See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/226701381

Family Therapy in India: A New Profession in an Ancient Land?

Article  in  Contemporary Family Therapy · December 2000

DOI: 10.1023/A:1007892716661

CITATIONS READS
32 1,056

2 authors:

David K. Carson Aparajita Chowdhury

Parent-Child Interaction Center and Canopy Counseling; Boulder Colorado Berhampur university
92 PUBLICATIONS   1,355 CITATIONS    32 PUBLICATIONS   145 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Family Supportive Milieu: A Study of Protective Factors and Mechanisms among the Invulnerable Adolescents View project

All content following this page was uploaded by David K. Carson on 11 July 2017.

The user has requested enhancement of the downloaded file.

FAMILY THERAPY IN INDIA: A NEW
PROFESSION IN AN ANCIENT LAND?
David K. Carson
Aparajita Chowdhury

ABSTRACT: This paper examines the need for family therapy in India
and its evolution as an integrated academic discipline and widespread
form of clinical practice. Included is a discussion of the numerous factors
placing Indian families at risk today, both common and more serious
child, marital, and family difficulties, the current status of mental
health services and minimal emphasis on family-based treatment, and
the potential benefits of family therapy to such a radically diverse and
rapidly changing society. Targets of and settings for family therapy
training are highlighted, and a brief outline of a training-the-trainer
approach is provided.
KEY WORDS: India; family therapy; mental health.

India is a rapidly developing country which, in the next 25 years,

will be the most populated nation on earth. As the world’s largest
democracy it includes within its borders ancient and diverse cultures,
languages, and religions. Despite unparalleled modernization and mo-
bilization in recent decades, millions of Indian families, both rural
and urban, have remained undeniably close and resilient. Family has
always been at the foundation of Indian society, and contemporary
Indian people continue to take pride in the centrality of marriage and
family life (Mullatti, 1995). Children and adolescents are given a special
place in the family and community, and interdependency, support, and
nurturing across the generations are uniquely valued in the Indian
family system (Madan, 1990; Simhadri, 1989). Parents and extended

David K. Carson, PhD, is Professor of Child and Family Studies, Department of

Family and Consumer Sciences, University of Wyoming, Laramie, WY 82071. Aparajita
Chowdhury, PhD, is Associate Professor of Home Science, Post Graduate Department
of Home Science, Berhampur University, Berhampur (Bhanja Bihar), Orissa, India.
Reprint requests should be sent to Dr. Carson.
Contemporary Family Therapy 22(4), December 2000
 2000 Human Sciences Press, Inc. 387
388

CONTEMPORARY FAMILY THERAPY

family members continue to be the primary socializers of children in

ways that are no longer evident in many regions of the world, and
parents and adult children tend to maintain close ties even when great
geographical distances separate them (Gupta, 1987; Shukla, 1989).
At the same time, today’s Indian families are encountering complex
and disturbing problems (Baral & Bishoyee, 1999; Desai & Bharat,
1989). The majority of roughly 80% of Indians who live in villages and
rural areas are still poor, lacking in social resources and supports,
and generally isolated from the mainstream. Urban dwellers also are
experiencing a multitude of difficulties which are challenging tradi-
tional family structures and relationships, and putting marriages and
families at risk. These problems, both urban and rural, include: a
prevalence of poverty and disease; overcrowding; water and air pollu-
tion; migration of individuals and families from rural to urban areas
due to a lack of viable employment and vocational opportunities; a
gradual weakening of age-old traditions including transformations in
religion, caste, and other social institutions; natural disasters that
make transportation, communication, and modernization difficult; eth-
nic conflicts and ongoing political instability; increased crime, social
violence, and terrorism; inadequate housing and sanitation; poor nutri-
tion and health care; illiteracy and low quality (and sometimes non-
existent) education for children; minimal enforcement of child labor
laws; and especially in rural areas the continual promotion of early
marriages and large families which facilitates more than impedes the
cycle of poverty.
More recent crises in families encompass many of the same kinds
of problems that have plagued countries in the West at least since
the 1960s. These include, for example, marital strain and dissolution,
parent-child conflicts, various forms of family violence, substance
abuse, juvenile delinquency, school dropout or low school attainment
among the lower class, and excessive pressures in many middle and
upper class families for adolescents and young adults to achieve aca-
demically (Agarwal, 1989; Chowdhury, 1999; Das, 1999; Madan, 1990;
Nanda & Dash, 1996; Parikh & Krishna, 1992; Patnaik, 1999; Sarkar,
1988). Given these conditions and difficulties, the future and well being
of the Indian family is uncertain.
As part of a comprehensive mental health effort in India, the field
of family therapy holds great promise as a keeper and restorer of the
family unit. However, family therapy is a relatively new concept in
India, and one that (with few exceptions) has not been articulated or
actualized in current mental health and social welfare programs. Yet,
family therapy may be in the early stages of acceptance in the profes-
 389

