Understanding Muslim clients: Cultivating effective practices

1. Affirmative Practice with Muslim Clients Increasing Knowledge, Skills, and Awareness for Working Effectively with Muslim Clients Hamid Mirsalimi, Ph.D., ABPP 981 Canton Street, Suite 200C Roswell, GA 30075 1784A Century Blvd. Atlanta, GA 30345 (404) 579-1987 www.drmirsalimi.com ---------------------------------------- Department of Clinical Psychology Georgia School of Professional Psychology at Argosy University/Atlanta

2. Learning Objectives • In this workshop we will discuss: • Within group diversity in Muslim communities • Ecological systems theory • Application of ecological systems theory to provide a framework in understanding Muslim clients • Cultural transference and cultural countertransference • Acculturation and enculturation • Importance of collectivism in Muslim thought and family and community dynamics • Specific approaches that should be considered in providing therapy to Muslim clients

3. Within Group Diversity • Consider the parallel • Within Group Diversity • Muslims from various national, ethnic, and racial backgrounds. • Degree of belief in major philosophical tenets of Islam • Degree of belief in the need to practice behavioral mandates of Islam

4. Within Group Diversity (continued) • Muslim’s born and raised outside the U.S. vs. those born and raised within the U.S. • Degree of acculturation (taking on the culture of the U.S.) • Degree of enculturation (process of learning and adopting one’s own culture) • Individuals who were born within a Muslim family vs. Individuals who have converted to Islam

5. Within Group Diversity (continued) • Differential rates of acculturation and enculturation within a dyad • Differential rates of acculturation and enculturation within a family

6. Ecological Systems TheoryUrie Bronfenbrenner

7. Islam in the United States • Religion of about 1.6 billion people in the world or about 23% of the world population (Pew research) • Religion of about 3.3 million in the United States, or about 1% of the U.S. population (Pew research)

8. Islam and Muslims • Second largest religion in the world • Indonesia has the largest Muslim population with nearly 170 million Muslims • “Islam” comes from Arabic “salema” meaning peace, purity. • It also is related to the word “taslim” which means “surrender” or submission to the will of god. • “Muslim” denotes one who is a believer of Islam literally translates as “one who submits to the will of God.”

9. Current Zeitgeist • A Roper poll has shown that more than 50% of the people in the U.S. who were surveyed endorsed the view that Islam is • Inherently anti-American, anti-Western, or supportive of terrorism. • Only 5% of those who were surveyed had ever come in contact with a person who was Muslim. • 9/11 has fueled such prejudgments

10. History • Islam began in 7th-century Arabia (current Saudi Arabia) • Mohammad (the prophet) and his background: • A businessman in the city of Mecca, who did an annual meditation in a cave in the Mountain of Hira. • During the annual meditation, he would fast, pray, and give money to the poor.

11. History (continued) • Mohammad: • Was deeply troubled by the state of religious affairs in Arabia • Was concerned with treatment of the poor, the elderly, and women; and with slavery. • It has been said that “On the 17th of Ramadan, 610 A.D., while meditating in the cave of Hira, the angel Gabriel brought the first of 6340 verses of the Qur’an to Mohammad. Over the next 22 years, it is believed that the angel Gabriel continued to bring the message of God to Mohammad, who, in turn, preached to the people of Arabia until his death in 632 A.D.” Saba, et al. (2004) p.636

12. History (continued) • Mohammad’s Miracle: The Quran • Early Islam: Notion of rescuing the oppressed • Bilal • Arab invasion of Iran and surrounding countries • Sunni vs. Shiite Muslims

13. Five Basic Pillars of Islam • There is only one God and Mohammad is the messenger • Prayer – 5 times per day • An annual donation (Zakat); it intended to be used to help the poor • Fasting – Refraining from food and liquid from sundown to sunset • Pilgrimage to Mecca

14. Three Important Sources of Religious Doctrine • The Quran • Hadith (what prophet Mohammad said or did) • (in Shiite Islam) “Mojtahed” or “source to follow” - typically a high ranking clergy (Ayatollah) who has written a book of rules and conduct (similar to the Pope).

15. Several Important Concepts • The Golden Rule Applies • Turning the other cheek does not • Intimate relationship between men and women prior to marriage is prohibited • Importance of fairness • Importance of generosity • Importance of recognizing oppression and then attending to the oppressed

16. Therapeutically Important Concepts • Importance of family – Collectivistic societies • Individualism is mostly frowned upon • Importance of traditions • Importance of honor and respect • Traditional family hierarchy: • Fathers are typically heads of households • Sons are typically given more status and power

17. Specific Variables to Consider in Problem Formulations • Degree of acculturation (taking on the culture of the U.S.) • Degree of enculturation (process of learning and adopting one’s own culture) • Degree of rigidity in thinking vs. openness to other opinions

18. Cultural transference • Feelings and reactions that a patient may have toward a therapist of a different ethnic background based on the patient’s previous experiences with people of the same ethnic background as the therapist. Ridley, 1989

19. Cultural Transference Exercise • In small groups of 2 or 3, discuss what you know about the way Muslims are being viewed and treated in the U.S. Then discuss possible cultural transferences toward you as the therapist. • Discussion

20. Cultural Countertransference • Feelings and reactions of a therapist toward a patient from a different ethnic background, based on previous experiences and reactions toward others of that ethnic background. Ridley, 1989

21. Cultural Countertransference Exercise • In small groups of 2 or 3, discuss your previous experiences (via personal interaction, through media, etc.) with Muslims and how those experiences may shape a countertransference reaction from you toward your Muslim clients. • Discussion

22. Religious Conservatism and Attitudes Toward Therapy • More conservative (and at times less acculturated) Muslims tend to be more rigid in their thinking • More tendency toward all-or-nothing thinking • More self-righteousness • More conservative (and at times less acculturated) Muslims tend to have more negative attitudes toward mental health issues and mental health treatment.

