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Year : 2020  |  Volume : 36  |  Issue : 5  |  Page : 174-180

Psychotherapy during Corona crisis

Emotions Clinic, Education and Training Centre, Staffordshire, United Kingdom

Date of Submission23-Jul-2020
Date of Acceptance23-Jul-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Dr. Kishore Chandiramani
Emotions Clinic, Education and Training Centre, Staffordshire
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_227_20

Rights and Permissions

The corona infection is peaking in India, and we have seen a surge in mental health problems; sadly the mental health peak is yet to come. The populations hit hardest are the front-line staff, children, elderly, people who live alone, individuals with comorbid health conditions, socially and financially deprived groups, and those who are vulnerable to suffering domestic violence. Alcohol- and drug-dependent individuals have also reported a worsening in their mental health and suicides that could have been prevented have occurred. The financial desperation in society has increased the risk of crime rates. The lockdown has made it difficult for people to use their habitual coping strategies, and access help from their own social and spiritual support systems and the mental health services. This article in intended to help psychotherapists make sense of the unique nature of the corona related psychological problems and to learn new ways of dealing with them.

Keywords: Corona, lockdown, pandemic, psychological, psychotherapy

How to cite this article:
Chandiramani K. Psychotherapy during Corona crisis. Indian J Soc Psychiatry 2020;36, Suppl S1:174-80

How to cite this URL:
Chandiramani K. Psychotherapy during Corona crisis. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Oct 28];36, Suppl S1:174-80. Available from: https://www.indjsp.org/text.asp?2020/36/5/174/297138

  Introduction Top

By now, we all know what the corona pandemic and the lockdown have done to our conscious mind, and perhaps, we are now less terrified of them but more frustrated with the life-in-a-limbo. Perhaps, we have also become more insecure about our future and less hopeful of returning to the world we knew. It is a kind of grieving for our former lifestyle, no matter how good or bad it was. Added to that, for the majority of us, uncertainties of all kinds, including financial ones, are taking their toll, and they seem to have overtaken the fear of dying. We are experiencing the symptoms of lockdown fatigue and seem to have lost interest in corona, but corona does not seem to have lost interest in us.

There is a global recognition that mental health problems are on the rise as a result of the pandemic and will need greater attention, and the problems have been worse for the front-line staff, key professionals, and those who have survived the infection. However, we do not know what the long-term psychological consequences are going to be and how we can prevent them. The mental health professionals have not yet figured out the extent of the problem because of the difficulties in the logistics of carrying out research during the lockdown. We do not have ready-made models of the care specific to this pandemic-related mental health crisis and have been using what we already know from before the pandemic.

An average citizen's thought, “I feel all right for now” is perhaps coming out of their conscious mind, but that's only 10%–20% of the totality of their being, what is happening at the unconscious level is unknown even to the individual, apart from getting some intuitive or gut feelings or through their dreams. The majority of us will come out of this crisis psychologically changed; some perhaps weaker and others stronger, and it would be a worthwhile exercise to reflect on this thought.

  The Hidden Psychological Cost of the Pandemic and the Lockdown Top

The actual toll on the mental health of the population, more so for the front-line staff and those who have survived the infection, will be visible only after a few months or years – long-term effects will be felt even by those who now feel they are coping all right now.

There are indications that illnesses that require social support systems for recovery, i.e., depressive disorders, including postnatal depression, mental health of children, anxiety among elderly, etc., are likely to get worse. People who have lost their jobs and loved ones are also in this vulnerable category. There are the reports of higher incidents of anxiety, panic, obsessive-compulsive disorder, eating disorder, and posttraumatic stress disorder (PTSD) symptoms among professionals who are exposed to corona patients and also among general population and suicide rates have gone up amongst those who see gloom and doom ahead of them.