DAVID K. CARSON AND APARAJITA CHOWDHURY

sional community. Over a decade ago the prominent psychologist Dur-

ganand Sinha (1988) noted that there was a general consensus in the
mental health community in India that, echoing the words of Channa-
basavanna and Bhatti (1982, p. 149), “a patient is only a symptom of
a troubled family.” And more recently, T. K. Oommen (2000), a professor
of sociology at Jawaharlal Nehru University in Delhi, asserted that
today’s Indian family is indeed ready for and in great need of family-
based treatment. Thus, this country appears ripe for family therapy
as an alternative approach in clinical intervention.
The purpose of this paper is to examine the range of marital and
family difficulties in light of the undercurrent of social and economic
changes in India today, to examine how a family therapy “movement”
might take root in the context of the current mental health system and
social service practice, and to discuss the potential benefits of family
therapy training and services in meeting the tremendous needs of
married couples and families. This discussion will include an integra-
tion of the authors’ practical experiences and observations in both con-
ducting research on Indian couples and families, and conducting ther-
apy with them. Four observations are initially important to mention.
First, counseling or therapy is generally an unknown, misunderstood,
or devalued enterprise in India. “Therapy” or “psychotherapy” in partic-
ular are frequently viewed in negative terms, in that these practices
are almost solely associated with hospitalized treatment of the mentally
or emotionally ill. Second, marital or family therapy is not a common
practice in India, and it is generally a foreign notion that married
couples or family members would need therapy, much less feel comfort-
able receiving it. Third, family therapy as an intervention is likely to
entail a much greater involvement of extended family members, as
well as integration of education and prevention practices, than in many
western countries which emphasize therapy and treatment of existing
problems and disorders. Finally, the training and practice of family
therapists in India, and the growth of family therapy as a profession,
is likely to follow a radically different pathway than it has in other
countries around the globe, including the United States.

AN OVERVIEW OF THE CHANGING INDIAN FAMILY

In rural areas, villages, and smaller cities, family life in India is

deeply embedded in the community as friends, neighbors, and relatives
share responsibilities for children’s lives and well being. It provides
stability and support when problems arise, and maintains the physical
390

CONTEMPORARY FAMILY THERAPY

and psychological integrity of individual family members over time.

Traditional Indian society has been based on the joint family system
which, while in transition, is still common. This system consists of well-
defined rules, roles, and sentiments that bind family members together.
Members share feelings of solidarity (familism) and strive to uphold
family dignity and status in the society. A high premium is placed on
family unity and cohesiveness, which are necessary for family stability
and survival. Any behavior that threatens this cooperative spirit and
unity is discouraged. Sharing and mutual dependence occur at all
stages of the family life cycle, thus contributing to a sense of safety
and security in the family fold. In addition, elaborate family practices
and rituals foster feelings of belongingness and convey the message
that family bonds are immutable, dependable, and life long (Bharat,
1997; Mullatti, 1995).
Yet, numerous changes are having far-reaching implications in
Indian family, social, cultural, economic, and political life. These in-
clude the widespread growth of education (especially women’s educa-
tion), the impact of the mass media and modern communications, west-
ernization (i.e., gradual adaptation of values and life-styles of western
nations), industrialization and modernization, and economic liberaliza-
tion. In the age of electronic media, including televisions and computers
in even remote areas, the Indian family is being exposed to ideas,
ideals, and values swept across distant societies. According to Baral
and Bishoyee (1999), the most significant challenges to the transitional
Indian family can be grouped into four categories. These are summa-
rized as follows.

Functionalists vs. Marxists

Although Functionalists argue that the Indian family performs
useful functions for its members as well as for the society, particularly
in a free market system, Marxists contend that the family contributes
to capitalist exploitation. This is because millions of families provide
cheap labor for those with wealth and power. Politically and philosophi-
cally in India, both schools of thought are prevalent and often in conten-
tion. A few states (politically and governmentally) have remained
staunchly communistic.

Socialization and Gender Inequality

For children, the family is the first agent of socialization. Children
internalize human qualities such as love, affection, solidarity, and coop-
 391

DAVID K. CARSON AND APARAJITA CHOWDHURY

eration. They also learn respect for and obedience to parents and other
elders. Yet, despite the gradual trend toward democratization within
families, cultural values and practices continue to block equality by
reinforcing gender discrimination, with males being the gender of pref-
erence, power, and privilege.

Nuclearization of the Indian Family

Today, the gradual shift from the joint family system to the nuclear
family system is easily discernible. This is more evident in urban than
rural areas. Nuclearization entails not only structural but psychologi-
cal, attitudinal, and behavioral changes in family members, particu-
larly when women work outside the home. One result (which may be
both positive and negative) is a redefinition of roles, reallocation of
responsibilities, and redistribution of power in the family system.

New Economic Policy and Value Crisis

The New Economic Policy (NEP), which was implemented by the
government of India in 1991, is bringing about a marked change in the
values and attitude of people. Emphasis on “quick money” and short-
term benefits has already started to dehumanize and destabilize Indian
society, including family life. As a result of the adverse work conditions
(or unemployment) of the poor, the disproportionate burden on working
women, and the overall value crisis in Indian society, it is feared that
family relationships are in danger of eroding.
Misra (1995, p. 30) summarizes the current state of affairs with
regard to the changing Indian family and its influence on family mem-
bers as follows:

Family in India, particularly in the urban educated class, is

undergoing transformation. The economic, social and cultural
forces are reinforcing individualism and changes intrinsic to
traditional family system are leading to structural changes.
Family members are questioning the roles, obligations and
relationship which have been nourishing the inherently social
texture of the Indian family. The tension experienced in the
course of pursuing personal (individual) goals and familial
goals are becoming an important source of stress. This situa-
tion calls for a perspective, which views individuality and relat-
edness as mutually constitutive and complementary. Such a
solution shall constructively utilize indigenous values in which
392

CONTEMPORARY FAMILY THERAPY

family happens to be a value in itself rather than mere instru-

ment for personal growth.

Some Indian social scientists and family scholars propose that,

once the conditions of equality are negotiated and obtained at all levels,
mental and relational well being will be an inevitable outcome for a
large portion of the society (e.g., Bharat, 1991; Belle, 1990; Sinha, 1984).
However, these changes are slow and often met with great resistance
(Baral & Bishoyee, 1999; Sinha, 1988).

