The Assessment and Treatment of Muslims - Term Paper Example

The Assessment and Treatment of Muslims On September 11, 2001, terrorists attacked the twin towers of the World Trade Center. It was the most devastating attack on the United States that our country had endured in our history. Many people were lost, injured or died in the attack; there are some people who are still dealing with the after effects of challenges that happened because of their exposure to the dust and the debris that day. Americans were emotionally and psychologically scared whether they were part of the tragedy personally or not and it has never been forgotten. Osama Bin Laden, a Muslim leader, was cited as the culprit who initiated the attack and because he was Muslim, many Americans began to strike out against Muslims who were living in America or anyone who "looked" like they came from Afghanistan or Iraq. Anyone who looked like the perpetrators was considered "the enemy". Although it is difficult to know exactly how many Muslims live in the United States, best estimates for 2009 suggest that there are 1.6 million (CIA World Fact Book, 2009). Today, therapists are faced with one of the most difficult challenges in working with multicultural groups when they have to work with Muslims. How does one counsel a group of people who have attacked our country and killed so many people? This question may be on the minds of many but the answer to the question is that we treat them with dignity just like anyone else. One of the challenges when a tragedy happens and an individual or group is held responsible is the fact that the group becomes an enemy. Whether they are American citizens or not, they are seen as someone to be wary of or to attack verbally or physically. In a sense, therapists may be seen as "above that" but in reality, counselors are people and they bring to the counseling session their own prejudices and biases that they must constantly battle in order to help their clients. With this in mind, Muslims may be one of the most difficult groups to counsel, not because of their differences in beliefs but because of the inherent prejudice that has been fostered since 9/11. A Short History Of Muslims In The United States Muslims in the United States began in the 1800s and they came primarily from the Middle East (Locke, 1998, p. 206). The Muslim religion grew rapidly in the United States because of the conversion of approximately tree million African Americans (Locke, p. 206). One important concept to understand about Muslims is the fact that they believe in unity. This unity is both their spiritual understanding and their belief on the physical plane (Locke, p. 207). Acculturation For Muslims living in the United States, it has been difficult because their religion is both religious and ethnic culture. They are taught from an early age to take responsibility for themselves and their families. Muslims must decide how they will live in the United States: will they adhere strongly to their faith or must they present themselves as Americans who happen to be Muslim (Locke, p. 208). Historically, when Muslims first came to the United States they isolated themselves with other Muslims because this action was safer than living in areas by themselves. Basic Family Structure Living in America for Muslims is not easy because of their very different beliefs. They have religious laws that they abide by and these set them apart from other religions in America. As an example, their family structure is sometimes difficult for women to understand in America. Their structure is patriarchal and it puts the male as the head of the family. He is the one that makes decisions for the entire family and his words and decisions are not to be disputed. Children are seen as precious and they are to be protected but they also must obey their parents. Mothers are lenient with their children while fathers are strict. Honor is very important to a Muslim family but it is different for mothers and fathers. For fathers, a son is honorable when he fulfills his manly role by marrying and having sons. A woman is honorable when she is modest, faithful, and she bears sons for her husband (Locke, p. 214). Children are educated to be strong, self-reliant and to obey the laws of Islam (Locke, p. 216). Religious Beliefs The Quran is the book that Muslims use for religious instruction. They believe that the prophet Muhammad was made a messenger of Gods word (Locke, p. 216). There are 114 suras (chapters) that are divided into ayas (lessons). The Quran also teaches Muslims how there are Five Pillars of Faith that every Muslim must abide by: 1. Pillar one teaches Muslims to love God and to state that there is only one God and that Mohammed is the messenger from this god. 2. Pillar two creates a prayer schedule for all Muslims to pray at certain times during the day. This promotes "familiarity, friendliness, selflessness and equality" among them (Locke, p. 217). 3. Pillar three creates a giving atmosphere for Muslims. They are to give at least 2% of their assets to take care of the poor and needy; they can also use this money for education. 