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Spirituality in Clinical Practice: An Islamic Perspective

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1 Spirituality in Clinical Practice: An Islamic Perspective
Shehzi Yusaf Clinical Psychologist Will give a brief hx and background about clinical psych.

2 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 Study of the psyche or the soul. Many believe that psychology lost its soul somewhere along the way! No conflict between science and Islam as evidenced by the scientists, mathematicians, astronomers physiologists from early islamic hx.As I will explain later Islamic scholars also produced models and methods of psychology

3 Evidence based Treatments
Behaviour Therapy Cognitive Therapy Cognitive Behaviour Therapy (CBT) Dialectical Behaviour Therapy (DBT) Interpersonal Psychotherapy (IPT) But something is missing! BT 60s Ct 70s CBT 80s DBT 90s IPT also same time Aimed at symptom reduction. Dealt with thoughts, feelings behaviour, relationships but something was missing. That human beings have metacognitive awareness. Like to contemplate, ponder, reflect on their experiences and the world around them

4 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. This to some degree is being fulfilled by the third wave therapies. Also evidence based. MCBT arising out of the Budhist tradition. However both are in line with Islamic traditions

5 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 Thought cause feelings and behaviour which if acted on become habits. Ibn alQayyim. All three under our voluntary control and can be changed

6 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

7 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.

8 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 Read his poem.

9 Spiritual Assessment Are you spiritual? What is your religion?
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 Now would like to talk about how spirituality can be brought in practically in our clinical work. As per our practice as clinician imp to do a comprehensive ax and history of the client and the presenting problem. One can do the spiritual ax as part of this but I tend to do it after the first session as some of the questions can be seen as quite direct. Sometimes I wait until I commence therapy and

10 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.

11 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,

12 Treatment CBT based as most suited to religious clients including Muslims. Now ACT and MBCBT most effective As explained earlier of all the evidence based therapies CBT marries best with Islamic beliefs and traditions with the addition of the philosophy and techniques of acceptance and mindfulness.

13 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

14 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? Prophet hadith 7=7=7. V powerful for teaching parents of emotionally and behaviourally disordered children. Fitra means the primordial state of man. His natural spiritual purity with inherent knowledge of its Maker. Hence the clients ability to realign his beliefs with this rather than I am bad or worthless, or evil. Why me? Why do I always have to struggle while others have money, job etc Depressed clients always compare. Acceptance of ones present situation if this is recog. As coming from Allah. Whatever is due to us will always come to us. Hence patienceProphet hadith 7=7=7. V powerful for teaching parents of emotionally and behaviourally disordered children.

15 Contemplation of the relevant text from the Quran eg
Contemplation of the relevant text from the Quran eg. ‘On no soul do We place a burden greater than it can bear’ (23:62) Aim; re-alignment of competing beliefs. “I could have died. I didn’t, because my time had not come” So I already have the strenght to bear this I need to find it. Self confidence

16 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)

17 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.

18 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. Fasting, dua, when one views his creation such as nature.

19 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. Islamic coping strategy only comparing to those worse off.

20 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’ Zikr, salat mosque, quran study. Nil nightmares or reliving. No avoidance IES mild. Sis in law died 1 ax and 13 trt sessions


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