Recognition that one is possessed of a mind in all its complexity.

It is the
acknowledgment, however vague, unwilling or conflicted, of a subjectivity that fates
one to episodic suffering through some of its ideas and feelings, simultaneously with
the knowledge, at some level of awareness, that the mind can help in containing
and processing disturbed thoughts.
By contrast, in Asian countries, for example in India, Chinese and Japan, the
patients have in their minds what might be called a relational model of the self. The
person derives hi nature of character interpersonally. He is constituted of
relationships. His distresses are disorders of relationship not only within his human,
but also his natural and cosmic orders. The need for attachment, connection, and
integration with others and with his natural and supernatural world represents the
pre-eminent motivational trust of the person, rather than the press or expression of
any biological individuality.
In Indonesia, the situation is more relatively complex because there are so
many different cultures (as there are thousands of ethnics) which affecting the
patients and therapists daily life. Biside culture, religion are also influence their
daily activities, the communitys life and in valuing the communitys traditions.
Furthermore, its often happens that the therapist culture and religion is different
with the patients culture and religion; therefore as therapists, psychiatrists and
psychologists, have to study at the least consider the cultural background and the
religion of their patients in order to have the capacity for empathy with their
patients.

Other factors influencing the psychotherapeutic approach

To understand the differences between therapists in different countries is to
view those differences in the context of other factors that influence therapists
description of their relationships. These factors include the therapists professional
background, experience level, and the theoretical orientation. In Indonesia, like in
many other countries, psychotherapy is done by psychotherapist and psychologist.
The theoretical orientations of the psychiatrists and psychologist, are in variety of
psychodynamic or psychoanalytically oriented, humanistic existentialist, cognitivebehavioral and some are mentioned themselves as being spiritual or religious
therapists.
Eunsun et al had done an international study on evaluation of the
psychotherapeutics relationship in six different countries (Korea, Belgium, France,
Germany, Israel and USA). Their study focused on the cultural influences shaping
therapists experiences of the therapeutic relationship with their patients. According
to their study, for the professional background, there was no significant differences
in relational style between medically trained and psychologically trained
psychotherapists. Unfortunately, we havent had any study for proving this evidence

in Indonesia. They also found that the therapists level of experience had an
influence on style of relating with respect to being warmly involved, and on the
other hand, with respect to being formal with patients (they categorized the
psychotherapists style in relating to patients as five category; warmly involved,
care-taking, active-directive, critical demanding and formal).

The culture in psychotherapeutic approach

The conflicting demands of Asian culture and of western psychotherapy,
however, are not always so easy to reconcile. The reconciliation becomes much
more difficult if the therapist and the patient do not share fundamental cultural
assumptions about human nature, human experience and the fulfilled human life.
The Asian therapist has absorbed from early childhood, stresses that
surrender to powers greater than the self is better than individual effort that source
of human strength lies in harmonious integration with ones group, in entering into
the living stream, naturally and unselfconsciously, of the communitys life and in
cherishing the communitys gods and traditions.
In Indonesia, although the people consist of so many ethnics, fortunately,
people are inherited and born of almost the same ancestral. The ancestral of most
Indonesian people who lived thousands years ago were animist. The cultural that
constructed by the ancestral were affecting peoples daily life and activities.
Next thousands years after that era, most Indonesian people were deeply
complied with what was mentioned in their belief system which was from Hindu
and Buddha in their personal and the communitys life and in valuing the
communitys traditions. The tendency to look at a person in transpersonal or
relational terms in reflected in all aspects of the culture. But some of them in east
Indonesia, such as Maluku, Papua, Celebes, and also in Java, are Christians. The
cultural which inherited from their ancestral were mixed with what they belief in
those religions, therefore, for instance, the Hindu in Bali, is different from Hindu in
India, for the reason that is also affected by the culture beside its rules and pattern
in the religion.
After Islam entering Indonesia (It was around the year of 1500), people
thoughts, behavior and activities were affected by Moslem belief. It transpired in
around 90% of Indonesian people. The cultural standard of moral and ethnics had
not been totally changed, except their belief system that the communitys gods that
previously plural, then it becoming single; they only believed in one God. A Muslim
is one who resigns himself to God and thereby professes the faith of al-Islam. In
order to be a true Muslim there things are necessary: faith, action according to that
faith and the realization of ones relation to God as result of action and obedience.
Most of that Moslem people than seemed to obey and follow the rules. The