It is a new territory for psychiatrists and other mental health professionals, and we still do not have scientific data to understand the actual magnitude of the problem, but one thing is certain – that they are on the rise. Mental health professionals have no readymade solutions to the peculiar nature of this problem apart from treating it as a stress-related disorder and an exacerbation of preexisting psychiatric illnesses and predilections, and they are employing their familiar tools.

  Doing Psychotherapy during the Lockdown Top

Is it possible to do psychotherapy effectively under lockdown? How should it be different from psychotherapy under normal circumstances? Are telephone/video therapy sessions good enough? How should therapists respond to clients' anxieties when they themselves are experiencing fear and insecurity? Is it okay to de-catastrophize patients' anxieties related to the pandemic? Should therapists behave such as national leaders during wartime, inwardly insecure, and frightened but outwardly courageous and boosting public (client) morale? Should they be more authentic in the therapy room or hide away their emotions behind the therapist's opacity and impenetrability that they can use legitimately?

During this crisis situation, the emotions our clients are confronted with are not very different from the one's they normally experience and bring to the therapy session, it's just that instead of being frightened of their past emotional traumas and fears (I have chosen to call them ghost emotions as opposed to real emotions)[1] that manifest as their psychiatric symptoms, they are now worried about their current anxieties (real emotions), and their usual worries fade away in the background, Their habitual ways of reacting to them are also no different from the ones they employed before, i.e., being more frightened, and feeling more insecure and helpless.

What can be different here for the therapist is that they cannot approach the therapy material in the same way they did before, as these are not imagined fears or a replay of clients' old emotions that have no real consequences and would not endanger their lives. A therapist's reassuring stance can't be justified here, as the disease can kill people and a denial of the threat can be dangerous. The therapist can't assume – that these are mere thoughts and not the reality of the patient, which happens often in therapy.

The therapist can't say things to mean – it was your reality before and your emotions were justified then but not anymore, you were scared because you were a child but not anymore, you were subject to traumatic experiences but now you can understand them differently and act in a mature way.

The threat is real here, and we need a different set of coping strategies – cognitive restructuring is not going to reduce the realistic fears, as it is supposed to bring people closer to reality and not move them away from it. The cognitive behavioral therapy (CBT) model is very good with unrealistic fears and cognitive errors and can help clients who have such fears, but it won't work that effectively with rational fears. As the saying goes – no amount of cognitive therapy can make me believe that the color of the sky or the sea does not appear blue. It doesn't mean the CBT model can't be employed; perhaps, the emphasis can shift from the cognitive to behavioral approaches in confronting one's fears. The cognitive techniques can also be employed in helping the client avoid taking extreme measures in risk management. Looking for absolute certainty of safety can be a trap, and it can make us more anxious. Managing risks with reasonable efforts is a positive attitude and accepting the remaining risks is also a positive attitude.

Sigmund Freud, the father of psychoanalysis, said that all psychoanalysis could do was to replace “neurotic” or hysterical unhappiness with everyday unhappiness, and it did not have answers for normal human suffering. Here, we are dealing with the normal human suffering related to the pandemic. However, my understanding is that psychotherapy can deal with normal human suffering as well, if we analyze deeply how psychotherapy brings about therapeutic change, which I have discussed later on in this article.

It is commonly believed that psychotherapy deals with the irrational aspects of normal human suffering such as relationship issues, work-related stress, coping with normal life stress, but it doesn't work well with the rational aspects of normal human suffering.

The next question that comes to mind is how to handle the rational aspects of normal human suffering? Since its something mental health professionals are not familiar with and haven't received adequate training in, they don't feel confident about handling such issues in therapy settings. What sort of psychotherapy will be helpful to the doctor, who comes to you as a client, who has just heard on the television that 99 doctors have died in India as a result of the corona infection, and is now getting into his Personal Protective Equipment (PPE) gear to attend to patients in the corona ward.