CURRENT STATUS OF MENTAL HEALTH

SERVICES IN INDIA

According to Dennerstein, Astbury, and Morse in a 1993 World

Health Organization report, mental health is the capacity of the individ-
ual, the group, and the environment to interact with one another in
ways that promote subjective well being, the optimal development and
use of mental abilities (cognitive, affective, and relational), the achieve-
ment of individual and collective goals consistent with justice, and
attainment and preservation of conditions of fundamental equality.
In India the mental health scenario is complex, with tradition and
modernity thriving side-by-side in a confusing but intimate relationship
(Sharma & Chadd, 1990). Individuals with mental or emotional prob-
lems or relationship difficulties go to native healers, shamans, gurus,
and exorcists more often than trained professionals (Davar, 1999). The
professionals are usually psychiatrists and medical general prac-
titioners who dispense prescriptions for anti-depressants and tranquil-
izers, untrained Primary Health Center (PHC) staff in rural areas, or
self-proclaimed “counselors” who practice with minimum or no qualifi-
cations. The complexity and diversity of mental health “services” are
also confounded by issues of public monitoring and audits, all of which
make it difficult to enact a comprehensive mental health policy and
provision of services that would enhance the quality of care in both
rural and urban areas (Davar, 1999).
Mental health problems in India are often associated with inter-
relational or intra-family conflicts. These are typically everyday diffi-
culties that in many cases could be resolved, but frequently tend to
accumulate. Due to decreasing assistance or support systems within
communities, more serious problems such as suicide, homicide, rape,
and sexual harassment are increasing (Devar, 1998, 1999; Kapur, 1995;
 393

DAVID K. CARSON AND APARAJITA CHOWDHURY

Sharma & Chadd, 1990). In the last 50 years, medical and mental
health efforts have gradually moved from care of the mentally ill to
the prevention and promotion of mental health. Yet little has been
done to help individuals and families in immediate distress. Further,
public attitudes toward couples and families in crisis or persons with
mental or emotional disorders are often negative. For example, research
conducted in Delhi indicated that educated lay persons generally
viewed the mentally ill as aggressive, violent, and dangerous (Prabhu,
Raghuram, Verma, & Maridass, 1984). Optimism about the outcome
of psychiatric treatment for these individuals was not high, and there
was a lack of awareness about available facilities to treat the mentally
ill. A study by Boral, Bagchi, and Nandi (1980) showed that the relatives
of the mentally ill preferred magic healers, ayurveds, and homeopaths
to psychiatrists and psychotherapists. Moreover, a majority of partici-
pants believed that marriage would cure mental illness, even though
(paradoxically) most of them did not want to forge marital alliances
with a mentally ill person.
Training of mental health professionals, and research pertaining
to mental and emotional disorders, are greatly lacking despite existing
national policy guidelines. Exceptions are centers such as the National
Institute of Mental Health and Neurosurgery (NIMHANS) in Banga-
lore, the Tata Institute of Social Sciences (TISS) in Mumbai, and a
handful of other social science institutes (e.g., in Ranchi and Patna)
and graduate training programs in counseling or clinical psychology
(e.g., Chennai, Allahabad, Bhubaneswar). However, these few insti-
tutes and training programs cannot even begin to provide the educa-
tional preparation, research, and services to meet the needs of India’s
vast population.
A survey of prevalence studies of child mental health problems
(Sitholey & Chakraborthi, 1992) highlighted a number of issues. This
investigation revealed that there were considerable differences in psy-
chiatric disorders in the small number of general population studies
that had included children. Disorders varied greatly across age, gender,
and socio-demographic status. When the extremely high or low reported
prevalence rates were excluded (about 1% of children under 18), the
acceptable range of mental and emotional disorders ranged from 50 to
150 per 1000 children and adolescents (approximately 5 to 15 percent).
Often these individuals had accompanying developmental delays and/
or scholastic difficulties. Given the extensiveness of psychiatric distur-
bances among youth, both inpatient and outpatient mental health care
facilities are extremely sparse. At present there are only about 100
394

CONTEMPORARY FAMILY THERAPY

child guidance clinics in the entire country. Most of these clinics are
located in large cities such as Mumbai, Poone, Bangalore, Hyderabad,
and Delhi. These clinics provide services to children with mental retar-
dation and emotional problems. Indeed, much of the emphasis on men-
tal health treatment in India is geared toward children in accordance
with the National Mental Health Program for India. Although the
program covers adults and children alike, whole family mental health
coverage receives little attention and is downplayed in its importance.
There is empirical evidence, however, that parents and family
members play a key role in the competence and psychosocial adjustment
of youth. For example, a recent investigation of 107 Orissan families
and adolescents aged 12 to 16 (Carson, Chowdhury, Perry, & Pati,
1999) that included parent, adolescent, and teacher rated data, found
that families of both socially and academically competent adolescents
tended to be more communicative and emotionally expressive; demo-
cratic with regard to parental discipline, input, and decision-making;
close but not enmeshed; higher in family ideals; and lower in external
locus of control. Conversely, families of more socially maladjusted (i.e.,
less socially competent and more antisocial) and lower achieving adoles-
cents had more conflict, were more enmeshed and external locus ori-
ented, and leaned toward either a permissive or authoritarian style of
parenting. Such studies support the need for family-based treatment.
A mental health program in Amritsar (Vidyasagar) was one of the
first in India to encourage families to stay with the patient during the
entire treatment program. Bangalore and Vellore are two other cities
which have programs where family members are actively involved in
the treatment. In Vellore, for example, Verghese (1988) reported that
family members showed a marked improvement in their attitudes to-
ward various aspects of mental illness as a result of participation in
the hospital treatment program with the patient. However, these kinds
of treatment programs are rare in India and have not tended to increase
in number, possibly because of extreme resource limitations and the
negative social stigma attached to couples and families seeking counsel-
ing or involved in any type of therapy (Shanker & Menon, 1991).
In sum, the success of any community mental health program in
India depends on each community’s sensitivity to mentally distressed
children, adolescents, and adults, as well as married couples and fami-
lies in conflict. However, according to Devar (1998) there have been
few efforts to demythologize mental illness in India, and a community
language for mental illness does not exist. Compared to some countries
in the West, there has been no formal de-institutionalization of the
 395

