Can the psychotherapy of Muslim patients be of real help to Them Without being Islamimized?

There are those who, like a horse with tight eye-blinders, can only view psychotherapy through the tunnel vision of their particular school, and those who open the doors of psychotherapy to include almost all forms of treatment and goodwill towards the,patient. An example of the first group is clearly seen in the definitions offered by psychoanalysts who consider any form of psychological treatment that does not deal with resolving the alleged unconscious complexes as a waste of time and effort. The second group is presented by psychiatrists like English and Finch (1954) who define psychotherapy as, "...almost any method utilized to alleviate or remove the results of emotional conflict and improve psychic adjustment".

As a result of this confusion, the field of psychological therapy and counseling has become an arena for all sorts of fads and crazes. In editing a handbook of psychotherapy, Richie and Herink (1980) found themselves compelled to limit the number of different therapies to about 250! In going through their handbook one will find that there is probably not even one aspect on which all therapists agree on. As Harper (1965) says:

"There is scarcely a psychotherapeutic theory or technique endorsed today by some reputable therapists which has not been skeptically viewed or seriously questioned by others."

As a reaction to this confusion regarding the nature of psychotherapy, Raimy, as early as 1950, came up with the facetious definition that psychotherapy cannot be defined except as, "an unidentified technique applied to unspecified problems with unpredictable outcomes". A more modern equally interesting definition is that psychotherapy is what psychotherapists do!

The Psychotherapist as a warm accepting friend

If psychotherapy is what psychotherapists do, then it would indeed be justifiable for us to ask, "What do they really do?" As the popular stereotype shows them, they are warm, accepting and empathic good listener to their patients. Indeed this is the most portrayed image of the psychotherapist. Of course being a friendly listener and offering wise advice to people with problems is as old as human existence on this earth. It was universally accepted since ancient times as one of the major factors that help to heal psychological wounds. People in distress would naturally seek the help of their sincere friends or gurus or elders to counsel them and relieve their psychological suffering.

In our modern time the psychologist who is credited for advocating this most important role of the psychotherapist is Carl Rogers who in many of his publications on his psychotherapeutic technique known as the person-centered therapy stipulated that the counselor should first be a real genuine person and should unconditionally accept the client without judging or evaluating him. Furthermore, he should always be warm and empathic and he should not directly tell his client what to do or not to do in order to solve his problem or actualize himself but to indirectly guide him to take his own decisions.

But though it certainly helped in making psychotherapy a more humane and friendly endeavor, Rogerian counseling has been criticized for being contradictory in telling the therapist to be genuine and at the same time to be unconditionally accepting to his client. No one can have a genuine inartificial social relationship with any one without being judgmental. As normal people with genuine feelings we are all the time making judgments about other people. This is particularly so in societies where moral and religious teachings are highly valued.

Secondly, if the therapist refuses to interfere in directing his clients about what is good or not good for them as is usually the case with such counselors, they would often feel confused. As Martin Seager puts it:

"Many clients (of person centered counseling) feel lost and confused. They often lack a clear sense of identity and self. They themselves cannot be 'client-centered' because they don't have any sense of where their centre is, (The Psychologist, August, 2003 issue, Vo116, No.8).

If this is what is happening to British patients in secular Europe o f the year 2003, it is no surprise to find that this kind of "nonjudgmental unconditional acceptance" gre~ failing in Muslim countries.

Thirdly, it was questioned whether being warm and friendly and psychologically helpful to people really needs all the years of training that psychotherapistsago,th~ough and whether in this matter there is any difference between a psychotherapist and a lay person. In his well documented book, Against therapy, Dr. Jeffery Masson writes in a section indicatively titled, "The myth of training" of psychotherapists in the following mocking manner:

"Therapists usually boast of their 'expertise,' the 'elaborate training' they have undergone. When discussing competence, one often hears phrases like 'he has been well trained,' or 'he has had specialized training.' People are rather vague about the nature of psychotherapy training, and therapists rarely encourage their patients to ask in any detail. They don't for a good reason: often their training is very modest (1988, p.248)

This skeptic approach has led many contemporary experts to state that an untrained sincere friend can be as good as or at times even better than a trained therapist. Some scholars have even advised clients to avoid psychotherapists who are highly trained and who have long letters after their nam s. Their outlook would be narrowed down to their restricted specialization, wondering where to pigeonhole the patient from his 'symptoms' by the help of the Diagnostic and Statistical Manual of Mental Disorders rather than simply seeing him as a person with a psychic problem. A friend who has been through a similar problem as the client and who has since recovered from it would be a much better therapist.

