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What, then, does the mental health professional, pastoral counsellor or Hindu clergy do with this information? I begin with a case vignette to illustrate the situation that mental health professionals and even clergy may find themselves in when seeking to help Hindu clients.
Case Vignette
Raja Gupta is a 39 year old executive at a pharmaceutical company who has come to see his mental health counsellor for feelings of high stress and depressive symptoms. He reports that his job is putting too much pressure on him, and he is having trouble sleeping, lacks energy and motivation, and has been losing weight. Raja is a devout Hindu and asks his therapist whether she knows of any Hindu practices might help reduce his stress level and relieve his depressive symptoms. His therapist is not sure how to respond since she knows nothing about Hinduism. After asking the patient, “Have you tried yoga?” (the only Hindu practice the therapist knows about), the therapist directs the conversation to more secular issues that she feels comfortable dealing with.
The suggestions I make in this chapter are based on knowledge about Hindu beliefs and practices discussed earlier, evidence from systematic research, clinical experience with faith-based interventions, and simply common sense.
1. Take a Spiritual History
A spiritual history should always be taken on initial evaluation, or soon afterwards. The purpose of the spiritual history is to identify the specific Hindu beliefs of the client, the importance of those beliefs to the person, and the extent to which beliefs and practices are adhered to. Finally, both good and bad experiences with the Hindu faith tradition across the client’s lifetime should be asked about. This information will be valuable in deciding on the treatment approach and in providing treatments that meets the minimum standard of showing respect for clients’ personal beliefs and values (as required by most credentialing organisations at least in the U.S.). Mental health professionals should assume nothing in this regard, but rather have each client educate them about (a) what role their Hindu faith plays in life, (b) how that faith helps them to deal with their illness or associated life stressors, and (c) how Hindu beliefs/practices may be initiating, worsening or maintaining the illness.
If the therapist is uncomfortable asking about religious issues (i.e., taking a spiritual history) then such resistance must be overcome with training and practice. Learning about the role that religion plays in the Hindu client’s illness, particularly when it influences just about everything in that person’s psychological, behavioural, social, and work life (Hinduism is often described as a “way of life”), is quickly becoming the standard of care. Again, this does not mean the therapist needs to integrate those Hindu beliefs into the treatment, but knowing about them will be essential in providing therapy that is sensitive to and respectful of those beliefs.
Taking a detailed spiritual history is the most important recommendation that I can make for those treating Hindu clients. Knowing something about the religious beliefs and practices of Hindus (as described in this book and elsewhere) will help the mental health professional make informed inquiries in this regard. However, given the wide range of religious beliefs and practices among Hindus, clinicians should not assume that what they know about Hindu beliefs applies to a particular client sitting in front of them. Instead, mental health professionals and clergy should ask each person about what he or she believes and what types of religious practices are important to them (if any) in coping with their illness. In particular, it is important to understand what the client feels is the underlying case of the illness (especially the role that “God’s will” or “bad karma” may be playing).
2. Don’t forget the family (and broader community)
Hindu clients will each come out of a particular family and community of friends and support persons. Unlike Westerners who treasure their independence and self-sufficiency, Hindus are often heavily dependent on relationships within the family and the community (as part of South Asian culture). Therefore, religious beliefs and religiosity of the client’s family of origin, and the religious beliefs and religiosity of the client’s family of origin, and the religious beliefs and religiosity of the client’s support system need to be inquired about as well. This will give the clinician a sense of whether changes made during therapy will be supported (or opposed) after the client leaves the therapist’s office. Although patient confidentiality should be maintained at all times, and most clinical encounters will involve only the client and the treating professional, there will be times when the therapist will need to ask permission from the patient to include the family during the assessment and the treatment.
3. Provide a Safe Place
Provide an open and safe place where clients can talk freely about their religion, good or bad, without judgement. Maintain a respectful, interested, and receptive attitude at all times with regard to the client’s Hindu beliefs and practices (whether the person is currently active in their faith tradition or not, whether he or she speaks well of their faith or not).
4. Be Supportive and Neutral
Be respectful and supportive of the Hindu client’s religious beliefs/practices that he or she finds helpful (or might find helpful in the future) as a way of coping with emotional issues. However, always do so from the client’s perspective. If the client is receptive and open to healthy religious practices, and these beliefs/practices are not clearly pathological, then they may be encouraged. If the client shows any resistance, don’t push; however, it may be informative to gently explore where the resistance to religious beliefs/practices is coming from in a future session. Never give clients the impression that they are not religious enough, since they probably get plenty of that from family members or those in their religious community. Whether you are a psychiatrist prescribing biological therapies or a therapist providing counselling, the mental health professional should be viewed by the client as neutral, interested in, open to and supportive of the client’s Hindu faith tradition, but always on the client’s side and never judgemental. This advice also applies to Hindu clergy who may be counselling members of their temple or religious community.
