Spirituality in Clinical Practice:

An Islamic Perspective
Shehzi Yusaf
Clinical Psychologist
Bringing back the soul in psyche – ology

• Science and religion or spirituality do not mix

• Psychology’s endeavour to become a science
• Experimental psychology, behaviourism,
cognitive theories, attachment theory
• Neuroscience, reduction theory, brain-behaviour
Evidence based Treatments

• Behaviour Therapy
• Cognitive Therapy
• Cognitive Behaviour Therapy (CBT)
• Dialectical Behaviour Therapy (DBT)
• Interpersonal Psychotherapy (IPT)

But something is missing!

New third wave therapies

• Mindfulness Based CBT: non judgmental

attention and acceptance of the here and now.
Metacognitive awareness. Thoughts/feelings as passing
events rather than inherent aspects of the self or reality
• Acceptance and Commitment
Therapy(ACT):acceptance of internal experiences
instead of avoidance or control. Cognitive
defusion.Learning to live a valued life. Use of
mindfulness, goal setting, behaviour change.
What works for Muslim clients?
Cognitive Behaviour Therapy!(Badri.M,2000)
‘
•Early
CBTMuslim scholars described and taught cognitive
behavioural models and methods: SD, exposure,
cognitive restructuring, behaviour change

Cognitions underlie feelings and behaviour which are under our

voluntary control and can be changed (Ibn al Qayyim)

Graded exposure to the threat will lead to habituation of negative

feelings (Al Ghazali)

Contemplation and the rememberance of Allah (Zikr) is the key to

inner peace and well being
• Highly detailed Islamic belief / schematic
system

• Islamic teachings / practices embody potent

cognitive & behavioural prescriptions: decreases
physiological arousal (anxiety) and enhanced
emotional functioning (mood management).

• Cognitive restructuring is fundamentally

characteristic of Islamic thinking style prescribed
by early Muslim scholars eg Ibn al-Qayyim
• Muslims prescribe to religious schema
above all other competing schema (eg.
Familial, traditional, cultural)
• Islam is a powerful instrument for
cognitive realignment
• Islamic psychology uses CBT, offering key
to unlock / access / modify schema for
enhanced pt wellbeing / outcomes.
Mindfulness and Acceptance Based
Therapies
• Concept of Mindfulness identical to Islamic
contemplation and Sufism (eg Rumi)
• Methods similar: focus on breathing, Zikr and
“Allah Hu”
• Notion of unconditional acceptance of the here
and now akin to concept of total submission and
trust in Allah
Spiritual Assessment
General
• Are you spiritual?
• What is your religion?
• What do you think drives our mind and our body?
• Where do you believe we came from?
• What are your beliefs about the nature of Man?
• What happens when we die?
• What do you see as the purpose of life?
• Why does adversity happen to us?
• What does your faith say about acceptance?

Note: assess suitability and willingness of client to answer

Muslim

• You said that you are a Muslim, tell me about

some of your beliefs?
• How do you make sense of what is happening to
you?
• What does Islam say about this event?
• Why do you think it happened?
• As a Muslim how do you cope with this?

Identifies Muslim clients with various degrees of

faith, eg was born a Muslim but do not follow any of its
tenets to, Islam is an integral part of my life, I live and
breathe it.
• Further explore the level of knowledge
about Islam, their practice of Islam, their
cognitive evaluation of what it means for
them eg say prayers five times a day
because it is compulsory vs indepth
knowledge of why it is prescribed, what
are the benefits and how it is meant to be
said.
• Explore what spiritual practices they have,
eg fasting outside of Ramadhan, doing
Zikr, reading the Quran, contemplation,
Treatment

• CBT based as most suited to religious

clients including Muslims.

• Now ACT and MBCBT most effective

Components of Treatment
• Psychoeducation: nature, cause and
maintenance of the disorder.
• Cognitive restructuring/acceptance model
• Emotional distress management
• Exposure
• Problem solving
• Assertion training
• Activity scheduling
• Goal setting
Islamic Methods
Education from the Quran and Hadith.

• Human Nature. Concept of Fitra. every soul is born pure.

• Individual differences recognised in Islam (single ummah but

made you different so you may know each other, Allah gives some
more others, less)

• Concept of Rizq or what is due to us: sustenance

• Role of parents in Islam: Unconditional love and acceptance of

children. Parenting rules specified

• Homework to research topic, eg why does adversity happen to us?

• Contemplation of the relevant text from
the Quran eg. ‘On no soul do We place a
burden greater than it can bear’
(23:62)
• Aim; re-alignment of competing beliefs. “I
could have died. I didn’t, because my time
had not come”
Concept of the Self
• Aql (intellect, rational/reasoning mind)

• Qalb (spiritual heart, seat of knowledge,

intention, belief, justice)

• Nafs (ego, feelings, desires, -ve thoughts)

• Ruh (the spirit, the true human, the one in

charge, live on after physical death)
Aim
• To use the rational, reasoning mind (Aql) to problem
solve, understand ourselves and the world
• To develop the Heart (Qalb), make it pure, eg through
Sadaqa (charity), patience, compassion, kindness,
honesty.
• To tame the Nafs Ammara (lower negative self) via self
discipline
• To develop the Nafs Lawwama (self reproaching self) via
self analysis, remorse and repentence
• To continuously strive to achieve Nafs Mutmainnah
(peaceful self) via following the righteous path,
overcoming negative thoughts, feelings, behaviour. Use
of Zikr, prayers, contemplation, mindfulness.
• Teaching Mindfulness Meditation: Focus on
breathing and “Allah Hu”
• Application of Mindfulness to:

• Zikr (recitation of the 99 attributes of

Allah, Ya Sabir, Ya Qavi, Ya Salamu).

• Salat (prescribed prayers 5 times a day)

• Recitation of the Quran as a meditative

spiritual exercise.
Case Study
• 35 yr old Salman, married to a Christian. No children.
Involved in an MVA. Minor physical injuries. Developed
PTSD. Stopped driving for 4mnths. Sx of reliving (thgts,
images, emot arousal, hallucinations, nightmares,
flashbacks) avoidance (of thgts feelings situations,
amnesia, dissociation, detachment) hyperarousal
(irritability, insomnia, poor memory, startle,
hypervigilance at home and outside).
• IES: v. high. Impact: moderate on interpersonal/marital,
high on occupational and severe on social.
• Spiritual Ax: “Good” Muslim family
background but limited knowledge of the
essence, spiritual basis .
• Treatment: CBT plus the Islamic methods
and Mindfulness meditation. Exposure
imaginal and in-vivo. Cognitive re-
alignment re fear of death, chronic pain,
‘why me?’
• Outcome: V. effective. Reduction in all Sx,
increase in quality of life, in spirituality,
sense of self ‘peaceful’