To empirically test this claim, a number of studies have been carried out to compare professional "psychotherapy" with discussing one's problems with a friend. The results were almost always "No difference, between the lay therapists, and the trained counselors". One such study was carried out at the Vanderbilt University. Young men with various neurotic disorders were assigned to one of two groups of therapists. The first group was made up from leading psychotherapists who have completed an average of 23 years of experience while the second group consisted of college professors with unrelated academic specializations but who have earned the reputations of being warm and good people to talk to. Both groups had about 25 contact hours with their clients. The results came up with the expected outcome of no difference between the two groups. The tests showed that both groups improved but there was no difference between them. (Bernie Zilbergeld, 1986).

By stating these views, I am definitely not saying that modern training in counseling and psychotherapy is a useless endeavor. I simply want to affirm two things: Firstly, that training in counsel and „psy_chotl_erapy_, is like teacher-training. A good teacher has both inborn qualities plus good training. Many excellent teachers have had no training in their field, but they possess the talent of simplifying their subject matter and making it very interesting to their students. On the other hand a lot of highly trained teachers with many letters after their names simply bore their students and fail to motivate them. Obviously, this fact would not stamp the science of teacher¬training as an ineffective practice and no wise person would call for declaring the discipline a useless endeavor. When applicants apply for a teaching job, it is only sensible for the school to choose the one who was trained; the probability that he would do a better job than the untrained teacher clearly out ways the contrary. Similarly we expect the trained counselor to do better than the untrained person though we may often be surprised to find that he doesn't. My second point is a consequent of the first. Bearing what I said in mind, counselors and psychotherapists should develop the humility to see themselves and their training for what it is. They are not being taught in skills like those of surgery in which a person is either trained as a surgeon and can operate or he is not and should stay away from the profession. They are simply instructed in giving better help to people with problems, an enterprise that everybody else is doing without their sophisticated apprenticeship. Some have natural qualities to be good therapists without being specialized.

We have thus far been discussing the role of the psychotherapist as a warm understanding good listening friend. This is one of the few areas that have a clear consensus among modern psychotherapists. But isn't it really surprising that it took modern psychotherapy that long to come up with therapeutic practices that humans have been successfully applying since antiquity. It is more than a hundred years since Freud established psychotherapy as a specialty in his psychoanalytic school, while Carl Rogers developed his complete theory and therapeutic techniques of client-centered therapy as late as 1959.

What is the reason for this delay? The main reason is that psychotherapy as a branch of psychology has alienated itself from being a humane endeavor of helping those who suffer from psychological problems to an artificial replica modeled after exact sciences and medicine. Ironically it was Freud himself, the very founder of this field, who, by adopting a medical model to the etiology and treatment of the neuroses, has neglected the obvious colnmonsense fact that psychotherapy is a process of learning and education in a friendly ~m~iance. Furthermore, with his indefatigable effort to establish psychoanalysis as the uncontested science of psychological therapy, he was able to establish an association of devoted, mainly Jewish scholars and scientists who had themselves been psychoanalyzed and 'brainwashed' into accepting the pseudo-scientific claims of their profession as authentic science. Thus psychoanalytic theories have become an immense system of a psycho-philosophical edifice that influenced all forms of disciplines from medicine, sociology and anthropology to political science, art, literature, economics, religion and other fields of information.

Accordingly, it was only after the decline and fall of the Freudian empire and its psychodynamic offshoots that psychotherapy regained its rightful down-to-earth role as the practice of helping the emotionally disordered to unlearn their pathological habits and thinking patterns and develop new ways of healthy adjustment without wasting time in 'uncovering' unconscious sexual complexes or digging up trivial experiences of early childhood. Before discussing the vital endeavor of Islamizing psychotherapy, it may be more useful to give the reader a more detailed but simplified exposition about the long journey of this discipline from Freudian psycho-dynamism through behaviorism to cognition and finally to the shy emergence of spiritualism.

