The Varieties of Religious Therapy: Islam

Psi with Crescent and Star, by WG

The Varieties of Religious Therapy (VRT) blog series features representatives from twelve belief systems discussing how they integrate faith with their approach to psychotherapy. This installment is an interview with a Muslim clinician and scholar. See the Introduction for a full description of VRT and the table of contents.

Islam is a monotheistic religion based on revelations to the Prophet Muhammad 1400 years ago which were recorded in the sacred Qur'an (Koran). The word islam in Arabic means "submission," reflecting the central tenent of submitting to the will of God. Islam is the second largest religion with about 1.5 billion Muslims worldwide.

Hanan Dover (MA, University of Western Sydney) is Managing Director and Forensic Psychologist at PsychCentral Psychological and Consulting Services, serving eight Sydney, Australia locations. She has been affiliated with the Arabic Mental Health Professionals Network, the Journal of Muslim Mental Health, and was a Founding Member of the International Association of Muslim Psychologists and the non-profit Mission of Hope. In 2011 she was awarded the Women of the West Award - Highly Commend - from the University of Western Sydney for her contributions to the mental health resources in her community.

Please enjoy this VRT response from a truly dedicated clinician and scholar:

What is the role of religion or spirituality in your clinical practice?

I work in an area of Sydney, Australia where many clients come from differing ethnic, religious and spiritual backgrounds (mainly from Muslim and Christian faiths). Many of our practitioners have developed a strong interest in the relationship between the influence of culture, religion, spirituality and psychology, and how this relates in clinical practice. I consult as psychologist with the majority of clients having a religious and/or spiritual worldview. By adopting an approach where their worldviews are invited, it allows me as a psychologist to listen to their narrative to get in touch with the human strengths of thought, feeling, behavior, spiritual and/or religious experiences that are beneficial in therapy.

Religious and spiritual worldviews are not imposed on clients, but are only included upon the consent given by clients, or requested by clients.

In Islam, religion and spirituality are not mutually exclusive as you cannot have one without the other. Other religious and spiritual traditions may see them as separate where you can have one over the other. Spirituality forms part of the religion and human beings in Islam are spiritual beings. An individual's relationship with Allah* is the central component of Islamic spirituality. In the theological underpinnings of understanding human nature and the nature of human beings, what distinguishes humans from animals and angels is that Allah has breathed in the Divine Spirit in the unborn child whilst in the mother's womb. Thus, the Divine spirit is what makes human beings more blessed than all other creations created by God.

How does your technique or theory differ from mainstream psychotherapy?

The technique used in therapy is about accepting and acknowledging that many religious, spiritual, and ethnic clients believe that God may be a central part of understanding themselves, their core values, and being part of the solution as to why they present for therapy. In mainstream psychology, religion could be considered an antithesis to the discipline or science of psychology. However, psychology is not a hard science and psychologists in practice are people's persons. Culture, religion, and spirituality can form part of the client's problem but can also be part of the client's solution so avoiding these underlying core issues limits therapy. A client's core values in religion and spirituality can form a central focus in human life, so understanding and knowing this should be used by the clinician as a resource to aid therapy. It is not the same as pastoral care, but is the ability to skillfully apply evidenced-based psychological interventions and the client's religious and spiritual narratives in clinical practice.

I was born into a Muslim family, studied courses about Islam and its perspectives about human nature, and am a practicing Muslim. I am able to see and understand how it is important to employ Islamic views of human nature whilst using different psychotherapeutic strategies and evidence-based treatments to deliver a holistic service to Muslim clients. Often, in my experience, Muslim clients will search for Muslim psychologists because they know their lived, personal, and religious/spiritual experiences may not be understood by therapists who are not Muslim. I run a clinic in eight different locations across Sydney, and often the first question clients ask is for a therapist who adheres to their religious belief. This is expected, especially when we are located in suburbs with high concentrations of ethnic, migrant, refugee communities. In six years we have gone from one clinic to eight because we are able to cater the needs of those who have culturally and religiously diverse needs.

Further, I would use Quranic metaphors with Muslim clients because it is an effective communication style for those who place imagination and metaphors central to their everyday life as it is reflected in the language of the Quran and Hadith**.

A new client comes to therapy reporting his main problem is feeling detached from God. How would you proceed?

In general, having a secure attachment has been linked to over-all wellbeing, coping, better mental health outcomes, enhanced self-esteem, and stronger relationship functioning. Insecure attachments have been found to associated with poorer wellbeing, mental health outcomes, and poorer coping skills. Thus, having a healthy attachment to God then, would also be linked to better psychological functioning.

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There is a difference in how Christians and Muslims understand and perceive attachment towards God. The Christian traditions tend to use the metaphor of human attachment to explain a central notion of divine-human relationships. So, God in the Christian experience is perceived to function psychologically in a manner similar to the function of a human attachment figure. Christians experience God as Holy Spirit, Father, and Son. In Islam, there is no reference to these to explain God's existence, but God is described in terms of Divine attributes. In relation to attachment to God, one of the most important attributes is His Omnipresence. God's Omnipresence assures individuals of His availability and access to everyone without limiting or reducing Him in time or space, or material boundaries. There are many references in the Quran as to the closeness of Allah to human beings.

As part of the initial assessment process, asking about the client's religious and spiritual beliefs would be ascertained in order to explore the client's level of religiosity and spirituality at the time of the assessment. If the client is feeling detached from God, then it would convey that a) the client had developed religious faith which may have been a powerful source of meaning and purpose in their life and, b) a feeling of a sense of disconnection from God is troubling for the client. Through the questioning and responses the client-practitioner, it would hopefully allow the client to engage in their own self-discovery about their relationship with God. Because Islamic scriptural sources emphasize an Omnipresent, Loving and Forgiving, Merciful and Compassionate God, it becomes easily to remind, convey, suggest to the Muslim client of God's close reality.