4. Pillar four creates a time for fasting each year. The holiday of Ramadan is used for Muslims to fast from "food, drink, smoking and sexual intercourse"(Locke, p. 217). They must start fasting a half hour before sunrise and continue this practice until a half hour before sunset; this is done in the ninth month of their calendar (Locke, p. 217). 5. The fifth and final pillar teachers Muslims to make a trip to Mecca at least once in their lifetime. This is the holiest place for them and it is a way to bring Muslims together and unite them in prayer (Locke, p. 217). For the therapist who works with Muslims, it is important to understand these religious practices because they will most likely have to work around them throughout the therapy process. Mental Health Needs of Muslim Americans When discussing the mental health needs of Muslims it is important to understand that just like any other culture, there are a myriad of different types of Muslims living in America. Most actively practice Islam and living in America creates suspicion and fear amongst other Americans (Ahmed and Reddy, 2007, p. 207). According to Ahmed and Reddy, Islam is the second most popular religion in America and it is growing (p. 207). In terms of mental health, they are underserved. Another challenge for them is that they are dealing with racial profiling and religious harassment (p. 208). The Muslim culture and religion are intertwined in such a way that the counselor may find that American Muslims have many different values and traditions that stem from their culture rather than from their religion. Ahmed and Reddy suggest that there are four different types of Muslims that therapists may encounter: Immigrants Because of the passage of the U.S. Patriot Act in 2001, many Muslims are interrogated when they come into the United States. They are already challenged by the changes in environment, physical space, climate, medical concerns and more (Ahmed and Reddy, p. 20). Many will suffer psychological distress because of the stress these attitudes create. Feelings of discrimination, loss of social status, alienation because of their religion and culture as well as a low self-esteem and lack of social report have contributed to a higher level of depression and anxiety among Muslims than with other groups (Ahmed and Reddy, p. 209). Many suffer the effects of Post Traumatic Stress Disorder (PTSD) which has been attributed to an uncertainty as to their fate in the United States. Another area where Muslims find it difficult is in the area of parenting. In their own land they had extended family to help them look after their families. In America, this may not be true and they can feel overwhelmed with the new responsibility of bringing up children in a culture that is foreign to their culture and religion (Ahmed and Reddy, p. 209). Some parents find that they are uncertain as to how to raise their children in this new culture and they may experience feelings of isolation. Family units are also under stress because they have to adopt different ways of parenting in America. As an example, corporal punishment is allowed in their country but frowned upon in America. This can create marital problems that can be passed on to the parent child relationships, can create a lack of cohesion in families and can make it difficult for immigrant children to adjust to school and the society at large (Ahmed and Reddy, p.210). In their homelands these difficulties would be dealt with through their extended families but in America, they would most likely be dealt with through marital therapy. Unfortunately, Muslims generally do not seek marriage counseling because they are not familiar with the therapist and they are unsure of the therapists orientation to their culture (Ahmed and Reddy, p. 210). Muslim Refugees Another type of Muslim that a therapist may encounter will be the Muslim refugee. These are Muslims who most likely have been cast out of their countries and have had to leave families and possessions behind. They have survived violence related to war that may have included torture, sexual assault, personal injury, malnutrition or disease (Ahmed and Reddy, p. 210). Many are here because of political asylum. When they come to the United States it is not uncommon for them to live in poverty, be discriminated against and be unable to find a job. Also, they will feel insecure, uncertain and hopeless because of what has happened to them and because of what they perceive as racial discrimination in America (Ahmed and Reddy, p. 210). For refugees, mental health is a taboo subject in their culture and this may mean that lack of education in this area will prevent them from seeking help; the situation can also increase their risk for depression, domestic violence and anger (Ahmed and Reddy, p. 210). PTSD symptoms are prevalent in this group and they may have sleep and concentration challenges. Traditional therapy techniques have not proven successful with this group and sometimes narrative exposure therapy that is based on cognitive behavior therapy is more helpful (Ahmed and Reddy, p. 211). Indigenous Muslims This category of Muslims generally refers to someone who is "of African American, European, or Hispanic origin who were born and raised in the United States" (Ahmed and Reddy, p. 211). African Americans are the largest group of indigenous Muslims because they were descendents of those enslaved Muslims