Working with Muslim Clients: Grief, Terminal Illness

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Working with Muslim Clients Grief, Terminal
Illness Bereavement

• Psychology
• from an
• Islamic Perspective
• Interest Group
• CBT Interventions
• Shehzi Yusaf Wendy Sawtell
• Clinical Psychologists

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Program Outline

• Normal Grief
• Complications
• Therapeutic Approaches
• Cognitive Behavioural Therapy
• CBT-Islamic application
• Islamic Beliefs the basics
• Case Scenarios
• Religious Assessment
• Interventions putting it together
• Therapist Considerations

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Normal Grief

• Cognitive Sx
• Disbelief / Confusion/Memory
• Preoccupation / Obsessive thoughts
• Sense of presence / Hallucinations / Dreams
• Behavioural/ Physiological Sx
• Sleep / appetite disturbance
• Social withdrawal / loss of interest
• Avoidance of reminders
• Crying / sighing / agitation / restlessness
• Emotional Responses
• Sadness / shock / anger / guilt / anxiety /
  denial / irritability / worry /

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Risk Factors

• Hx of
• psychopathology
• Stress related medical cond.
• Unexpected or violent death.
• Death of spouse / child
• High dependency on deceased
• Lack of social support

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Complications

• Post Traumatic Stress Reaction
• Sudden traumatic death
• Diagnosis of terminal illness
• Complicated Grief
• Lack of acceptance
• Major / Clinical Depression
• Premorbid risk factors

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Therapeutic Approaches

• Psychodynamic
• Rogerian / Humanistic
• Systems Family Therapy
• Cognitive Behavioural Therapy

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Cognitive Behavioural Therapy

• Empirically Derived
• Scientist practitioner model
• Evidence based interventions / optimised
  outcomes
• Emphasizes Ax / Outcome

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CBT Model

• Situation
• Thoughts
• Emotions Physiology
• Behaviour

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Cognitive Restructuring

• Identifying and challenging
• automatic negative thoughts,
• dysfunctional attitudes,
• Unrealistic expectations
• Irrational beliefs / schemas
• Muslim scholars have long held that emotional
  dysfunction is a by-product of irrational
  negative thinking (eg. Al Ghazali 11th Century).

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What Works for Muslims

• Cognitive Behaviour Therapy! (Badri.M,2000)
• Highly detailed Islamic belief / schematic
  system
• Islamic teachings / practices embody potent
  cognitive behavioural prescriptions decreases
  physiological arousal (anxiety) and enhanced
  emotional functioning (mood management).
• Used by early Muslim scholars exposure,
  cognitive restructuring.
• Cognitive restructuring is fundamentally
  characteristic of Islamic thinking style.

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Cognitive Schemas

• Muslims prescribe to religious schema above all
  other competing schema (eg. Political,
  traditional etc)
• Islam is a powerful instrument for cognitive
  realignment
• Islamic psychology uses CBT, offering key to
  unlock / access / modify schema for enhanced pt
  wellbeing / outcomes.
• Issue of CONGRUENCE.

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Islamic Beliefs the basics

• Journey of life
• Purpose to be Allahs viceroy
• Meaning of illness,disability,adversity
• Death is a beginning of eternal of life
• Time of death preordained
• No human being can die save by Allahs leave at
  term preordained (Q 3145)
• All creation / circumstance in accordance with
  Allahs Will.
• Muslims total submission and trust in Allah
  (Tawakul)

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Islamic Beliefscont

• No individual is burdened beyond its capacity to
  cope
• Accountability for all deeds
• Concept of Free Will
• Good deeds rewarded many fold
• Repentence Forgiveness
• ..Despair not of the mercy of Allah, for Allah
  forgives all sins, for He is Oft Forgiving most
  merciful. (Q,3953)

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Islamic Beliefs cont

• Patience (Sabr)
• ..to those who patiently persevere who say,
  when afflicted with calamity To Allah we
  belong, and to Him is our return they are those
  on whom (descend) blessings from their Lord, and
  mercy, and they are the ones that receive
  guidance
• (Q 2155-157) After hardship comes ease surely
  after hardship comes ease (Q, 945-6).
• Actions benefiting the deceased
• Sadaqa charity
• Dua supplication
• Ongoing blessings / rewards

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Assessment

• Standard Biopsychosocial Ax
• Spiritual Ax
• How do you make sense of what is going on for
  you?
• Are you religious? (What religion are you?)
• How does Islam guide you in looking at this?
• How is this way of looking at things helpful?
  (thoughts, feelings, behaviours)
• How does this help you cope with the pain? Deal
  with your stress?
• What sorts of things do you do that you find
  helpful in relaxing you?

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Islamic Interventions

• Wudu ablution
• (spiritual / physical cleansing)
• Initiation / motivation / self-care /refreshing /
  distraction / diversion
• Salat Prayers 5 times per day
• Mindfulness / relaxation / decrease physiological
  arousal / exercise stretches
• Recitation of the Quranic verses
• Dua Supplication direct communication /
  connection to Allah
• No intercession needed
• Zikr- Rememberance of Allah (99 attributes of
  Allah) eg. Recitation and contemplation of the
  names illicit same attributes in us. Eg. Saabir,
  Shaafi, Salamu,
• Breathing Allah Hu

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Community Support

• Protective Factors
• Social support typical of Islamic community
• Rituals gatherings, religious service,
  assisting the family (food, practical
  assistance), reading of the Quran, Zikr,
  normalizing death.

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Case Study 1

• Mona
• 32 yo mo., 6 chn b/w 15 and 2 yrs
• Multiple trauma / grief
• Eldest Hodgkin's 12 months of Rx at age 12.
• Daughter with moderate intellectual disability
• Displacement left homeland
• Jan. 06 backed van over 3 yo son
• Playing the holy shuffle got it!

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Case Study 2

• Nargis, 55 years old, married with 3 adult
  daughters, all married and settled. Had cervical
  cancer which she survived a decade ago.
  Oncologist did not order the relevant tests on
  the latest follow up visit resulting in secondary
  tumours not being picked up in her abdomen and
  gut. She collapsed a work a week later then she
  was taken to hospital and the cancer was
  discovered. Prognosis was very poor.
• Main psychological symptom was anger at
  oncologist but sense of frustration and injustice
  when he would not see her.
• Also depression because of late detection

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Scenarios

• Irrational Belief
• I cant take this anymore
• Islamic Reframe
• ..no soul is burdened with more than it can
  bear
• Irrational Belief
• .. I could have saved her, if onlyif onlymy
  fault
• Islamic Reframe
• ..it is Allahs Will.her time had come..nothing
  / no one could have prevented it

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Scenarios

• Irrational Belief
• Too late.. Not time to repenthavent done
  enough..I will got to hell..
• Islamic Reframe
• ..Allah loves all those who repent Oft giving
  most merciful
• Irrational Belief
• .. Why me? Im being punished I am bad.
• Islamic Reframe
• Illness and suffering cleanses a Muslims soul by
  diminishing their misdeeds Allah is testing me
  I must be patient persevere

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Therapist Considerations

• Awareness of own sensitivities / biases resolve
  them
• Dont be afraid to ask
• Convey curiosity, interest, respect
• Use Socratic questioning, reflection,
  summarizing, empathic listening
• Illicit self-affirming beliefs

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References

• Psychology from an Islamic Perspective
• Interest Group (PIPIG)
• www.groups.psychology.org.au/ipig/
• Books Articles
• Badri, M (2000). Comtemplation An Islamic
  Psychospiritual Study. Madeena Books, KL.
• www.quranicstudies.com\article42
• by Salma Yakoub