Presentation on theme: "Spirituality in Clinical Practice: An Islamic Perspective"— Presentation transcript:
1Spirituality in Clinical Practice: An Islamic Perspective Shehzi YusafClinical PsychologistWill give a brief hx and background about clinical psych.
2Bringing back the soul in psyche – ology Science and religion or spirituality do not mixPsychology’s endeavour to become a scienceExperimental psychology, behaviourism, cognitive theories, attachment theoryNeuroscience, reduction theory, brain-behaviourStudy 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
3Evidence based Treatments Behaviour TherapyCognitive TherapyCognitive 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
4New 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 realityAcceptance 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
5What 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 changeCognitions 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 beingCBTThought cause feelings and behaviour which if acted on become habits. Ibn alQayyim. All three under our voluntary control and can be changed
6Highly 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
7Muslims prescribe to religious schema above all other competing schema (eg. Familial, traditional, cultural)Islam is a powerful instrument for cognitive realignmentIslamic psychology uses CBT, offering key to unlock / access / modify schema for enhanced pt wellbeing / outcomes.
8Mindfulness 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 AllahRead his poem.
9Spiritual Assessment Are you spiritual? What is your religion? GeneralAre 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 answerNow 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
10You 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 offaith, 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.
11Further 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,
12TreatmentCBT based as most suited to religious clients including Muslims.Now ACT and MBCBT most effectiveAs 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.
13Components of Treatment Psychoeducation: nature, cause and maintenance of the disorder.Cognitive restructuring/acceptance modelEmotional distress managementExposureProblem solvingAssertion trainingActivity schedulingGoal setting
14Islamic 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: sustenanceRole of parents in Islam: Unconditional love and acceptance of children. Parenting rules specifiedHomework 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.
15Contemplation 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
16Concept 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)
17AimTo use the rational, reasoning mind (Aql) to problem solve, understand ourselves and the worldTo 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 disciplineTo develop the Nafs Lawwama (self reproaching self) via self analysis, remorse and repentenceTo continuously strive to achieve Nafs Mutmainnah (peaceful self) via following the righteous path, overcoming negative thoughts, feelings, behaviour. Use of Zikr, prayers, contemplation, mindfulness.
18Teaching 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.
19Case Study35 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.
20Spiritual 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