Freud and his medical model

Freud viewed all neurotic and emotionally disordered symptoms as the visible upshots of largely sexual and aggressive unconscious conflicts or complexes. This was so because he viewed all human activities as motivated by libidinal sexual instincts and aggression, either in a clear or symbolic manner. Emotional disorder is caused by supposed mainly sexual unconscious conflicts largely repressed during the early childhood of the patient. Accordingly, the treatment of psychological disorders in psychoanalysis should not be directed towards the symptoms themselves but to the underlying unconscious dynamics which caused them. Consequent to this view, trying to relieve the disorder by direct symptomatic treatment will not succeed, and if it temporarily does, it will definitely be followed by other symptoms which may be more serious in nature. This is what is known as the medical model of psychotherapy which ruled over the field for more than 70 years.

Let me simplify this to the lay readers. Since Freud was a medical practitioner, he perceived psychological symptoms in terms of physical symptoms. If one presents to a doctor with high fever and headache, he would not simply treat the symptoms directly by giving aspirins or painkillers. Instead he would look for the 'underlying' indiscernible causes of these complaints. He would ask for an X-ray, blood or urine test or some other tests to help him make the correct diagnosis and then he would prescribe the medicine to attack the unseen causes and not the symptoms themselves. Once the microbe has been detected, the right antibiotic will deal with it and the symptoms will automatically disappear.

Similarly, the psychoanalytically oriented therapist would not deal with the anxiety, phobias, depression or obsessional disorder of the patient directly but work to uncover the unconscious complexes that had caused them by techniques such as the interpretation of the symptoms and their 'real' hidden meanings, free association, in which the patient relaxes and says whatever comes into his head, and dream analysis. Once these conflicts become conscious and the patient relives his ordeal through transference, in which the patient is supposed to project attitudes and emotions he had towards parents or important people in his life onto the therapist, he is supposed to get over his symptoms.

Just as fever and headache can be caused by a host of illnesses, anxiety, phobias and other psychological symptoms can be the result of different kinds of conflicts. But to try relieving the psychological symptoms directly one would be like the fellow who tries to close the mouth of a volcano by rocks and reinforced concrete. Even if he succeeds in this impossible hypothetical illustration, the boiling lava in the "unconscious" of the mountain will increase in pressure until a new volcano irrupts in another weak side of the mountain. This is what is meant by "symptom substitution".

In physical medicine, physical symptoms like headache and fever are useful in telling us that something is wrong and that a battle is being waged by our immune system against the invading bacteria. According to the medical model of Freudian psychoanalysis, psychological symptoms are also adaptive in nature. They are also supposed to tell us that an internal battle is being fougl~t between our id unconscious sexual and aggressive instinctual impulses which discharge energy for immediate satisfaction (cathexis) and the antagonistic defensive energy of our ego which blocks this animalistic drive since it does not agree with social and moral norms (anticathexis).

This psychoanalytic model is obviously fascinating, but what is fascinating and interesting is not necessarily true! As a therapy, it was found to be generally as good as no therapy at all! Not only that, but a number of researchers have concluded that in some cases receiving psychoanalytic therapy may even do more harm than good to the patient. At times, if a patient is made to remember very painful and embarrassing experiences of his childhood such as being raped, his condition may actually c~eteriorate. A famous British psychiatrist who had been a member of te British Psychoanalytic Association for many years, resigned after discovering the serious flaws in its theory and practice and the harm that psychoanalysis can sometimes do to patients. She wrote an article in the sixties in The British Journal of Psychiatry, indicatively titled, "Psychotherapy for patients treated by psychoanalysis". She was treating them from the treatment they had received at the hands of psychoanalysts! It is unfortunate that l have lost the reference.

In criticizing this medical approach, Tom Rusk, in his best-selling book, Instead of therapy says:

"Although I am a psychiatrist, and therefore a medical doctor, I no longer believe that the language of science and medicine applies to the work that I do with my clients. I am one of the growing number of psychological counselors who believe that psychological healing did not ever belong in the realm of medicine.

The focus of all counseling is on helping us learn to change our relationships with ourselves and others. I believe this kind of learning is really no different from any other deliberate learning" (1997, p. xiv),

The rise of behavior therapy

Though different researchers like Watson and Rayner in 1920 and Mary Cover Jones in 1924 have clearly shown that neurotic symptoms can be initiated or cured in the laboratory by experimental techniques based on learning by conditioning or by 'deconditioning', thus experimentally refuting the established Freudian claim of unconscious conflicts as the cause of neuroses, it remained for Eysenck in 1952 to empirically expose the inefficacy of psychoanalytic therapy. In his now historic research, Eysenck compared an experimental group of neurotic patients who were admitted to British hospitals for treatment by psychoanalytically oriented therapies with a carefully matched control group of similar patients who could not find beds in the hospitals and who accordingly received no therapy. After one year, Eysenck found about two¬thirds of the treated group have improved. He was astonished to find that the same proportion of the untreated control group have also improved! The publication of this study was literally like an exploding bomb in the face of psychoanalysts who retaliated with all sorts of "conscious" and "unconscious" defenses but their battle was eventually lost since many experimenters who repeated Eysenck's study came up with similar results.