23. Religious Conservatism and Attitudes Toward Therapy (continued) • More conservative (and at times less acculturated) Muslims are more likely to view mental illness as the work of the devil • Hence, fear may be strong, and obsessional behaviors (e.g., obsessional praying, washing) may be practiced • At times of tremendous need for mental health treatment (e.g., severe depression or anxiety), conservative and less acculturated Muslims are likely to seek psychiatric medication from a primary are physician.

24. Who May Seek Therapy? • More moderate, less conservative, and more acculturated Muslims. • Families with a member who has a severe mental health issue (e.g., severe depression; severe anxiety; severe OCD; severe panic attacks; bipolar disorder; schizophrenia) • Couples with differential levels of acculturation and enculturation • Families with differential levels of acculturation and enculturation

25. Common Mental Health Issues • Refugee issues • Political Anxiety (post 9/11; Trump policies, etc.) • Depression and Suicide • Alcoholism and Drug Abuse • PTSD • Women’s issues • LGBTQ Issues • Couples and Family issues • Other religious minority issues

26. Therapeutic Recommendations • Establishing rapport • Be welcoming • Be aware of negative stereotypes • Be aware of discrimination • Ask questions • Ask about their pre-existing notions about therapy • Pay attention to their therapeutic goals (they may differ from yours!)

27. Therapeutic Recommendations (continued) • Go slow; don’t get frustrated with slow pace of disclosure • “the patient stone” • Think collectivistically • Consider cultural transference • Consider cultural countertransference • Use Motivational Interviewing to plant seeds

28. Therapeutic Recommendations (continued) • Inquire from patients how their problem would have been resolved if they were still within their support community (e.g., newly married women who recently immigrated to the U.S.) • Inquire about client’s own resources • With couples and families, if there is an aggressor, appeal to his/her sense of fairness and honor (e.g., “you are better than this!”)

29. With patient in danger of suicide, don’t ask whether they wish to end their life, instead, ask whether they wish god would take their life, or would let them die. • Explore identity issues • Consider Ronnie Janoff-Bulman’s assumptive world hypothesis and the shattering of assumptions: • The world is benevolent • The world is meaningful • The self is worthy

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31. Review • In this workshop we discussed: • Within group diversity in Muslim communities • Ecological systems theory • Application of ecological systems theory as a framework in the understanding Muslim clients • Cultural transference and cultural countertransference • Acculturation and enculturation • Importance of collectivism in Muslim thought and family and community dynamics • Specific approaches that should be considered in providing therapy to Muslim clients

32. References and Resources • Abu-Raiya, H. (2013). The psychology of islam: Current empirically based knowledge, potential challenges, and directions for future research. In K. I. Pargament, J. J. Exline & J. W. Jones (Eds.), APA handbook of psychology, religion, and spirituality (vol 1): Context, theory, and research; APA handbook of psychology, religion, and spirituality (vol 1): Context, theory, and research (pp. 681-695, Chapter xxvii, 740 Pages) American Psychological Association, Washington, DC. doi:http://dx.doi.org.libproxy.edmc.edu/10.1037/14045-038 • Abu-Raiya, H., & Pargament, K. I. (2011). Empirically based psychology of islam: Summary and critique of the literature. Mental Health, Religion & Culture, 14(2), 93-115. doi:http://dx.doi.org.libproxy.edmc.edu/10.1080/13674670903426482

33. References and Resources (continued) • Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma Free Press, New York, NY. Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com.libproxy.edmc.edu/docview/618214695?accountid=34899 • Kizilhan, J. I. (2014). Religious and cultural aspects of psychotherapy in muslim patients from tradition-oriented societies. International Review of Psychiatry, 26(3), 335-343. doi:http://dx.doi.org.libproxy.edmc.edu/10.3109/09540261.2014.899203

34. References and Resources (continued) • Ridley, C. R. (1989). Racism in counseling as an adversive behavioral process. In P. B. Pedersen, J. G. Draguns, W. J. Lonner & J. E. Trimble (Eds.), 3rd ed.; counseling across cultures (3rd ed.) (3rd ed. ed., pp. 55-77, Chapter xii, 402 Pages) University of Hawaii Press, Honolulu, HI. Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com.libproxy.edmc.edu/docview/617678625?accountid=34899

35. References and Resources (continued) • Saba, R. A., Liu, W. M., & Humedian, M. (2004). Islam 101: Understanding the religion and therapy implications. Professional Psychology : Research and Practice, 35(6), 635-642. Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com.libproxy.edmc.edu/docview/224852097?accountid=34899