Spirituality in Clinical Practice: An Islamic Perspective

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Spirituality in Clinical Practice An Islamic
Perspective

• Shehzi Yusaf
• Clinical Psychologist

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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

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Evidence based Treatments

• Behaviour Therapy
• Cognitive Therapy
• Cognitive Behaviour Therapy (CBT)
• Dialectical Behaviour Therapy (DBT)
• Interpersonal Psychotherapy (IPT)
• But something is missing!

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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.

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What works for Muslim clients?
Cognitive Behaviour Therapy!(Badri.M,2000) Early
Muslim 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

• CBT

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• 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

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• 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.

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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

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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

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• 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.

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• 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,

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• Treatment
• CBT based as most suited to religious clients
  including Muslims.
• Now ACT and MBCBT most effective

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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

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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?

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• Contemplation of the relevant text from the Quran
  eg. On no soul do We place a burden greater than
  it can bear
• (2362)
• Aim re-alignment of competing beliefs. I could
  have died. I didnt, because my time had not
  come

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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)

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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.

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• 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.

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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.

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• 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

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