Eysenck has thus paved the way for Wolpe the founder of behavior therapy. Since 1947, Wolpe was doing experimental studies with cats in his laboratory in South Africa to prove that neurotic symptoms were actually maladaptive learned habits acquired by conditioning and that they can be treated by a process of 'rewarding' in the gradual presentation of the feared object. This led him to lay the foundations of behavior therapy and to pioneer his distinguished work in his classic textbook, psychotherapy by reciprocal inhibition (1958). In this book Wolpe introduced behavior therapy as an explicitly formulated highly successful alternative to the defeated psychoanalytic therapy.

For the first time in almost 70 years, Western psychologists started to abandon the useless search for trivial unconscious conflicts to attack the symptoms of emotional disorder in a direct manner and to use a simple learning theory approach in diagnosing and treating neuroses. Many patients, particularly those suffering from phobic anxieties, sexual disorders and obsessional neuroses, who wasted years of their lives and much of their savings in fruitless Freudian analysis, have been cured or greatly improved after a few weeks of behavior therapy.

The main tenets of this new therapy are that we learn our neurotic symptoms in the same way that we learn useful habits. We learn to fear snakes and this is an adaptive habit but we can also learn to fear parties and social situations, lifts or cockroaches and these are maladaptive habits. There is no deep-down unconscious cause for either the adaptive or the maladaptive habits. Both are the outcome of learning by conditioning. If you decondition the 'bad' habit by unlearning, extinction or reciprocal inhibition you have treated the neurosis. Once cured, no other symptom will appear in its place, but on the contrary, it was found that treating one neurotic symptom often results in the improvement in other symptoms that were not treated.

For example I have known patients who suffered from a phobia and reactive depression. When the phobia was cured, the depression disappeared. Since psychological symptoms are rarely related to deep-rooted unconscious etiology, one would logically expect the depression to improve because it must have been wholly or partly caused by the incapacitating phobia. Similarly a patient referred to us in the Department of Psychiatry of the Middlesex Hospital Medical School who complained from social anxiety and non-assertiveness together with sexual impotence, was surprised to find himself sexually normal with his wife after behavior therapy made him assertive. The relationship between the two complaints is obvious.

Let me say a few words about conditioning and reciprocal inhibition to those who are not familiar with them; psychologists either bear with me or skip this section. We learn habits by classical Pavlovian conditioning when a'natural' or unconditioned stimulus which reflexively elicits an involuntary unconditioned response e.g. salivation to food as in Pavlov's dogs, is associated with another neutral or conditioned stimulus e.g., the bell in Pavlov's study, until the organism learns to respond to the new neutral stimulus in the same way as the 'natural' stimulus i.e. the dog learns to salivate to the sound of the bell. In the experiment done by Watson a baby was made to develop conditioned fear of a white rat (conditioned stimulus) when the experimenter sounded a big terrifying bang (unconditioned stimulus) whenever the baby touched the rat. The baby naturally responded with terror (unconditioned response) and eventually learned to fear rats (conditioned response). So in a behavioral therapeutic paradigm the symptom is always a learned conditioned response.

And when we learn habits by the other form of conditioning espoused by Skinner, instrumental conditioning, we first have to do some voluntary action. If this is immediately followed by a reward or positive reinforcement, it will be repeated more frequently in future and if on the other hand it was followed by a painful stimulus and we stop doing it and consequently relieve ourselves from the painful stimulation, (negative reinforcement) the repetition of this act will be less in future.

If we want to get rid of a neurotic symptom which causes us anxiety we should stop its association with the original stimulus, i.e., in Watson's experiment, we repeatedly bring the rat to the baby without any more banging or terrifying noise. This is known as extinction and it is not generally very helpful in such highly fearful stimuli. Reciprocal inhibition or treatment by the opposite is the symptomatic treatment of choice in such cases.

