. Contemp Fam Ther. 2005;27:483–506. [Google Scholar]

63. Chacko R. Family participation in the handling and rehabilitation of the mentally sick. Indian J Psychiatry. 1967;9:328–33. [Google Scholar]

64. Narayanan H, Embar P. Review of treatment in a family ward. Indian J Psychiatry. 1972;14:123–half-dozen. [Google Scholar]

65. Pai S, Kapur RL. Affect of treatment intervention on the relationship betwixt dimensions of clinical psychopathology, social dysfunction and burden on the family of psychiatric patients. Psychol Med. 1982;12:651–8. [PubMed] [Google Scholar]

66. Pai S, Kapur RL. Evaluation of abode care handling for schizophrenic patients. Acta Psychiatr Scand. 1983;67:fourscore–8. [PubMed] [Google Scholar]

67. Pai Due south, Roberts EJ. Follow-upwards written report of schizophrenic patients initially treated with home intendance. Br J Psychiatry. 1983;143:447–50. [PubMed] [Google Scholar]

68. Pai S, Channabasavanna SM, Nagarajaiah, Raghuram R. Home treat chronic mental illness in Bangalore: An experiment in the prevention of repeated hospitalization. Br J Psychiatry. 1985;147:175–9. [PubMed] [Google Scholar]

69. Verghese A. Family participation in mental wellness care: The vellore experiment. Indian J Psychiatry. 1988;30:117–21. [PMC free article] [PubMed] [Google Scholar]

seventy. Narayanan HS, Girimaji SR, Gandhi DH, Raju KM, Rao PM, Nardev G. Cursory in-patient family intervention in mental retardation. Indian J Psychiatry. 1988;30:275–81. [PMC gratis article] [PubMed] [Google Scholar]

71. Mehta One thousand. A comparative study of family-based and patient-based behavioral management in obsessive-compulsive disorder. Br J Psychiatry. 1990;157:133–5. [PubMed] [Google Scholar]

72. Shankar R, Menon One thousand. Evolution of a framework of interventions with families in the management of schizophrenia. Psychosoc Rehabil. 1993;sixteen:75–91. [Google Scholar]

73. Sovani A. Agreement schizophrenia: A family psychoeducational approach. Indian J Psychiatry. 1993;35:97–eight. [PMC free article] [PubMed] [Google Scholar]

74. Russell PS, al John JK, Lakshmanan JL. Family intervention for intellectually disabled children. Randomized controlled trial. Br J Psychiatry. 1999;174:254–8. [PubMed] [Google Scholar]

75. Shihabuddeen TM, Gopinath PS. Group meetings of caretakers of patients with schizophrenia and bipolar mood disorders. Indian J Psychiatry. 2005;47:153–half dozen. [PMC gratis article] [PubMed] [Google Scholar]

76. Thara R, Padmavati R, Lakshmi A, Karpagavalli P. Family unit education in schizophrenia: A comparison of ii approaches. Indian J Psychiatry. 2005;47:218–21. [PMC free commodity] [PubMed] [Google Scholar]

77. Das S, Saravanan B, Karunakaran KP, Manoranjitham Southward, Ezhilarasu P, Jacob KS. Outcome of a structured educational intervention on explanatory models of relatives of patients with schizophrenia: Randomised controlled trial. Br J Psychiatry. 2006;188:286–7. [PubMed] [Google Scholar]

78. Suresh Kumar PN, Thomas B. Family intervention therapy in booze dependence syndrome: One-yr follow-up study. Indian J Psychiatry. 2007;49:200–4. [PMC free article] [PubMed] [Google Scholar]

79. Kulhara P, Chakrabarti Due south, Avasthi A, Sharma A, Sharma Southward. Psychoeducational intervention for caregivers of Indian patients with schizophrenia: A randomized-controlled trial. Acta Psychiatr Scand. 2009;119:472–83. [PubMed] [Google Scholar]

lxxx. Chow W, Law Due south, Andermann 50, Yang J, Leszcz 1000, Wong J, et al. Multi-family psycho-education group for assertive community treatment clients and families of culturally diverse background: A airplane pilot study. Community Ment Health J. 2010;46:364–71. [PMC free commodity] [PubMed] [Google Scholar]