5. Accommodate the Environment
In office or hospital settings, every effort should be made to accommodate the environment to make it easier for Hindu patients to practice their religion. this may include placing a copy of the Bhagavad Gita or of The Hindu magazine on a table in the waiting room. In the hospital, this may include accommodating the chapel so that Hindu patients feel comfortable worshiping in this setting.
6. Experience with Traditional Healers
Given the frequent use of traditional or faith healers by Hindus in East Asia (as well as by Hindu immigrants to other countries in the West), clinicians should ask about what other sources of help outside the mainstream mental health profession that Hindu patients have sought. Family members may be a particularly important source of such information.
7. Consider a Religiously-Integrated Therapy
If clients prefer this approach and therapists are willing and qualified, religiously-integrated cognitive behavioural therapy (CBT) from a Hindu perspective should be considered for those with emotional disorders. There are resources that may help the therapist or Hindu clergy in this regard. This includes a Hindu CBT manual, along with therapist and patient workbooks, and an introductory video, that can be accessed at the Centre for Spirituality, Theology and Health website, all without charge (CSTH, 2014). Religiously-integrated CBT, including that from a Hindu perspective, is an evidence-based treatment that has documented effectiveness in the treatment for depression, especially in highly religious patients (Koenig et al., 2015).
There are also evidence-based Hindu treatments such as Omkar meditation, Hartha yoga, other integrated yoga interventions (relying on Patanjali yoga sutras and Mandukaya Karika scriptures) that have been shown to be effective in relieving a variety of emotional disorders (see Religious Interventions in Chapter 6). Another invaluable resource for self-care among Hindus is the Bhagavad Gita, which is full of wisdom on how to maintain and enhance mental health (for an easily accessible version of the Gita, see Johnson, 1994).
8. Utilise Religious Resources
If the client is religious, but not a candidate for a religiously-integrated psychotherapy, meditation or yoga therapies, or does not prefer these approach, then the therapist should provide secular psychotherapy that is supportive and respectful of the client’s Hindu beliefs. There may be times during secular psychotherapy when the client’s religious beliefs may be utilised to support changes in attitude and behaviour. Knowing about those religious beliefs/practices (as covered in earlier chapters) will be helpful, as will a detailed spiritual history to identify ones are particularly important to the Hindu client being treated. Consultation with knowledgeable experts in Hinduisms may need to be sought as well, particularly if beliefs are to be challenged.
9. Challenge / Re-Educate
If the client’s Hindu beliefs or practices are contributing to their psychopathology, and this is confirmed following consultation with an expert from the client’s local Hindu congregation (after the client provides consent), then the following approach is suggested. First and foremost, the mental health professional should inquire further about the role that particular religious beliefs are playing in supporting psychopathology. The therapist should listen respectfully, gathering as much information as possible about the natural history of how religion became intertwined with the emotional problem. This must be done in an open and receptive manner and without confrontation (at least initially during this information gathering stage). There will come a time, once the therapeutic relationship is firmly established and the client feels safe and accepted, when gradual, gentle, and persistent “Socratic questioning” may help to guide the client towards a “healthier” use of their Hindu beliefs/practices. I emphasise gradual, gentle, and persistent questioning by an informed therapist within an atmosphere that is safe and comfortable. Arguments over religious beliefs will almost always be unsuccessful and will adversely affect the therapeutic alliance.
10. Non-Religious Hindus
If the client was raised in a Hindu family but is not actively religious, then the mental health professional should proceed with secular psychotherapy that is respectful of the client’s personal and cultural beliefs. Aggressive attempts to reconnect the person to his/her Hindu faith tradition should be avoided. If the client was once religious and has now become socially isolated or is despairing for lack of meaning in life, the therapist might gently ask if the client has considered re-establishing connections with a local faith community. The therapist may help the client weight the pluses and minuses of such re-involvement, but again always from the client’s perspective and following the client’s lead.
11. Consult or Refer
If addressing religion or integrating it into the treatment seems indicated in a Hindu client, and the therapist lacks the desire or experience to do so, consideration should be given to consultation with, co-therapy with, or referral to a Hindu chaplain or pastoral counsellor. If clergy trained to provide counselling from a Hindu perspective are not available, then the therapist should consider obtaining additional training in this regard (see CSTH, 2014).