that came from Africa. This group has most likely come from backgrounds as religious scholars, kings and queens, military leaders or judges who were prisoners of war during the sociopolitical events that happened in Africa. Because of their African American origins, they were discriminated against on more than one level and many reported that Islam helped them created a more internally integrated identity (Ahmed and Reddy, p. 211). When these individuals accept Islam, they often have mental health challenges that include guilt, identity issues and family tension (Ahmed and Reddy, p. 211-212). Transference and Muslims Before a therapist begins work with a Muslim client it is very important that they understand how they feel about Muslims in general. This is important because they cannot give their best service if they have some of the attitudes that have been presented. According to Raiya, Mahoney and Trevino (2008), a USA Today/Gallup Poll over 1,000 people in 2006 showed that 30% of those who took the survey had "some prejudice against Muslims" (p. 322). Although therapists may think that they are immune from these attitudes, it is important for them to clearly understand how they feel. Some counselors may have difficulty with a client if they have a different religion. As an example, the study done by Raiya, Mahoney and Trevino revealed that when people had a low perception of Muslims, they were more likely to feel them as a religious threat. If they had a higher level of perception regarding Muslims as desecrators of Christianity (p. 323). Although this was a study on anti-Muslim feelings, may find themselves with similar feelings. Assessment of Muslims Assessment is difficult because of the various instruments that are not culturally sensitive. Ahmed and Reddy suggest that counselors must conduct a comprehensive assessment that includes more than one method of gathering information. They suggest that multiple methods and various informants will give the therapist more information than only relying on one or two sources (p. 212). Dwairy (2006) points out that the normal assessment techniques are derived from personality theories and for Muslims this is difficult since they do not partake in an individualistic structure (p. 71). He also points out that many issues that therapists usually assess are difficult to assess with Muslims because they are culturally specific. As an example, the words independence and intelligence have a different meaning in the Muslim culture than they do in the Western culture. This issue points out that in the event that an instrument is used to assess these terms solely on the Western cultures basis would invalidate the test for Muslims (Dwairy, p. 71). In order to make appropriate assessment it will be important for the therapist to look at the family dynamics within the Muslims family structure. It is the "intrafamilial domain that is the key to understanding the behavior and experience of Arab/Muslim clients" (Dwairy, p. 74). Another area of concern would be acculturation and worldview of the family unit. In other words, the way that the family members view the world will determine how they feel a part or not a part of the community in which they live. Because Muslims are a diverse group, it is very important to talk to the family about acculturation and their worldview because these two areas may be different for the family than they are for the individual client (Dwairy, p. 74). In order to understand these two areas better, the counselor would need to use some type of worldview scale (Dwairy suggests the Scale to Assess Worldview) or a semi-structured interview of some type (Dwairy, p. 75). Using assessment instruments may be difficult for many reasons. The therapist must take into consideration that Muslims generally are unfamiliar with the counseling setting and if they do come to counseling, it is because they have not been able to get help from their family members. They are more apt to look for directives instead of attempting to respond to a personality test. Generally these tests ask them to respond in a structured way that does not fit their culture (Dwairy, p. 76). Ahmed and Reddy agree with Dwairy in that there is a need for culturally sensitive assessments. They also state that using religious and spiritual assessments are very important for Muslim clients because they are so tightly tied to religion. Also, this is a very strong way to find out how religion plays a part in their life (p. 213). There are other issues to take into consideration when developing assessments and this includes the attitudes that Muslims have towards mental health issues and this could affect the diagnostic process (Ahmed and Reddy, p. 213). Religion seems to be a common theme that must be used when counseling Muslims. Hamdan (2007). When thinking about religion the therapist must understand that there are four religions that their Muslim clients may believe in: Sunni, Shiite, Sufis and the Nation of Islam (Hamdan, p. 93). After September 11, the American people understand that the Shiites are the people that are "the enemy." A therapist who is counseling Muslims will need to understand that counseling this group may not be easy on many levels and it may become complicated. Issues for