Let us examine what happens during therapy under normal circumstances, it is the healthy, rational, conscious part of the mind of the client that, with the help of the rational observation of the therapist, is able to detoxify the toxins of the unrealistic fears and fantasies in the unconscious mind of the client. However, how can the situation be helped when the conscious mind itself is toxic with the fears and other negative emotions, as it happens during psychotic episodes, dissociative states, and borderline personality disorder? The therapy work is severely compromised.

What happens during crisis times such as the corona pandemic and the effects of the lockdown is that the healthy part of the mind of the patient as well as that of the therapist is also emotionally charged and engaged in coping with real-life challenges. The therapeutic alliance, which is defined as the nonneurotic and nontransferential relational component established between patient and therapist is also under threat. Greenson [2] defines the working alliance as a reality-based collaboration between patient and therapist. This reality-based collaboration also gets impacted by the fears and difficulties of various kinds.

The therapy work, therefore, shifts from transference/therapeutic alliance to a different kinds of therapeutic alliance during such a crisis, where the client, with the help of the therapist, is working on their realistic fears as opposed to their illness linked fears. One might argue that the two are not totally independent entities, as the disease linked fears latch onto the realistic fears and make them worse.

It is, therefore, perfectly okay for the client as well as the therapist to spend the entire therapy session talking about the client's fears and thoughts about the corona infection and lockdown issues. The yardstick of measuring improvement would be that the patient feels less afraid of catching the illness and feels more empowered in dealing with their lockdown issues, and at the same time is not undermining the importance of taking all the precautions. They feel empowered in their ability to make a difference in the level of risks to their health, finances, relationships, etc., through their actions.

The importance of this work should not be underestimated as the skills acquired in dealing with one's corona fears can also be utilized by the patient at a later stage in dealing with their unrealistic unconscious illness-linked fears as well and also the real-life challenges.

The clients with long-standing nature of their anxiety and depression and who have learnt some coping skills are better prepared to deal with the corona crisis than someone else who has recently acquired this anxiety and has not learnt the technique. The situation can exacerbate clients' anxieties if they are already struggling with it such as clients with PTSD, acute psychotic episodes, borderline personality disorder, etc.

I was having a chat with my doctor relatives who were doing duties in corona infection wards in North India, and I said to them, although it may be a nerve-wracking experience for you but if you are able to keep some equanimity (emotionally neutral and non-reacting attitude) during your shifts, and just focus on your present moment you will come out a stronger person. Moreover, after encountering these fears you will notice that your capacity to deal with fears of other kinds later in life will increase.

It is important to note that therapy work will be possible only when the therapist is also able to put behind their fears and operates from the part of their mind that is fearless. The therapist should not undertake a therapy session if they find themselves unable to shake off their anxieties related to the infection and the lockdown, as they will only be passing their own “psychological virus” to the patient.

It would be okay for therapists to acknowledge patient's fears and discuss them, but it may not be appropriate for them to discuss their own fears of corona infection and worries about the consequences of lockdown, as it may compound the client's worries. However, an existential therapist may have a different take on this thought and may say being authentic will help the therapist work together with the client by being with them.

On the practical front in my opinion, telephone therapy sessions fall short of the requirements for therapy, but video sessions are good enough. Sadly, many hospitals in the public sector have not yet provided this facility to their therapists, although the costs involved are negligible compared to the good they will do not just during the corona crisis but afterward as well.

As a therapist, one should ask oneself – Am I prepared to deal with such a situation apart from giving the client a patient ear to get the stuff of their chest, which gives the client a feeling that there is someone there to listen to them. It may help the client at some level as they know there is someone out there who understands their problems and feels in the same way as they do. If not, one needs a deeper understanding of the process of therapy and improvised therapy skills before taking on such clients.