I can give the reader a concrete example from a very rare case of obsessive-compulsive disorder that I treated last year in the clinic of the Health Center of Dewan Bandaraya in Cheras, Kuala Lumpur. The patient, a male janitor in a Government building, cannot resist the compulsion of taking a shower and changing his clothes whenever he smells certain offensive odors. These were mainly old fish and to a lesser extent, the smell of decomposing dead rats and similar bad smells he encounters in his work as a cleaner or in the street. After a few sessions of cognitive therapy and relaxation, I brought into the clinic a plastic bag containing a dead decaying fish and a bottle of concentrated perfume. The patient would smell the fish until his anxiety mounts and the overpowering compulsion to wash has overwhelmed him; then he would quickly take deep smells from the perfume until the anxiety provoking smell of the fish is diminished. With cognitive support and encouragement he was able to increase the time of smelling the bad odor. He reported much improvement after these sessions. He reported that he wouldtake a small bottle of perfume in his pocket to use if the compulsion returns. In this case the perfume is opposed to the bad odor and the relaxation and cognitive therapy would bring responses contrary to anxiety.

This reciprocal inhibition method has been developed by Wolpe into psychotherapy's most successful technique by using the ability of the patient to imagine and by presenting the anxiety provoking stimuli in a gradual fashion. These are the techniques known as systematic desensitization and that of practical retraining. People phobic of animals and insects, for example, can first look at them as dead and small in size at a far away distance and gradually brought nearer and nearer to them as they are presented live and bigger in every consecutive session. When the noxious stimulus cannot be brought into the clinic or when the therapist prefers to use 'imaginal' desensitization, the patient is asked to imagine the feared or noxious situation in the graded fashion designed by him and his behavior therapist and while reclining or lying in full relaxation in the clinic he imagines himself dealing with the least anxiety-provoking scenes and gradually going up the hierarchy to the most difficult ones. For instance patients who suffer from social fear and anxiety with authoritative adults can be trained when relaxed to imagine themselves mixing only with children and gradually the age and number of people is raised until they achieve the ability to transfer the learning of the clinic to real life situations.

However, some behavior therapists have challenged this gradual approach by exposing patients from the start to prolonged sessions involving the most intense anxiety-eliciting situations, in the hope that, by finding no way out of facing their feared object, as they generally do in real life, they would learn to anticipate that there is no real catastrophe in facing it; in everyday language, they would get used to it. This technique is indicatively named "flooding". Though some claim that it is very successful in the treatment of generalized anxiety in a much shorter time, long-term comparisons have shown the superiority of gradual systematic desensitization.

When the patient presents with symptoms that are pleasurable to him but he wants to get rid of them such as taking alcohol, drugs, or unacceptable sexual behavior, symptomatic treatment by reciprocal inhibition would necessitate the use of opposite painful stimulation while the patient actually takes or imagines that he is doing the pleasurable unwanted act. Therapists use electric shocks to the arm, shaming, flagellation with a rubber band, offensive smells, chemicals that induce nausea and other painful stimuli in the hope that the once pleasurable response will be associated with this these very painful punishments. This aversive therapy was found to be successful with all kinds of addictions and sexual disorders. Some therapists have even used it with obsessive compulsive disordered patients.

On the other hand if the therapist wishes to use positive reinforcement according to Skinnarian instrumental conditioning, he can quickly reward the patient whenever he does what he is supposed to do, for example refusing to eat chocolate for an obese person or spitting out a mouthful of an alcoholic beverage for an addict. If what is to be done is complex such as cleaning himself and making his bed if he were mentally subnormal then the therapist should "shape" it like a coach teaching an athlete or an expert training a falcon to catch a prey. He first gives a reward for achieving a simple task and then gradually the reinforcement is given only to more advanced skills until the complex behavior is completed. The therapist works like a coach training an athlete in high jump. First the bar is placed in a low position and gradually raised as he learns to perfect his skill.

I have devoted these pages to acquaint the reader with the second agreed upon role of modern psychotherapy in helping people with emotional problems. It is that of helping the disordered to change their pathological emotional habits or external behavior. Though, as stated earlier, there is much confusion as to what psychological therapy is, there is general consensus among psychologists that these techniques of behavior modification are among the most beneficial and efficacious methods of the field since their effectiveness has been empirically confirmed. In fact, most early behavior therapists were so proud of their achievements that they did not use the term "psychotherapy" to describe their specialty. They thought of themselves as scientists of specified techniques of behavior change that should not be mixed up with unscientific psychoanalytic and psychodynamic perspectives or loosely defined person-centered counseling. They speak and write about two separate areas in treating psychologically disordered people: psychotherapy and behavior therapy.

