Has the Kama Sutra Not Made a Difference? Making Psychologists in India Explore Sexual Functioning and Master Sex Therapy

Abstract

Abstract

There is no dearth of web-based scientific information on sexuality and related matters, and it is shared in private social groups. Yet there appears to be a resistance on the part of psychologists in India in exploring the sexual functioning of clients. This article explores the possible reasons for the neglect that prevails and the consequences. Since, psychologists who are qualified in helping avoid addressing the sexual concerns of the people, it leads to widespread “malpractice” by the quacks. Neglect in identifying the underlying sexual problems that are manifested as various somatoform disorders and other medically unexplainable symptoms leads to emotional distress of the clients and increases the health costs. Hesitation and the “taboo” of the psychologists hinder the therapeutic contact between the therapists and the clients and, hence, people do not disclose their sexual concerns and problems. Personal discomfort of psychology trainees due to “unfinished business,” inadequate input on the role of sexual functioning and the inadequate exposure to people with sexual concerns may have contributed to this impasse. Supervised training of upcoming psychologists would help improve the quality of sexual life of people of all ages and prevent children and adolescents from sexual abuse. The need for using the ancient Indian masterpiece of sexual science, Kama Sutra, in getting over the taboo is also recommended.

Introduction

Net-based social media is wide open to sexually related matters and are flooded with healthy as well as unhealthy information. However, different cultural groups and communities in India still consider “sex” as a “taboo” and shy away from discussing it in open forums. Even in scientific settings where the science of sex has a “legitimate” place, some of the professionals wish to exclude the topic, and there have been occasions when the presenters were frowned upon, because of the “language” and the “humor” of the speaker. ¹ A successful practicing sex therapist may also get “black listed” because of the mindset of the professional’s group, if one is not highly sensitive to nonverbal feedback from the audience. ²

On the other hand, professionals as well as public discuss about sexual matters privately, vividly, and extensively. As a manifestation of the societal attitude, clients, who are young, adults, and elderly hesitate to present their fears and concerns about sexual functioning to the professionals, even in a very closed setting. Those who approach the clinicians with the primary concern about their sexual functioning, irrespective of the clinician’s acceptance and nonjudgmental attitude, hesitate to open up in the initial few sessions. It is even harder to “crack” those who manifest various somatic symptoms which originate from their “unconscious” and “early childhood sexual traumas.”

Concerns

Professionals working in the area of psychosexual health in India and the neighboring region are seriously worried about the widespread “malpractice” by the quacks and misguidance of those whose are affected. By the time the persons reach the appropriate professionals, one is “intensely anxious and depressed, with an utter sense of hopelessness about self and future and is exhausted both emotionally and financially.” ³ Treating unmarried young adults with sexual disorders was a great challenge couple of decades ago ³ and it still continues to remain the same due to the culturally acceptable and ethical practice in professional settings. The Dhat syndrome remains an important diagnosis and is reported in North India and the neighboring the region.^{4, 5} Moreover, when the clients present their problems as somatoform disorder, ⁶ dissociative disorder, ⁷ psychogenic disorders, ⁸ or in any other form of psychological disorder, there is/are often underlying sexually related conflict(s). Only a careful exploration can bring out those conflicts, and the resolution of the conflicts during psychotherapy brings about the removal of the symptoms or healing of the disorders. Clients who are married for a long period of time or clients who are married for many years are at the verge of marital breakup when provided with sex therapy techniques regretted later for having “wasted their golden years” for want of the particular “skill” in marriage. Although the clients present to the “doctor” or the clinicians with symptoms that are of somatic nature, the underlying psychodynamics cannot be unraveled unless the clinician is sensitive and sensible to address the issues that the clients are “unconsciously” struggling with. Attending to the persons unconditionally and empathetically is the “first line of treatment” for those who struggle with sexual conflicts.

Sexual Abuse

A study on children in India conducted by the Ministry of Women and Child Development, Government of India, found that around 42% of the children undergo sexual abuse in one form or the other, ⁹ which is a huge number and indicates poor physical, behavioral, social, and mental health outcomes. ¹⁰ Of late, children have started sharing their experiences with the significant members of the family or caregivers, but still it is underreported. ¹¹ However, helping them to get over the trauma requires skilled intervention for which we need to develop a practice guideline, which is long overdue. Adolescence is the appropriate period when the “unfinished business” from childhood can be worked through and the psychologists working in schools, who are trained in dealing with trauma and sexual abuse can facilitate them to resolve the issues.^{12, 13} Therapy can begin only through establishing a therapeutic relationship between the child and the therapist built on making the child feel secure, supported, and believed about the abuse. Helping the child achieve resilience and feel empowered depends on the relationship built with children who have experienced sexual abuse.

The Therapist’s Attitude to Sex and Sexuality

The type of sexual problems that were presented to us in the 1980s are changing and newer forms like porn addiction and “sexting” have appeared. ¹⁴ But what has not changed is the need for facilitating therapeutic alliance between the client and the therapist and the onus is on the therapists. The attitudes of people, who lived in this geographical region in ancient times, toward sex and sexuality as manifested in the Vatsyayan’s classical work Kama Sutra (aphorisms of love) presumed to be written between the first and sixth centuries are noteworthy. ¹⁵ It comprises of the 3 pillars of the Eastern thought: the “Dharma(Duty), Artha (worldly welfare), and Kama (sensual aspects of life), which represent the integrative functioning of the person. Sexuality was considered as an integral part of human personality and it is depicted in the art and sculpture even in highly esteemed places suggesting that it was considered to be sacred. How the attitudes turned around among those in the psychological helping profession in India making it a “taboo” is worth exploring? Although the training of therapists emphasizes various qualities that would help their clients, the fact that many psychologists are not sensitive to the issues may thwart our effort to help prevent the future generation from child sex abuse and helping those who we are bound to serve.