A CBT therapist might want to encourage their clients to reflect on the cognitive distortions of – black and white thinking, catastrophizing, over-generalization, labeling, mental filtering (looking for the negative within every situation), jumping to conclusion (negative ones), emotional reasoning, etc., There is a risk of irritating the patient as we are not acknowledging the patient's real fears and minimizing them. However, it may be more appropriate to use exploratory, experiential including client-centered therapy or phenomenological (existential), models where we give them a safe space and permission to talk about their thoughts of dying, financial ruins, job insecurities, relationship issues, etc. The client's observing-self working in collaboration with the therapist's un-frightened stance will offer a ground for detoxification of the client's negative emotions.

An acknowledgment of the suffering and giving them a safe space helps, but that isn't enough to eliminate the suffering completely. For that one has to create psychological immunity, like the military building defence capabilities in peace times. Creating a personality that has already come to terms with the ontological concerns such as death, uncertainties of life, loneliness, one's thrown conditions, meaning in relationships, and the ultimate purpose of human life.

If we take a closer look at how psychotherapy works and what heals in therapy, we will realize that psychotherapy, just like mindfulness meditation, can also help with the normal human suffering.

  How Does Psychotherapy Work? Top

The stages of change

  1. Activation or decoding of past emotional experiences – through in vivo and in vitro exposure or lying on the couch – it won't be required during corona crisis as it is already happening.
  2. Re-living of past experiences – this is also happening in a disguised way, the anxieties of one's past are being relived in the form of specific fears. Rollo May has pointed out that additional stress may bring a great relief from anxiety. In wartime Great Britain amid the bombing, painful austerity and other great stress, there was a clear dimunition of neurosis; this situation has been demonstrated in many countries that neurotic problems are allayed in times of stress because the persons have something definite on which to pin their inner turmoil and they can just focus on concrete pressures indeed.[3]
  3. Integration of corrective therapeutic experiences with the past experience – this will require therapist work in trying to convert clients' unrealistic fears into the realistic ones.
  4. Recording or Recoding of the changed experience into the memory system-which happens automatically.

Processes of change

  1. Fusion-when destructive urges from the id are mixed with more powerful libido from ego the result is the dissolution of the urge.[4] It's like mixing a spoonful of very salty water with a bucketful of normal water which will make the salt lose its potency. Another metaphor that can be used here is that of sunlight and mountain ice. Mere contact of sunlight is enough to melt the ice, in the same way a mere contact of emotionally neutral consciousness from the ego (observing self) with the emotionally charged emotions and instincts within the id (experiencing self) is enough to result in a fusion. Once this fusion has taken place symptoms are likely to disappear. The therapeutic technique used here would be to convert the unconscious into conscious by way of reflection and interpretation by the therapist in psychoanalytic settings. This is easily achieved during meditative practices
  2. Diffusion: it is like defusing a bomb, separating the stimulus from the response emitting system in our psyche.[4] Separating the flame from the explosive liquid, or not allowing a snake to bite us until the stimulus is neutralised or the response system is made immune. This separation can take place with the help of the technique of nonidentification with one's negative thoughts and emotions or put it in psychoanalytic terms with one's destructive instinctual urges
  3. Containment – when the emotionally neutral consciousness or the observing self, which is the healing part of our psyche, has enveloped the negatively charged psychic content but no fusion is taking place, and no damage either
  4. Frustration - not allowing gratification of the instinct – it is akin to diffusion, but some therapists might see it as diffusion with a different slant
  5. Gratification and/or acting out of instinct in a controlled fashion – is another way of getting rid of instinct – the only risk is that it has a tendency to come back if we are not continually mindful of the fact that this process does not have our approval, we are simply allowing it to exhaust its energy, just as we allow a child to play out their tantrums
  6. Exposure to the stimulus – not being scared of all the negative thoughts that pop up in our mind, like soldiering on. It will be akin to flooding or exposure therapy
  7. Nonidentification [1] - when the negative is on the surface and is influencing our thoughts and actions, i.e., experiencing self is dominant and observing self is overwhelmed-the only approach that can work is nonidentification with one's ongoing experiences, saying “this is not my real self.” The mindfulness meditation model would be appropriate here. The existential model can also work here but in a different way; a client can be healed if he can see the meaning behind or hidden inside their negative experiences
  8. Creating something positive – courage, love and compassion, life affirmation, etc., What Tillich has described, in his book Courage to Be, as our courage, that comes from our Being, can counter our fear of nonbeing. Love is the antidote to fear.[5]