DAVID K. CARSON AND APARAJITA CHOWDHURY

mentally ill in India, although the last two decades has seen the intro-
duction of a short-stay in-patient policy. Since custodial care is available
only for the chronically and severely mentally ill, the majority of men-
tally ill person’s live with their family (Sethi & Manchanda, 1978;
Sinha, 1988). Thus, in order to meet the needs of a rapidly expanding
society, mental health services may need to be provided in large part
by trained professionals who are regularly engaged with youth, such as
teachers, social workers, and school counselors. An additional approach
would be to identify and train motivated para-professionals and citizens
in cities, small towns, and rural areas in basic counseling skills (i.e.,
volunteerism). One untapped resource, for example, includes older
adults and aging family members. Given the large percentage of retirees
from government related services in India and the fact that the manda-
tory retirement age is now 58–60, these individuals would be ideal
candidates for counselor training. In our view, members of this age
group not only have the time but often have the need for a greater
sense of purpose and involvement with others. As known and respected
members (and often “elders”) of their community, their impact as desig-
nated lay counselors could be significant. In this regard, families would
be both a contributor to and receiver of services provided by a strong
and encompassing force of lay family counselors.

THE NEED FOR FAMILY THERAPY IN INDIA

Indian families face a wide variety of everyday problems, including

the stresses and strains of rearing children, conflicts with in-laws,
difficulties associated with various chronic illnesses, and develop-
mental delays and disabilities of children or other family members.
Sinha (1984, 1988) argues that the majority of urban and rural dwellers
today prefer to live in small nuclear family units, while at the same
time want to maintain close relations with their extended family and
have them available during times of crisis. This practice has created
role strain, ambiguity, and conflict between family members (such as
authority over children between mothers and their mother-in-laws),
as well as confusing expectations for children. Moreover, unlike the
scenario in the traditional joint family system, elderly persons today
not only have few roles to play in child socialization, but in educated
families are less likely to live with their adult children and grandchil-
dren due to increased mobility. In many families the result is an absence
of clear and consistent role models for the child beyond his or her own
396

CONTEMPORARY FAMILY THERAPY

parents. In addition, partly due to safety reasons, parents are becoming

more restrictive of their children in having free time to interact with
peers, either at school or in the neighborhood. This not only reduces
children’s social network but also tends to instill feelings of fear and
distrust. The mass media (especially the electronic media) also aggra-
vates the situation by creating unrealistic aspirations in children and
parents, including a “you can or should have it all” mind set.
Exposure to “western thinking” (e.g., European and American) has
brought about changes in attitudes towards traditional methods of
disciplining, toilet training, feeding, and other child-rearing practices
(Mullatti, 1995; Sinha, 1984, 1988). However, because traditional atti-
tudes have not been completely abandoned, many parents alternate
between permissive and strict (authoritarian) child-rearing, thus creat-
ing anxiety and confusion in children and making them more vulnerable
to behavioral or emotional disorders (Bharat, 1997). Marital difficulties,
coupled with inadequate or conflictual co-parenting practices, are also
becoming more prevalent as women are breaking out of traditional
roles, becoming educated in greater numbers, and advocating for equal
rights both at home and in the work place (Baral, Das, & Dash, 1999;
Mohanty, 1999). With so many women employed outside the home
today, some Indian researchers contend that children’s needs are not
being met, and that there is little time for parents to listen to and
converse with their children (Desai & Bharat, 1989; Mullatti, 1995).
Studies of female-headed households have shown that these women
face numerous problems (Pati & Patnaik, 1999). Some researchers
assert that this increase in single-parent families has contributed to a
greater percentage of children and adolescents experiencing serious
difficulties (Bharat, 1991; Das 1999). This may be more common in
middle and lower class families, where alternative child care provisions
are often not available. In sum, increased role strain, marital difficul-
ties, parent-child conflicts, feelings of guilt, and status confusion are
commonly observed among working women (Chowdhury, 1995; Muni,
1995), even though there are some economic and self-esteem related
advantages (Mohanty, 1999). Since more women in India are joining
the labor force without proper support and assistance, often in the face
of extended family and community opposition, an increase in family
difficulties are expected (Das, 1999; Kapur, 1995).
Also contributing to family problems is a school curriculum and
environment that often does not meet children’s needs, be they aca-
demic or personal. It is not uncommon for teachers to use strict and
sometimes physical punishment to maintain order, practices with
 397