Is Sex a Taboo Even Among Some of the Psychologists?

The discomfort of psychology trainees in different branches including clinical psychology in providing care for persons with sexual problems and disorders and taking them up for assessment and treatment are of great concern. Before deciding to take up clinical psychology as a profession, the author visited the National Institute of Mental Health and Neurosciences, the only center for providing clinical psychology training at that time in South India, to explore whether the profession and the institute would be an appropriate one. The same year a senior of his was selected for the same course and within a short span of time the person quit the course leaving the author curious to know the reason. The person informed that the Thematic Apperception Test had pictures that were against the person’s faith and that administering them was even more difficult and hence could not cope with the course. However, after the author joined the institute, he came to know that the person while presenting the case history in small groups had omitted sexual history and when another member of the team asked about it, the person broke down and quit the course irrespective of the support that was offered. Even before, in 1974, a student of clinical psychology had difficulty providing sexual counseling to a client of the opposite gender and broke down, when the request for a change of client was turned down by the supervisor. ¹⁶

Time does not seem to make a difference. 25 years later, in 2005 trainee clinical psychologists who were “all women” group showed much resistance in discussing about sexual dysfunction and sex therapy, the topics that were part of the curriculum. Irrespective of having a woman faculty member in the group, all of them withdrew and played an articulated game which was well orchestrated by some other women faculty members who had never helped clients who had sexual dysfunction and “prevented” the trainees from acquiring the skills. If clinical psychologists and psychologists cannot facilitate people to talk about their sexual problems who else can do it in a comforting manner? Although Kama Sutra originated from India, clinical psychologists in India appear to be taking a back seat when it comes to sex therapy. ¹⁶ Therefore, if the psychologists and the clinical psychologists are not equipped to take up what is expected of them, people who have different kinds of sexual diversions and dysfunctions land up with quacks and alternate therapists who provide treatments which are not evidence based and the blame has to be borne by the “psychology profession in India.”

Can Training Help Improve?

Though there are no big data and experimental evidence to substantiate several of the psychoanalytical concepts, discussing and debating Freud’s theories by the psychologists in making provided an opportunity for each one to be familiar with the “possible role of sexuality” influencing the development of personality in the 1980s. A lack of familiarity with the concepts and the neglect of orienting the trainees to the psychodynamic psychotherapy deprived the psychology student the opportunity to become aware of the importance of sexuality. Manual-based newer forms of therapy may not help one to explore and unravel the “dynamics.” ¹⁷

It is also quite possible that the prospective therapist’s own anxiety and “unfinished business” are leading to the discomfort in exploring the sexual functioning of clients, identification of the problems and providing them with appropriate treatment. While asking to list down the personal problems faced by the postgraduate students of psychology of a prestigious university in the country, there were omissions of issues related to sexuality and gender. It was also felt that the group was highly sensitive toward the topic of sexual health. Later it was reported by the group that “talking about sexual topics is a very sensitive one for most of the students here” and that this is not an isolated event. ¹⁸

While training the counselors in sexual health and reproductive health projects in Kerala, it was interesting to observe that through systematic training using video-recorded feedback, the participants could achieve adequate skills in different areas of sexual health. Interestingly, clients who had undergone sex therapy for their problems appeared to be better educators to their peer group, not only in dispelling misconcepts but also in transferring the knowledge that they had acquired during the therapy. The information thus transmitted had helped their peers develop a better understanding of one’s sexuality, and even helped to get over their problems. So, it is possible to train the students of psychology to deal with this sensitive topic, provided the professional community makes a concerted effort. Systematic research on therapist’s fears and perspectives in treating different sexual dysfunctions may bring up issues, if there are any, that are peculiar to our cultural context and milieu.^{19, 20}

Traversing Through a Newer Path

From a professional perspective there are a good number of clients who require help to resolve their problems related to sexuality in both urban ²¹ and rural areas. ²² Therefore, the prospective clinical psychologists and counseling psychologists irrespective of their work setting need to be equipped to take up the challenge. In authors’ experience, professionals had reported that they would prefer to get accurate information about sexual functions from their own peer group. Hence, during the period of professional training, they can be provided with scientific information about sex and sexuality and be equipped with the skill to communicate the same to another person or group of the same gender and/or of the opposite gender, without shame, guilt, and inhibitions. This is an urgent need since there are increasing numbers of people of different age groups, wanting to clarify and seek help for their sexual problems.

At the national level, the need to appoint a psychological help provider in every educational institution is on the anvil and, therefore, the psychologists need to acquire the adequate and appropriate skills to take up the challenge and perform the assigned tasks effectively. Professionals who opt to be in such jobs need to be trained to be comfortable enough to deal with the issues related to sexuality and do justice to the requisite job profile than shying away from what is expected of them. How much relief it would bring to those who are suffering would be known only if one is willing to listen to the verbal and nonverbal communication of those who are on the other side. With the help of trained supervisors, let us together travel through a path that may appear to be unconventional and unorthodox but that leads to the improved quality of life or rather sexual life which leads to the wellness and happiness of people of all ages. Since we are deeply concerned about “Make in India,” let us make best use of Kama Sutra, the text of “master piece of sexual science” which is “made in India,” and provide the world, without fear, unbiased perspectives about sexuality.