Spirituality in Clinical Practice: An Islamic

Perspective

Shehzi YusafClinical 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

• Behaviour TherapyBehaviour Therapy

• Cognitive TherapyCognitive Therapy

• Cognitive Behaviour Therapy (CBT)Cognitive Behaviour Therapy (CBT)

• Dialectical Behaviour Therapy (DBT)Dialectical Behaviour Therapy (DBT)

• Interpersonal Psychotherapy (IPT)Interpersonal Psychotherapy (IPT)

But something is missing! But something is missing!

Evidence based TreatmentsEvidence based Treatments

New third wave therapiesNew third wave therapies

• Mindfulness Based CBT: Mindfulness Based CBT: non judgmental non judgmental attention and acceptance of the here and now. attention and acceptance of the here and now. Metacognitive awareness. Thoughts/feelings as Metacognitive awareness. Thoughts/feelings as passing events rather than inherent aspects of the passing events rather than inherent aspects of the self or reality self or reality

• Acceptance and Commitment Acceptance and Commitment Therapy(ACT):Therapy(ACT):acceptance of internal acceptance of internal experiences instead of avoidance or control. experiences instead of avoidance or control. Cognitive defusion.Learning to live a valued life. Cognitive defusion.Learning to live a valued life. Use of mindfulness, goal setting, behaviour change.Use of mindfulness, goal setting, behaviour change.

What works for Muslim clients?What works for Muslim clients?

• CBTCBT

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

• 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 Muslims prescribe to religious schema above all other above all other competing competing schema (eg. schema (eg. Familial, traditional, cultural)Familial, traditional, cultural)

• Islam is a powerful instrument for Islam is a powerful instrument for cognitive cognitive realignmentrealignment

• Islamic psychology uses CBT, offering Islamic psychology uses CBT, offering key to unlock / access / modify schema key to unlock / access / modify schema for enhanced pt wellbeing / outcomes.for enhanced pt wellbeing / outcomes.

Mindfulness and Acceptance Based Mindfulness and Acceptance Based TherapiesTherapies

• Concept of Mindfulness identical to Islamic Concept of Mindfulness identical to Islamic contemplation and Sufism (eg Rumi)contemplation and Sufism (eg Rumi)

• Methods similar: focus on breathing, Zikr Methods similar: focus on breathing, Zikr and “Allah Hu”and “Allah Hu”

• Notion of unconditional acceptance of the Notion of unconditional acceptance of the here and now akin to concept of total here and now akin to concept of total submission and trust in Allahsubmission and trust in Allah

Spiritual AssessmentSpiritual AssessmentGeneralGeneral

• Are you spiritual? Are you spiritual? • What is your religion? What is your religion? • What do you think drives our mind and our body? What do you think drives our mind and our body? • Where do you believe we came from? Where do you believe we came from? • What are your beliefs about the nature of Man?What are your beliefs about the nature of Man?• What happens when we die? What happens when we die? • What do you see as the purpose of life? What do you see as the purpose of life? • Why does adversity happen to us? Why does adversity happen to us? • What does your faith say about acceptance?What does your faith say about acceptance?

Note: assess suitability and willingness of client to answerNote: assess suitability and willingness of client to answer

MuslimMuslim

• You said that you are a Muslim, tell me You said that you are a Muslim, tell me about some of your beliefs? about some of your beliefs?

• How do you make sense of what is How do you make sense of what is happening to you?happening to you?

• What does Islam say about this event?What does Islam say about this event?• Why do you think it happened?Why do you think it happened?• As a Muslim how do you cope with this?As a Muslim how do you cope with this?

Identifies Muslim clients with various degrees ofIdentifies Muslim clients with various degrees of faith, eg was born a Muslim but do not follow any faith, eg was born a Muslim but do not follow any

of its tenets to, Islam is an integral part of my of its tenets to, Islam is an integral part of my life, I live and breathe it.life, I live and breathe it.

• Further explore the level of knowledge Further explore the level of knowledge about Islam, their practice of Islam, their about Islam, their practice of Islam, their cognitive evaluation of what it means cognitive evaluation of what it means for them eg say prayers five times a day for them eg say prayers five times a day because it is compulsory vs indepth because it is compulsory vs indepth knowledge of why it is prescribed, what knowledge of why it is prescribed, what are the benefits and how it is meant to are the benefits and how it is meant to be said.be said.

• Explore what spiritual practices they Explore what spiritual practices they have, eg fasting outside of Ramadhan, have, eg fasting outside of Ramadhan, doing Zikr, reading the Quran, doing Zikr, reading the Quran, contemplation,contemplation,

TreatmentTreatment

• CBT based as most suited to religious CBT based as most suited to religious clients including Muslims.clients including Muslims.