DAVID K. CARSON AND APARAJITA CHOWDHURY

which today’s Indian youth are not always in agreement. Perhaps most
notable in educated families are the extreme pressures for children to
achieve academically so they can gain entrance into the better colleges
and universities (often with little free time with peers or family play
time). This pressure tends to increase the vulnerability of older children
and adolescents to various personal and relational difficulties (Nanda &
Dash, 1996). Further, similar to the Carson and associates (1999) study,
Padhi and Dash (1994) found strong evidence of a connection between
positive parental attitudes, and adolescent social and academic compe-
tence. Among lower income families in India, studies have indicated
that children who are the most at-risk for school difficulties and failure
are from multiply disadvantaged groups, including those commonly
referred to as Scheduled Castes (SC) and Scheduled Tribes (ST) (Chow-
dhury & Chowdhury, 1996; Nanda & Dash, 1996; Sahoo & Sia, 1988).
Those SC and ST children who are rejected by their higher class and
caste peers are particularly at risk for developing behavior problems,
dropping out of school, and experiencing disorders such as anxiety and
depression (Chowdhury & Chowdhury, 1996; Sarkar, 1988). However,
Chowdhury and Chowdhury suggest that, if such children received the
necessary resources and support to successfully navigate this transi-
tion, patterns of long-term low academic achievement and personality
difficulties might be averted.
Indian families with a disabled or chronically ill member experi-
ence all of the burdens associated with life-long care (Kapur, 1995).
These families need social support and require special coping skills to
manage. Further, families facing situations caused by demoralizing
events, such as suicide, rape, family violence, unwed motherhood, “bride
burning” (caused by the dowry system), and loss of home or property
due to exploitation, job loss, or natural disasters, run the risk of break-
down or disintegration (Davar, 1999; Desai & Bharat, 1989). Serious
marital maladjustment in families is more likely to result in abuse,
conjugal separation, juvenile delinquency, mental health problems, ex-
tended family disputes, and an unhealthy environment for children
(Baral, Das, & Dash, 1999; Das, 1999).
In sum, mental health professionals in India are presented with
numerous challenges in working with couples and families. Individual
psychopathology is frequently associated with family problems and
dynamics. When individuals are treated apart from the family (as is
customary) therapy sometimes yields positive results (Sharma &
Chadd, 1990). However, when the client returns to the family, often
there is a regression to earlier patterns of behavior and functioning,
398

CONTEMPORARY FAMILY THERAPY

for while the client has changed, the family has not (Devar, 1998, 1999;
Sethi & Manchanda, 1978). Moreover, Oommen (2000) suggests that,
unlike family therapy in the west where individual well being and
independence are often a goal or focus of treatment, in Indian tradition
the individual is subservient to family, kin, caste, and religion, and
his or her identity is defined accordingly. Traditionally, individuals
emerged or differentiated only when they renounced the world, when
they were widowed, or when they were dismembered from the family.
Even today in the lives of many highly educated young adults it is
often difficult for both parents and adult children to “let go.” According
to Oommen, in order for Indians to overcome both the alienation of
individualism and the tyranny of collectivism, a balance must be struck.
Hence, given the power and significance of the family system, family
therapy may very well be the most effective mode of treatment for both
individual (child or adult) and family-related problems.

THE DEVELOPMENT OF FAMILY THERAPY AS A

PROFESSIONAL FIELD OF PRACTICE

Currently, there is a dearth of mental health professionals who

have received training and supervised clinical experience in family
therapy theory and methods. Information about family therapy theory
or methods is almost non-existent in traditional academic disciplines,
including psychiatry, psychology, social work, home science, and educa-
tion. Even if many professionals were able to receive training, however,
the number of families (both rural and urban) and problems needing
addressed are way too numerous for these professionals to handle.
Ultimately, a “lay training” approach (referred to later) may be the most
cost-effective and influential on a wide scale basis. Another challenge
presently is that family therapy theories and interventions, to a large
extent, would have to be imported from western cultures and may
not be appropriate for treating Indian couples and families. Yet, until
uniquely Indian approaches to family therapy are generated, modifica-
tions and extrapolations of certain “western” treatment modalities may
not only be necessary, but in some cases effective. Although an in-
depth discussion of these approaches would best occur elsewhere, some
preliminary notions about family therapy training and promotion, and
examples of potentially adaptable “western” theories of and approaches
to family therapy in an Indian context, are illustrated as follows. While
this is not an exhaustive list, this discussion shows what could possibly
 399

DAVID K. CARSON AND APARAJITA CHOWDHURY

be implemented with Indian families and couples. We are confident

that therapists with sufficient training and supervised clinical experi-
ence could learn how to do so.
Given the centrality of the joint family in India (which is often at
odds with the changing family structures of upwardly mobile married
couples), the fact that the vast majority of marriages are still arranged
(over 95%) and that marriage is as much between two extended family
systems as two individuals, four classes of family therapy schools of
thought may be particularly relevant to the treatment of couple and
family difficulties. Three other approaches will also be mentioned. First,
since extended family conflicts are common, intergenerational theories
and approaches (e.g., Bowen, Framo, Boszormenyi-Nagy) would appear
to be useful. This is because problems of differentiation, power and
control, emotional gridlock and cut-off, and transgenerational trans-
mission of patterns and behaviors are common in immediate and ex-
tended family relationships. Practical treatment approaches which em-
phasize involvement of not only members of the nuclear and extended
family but other key members of the family’s social network and com-
munity, such as Family Network Therapy (Speck & Attneave, 1973),
might be effective. Interventions such as genograms and family map-
ping might also prove useful.
Second, the systemic nature of couple and family difficulties in
India may be more pronounced than in most other societies. It is likely
that family therapy theories and practices that have a strong family
systems orientation, such as structural, strategic, and systemic (e.g.,
Milan approach), would be most beneficial to therapists and their cli-
ents. Therapists can expect to find problems associated with family
structure (and the need for re-structuring), boundaries (e.g., rigid/dif-
fuse, enmeshed/disengaged), and subsystem alliances and loyalties
(e.g., husband with his mother and father and against his wife). More-
over, many interventions inherent to these approaches (e.g., joining/
accommodating, enactments, role-plays and role-reversals, reframing,
straight directives, effective use of circular questioning, etc.) could be
effectively employed with Indian couples and families.
Third, since Indian couples and families are often more in need of
education and skill-training than therapy per se (or therapy second-
arily), psycho-educational approaches that include, for example, compo-
nents of parent training (e.g., positive discipline and behavior manage-
ment practices; effective communication with children and youth), and
basic information about child/adolescent development and health main-
tenance, could be extremely helpful.
400