communitys traditions afterward were gradually following the belief system too,
although it seemed that it had not totally changed, but it becoming mixed with the
previous one.
According to this condition, some of psychotherapists, specifically
psychiatrists, were tend to blend their approaches dealing with their patients,
between what they have learned from training which based on Western theories
with what they face and experiences in the field with their eastern patient. For
instance, with depressed patient, theories mentioned that we usually do not allow to
give advice or reassurance if the patient is still in his or her rage or very depressed
condition; but in fact, the patient usually asked the therapist to give advices,
because according to what they have been raised by culture and religion, that
surrender to the powers or the all mighty is greater than the self, and it is better
than individual effort. To response to this situation, many of therapists were not able
to stick on the psychotherapeutic principles, and they afterwards give their advices.
Fortunately, the patient responded well, he or she then seemed to be in a better
condition than before.

The current situation in Indonesia

In doing psychotherapy in our area, as well as in other country, is necessary
to consider the cultural standard of moral and ethics and social role of the patient.
As the amount of psychiatrists are too few compare to the total population,
the helping action towards mentally unstable and disturbed persons had been done
also by psychologist, counselors (who mostly have based training on educations),
udstadz (Islamic teacher who give lessons in guiding Islamic principles in life and
also teaching in reading Quran), priests (for Christians, Buddha, Khong Hu Chu, and
Hindu), and paranormals (who usually named as dukun or orang pinter). Fortunately
among those professions there looked as if not any conflict happened, as if each of
them had known their position, portion, and responsibilities. The psychiatrics,
Psychologist and counselors doing their job based on their so-called Westernized
knowledge and skill, where udstadz and priest worked based on rules written and
mentioned in the religion, on the other hand, paranormals do their work based on
traditional cultural belief systems which inherited form the ancestral.
As trained in Westernized resources and medical sciences, psychiatrics in
Indonesia are in a dilemma, because beside bond to the technical principles of the
psychotherapeutic approaches, they also have to adjust the mind, thoughts,
perception to those in the patients, which affected also by the cultural and religion
belief system. They are not only have the virtue of not questioning that because the
patients are usually basically want to ask advice, but they themselves as therapists
also have to distancing themselves from what they have been given and raised as
Eastern persons. Therefore in practice, they have difficulties applying therapeutics

techniques in their training on that eastern patient population. There are differences
in patient response to their techniques. Therapists are often left to their own
devices to build therapeutic rapport with their patient and resort to a paternalistic
kind of counseling (i.e. the Experimentally Supported Therapy) often with a religious
tinge, or outright religious or else resort or pharmacotherapy, perhaps with some
non specific reassurance gestures. As the consequences it built resistances in
psychotherapy, both in patients, and also in the therapists. Some of them are aware
of these resistances, but on the other hand the others are not. Fortunately, again,
the patient achieved better condition after therapy. This possibly because of the
good Therapeutic alliance in doctor-patient relationships, and could also be the
transference cured condition, beside the effect of pharmacologic agents that often
have been given too.

Conclusion
Assimilation of Western psychotherapeutic practice in Indonesia is not an
easy work, because of several factors that influences the condition, such as
different principles and approach between Westernized psychotherapeutic principles
and the Eastern approach which based on culture and religion belief system, also
the Indonesian therapists themselves as Easter person that had to adjust to what
they have trained.
As trained in Western resources and medical sciences, psychiatrists in
Indonesia are in dilemma in applying therapeutic techniques in their training on an
eastern patient population, because beside bond to the technical principles of the
psychotherapeutic approaches, they also have to adjust the mind, thoughts,
perception to those in the patients, which affected also by the cultural and religion
belief system. They are not only have the virtue of not questioning that because the
patients are usually basically want to ask advice, but they themselves as therapists
also have to distancing themselves from what they have been given and raised as
Eastern persons. Therefore in practice, they often left to their own devices to build
therapeutic rapport with their patient and resort to a paternalistic kind of counseling
often with a religious tinge, or outright religious or else resort or pharmacotherapy,
perhaps with some non specific reassurance gestures. As the consequences it built
resistances in psychotherapy, both in patients, and also in the therapists.
Fortunately, the patient changed to a better condition after therapy, its possibly
because of the good therapeutic alliance, and could also be the transference cured
condition, beside the effect of pharmacologic agents as well.