The cognitive revolution

Paradoxically, it was this strong determination to emulate an outdated paradigm of physics that brought about the revolutionary paradigm shift known as the cognitive revolution. In their zest to limit the field of psychological research to the objectively measurable forms of behavior, classical behaviorists refused to accept the so-called 'subjective' aspects such as mind, consciousness and other cognitive processes. To them, these were not worthy of scientific investigation. In 1929, Watson, the father of behaviorism, stated that consciousness, "...has never been seen, touched, smelled, tasted, or moved. It is a plain assumption just as unmovable as the old concept of soul" (Marx & Hillix, 1979, p.138). This position was strongly supported by Eysenck 43 years later when he argued that, "If you wish to postulate a mind, or a soul, or even consciousness, you are of course free to do so; all that the psychologist (or behaviorist) says is that these concepts do not enter into his formulae" (1972, p. 304). In his much quoted witty criticism of behavioral psychology, the late renowned British psychologist, Sir Cyril Burt, is quoted to have said, "modern psychology, having first bargained away its soul and then gone out of its mind, seems now, as it faces an untimely end, to have lost all consciousness " (Eysenck, 1972, p. 300, italics ours). Western psychology regains its mind and consciousness:

This extreme position is one of the main reasons for the rise of the "cognitive revolution" and the return of the mind and consciousness to Western psychology. Cognitive psychologists refuse to limit their role of studying emotional reactions as simply responses to external or internal stimuli that can be measured and manipulated while neglecting what goes on within the thinking mind of the responder, calling it "a black box" that cannot be deciphered. Conversely, the cognitive perspective view emotions as entirety a direct consequence of the way one looks at stimulating life events. It is not the stimulus by itself that directly brings about the response, as behaviorists like to believe, but more importantly the way the person views this stimulus. Thus one cannot experience an emotion before processing it. We must first understand an experience before feeling it, and feeling must be preceded by conscious thinking. Normal thinking gives normal emotions and pathological thinking begets pathological emotions. Man has a continuous dialogue with himself and the thoughts that cause emotions are often fleeting and swift but specific and discrete. Beck, (1976) calls them automatic thoughts. These thoughts if unchecked can develop into strong emotions and can motivate actual neurotic behavior. That is why cognitive therapists train their patients to catch the "culprit" or the cognitions and thoughts that just precede the disordered emotion.

To cognitive therapists, neurotic emotional reactions are generally generated by irrational thoughts. So an important aim of cognitive therapy is for the therapist to help the patient to use his problem solving and unbiased observation to consciously challenge and change his inner thoughts. In other words, to change the software in his mind! Once the inner conscious cognitions have been changed, the sick emotions will find no support and will eventually disappear. Consequently, the external behavior will also be normalized. Burns (1980) gives a very amusing illustration to the fact that emotions simply follow the way we think, whether we think logically or illogically. He writes, "Your emotions follow your thinking just as surely as baby ducks follow their mothers. But the fact that a baby duck follows faithfully doesn't prove that the mother knows where she is going!" (p.46).

This cognitive approach was influenced by the computer revolution. From a Pepsi Cola vending machine of stimulus-response behaviorism man is viewed as a processor of information. If man were to be a real computer, then the environmental events would act as strikes of selected keys in the 'keyboard' and his internal cognitive activity, like thinking and feelings, would act as the software or program which the "internal processing unit' uses to send out coded information to the "monitor". Thus two persons with different 'softwares' in their brains or minds will respond differently to the same environmental conditions, just as the same keys struck in two computers with different softwares will bring about different material in their monitors.

We have now given a simplified exposition of Western psychotherapy, showing the three beneficial areas on which psychotherapists have a general consensus. These are: the role of the psychotherapist as a warm accepting good listening friend, his role as a behavior therapist helping patients to unlearn their pathological habits and his role as a cognitive therapist helping the emotionally disordered to consciously change their thinking and the cognitive aspects that support and motivate their emotional symptoms. By completing this section of the paper we come to discuss our main objective of the Islamization of psychotherapy.