CONTEMPORARY FAMILY THERAPY

Fourth, marriage enrichment and skill-building approaches, many

of which are strongly rooted in behavioral and cognitive-behavioral
theories, would also appear to be appropriate and potentially life-chang-
ing for significant numbers of couples. In most arranged marriages,
for example, couples have either never, or perhaps briefly, met before
their wedding day. While publically Indians boast of a very low divorce
rate and marriages which seem to “work” much better than their love-
marriage counterparts in many western countries, privately what is
frequently observed is mis-matching, a lack of intimacy in their rela-
tionship, problems with co-parenting, and/or unwanted intrusions of
extended family members (e.g., mothers-in-law to daughters-in-law)
which fuels marital tension and conflict (Choudhury, 1999; Chowd-
hury & Baral, 1999; Das, 1999; Mullatti, 1995; Patnaik, 1999).
Finally, since learning by doing, seeing, story-telling and narrating
is paramount in many Indian cultures, adaptations of experiential
family therapy and narrative family therapy may find their rightful
place. In addition, solution-focused therapy may also prove useful, given
its emphasis on short-term intervention, finding exceptions to prob-
lems, and building on existing strengths.
Rather than developing stand-alone family therapy programs, it
is our contention that, at this point in time, family therapy training
could most effectively be integrated into traditional academic programs
mentioned previously. Indeed, these departments and programs al-
ready include some of the course work background essential to working
with couples and families (e.g., human development, child welfare is-
sues and practice). What is lacking is a curriculum that contains: (a)
essential courses in family theory (including systems oriented theories)
and human development as taught from Indian perspectives; (b) identi-
fication and assessment of couples and families in need of intervention,
(c) family therapy theories, models, and methodologies that are relevant
and applicable to Indian families; (d) professional ethics and practice
in working with couples and families, and (e) supervised practical expe-
riences which provide trained professionals and students at the gradu-
ate level opportunities to enhance their skills in treating couples and
families. Whether some kind of credential is tied to such training is a
matter of debate.However, it would be well within the realm of possibil-
ity to offer a 12-month (academic year equivalent) post-graduate certifi-
cation as a “family counselor” to individuals in training. A joint move-
ment by psychiatrists, psychologist, sociologists, social workers,
educators, and home scientists could entail different strategic centers
(or institutes) around the country for “family therapy training.” Involve-
 401

DAVID K. CARSON AND APARAJITA CHOWDHURY

ment of those working in child and family welfare programs and ser-
vices would also be vital to the success of this training effort. This is
because most of the Child and Family Welfare Programs in India are
run by government and non-governmental organizations (NGO). Al-
though presently the training and competency of child welfare workers
is exceedingly limited, provision of family therapy training for these
individuals is well within reach. Hence, these working professionals,
as well as physicians and other health specialists, academicians, and
graduate students, are prime targets for family therapy training. Pro-
moting family therapy as a legitimate and much-needed enterprise
in India may also have secondary benefits, in that it may provide
employment opportunities for many trainees.

SETTINGS FOR FAMILY THERAPY TRAINING

An ideal setting for family therapy training of course is in college

and university departments, and colleges of medicine, where this type
of training and course work can be integrated into existing programs
and curricula (as mentioned above). While many students who complete
a degree in medicine or a graduate program in the social sciences, social
work, home science, or education will seek employment in larger towns
and cities, some inevitably go back to their village to live and work.
In more remote rural areas, family counseling services could also be
provided through Ashrams and Anganwadi centers where caring for
women and children is of primary importance. Professionals trained
in family therapy, or graduate students in training (e.g., to meet practi-
cum or internship requirements), could spend time in or visit these
centers regularly to provide family counseling services. Schools are also
an excellent location for family therapy training and services, and
according to Kapur (1997), are currently the best places to develop
mental health programs for children. Since Indian parents (and other
family members) are typically very concerned about the child client’s
well being, they can become involved in (and recipients of) therapy in
a way that helps them save face in their community. Finally, the large
sector of child and family welfare workers who identify and work with
families at-risk in both urban and rural areas would be prime recipients
of family therapy training. A “training the trainer” approach, which
has proved successful in the United States and other countries, could
be adapted and utilized.
402

CONTEMPORARY FAMILY THERAPY

BRIEF OUTLINE OF A
TRAINING-THE-TRAINER APPROACH

Exchanges between family therapy professionals in India and other

countries where family therapy is a common and respected form of
mental health treatment would serve as the impetus to program devel-
opment and identification of trainees, supervisors, and training sites.
Sources of funding for these exchanges would come primarily from
NGOs, including various external grant-funding organizations, agen-
cies and programs (e.g., WHO, UNICEF, Fulbright Commission, World
Bank). While a detailed discussion of the content and procedures inher-
ent to this training is the subject of another paper, the general outline
below provides a preliminary view of such an approach.

Stage 1
(1) Identification of a “metavisor” in India for the entire training
program; (2) Identification of family therapy training sites in key areas
(e.g., three or four in one or more “test states” or geographical areas;
and (3) Identification and training of family therapy supervisors (mini-
mum of two) at each of these sites (i.e., “training the trainers”) over
a several month period (estimated four-six months) through grant-
sponsored international exchanges, where participating agencies and
institutions would send designated supervisors abroad for family ther-
apy and supervision training, and host visiting family therapists as
trainers in India. Supervisors-in-training will largely include experi-
enced mental health professionals, social workers and child welfare
specialists, physicians/psychiatrists, and university faculty in fields
such as home science, psychology, and sociology who have had some
prior training in or close familiarity with counseling and psychotherapy.