  Coping With Fear Top

Trying to suppress fear or distract ourselves from it generally doesn't work, trying to use logic also doesn't work, as these emotions are precognitive in origin. The physiological responses maybe even deeper than our emotions. Trying to understand the cause also may not work as there is a real threat and denying it will not be helpful.

First of all, we need to understand the structure of this fear. It exists in the form of some thoughts and emotions. If we analyze deeply when we have a fear in our minds we are thinking about the future. If we live totally in the present moment cutting ourselves off from the thoughts of the future and the past and connect with the experience of here and now this fear disappears. The health-care staff working in Covid-19 units have told me that the fear is at its peak when they are thinking about going to work, getting ready, and about to wear their PPE gowns, and it drops down considerably when they are engaged in treating patients. It's very much like anxiety is maximum before we go on the podium to deliver a lecture, but there is hardly any anxiety when one starts the presentation unless one doesn't know the subject. Therefore, living fully in the present can help us with this fear, and it involves a shift in our consciousness from our thoughts and emotions to our perception, and from our past and future to our present. It does not mean that thoughts can't be employed in overcoming our fear.

A cognitive-behavioral model encourages us to see our thoughts in terms of two categories: (i) the automatic thoughts that come to the mind uninvited and (ii) thoughts that we have created just now in response to the automatic thoughts – trying to control the automatic thoughts would be a futile exercise as they are like a horse that has bolted. However, creating a different set of thoughts can make things different for us in the future, by way of creating a different set of emotions. They stop us from fueling the fire of automatic thoughts, and the fire will settle down on its own. If we don't make an effort to create a new set of thoughts, mindfulness meditation being an exception here, we will get passively sucked into the automatic thought process endlessly.

Let us look at what sort of thoughts can be helpful, and here, we need to understand what is the opposite of fear which can be used to neutralize or replace it. Bringing the opposite can help us deal with this fear. The state of fearlessness is the absence of fear, and not it's opposite. We can't use fearlessness to counter fear because it can be witnessed only when the fear has gone. The fearlessness is not an entity or an emotion in its own right that can be used, it's the absence of the emotion of fear. Every fear has an object and the fearlessness that comes after the fear has gone will also be related to that particular fear.

The courage on the other hand has an existence of its own, it's the mental capacity to counter fear, and it comes into existence whilst one is experiencing the anxiety or fear, and therefore, can be employed in dealing with it. The courage springs from the depths of our being and reaches out and deals with the possibility of our nonbeing. Hence, courage would be a therapeutic factor that can be used in therapy settings. In fact, Nietzsche [6] and Tillich [5] remind us that the prime mover in therapy are not insight but courage.

Another antidote to fear is love. Fear causes a disconnect and love keeps the connection going. One might argue that love breeds fear, if I love my child, I will be fearful of the risks in such times, and if I don't love them, I won't worry about their safety. We are not referring to that kind of insecure attachment which is touted as love. The word love here means – an affirmation of Being that incorporates nonbeing as well, loving our fate which Nietzsche called Amor-fati, finding a deeper connection with one's inner consciousness, loving our own Being, loving our fellow Beings (not just their physical existence). This love is not threatened by death as it knows that it will live beyond death as well. Once connected with it, one can benefit from inviting even the thoughts of one's mortality. As the being has the power to overcome nonbeing.[5]

The mechanisms of mindfulness meditation will be slightly different – here by focusing on one's breath and inner body sensations one learns to step outside one's thoughts and feelings, as awareness of one's breath does not involve any thoughts and it's emotionally neutral. As a result, all automatic thoughts die their natural death and a new set of thoughts that arise from an equanimous (emotionally balanced) mind is going to be positive without us making any effort. Breath awareness also brings us into here and now, thereby reducing preoccupation with the future, and it also strengthens the observing self which can help us neutralize the emotions contained in our experiencing self.