The Islamization of Psychotherapy: An introductory statement

The Islamization of Western secular therapeutic techniques is so vital that one really wonders why it was not done decades ago. This is so because there are special disorders that cannot be treated without going into religious or local cultural issues. I can give a few examples. Epidemiological studies in many countries have shown that phobias or irrational fears are the most common anxiety disorders. Many Muslim patients complain of incapacitating phobias of death, disease or jinn. I often wondered how a therapist can succeed in treating such phobias in a Muslim patient without an in-depth cognitive intervention regarding the teachings of Islam about jinn, life, death and life after death. Without changing the irrational beliefs of a patient concerning these spiritual issues, no secular therapy can be of real help for him or her. In my long experience of almost forty years I have always found that whenever I applied an Islamically oriented psychotherapy, my patients who had previously failed to benefit from drugs and secular psychotherapeutic interventions, were simply cured or greatly improved in a short time.

On the other hand I also found many of my colleagues unable to help clients with marital problems because of their ignorance about Islamic family law and the Islamic teachings concerning sex, inheritance, divorce, and the custody and guardianship of children. This Islamic knowledge is vital particularly to women who greatly outnumber men in seeking the help of therapists. In our modern Islamic countries, women are generally deprived from their rights because of their ignorance about these rights. They may seek the help of a psychotherapist because they developed unwarranted guilt and anxiety as a result of their failure to cope with the unjust demands that men level against them. For example, many women develop serious anxiety and guilt because after their fulltime overwork in their offices they find themselves compelled to meet the uncompromising demands of their husbands. These good Muslim women are unaware that cooking, washing and other domestic chores are not required from them according to Islamic jurisprudence. They can volunteer to do them if they wish, but it is not Islamically mandatory.

Husbands, out of tradition and lack of knowledge believe that it is their Islamic right to be served whether the wife is too tired to do so or not. Because of this ignorance about the rights of wives they often misuse religious quotations to make their exhausted wives guilty. In fact it is the Islamic responsibility of the husband to provide for such help. If he cannot, he should be grateful to his wife if she volunteers to carry out these services rather than blaming her. Many Muslim therapists are also uninformed about these religious facts and so they often exacerbate their female patients' guilt by their misdirected therapy. I have found that just by knowing these Islamic teachings, a number of wives who consulted me have lost much of their guilt and with this new spirit they actually continued to give the same services they were grumbling about with enhanced spiritual acceptance of religion. Not only that, but the Holy Qur'an has explicitly stated that it is not mandatory for a mother to nurse her own newly born baby if problems break out between her and her husband. In Surat al-Talaq the Noble Qur'an says that if the married couple is at odds concerning their married life, the husband should either pay the wife for nursing their baby or hire another woman to nurse it. Not only that, but in many Muslim African countries, women are not given what they deserve in terms of inheritance. If the psychotherapist or counselor is himself ignorant about these Islamic teachings, how can he be of help with such problems?

Furthermore, therapists helping patients with debilitating guilt concerning what they view as terrible sins they had committed such as drug and alcohol intake or deviant sexual behavior like homosexuality would generally fail to help if they follow the secular psychotherapeutic techniques they studied in the West. There, they are told to be neutral and nonjudgmental and not to bring religious issues in their therapy. Here, if Islamic issues are not discussed in a warm friendly optimistic manner the patient may never improve.

Islam as a religion and a worldview has a much greater influence over Muslims than any other religion or worldview. That is why an Islamically oriented psychospiritual therapy can even help hardened drug and alcohol dependents whom modern western therapy consider as totally hopeless since they fail to get benefit from medical and psychological interventions. One of my popular stories in this connection concerns an honest broad-minded European psychiatrist, Dr. Karl Schmidt, who was practicing in Brunei. He read a valuable paper on his innovated techniques of treating drug and alcohol addicts in Brunei. The paper was read in Amman, Jordan, in 1987 in the Third Pan Arab Congress on Psychiatry sponsored by the Association of Arab Psychiatrists. He took a group of addicts to a camp outside the city and subjected them to a daily rigorous program heavily saturated with Islamic activities involving prayers, talks and video shows, and physical training accompanied by the chanting of Islamic slogans. The program started from dawn fajr prayers to bed time. The result was fantastic. The relapse rate of treated addicts was more than 90% with the secular methods. It fell to about 65% with the Islamically oriented therapy.