Stage 2
Identification of family therapy trainees in three categories, includ-
ing: (a) post-graduate professionals in medicine, child/family welfare,
social work, psychology, education, home science, etc.; (b) graduate
students in appropriate academic disciplines (as indicated above); and
(c) interested academic faculty in colleges and universities in the afore-
mentioned (or related) disciplines.
 403

DAVID K. CARSON AND APARAJITA CHOWDHURY

Stage 3: 12-Month Training Program

(1) 9 months of academic (content-based) training (including in-
class experiential learning and role playing), which incorporates a mini-
mum of five months of supervised internship experience (at approved
clinical locations and sites) in working with couples and families both
as a co-therapist (with supervisor or another therapist-in-training) and
singularly; and (2) three months of lay-training of motivated community
citizens (i.e., those who are concerned about families in their area/
social milieu) in basic counseling skills and couple/family related issues.
The “home visiting” approach would be used extensively in both the
clinical internship and lay-training activities.

Training Processes and Procedures

Family therapy classroom work and internship experiences would
be integrated with current academic programs in graduate schools of
psychology, social work, home science, and so forth. Training sessions
for full-time working professionals would occur weekly (three-four
hours) in both professional and academic environments, as well as key
locations in surrounding communities where trainees live and work.
Trained supervisors would be responsible for coordinating and oversee-
ing trainees’ internship and lay training activities, both at designated
clinical sites and out in the community. Supervisors and trainees in
particular geographical regions would meet once every four months
(total of three times) for one day of consultation. Each trainee’s supervi-
sor would provide on-going feedback to that person with regard to
strengths and needed areas of improvement. The supervisor, in conjunc-
tion with the metavisor, would provide the final evaluation of the
trainee that would determine successful completion of the program.

CONCLUSION

Such an approach is currently being proposed for implementation

in the state of Orissa in eastern India, with training sites targeted for
five major locations: the central (and capital) city of Bhubaneswar (e.g.,
Utkal University and Ramadevi Autonomous College) and its adjacent
city of Cuttack, Berhampur city in the south (e.g., the medical college,
and Berhampur University), Sambalpur in the northwest (university),
and the large coastal city of Puri on the Bay of Bengal (small colleges).
404

CONTEMPORARY FAMILY THERAPY

International exchanges among university faculty (with professionals

in the U.S.) have already begun to occur, and training of supervisors
and therapists on a larger scale basis in Orissa are likely to happen
in the near future. Depending on the success of this approach to family
therapy training and services (given appropriate outcome indicators),
the program may serve as a prototype for other states in India. Family
therapy may prove to be a powerful dynamic in the lives of couples
and families who are fighting for survival in a society where clashes
between traditional family structures and practices, and changing val-
ues, attitudes and life-styles, are fervently escalating.

REFERENCES

Agarwal, U.C. (1989). Creativity and adjustment of adolescents. New Delhi: DK

Publishing.
Baral, J. K., & Bishoyee, A. P. (1999). Family in transition: Some theoretical and
methodological questions . In J. K. Baral & A. Chowdhury (Eds.), Family in transition:
Power and development (pp. 1–15). New Delhi: Northern Book Center.
Baral, J. K., Das, U., & Dash, S. (1999). Power equation in family. In J. K. Baral &
A. Chowdhury (Eds.), Family in transition: Power and development (pp. 57–82). New
Delhi: Northern Book Center.
Belle, D. (1990). Poverty and women’s mental health. American Psychologist, 45(3),
385–389.
Bharat, S. (1991). Research on families with problems in India: Utility, limitations
and future directions. In Unit of Family Studies (Eds.), Research on families with problems
in India (Vol. 2, pp. 545–560). Bombay: Tata Institute of Social Sciences.
Bharat, S. (1997). Family socialization of the Indian child. Trends in Social Science
Research, 4(1), 201–216.
Boral, G. C., Bagchi, R., & Nandi, D. N. (1980). An opinion survey about the causes
and treatment of mental illness and the social acceptance of the mentally ill patients.
Indian Journal of Psychiatry, 22(3), 317–321.
Carson, D. .K., Chowdhury, A., Perry, C. K., & Pati, C. (1999). Family characteristics
and adolescent competence in India: Investigation of youth in southern Orissa. Journal
of Youth and Adolescence, 28(2), 211–233.
Channabasavanna, S. M., & Bhatti, R. S. (1982). A study of interactional patterns
and family typologies in families of mental patients. In A Kiev & A. Venkoba Rao (Eds.),
Readings in transcultural psychiatry (pp. 149–161). Madras: Higginbotham.
Choudhury, R. (1999). The changing family scenario in Orissa: Its impact on mental
health. In J. K. Baral & A. Chowdhury (Eds.), Family in transition: Power and develop-
ment (pp. 21–30). New Delhi: Northern Book Center.
Chowdhury, A. (1995). Employed mothers and their families in India. Early Child
Development and Care, 113, 65–75.
Chowdhury, A. (1999). The status and perceptions of aged in Orissan families. In
J. K. Baral & A. Chowdhury (Eds.), Family in transition: Power and development (pp.
47–56). New Delhi: Northern Book Center.
Chowdhury, A., & Baral, S. (1999). A study on vulnerable families. In J. K. Baral &
A. Chowdhury (Eds.), Family in transition: Power and development (pp. 131–138). New
Delhi: Northern Book Center.
Chowdhury, A., & Choudhury, R. (1996). Peer socialization: A new direction towards
socio-personal growth. Trends in Social Science Research, 3(2), 105–112.
 405

