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 Psychologys 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 Acceptance and Commitment
attention and acceptance of the here and now. Metacognitive awareness. Thoughts/feelings as passing events rather than inherent aspects of the self or reality

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)
Muslim scholars described and taught cognitive Early CBT 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 happen to us?

Homework to research topic, eg why does adversity

 Contemplation of the relevant text from

burden greater than it can bear (23:62)

the Quran eg. On no soul do We place a

Aim; re-alignment of competing beliefs. I

could have died. I didnt, 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 realignment 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