• Now ACT and MBCBT most effective Now ACT and MBCBT most effective

Components of TreatmentComponents of Treatment• Psychoeducation: nature, cause and Psychoeducation: nature, cause and

maintenance of the disorder.maintenance of the disorder.

• Cognitive restructuring/acceptance modelCognitive restructuring/acceptance model

• Emotional distress managementEmotional distress management

• ExposureExposure

• Problem solvingProblem solving

• Assertion trainingAssertion training

• Activity schedulingActivity scheduling

• Goal settingGoal setting

Education from the Quran and Hadith.Education from the Quran and Hadith.

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

• Individual differences recognised in Islam (single ummah Individual differences recognised in Islam (single ummah but made you different so you may know each other, Allah but made you different so you may know each other, Allah gives some more others, less)gives some more others, less)

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

• Role of parents in Islam: Unconditional love and Role of parents in Islam: Unconditional love and acceptance of children. Parenting rules specifiedacceptance of children. Parenting rules specified

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

Islamic MethodsIslamic Methods

• Contemplation of the relevant text Contemplation of the relevant text from the Quran eg. ‘from the Quran eg. ‘On no soul do On no soul do We place a burden greater than it We place a burden greater than it can bear’can bear’

(23:62)(23:62)

• Aim; re-alignment of competing Aim; re-alignment of competing beliefs. “I could have died. I didn’t, beliefs. “I could have died. I didn’t, because my time had not come”because my time had not come”

Concept of the SelfConcept of the Self • Aql (intellect, rational/reasoning mind)Aql (intellect, rational/reasoning mind)

• Qalb (spiritual heart, seat of knowledge, Qalb (spiritual heart, seat of knowledge, intention, belief, justice) intention, belief, justice)

• Nafs (ego, feelings, desires, -ve thoughts)Nafs (ego, feelings, desires, -ve thoughts) • Ruh (the spirit, the true human, the one in Ruh (the spirit, the true human, the one in

charge, live on after physical death) charge, live on after physical death)

AimAim• To use the rational, reasoning mind (Aql) to To use the rational, reasoning mind (Aql) to

problem solve, understand ourselves and the worldproblem solve, understand ourselves and the world• To develop the Heart (Qalb), make it pure, eg To develop the Heart (Qalb), make it pure, eg

through Sadaqa (charity), patience, compassion, through Sadaqa (charity), patience, compassion, kindness, honesty.kindness, honesty.

• To tame the Nafs Ammara (lower negative self) via To tame the Nafs Ammara (lower negative self) via self disciplineself discipline

• To develop the Nafs Lawwama (self reproaching To develop the Nafs Lawwama (self reproaching self) via self analysis, remorse and repentenceself) via self analysis, remorse and repentence

• To continuously strive to achieve Nafs Mutmainnah To continuously strive to achieve Nafs Mutmainnah (peaceful self) via following the righteous path, (peaceful self) via following the righteous path, overcoming negative thoughts, feelings, overcoming negative thoughts, feelings, behaviour. Use of Zikr, prayers, contemplation, behaviour. Use of Zikr, prayers, contemplation, mindfulness.mindfulness.

• Teaching Mindfulness Meditation: Teaching Mindfulness Meditation: Focus on breathing and “Allah Hu”Focus on breathing and “Allah Hu”

• Application of Mindfulness to:Application of Mindfulness to:

• Zikr (recitation of the 99 attributes of Zikr (recitation of the 99 attributes of Allah, Ya Sabir, Ya Qavi, Ya Salamu).Allah, Ya Sabir, Ya Qavi, Ya Salamu).

• Salat (prescribed prayers 5 times a Salat (prescribed prayers 5 times a day)day)

• Recitation of the Quran as a Recitation of the Quran as a meditative spiritual exercise.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 Spiritual Ax: “Good” Muslim family background but limited knowledge of background but limited knowledge of the essence, spiritual basis .the essence, spiritual basis .

• Treatment: CBT plus the Islamic Treatment: CBT plus the Islamic methods and Mindfulness meditation. methods and Mindfulness meditation. Exposure imaginal and in-vivo. Exposure imaginal and in-vivo. Cognitive re-alignment re fear of Cognitive re-alignment re fear of death, chronic pain, ‘why me?’death, chronic pain, ‘why me?’

• Outcome: V. effective. Reduction in Outcome: V. effective. Reduction in all Sx, increase in quality of life, in all Sx, increase in quality of life, in spirituality, sense of self ‘peaceful’spirituality, sense of self ‘peaceful’