  Coping With Lockdown and Solitude Top

Solitude can be both a blessing and a curse. It can be soul-destroying and dangerous, hence used as a form of punishment in a prison setting. One can come out of solitude as a damaged person with long-term psychological issues. However, there is a positive side to solitude as well, if one has learnt the skill of being on their own without creating any negative emotions or reacting emotionally to it. By doing so one can resolve one's deeper psychological issues during such periods and become psychologically and spiritually stronger.

On the love of solitude and silence Thomas a' Kempis quotes in his book “The Imitation of Christ” a saying, “whenever I have been among men, I have returned a lesser man.” It is easier to be completely silent, than not to exceed in speech. It is easier to lie hidden at home than to be able sufficiently to guard oneself abroad. He further says – no one can safely appear in public who doesn't enjoy seclusion. No one safely talks but he who gladly keeps silent. He further says – in silence and quietness the devout soul makes progress and learns the hidden things of the scriptures. There it finds the streams of tears in which each night it washes and cleanses itself. If you wish to be deeply rebuked in the heart (perhaps referring to self-reflection), go into your cell, and shut out the turmoil of the world. You will find in your cell what you too often miss abroad. The desires of sensuality draw you to walk abroad, but when an hour has passed what do you bring back but the heaviness of conscience and destruction of the heart? Often glad departure brings a sad return, and late evenings a sad morning.[7]

  Existential Issues Top

The current pandemic situation is offering us an opportunity to think deeply about what it means to be human and reflect on how we can address some of the core existential issues of human life. We should not let this corona crisis pass by without benefiting from it.

The consciousness that was always looking outward is now forced to withdraw itself partially and turn inward. When it turns inward and we don't make it busy again – there are only two ways it can respond to the emotions it experiences – either to not accept and react negatively which will multiply the negative emotions and our unhappiness, or to accept it calmly which will neutralise it. If we resent this lockdown and get upset, then we are certainly increasing our distress and misery. Or if we distract ourselves into some external activity such as music, television, picking up a new hobby, being on the telephone all the time, reading books – we are not making use of the opportunity of reflecting inwards.

Thinking deeply and a calm acceptance of all the emotions that come with the fear of this virus and dying, the financial losses, the lockdown, and social isolation etc., will help us go beyond all the anxieties and fears. Both attitudes, i.e., resenting these emotions or getting excited about them would be counterproductive. We should allow ourselves to experience all the anxieties that are happening to us but should not identify with them or respond to them negatively, its best to see these emotions as temporary. The client-entered therapies are helpful in creating the therapeutic environment of empathy, nonjudgmental attitude, and genuine regard that enables healing and growth to take place within the context of a client-therapist relationship.

It is quite likely that we may start liking the stillness in our physical environment and the solitude that is being forced upon us and may want to plan our living environments and neighbourhood differently. The world might appear too crowded when the corona crisis is over.

Such a crisis offers an opportunity for us to be fully human, we normally live from a limited subset of our true being and potentiality.

Living fully and with a deep understanding of life means – being aware of the full spectrum of human suffering, and shortness and uncertainties of human life all the time, and at the same time having a sense of equanimity. This will connect us to the joyful center of our being.

We are human beings but sadly have ended up being human doings. Corona is offering us an opportunity to become a human being again, let us return to our true self where we truly belong.

The longings for security that arise in a period of insecurity and that can give rise to new ways of living can be found in the spiritual traditions of mankind.

As Jung [8] has pointed out, in his book - Modern Man in Search of a Soul, that people in the East and primitive tribes are better connected with their psyche, perhaps referring to the instinctual side and the collective unconscious, and therefore are better able to deal with stress. In the West, psychotherapy has grown in proportion equal to the loss of religion.