DAVID K. CARSON AND APARAJITA CHOWDHURY

Chowdhury, A., Muni, A., Rath, A., & Pati, C. (1996). Assessing social support
network among socio-culturally disadvantaged children in India. Early Child Develop-
ment and Care, 121, 37–47.
Das, R .C. (1999). Marriage in transition: A bio-social approach. In J. K. Baral &
A. Chowdhury (Eds.), Family in transition: Power and development (pp. 16–20). New
Delhi: Northern Book Center.
Das, T. (1999). Employed women and problems of child care. In J. K. Baral & A.
Chowdhury (Eds.), Family in transition: Power and development (pp. 139–147). New
Delhi: Northern Book Center.
Davar, B. V. (1998). Writing phenomenologies of mental illness. Extending the uni-
verse of ordinary discourse. Paper presented at the Annual Culture Studies Workshop,
Centre for Studies in Social Sciences, Bhopal, India, January 15–20.
Davar, B. V. (1999). Mental health of Indian women: A feminist agenda. New Delhi:
Sage Publications.
Dennerstein, L., Astbury, J., & Morse, C. (1993). Psychological and mental health
aspects of women’s health. Geneva: WHO Report.
Desai, M., & Bharat, S. (1989). Research on families with problems in India: A
seminar report. The Indian Journal of Social Work, 50(4), 531–536.
Gupta, A. K. (1987). Parental influences on adolescents. New Delhi: Ariana Pub.
House.
Kapur, M. (1995). Mental health of Indian children. New Delhi: Sage Pub.
Kapur, M. (1997). Mental health in Indian schools. New Delhi: Sage Pub.
Madan, G. R. (1990). Social welfare and security. New Delhi: Vivek Prakashan.
Misra, G. (1995). Reflection on continuity and change in the Indian family system.
Trends in Social Science Research, 2(1), 27–30.
Mohanty, B. (1999). Dual-earner family: A journey to freedom and equality. In
J. K. Baral & A. Chowdhury (Eds.), Family in transition: Power and development (pp.
120–130). New Delhi: Northern Book Center.
Mullatti, L. (1995). Families in India: Beliefs and realities. Journal of Comparative
Family Studies, 26 (1), 11–25.
Muni, A. (1995). Development of Competency Among Advantaged and Disadvantaged
Adolescents. Unpublished doctoral dissertation, Berhampur University, Orissa, India.
Nanda, G. K., & Dash, A. S. (1996). Disadvantage, schooling, competence, and invul-
nerability. Bhubaneswar: Panchajanya, c/o URPL House.
Oommen, T. K. (2000). Family therapy: Challenging the system. Hindu, March 26.
Padhi, J., & Dash, A.S. (1994). The relation of parental attitudes to adolescent
competence. Psycho-Lingua, 24, 33–42.
Parikh, J. C., & Krishna, K. S. (1992). Drug addiction: A psychosocial study of youth.
New Delhi: Friends Publications.
Pati, C., & Patnaik, S. (1999). Status and problems of single women. In J. K. Baral &
A. Chowdhury (Eds.), Family in transition: Power and development (pp. 166–172). New
Delhi: Northern Book Center.
Patnaik, M. M. (1999). Family violence in traditional Oriya society. In J. K. Baral &
A. Chowdhury (Eds.), Family in transition: Power and development (pp. 148–156). New
Delhi: Northern Book Center.
Prabhu, G. G., Raghuram, A., Verma, N,. & Maridass, A. C. (1984). Public attitudes
toward mental illness: A review. National Institute of Mental Health and Neurosurgery
Journal, 2(1), 1–14.
Sahoo, F., & Sia, N. (1988). The socio-cultural antecedents of helplessness among
rural adolescents. Indian Journal of Comunity Guidance Services, 5, 34–47.
Sarkar, C. (1988). Juvenile delinquency in India. Delhi: Daya Publishing House.
Sethi, B. B., & Manchanda, R. (1978). Family structure and psychiatric disorders.
Indian Journal of Psychiatry, 20(3), 283–288.
Shanker, R., & Menon, M. S. (1991). Family intervention programme in schizophre-
nia: The SCARF experience. In Unit of Family Studies (Eds.), Research on families with
problems in India (pp. 128–144). Bombay: Tata Institute of Social Sciences.
406

CONTEMPORARY FAMILY THERAPY

Sharma, S., & Chadd, R.K. (1990). Mental hospitals in India: Current status and
role in mental health care. Delhi: Institute of Human Behaviour and Allied Sciences.
Shukla, M. (1994). India. In K. Hurrelmann (Ed.), International handbook of adoles-
cence (pp. 191–206). Westport, CT: Greenwood Press.
Simhadri, Y. C. (1989). Youth in the contemporary world. Delhi: Mittal Pub.
Sinha, D. (1984). Some recent changes in the Indian family and their implications
for socialisation. The Indian Journal of Social Work, 45, 271–286.
Sinha, D. (1988). The family scenario of a developing country and its implications
for mental health: The case of India. In P. R. Dasen, J. W. Berry, & N. Sartorius (Eds.),
Health and cross-cultural psychology: Towards applications (pp. 48–70). Newbury Park,
CA: Sage Publications.
Sitholey, N., & Chakraborthi, A. (1992). Child psychiatric research in India: Epidemi-
ology, assessment and treatment. In S. Malhotra, A.. Malhotra, & V. K. Varma (Eds.),
Child mental health in India (pp. 119–132). Delhi: Macmillan.
Speck, R. V., & Attneave, C. A. (1973). Family networks. New York: Pantheon.
Tiwari, R. (1990). Adolescents’ personality and frustration. New Delhi: DK Pub-
lishing.
Verghese, A. (1988). Family participation in mental health care: The Vellore experi-
ment. The Indian Journal of Psychiatry, 30(2), 117–121.
Copyright of Contemporary Family Therapy: An International Journal is the property of Springer Science &
Business Media B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written permission. However, users may print, download, or email
articles for individual use.

View publication stats