Counseling As stated previously, Muslims generally do not go to counseling initially when they are having problems in their lives. A very important aspect for counseling is that there are Muslim therapists. Unfortunately they are under represented which means that this may not be possible in most cases. In order to insure appropriate counseling, a non-Muslim counselor must have a deep understanding of the various issues that Muslims will bring and how to address them. There are many issues that are important to Muslims that may not be important in other cultures. Personal or social issues that may appear include issues of culture shock when Muslims are coming to the country for the first time, rebellion in the family from children or adolescents, and global or world issues that are different than what they find in the United States (p. 132). Muslims may also bring in career related issues that can include finding employment or finding a new job. Sometimes this may mean helping them to find English classes, or helping them find the resources for training or job placement. Some immigrants may have to deal with career obsolescence. In other words, some Muslims come to the United States as doctors, teachers or other professionals. The United States does not honor these professionals and this can cause stress and anxiety (Kobeisy, p. 133). Methods of Counseling that Work As it may be determined, although there are a variety of methods and theories that counselors are used to using with clients, some of them are not appropriate for Muslim clients. This is one area where multicultural understanding is very important to the therapist if they intend to be successful with this group. The following chart illustrates how to use the counseling approaches listed as well as those situations where the approach will not be helpful or appropriate: The counseling approach Recommended for Not helpful for Psychoanalytical Uncovering old conflicts, fears, anxieties and other deeply rooted problems. Family dynamics for the fear of breaking family ties and putting members against each other. It is also objectionable due to the fact that it suggests that some problems are beyond the persons control, which is against the religious teachings. Adlerian Social and community relations, rehabilitation from domestic abuse, racism, and victimization; family relations; and communications within family. Religious-based or related issues, such as grief, loss, and natural disasters. Person-centered Client-community relations, political activities, career advancement, and communication with ones own peers or superiors. Parent-child relations in particular and family relations in general. Behavior Education, training, eating disorders, budgeting, and family relations from Muslims perspective. This model may work mostly with immigrants who are looking for a guide, a teacher, and an instructor. Private and intimate issues, such as the husband/wife relationship and issues of a religious nature. Existential None None Gestalt Immediate and practical needs of clients, including family issues, refugees, and communication using body language and gestures. Intimate relations where Muslim clients feel most reserved and unable to express their intimate feelings. Transactional Educated Muslim clients who can benefit from the contract and the power it gives to the client. Low-educated clients and clients in crisis. Rational-emotive and cognitive-behavior therapy None, for the fear it creates conflict between the client and the counselor, thus leading to a withdrawal from counseling All. Reality therapy Issues related to various systems allowing Muslim clients to deal with assimilation and acculturation. Social injustice and inequality, racism and discrimination. Table 1: Counseling Approaches and Their Use with Muslim Clients from Kobeisy (2004). p. 135 Kobeisy suggests that following this chart will help counselors make fewer mistakes and it will also help them understand better how to counsel their clients. Other Issues to Consider Khalid (2006) suggests that in order to understand how to counsel Muslims, counselors must step out of their Western orientation and think from a Muslim perspective which means they must understand Islam (p. 7). Kahlid suggests that Islamic psychology can assist. Islam suggest that distress and mental issues are "manifestations of an incongruent heart or an unstable soul that is lost and as become distant from itself and the creator" (Khalid, p. 8). In other words, the soul and the heart must be balanced in order for the individual to free themselves from mental distress. Islam believes that the self has various states and they create both a negative and positive drive within the individual. Three of these selves are explored in the Quran: 1. The Nafs (soul) amarra -- this is the representation for what is called "the lower self and it promotes the negative drives. The researcher states that this is similar to Freuds Id. 2. Nafs law wa ma -- the self reproaching self is the part that understands when the individual has done something wrong and they feel remorse for it. This concept is similar to Freuds Superego. 