Perhaps people in India are still living and breathing religion and spirituality, hence therapies such as psychoanalysis, client-centered therapy, or interpersonal therapy haven't found inroads in Indian society, whereas iPhones and Artificial Intelligence have. Jung [8] further says, “while we are turning upside down the material world of the East with our technical proficiency, the East with its psychic proficiency is throwing our spiritual world into confusion. We have never yet hit upon the thought that while we are overpowering the Orient from without, it may be fastening its hold upon us from within. His prophecy seems to be coming true in the form of mindfulness meditation sweeping across the West.

Heidegger, a German philosopher, did a deeper analysis of the structure of psyche i.e., Being and came to a similar conclusion.[9] He defines religion as-a reconnection to power, forces, and laws that exceed human capability, and says no human being is without religion, the Marxist and the modern man also have a religion called science. He also commented upon the underdeveloped countries – when speaking of the underdeveloped it must always be asked what goal is conceived for development. According to the modern conception of the European and American sense of development, it means, in the first place, a modern technological world. From this standpoint, I would say that your country (talking to a Buddhist monk), on the basis of its ancient and ongoing traditions is highly developed. By contrast, the Americans, with their technology and atomic bombs are underdeveloped.[9]

It doesn't mean Western Models of therapy have nothing to offer to people in India. The Western models help us understand the meaning hidden behind our negative experiences, which is generally ignored when using Indian approaches as they are more focused on the processes rather than the contents of the mind. It may be that a certain percentage of Indian society is not spiritual minded and not yet ready to understand or embrace the deep meditative practices and are still caught up with religious rituals. For them, the Western models will be of great help in making sense of their predicament in the modern world.

It would, therefore, be appropriate to blend different therapy approaches. The client sitting in front of us is not just a scientific problem which can be addressed only through scientific psychotherapy. My teacher Professor N. N. Wig used to say – psychiatrists should have a Shakespearean breadth of knowledge which will enable them to understand a client's mind in its totality and respond with the fullness of one's Being.

  Conclusion Top

I have seen in my clinical practice that clients respond well to discussions on characters from Tolstoy's stories, Nietzsche and Paul Tillich's Philosophy of Courage, Rumi's poems, Gandhi's truth and nonviolence, Buddhist concepts of impermanence and nonidentification, Hindu and Greek concepts of the Soul, Byron Katie's formula of challenging one's thoughts, Raman Maharishi's and Eckhart Tolle's silent meditations and nonidentification, Jesus Christ's love, tolerance and forgiveness, the philosophy behind Islamic code of conduct and existential ideas of freewill, authenticity and a sense of responsibility. Perhaps, therapists have to be sensitive to a particular client's unmet needs, the receptivity of their mental set, and their readiness for change.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Chandiramani K. Emotions and Stress: How to Manage Them. United Kingdom: Troubador Publishing; 2015. p. 152.  Back to cited text no. 1
Greenson RR. The working alliance and the transference neurosis. Psychoanal Q 1965;34:155-81.  Back to cited text no. 2
May R. The Meaning of Anxiety. WW Norton & Company; 1996.  Back to cited text no. 3
Balint M. The Basic Fault: Theraeutic Aspects of Regression; 1979.  Back to cited text no. 4
Tillich P. The Courage to Be. 3rd ed. New Haven and London: The Yale University Press; 2014.  Back to cited text no. 5
Nietzsche F, Thus Spoke Zarathustra. London: Penguin; 1883/1961.  Back to cited text no. 6
Kempis TA. The Imitation of Christ. Great Britain: Hodder Stroughton Christian Classics; 1979.  Back to cited text no. 7
Jung CG. Modern Man in Search of a Soul. America A Harvest/HBJ Book; 1933.  Back to cited text no. 8
Heidegger, M. Martin Heidegger Interview with a Monk-on YouTube; 2020.  Back to cited text no. 9


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