81. Nattala P, Leung KS, Nagarajaiah, Murthy P. Family unit fellow member involvement in relapse prevention improves booze dependence outcomes: A prospective report at an addiction treatment facility in India. J Stud Booze Drugs. 2010;71:581–seven. [PubMed] [Google Scholar]

82. Devaramane V, Pai NB, Vella SL. The effect of a cursory family intervention on primary carer's functioning and their schizophrenic relatives levels of psychopathology in India. Asian J Psychiatr. 2011;4:183–7. [PubMed] [Google Scholar]

84. Nath R, Craig J. Practising family unit therapy in Bharat: How many people are there in a marital subsystem? J Fam Ther. 1999;21:390–406. [Google Scholar]

85. Shah A, Varghese M, Udaya Kumar GS, Bhatti RS, Raguram A, Sobhana H, et al. Brief family therapy training in India. J Fam Psychotherapy. 2000;11:41–53. [Google Scholar]

86. Carson DK, Chowdhury A. family therapy in India: A new profession in an ancient land? Contemp Fam Ther. 2000;22:387–406. [Google Scholar]

87. Natrajan R, Thomas 5. Need for family therapy services for middle-grade families in India. Contemp Fam Ther. 2002;24:483–503. [Google Scholar]

88. Rastogi M, Natrajan R, Thomas V. On condign a profession: The growth of union and family therapy in India^*. Contemp Fam Ther. 2005;27:453–71. [Google Scholar]

89. Mittal M, Hardy KV. A re-examination of the current condition and hereafter of family therapy in Bharat. Contemp Fam Ther. 2005;27:285–300. [Google Scholar]

90. Carson DK, Jain S, Ramirez S. Counseling and family therapy in India: Evolving professions in a speedily developing nation. Int J Adv Counselling. 2009;31:45–56. [Google Scholar]

91. Thomas B. Treating troubled families: Therapeutic scenario in Bharat. Int Rev Psychiatry. 2012;24:91–8. [PubMed] [Google Scholar]

92. Kumar P, Rohtagi G. Development of the marriage adjustment questionnaire. Indian J Psychol. 1976;51:346–58. [Google Scholar]

93. Prabhu R. Global Perspectives in Family Therapy: Development, Practice, Trends. In: Ng Kit S., editor. Beginning of family therapy in India. New York: Brunner-routledge; 2003. pp. 57–67. [Google Scholar]

94. Bochner S. Cantankerous-Cultural Differences in the cocky concept a exam of Hofstede's individualism/collectivism distinction. J Cross Cult Psychol. 1994;25:273–83. [Google Scholar]

95. Haj-Yahia MM, Sadan Due east. Issues in intervention with battered women in collectivist societies. J Marital Fam Ther. 2008;34:1–thirteen. [PubMed] [Google Scholar]

96. Leff J, Wig NN, Bedi H, Menon DK, Kuipers L, Korten A, et al. Relatives' expressed emotion and the course of schizophrenia in Chandigarh. A two-year follow-up of a starting time-contact sample. Br J Psychiatry. 1990;156:351–six. [PubMed] [Google Scholar]

97. Nand South. A comparative study of scientific and religious psychotherapy with a special written report of the role of the commonest shivite symbolic model in full psychoanalysis. Indian J Psychiatry. 1961;three:261–173. [Google Scholar]

98. Surya NC, Jayaram SS. Some basic considerations in the do of psychotherapy in the Indian setting. Indian J Psychiatry. 1996;38:x–two. [PMC free commodity] [PubMed] [Google Scholar]

99. Wig NN. Hanuman complex and its resolution: An illustration of psychotherapy from Indian mythology. Indian J Psychiatry. 2004;46:25–8. [PMC gratis article] [PubMed] [Google Scholar]

100. Neki JS. Psychotherapy in Republic of india. Indian J Psychiatry. 1977;nineteen:1–10. [Google Scholar]

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