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Working with Muslim Clients: Grief, Terminal Illness & Bereavement
Psychology
from an
Islamic Perspective Interest Group
CBT InterventionsShehzi Yusaf & Wendy Sawtell
Clinical Psychologists
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
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 /
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
Complications
Post Traumatic Stress Reaction Sudden traumatic death Diagnosis of terminal illness
Complicated Grief Lack of acceptance
Major / Clinical Depression Premorbid risk factors
Therapeutic Approaches
Psychodynamic
Rogerian / Humanistic
Systems Family Therapy
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy
Empirically Derived Scientist practitioner model Evidence based interventions /
optimised outcomes Emphasizes Ax / Outcome
CBT Model
Situation
Thoughts
Emotions Physiology
Behaviour
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).
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.
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.
Islamic Beliefs the basics
Journey of life Purpose to be Allah’s 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 Allah’s leave at term preordained” (Q 3:145)
All creation / circumstance in accordance with Allah’s Will.
Muslims total submission and trust in Allah (Tawakul)
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,39:53)
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 2:155-157) “After hardship comes ease: surely after hardship comes ease” (Q, 94:5-6).
Actions benefiting the deceased Sadaqa: charityDua: supplication Ongoing blessings / rewards
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?
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 –stretchesRecitation of the Quranic verses
Dua –Supplication – direct communication / connection to Allah
No intercession neededZikr- 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”
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.
Case Study #1
Mona 32 yo mo., 6 ch’n 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!
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
Scenarios
Irrational Belief“I can’t take this anymore…”Islamic Reframe “..no soul is burdened with
more than it can bear…”Irrational Belief “.. I could have saved her, if
only…if only…my fault”Islamic Reframe“..it is Allah’s Will….her time had
come..nothing / no one could have prevented it”
Scenarios
Irrational Belief“Too late.. Not time to repent…haven’t
done enough..I will got to hell..”Islamic Reframe “..Allah loves all those who repent…
Oft giving most merciful…”Irrational Belief “.. Why me? I’m 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”
Therapist Considerations
Awareness of own sensitivities / biases – resolve them
Don’t be afraid to ask Convey curiosity, interest,
respect Use Socratic questioning,
reflection, summarizing, empathic listening
Illicit self-affirming beliefs
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