What is the relationship between sin and psychopathology?

Firstly, and most importantly, I need to make note that in Islam, human beings are not born in sin. Human beings are born in a natural pure state of purity and goodness. This state is called "fitrah" in both the Quran and Hadith, which denotes the natural disposition to obey and understand God. It is similar to a moral compass where we turn to God or re-orient ourselves towards God. This is achieved by performing good and avoiding sinful acts. In terms of the relationship between sin and psychopathology, Islam recognises that having what is called "spiritual diseases of the heart," (e.g. envy, greed, heedlessness, excessive anger, lying, cheating, etc.) can lead to issues of psychopathology. Therefore, by continuously striving to re-orient one's self towards God via acts of worship, rituals, good actions, etc., they would least likely have issues with psychopathology. And this is no different to psychological health as committing to acts of goodness leads to psychological health and overall wellbeing and negative personal characteristics can also lead to psychological imbalance and poor over wellbeing and functioning.

But all is not doomed, as Allah states in the Quran that He is the Most Forgiving, the Most Merciful, and Most Compassionate and asks those who sin to repent and ask for forgiveness from God. Usually reminding clients about this, is healing and empowering in itself. And we know from psychological research literature that forgiveness has many health benefits, including psychological.

Who or what is the primary agent of change in therapy?

The primary agent of change in therapy is generally considered to be the client themselves. Although Muslims believe that a human being is instructed to internally strive (jihad) and make effort to towards beneficial change, it is the Will of God to decide whether or not to create that change. In therapy, I inform the client that they must travel on the journey of personal change and that I am the compass or guide that they can chose to take, or not, towards their desired destination. The most important person on that journey is themselves as they need to travel in order to try and get closer to their destination or goal, but that they need to build up resources in order to support their sense of direction which is why they are coming to therapy. When they thank me for helping them progress in their lives, I do remind them that it was all from God and His Will. Hence, change in therapy is relational where there is the client, the therapist, and God. Except that God's role is Divine, and is Superior.

What is the most difficult part of practicing psychotherapy while maintaining your beliefs?

I think one of the most difficult aspects of practicing as a psychologist whilst being an observant Muslim is when clients make choices in their lives I may believe creates injustice to one's own self, and then I am asked to help them live out those experiences. However, I have learned very quickly that it is not my place to impose my own personal values and perspectives onto anyone else and the human dignity of a person should be respected. Clients have their own lived experiences and values, and make their own choices, so the non-judgmental approach to therapy frees up any unnecessary anxiety I may have. Respecting one's own and other's human dignity and is central to Islam, so living by those principles had made it easier.

One of the most difficult aspects I have with counseling Muslims is when they ask for theological advice and they expect the "Muslim psychologist" to know so much about the Islamic religion. Sometimes they are expected to provide information that goes beyond the knowledge and experience of a psychologist. I tend to refer them to their local Shaykh, Imam, or religious leader as I inform them that psychology is not a place to access religious information. However, I will use the basic theological understanding I have in clinical practice when it is highly useful in cognitive-restructuring harmful views and beliefs. For example, if a female victim of domestic violence justifies herself being a victim because she has been told by her husband or family member that her husband is allowed to be violent, I would inform her about the Quranic verses and Hadith that theological suggest otherwise. Providing these examples if more empowering for a practicing Muslim than merely stating that it is against the law.

What is the most rewarding part?

Without a doubt, the most rewarding part of my role is seeing clients' psychological growth take shape, and thereby journeying towards achieving overall psychological wellbeing. Also, I work with a great team of psychologists who have incredible respect for one another's cultural, religious, spiritual, linguistic, and clinical competence and it provides and enriching workplace experience.

I wear a plain coloured, off-white hijab (an Islamic head veil worn by females). So when I am treating clients (even the non-Muslim clients), they comment on how peaceful they feel when they are in therapy. I never intended for the choice of style of hijab, but it appears to be a beneficial by-product. When I do counsel practicing Christian clients and I invite them to explore their own values so I can understand their narratives, they are surprised to hear when I am suggesting that they adopt certain religious/spiritual practices and activities that are reflective of their own religious and spiritual values. Perhaps, because I look observably Muslim, they do not expect it. But, being a psychologist who believes that our goal is to help clients to alleviate their distress, reduce their symptomology, problem solve, to provide psycho-education and solutions that involve assisting them to access their internal resources (religious, moral, spiritual, personal), is empowering. It helps the client believe in their own selves. And those clients who are religious, I can see that their faith, healthy attachment and connection with God can enhance therapeutic progress because they can rely on, and put their trust in, a Higher Power during their journey of therapeutic recovery.

Further, with wearing the hijab, when clients who are non-Muslim who present for the first time I can tell from their body reaction when I walk to the waiting room to call them into my therapy room, that they appear a little surprised that their psychologist is a Muslim (because of the identifiable hijab). However, I am always confident that as soon as we are in the therapy room and I open my mouth to start speaking that all their initial preconceptions are diminished, which is generally the outcome.

*Allah is the Arabic name for God in the Quran that is used universally amongst Muslims
**Quran and Hadith are the two primary sources of Islamic scriptures. Quran is the Holy Book and Hadith is the Narrations of the Traditions of the Prophet Muhammad (peace and blessing be upon him).

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