3. Nafs mutmainnah -- this is the peaceful self that brings about inner peace, happiness, and contentment. This is the state, in their belief, that humans are attempting to obtain. (Khalid, p. 8). These concepts are also attached to personality development which is considered to be the promotion of the "good" side of the individuals self. This self must be promoted so that it does not promote the "evil" side and go against what "Allahs description of his creation in its best form" (Khalid, p. 9). In other words, the point of therapy might be seen as a way to bring the individual selves back into alignment with a positive purpose. Because of the events of 9/11 and other ongoing struggles in the Middle East, many Muslims come to counseling because they have a range of emotions that are plaguing them. These emotions can range from feeling guilty because they are Muslims, being apologetic for the terrorist acts to being angry at governments and the injustices that are perpetrated against other Muslims (Khalid, p. 9). There is also the fear of discrimination because they are Muslims and deep sadness and suffering because of the inhumanity that happens globally. Counselors and clients will have challenges when events occur that make everyone feel nervous and afraid. Andrew Samuels is quoted as saying that "external events invade the psyche whether they are good or bad" (Pointon, 2006, p. 4). When these events happen to both what is perceived as "an enemy" they become more difficult to work through. By looking through an Islamic model, a therapist has a way to work with internal and external factors by using the model as a way to effect change in the individual. The most important feature here is to understand that spirituality must be a part of the practice when counseling Muslim clients. In order to do this, therapists must be able to find training in cultural competency and they must find transcultural supervision; they must also take time to reflect (Khalid, p. 10). Conclusion As therapists begin to understand multicultural counseling, they must take into consideration that there are some groups that may be very difficult fort them to counsel. In examining many cultures, therapists may find that there are some issues inside certain cultures that may be difficult for them to understand. Therapists must understand that they do not have to work with every single client that comes to them. When they work within an agency, they may have to work with whomever comes into their office. However, the therapist must be able to speak out and refer a client if they are unable to deal with the difference. Counseling Muslim clients may not be easy for the therapist who is neither religious nor able to see past the idea that "all Muslims" are not terrorists. They must have an inner understanding of themselves and who they can counsel versus who they cannot. If a therapist suffered deaths or illness in the 9/11 disaster, they may need to seek their own therapy before counseling Muslim clients. The role of the therapist is always to "do no harm." This means tat when a therapist finds that they cannot assist a client for whatever reason, they must refer the client to another counselor. In the case of Muslim clients, this may happen more often if a therapist cannot put behind them the idea that Muslims are responsible for terrorist attacks. This researcher also suggests that those who will counsel Muslim clients may need to have supervision while working with these clients. References Ahmed, S. and Reddy, L. (2007). Understanding the Mental Health Needs of American Muslims: Recommendations and Considerations for Practice. Journal of Multicultural Counseling & Development. 35 (4). p207-218. Retrieved November 14, 2009 from Academic Search Premier AN: 27063895. Abdullab, S. (2007). Islam and counseling: models of practice in Muslim communal life. Journal of Pastoral Counseling. 42, p42-55. Retrieved November 14, 2009 from Academic Search Premier. AN: 33363021. Central Intelligence Agency. (2009). U.S. Muslim Population. CIA World Fact Book. Retrieved November 19, 2009 from https://www.cia.gov/library/publications/the- world-factbook/geos/us.html#People. Dwairy, M. (2006). Counseling and psychotherapy with Arabs and Muslims. NY: Teachers College Press. Hamdan, A. (2007). A Case Study of a Muslim Client: Incorporating Religious Beliefs Journal of Multicultural Counseling & Development. 35 (2). p92-100. Retrieved November 14, 2009 from Academic Search Premier. AN: 24752077. Khalid, S. (2006). Counselling from an Islamic perspective. Healthcare Counselling & Psychotherapy Journal. 6 (3). p. 7-10. Retrieved November 14, 2009 from Academic Search Premier AN: 22192955. Kobeisy, A.N. (2004). Counseling American Muslims: Understanding the faith and helping the people. CT: Praeger. Locke, D.C. (1998). Increasing multicultural understanding: A comprehensive model. CA: Sage Publications, Inc. Pointon, C. (2006). Engaging political gear. Therapy Today. 17 (1). p4-7. Retrieved November 18, 2009 from Academic Search Premier. AN: 19994389. Raiya, H. A., Pargament, K., Mahoney, A. and Trevino, K. (2008). When Muslims are perceived as a religious threat: Examining the connection between desecration, religious coping, and anti-Muslim attitudes. Basic & Applied Social Psychology. 30 (4). , p311-325. Retrieved November 14, 2009 from Academic Search Premier. AN: 35498866. Read More