Indeed, after seeing many such alcohol and drug dependent patients, I have come to the conviction that unless the excessive guilt concerning their committing to such sins is dealt with through an optimistic approach stressing God's Mercy and forgiveness to all sins, they may lose hope of being accepted by God and hence indulge in their harmful habits of extravagant alcohol and drug intake either to relieve their stress or simply to enjoy their addiction since no treatment is helpful and anyway, according to them, God has already stamped them as evil. The secular approach of viewing religion as irrelevant or something to be avoided can thus be of no help or even harmful to such patients.

Since psychotherapy is supposed to be an educational endeavor, it should be based on the worldview and the culture of those seeking its help. Even European psychologists and psychotherapists are beginning to grumble about the hegemony of American psychology. They say that America is the superpower of psychology and that their students are being psychologically Americanized as they study psychology from American texts that flood their markets. Many Western psychologists are beginning to realize that their field is largely culture bound and mainly influenced by American psychology and its emphasis on extrapolating from animal studies and its use of American students as subjects. Listen for example to the well-known British psychologist Eysenck as he writes in 1995 in the journal of World psychology (Vo.1, No.4, p.13):

"Much of our psychology is based on studies of American college students, rats, pigeons, and mentally abnormal groups...It must be clear that this is not sufficient as a basis for a science claiming universal status."

If even European psychologists are complaining from this Americanization of psychology, though their cultures are identical in most of their major tenets, how can we, Muslim, Asian and Arab psychotherapists continue to counsel and treat our patients as though they were American clients. Our age, as some scholars say is the age of the idolatry of science. Most of our Muslim psychotherapists continue to swallow this ethnocentric psychotherapeutic culture bound stuff simply because they are sugar-coated with 'science'.

It is sad to say that while some of our Muslim therapists cling to their modern school of therapy as if it were a revelation, we find that some honest Western psychologists beginning to see the ethnocentric quality of their specialty and warning about its wholesale exportation to other cultures. For example, in their well written paper titled, "But is it a science? traditional and alternative approaches to social behaviour", one psychologist from Georgetown University, USA, Moghaddam, and a second psychologist from Oxford University, England, Harre', has this to state. I have put this long quotation from their article since it says clearly how our mental slavery to "Americanized" Western psychology can only perpetuate exploitative traditions of colonialism:

"...the most important factor shaping psychology in the international context continues to be power inequalities between and within nations. The inability of psychology to contribute to Third World development arises in large part from these inequalities... and surely this is an unethical issue. Putative psychological "knowledge" which is of highly questionable reliability and validity even in the Western context is being exported wholesale to Third World societies, as part of a large exchange system ultimately driven by profits.

The United States has established itself as the only psychology Superpower...Psychology continues to be exported from the U.S. to the rest of the world, with little or no serious attention given to the appropriateness of what is being exported...Similarly, Third World psychologists are trained in the U.S. and in other Western countries, without regard to the question of the appropriateness of their training. Indeed, the continued exportation... and inappropriately trained personnel from Western to Third World societies strengthens ties of dependency and continues exploitative traditions established through colonialism" (World Psychology,1995, pp. 53-54, italics ours).

It should now be clearly appreciated that without adaptation, some culture-bound forms of Western psychotherapy can be of no use to Muslim clients and can at times be harmful. But does adaptation mean Islamization? Yes, indeed. Though some kinds of adaptations in which psychotherapy is tailored to suit the clients of a particular country may not necessarily stand for Islamization, all forms of Islamizations are indeed adaptations. Western psychology itself asserts that the psychological and the socio-cultural components are the pillars of shaping human personality. Anyone who fails to see the very great influence of Islam as a religion and a way of life in molding the personality of a Muslim is a myopic who suffers from tunnel vision.

The main attribute or trait that gives the average Muslim client his uniqueness is his religion. Faith in Allah Ta'ala as the Almighty Creator and Sustainer of this universe and His knowledge about the secrets in the hearts of men and that which is beneath their secrets (subconscious) "~s}I 9;--JI ` 1~ *, " and that whatever happens to man in this world is already destined and has a Divine Wisdom behind it. The belief that there is life after this life and man has a free will and is accountable for whatever he had done during his brief stay on earth. These beliefs would make it necessary for any psychotherapist working with Muslim clients to Islamize his work even if he were not a Muslim himself. All the major perspectives of Western psychotherapy deny the soul. They treat man as though he were a talking animal. The terms "God", "soul", "spirit" or "good and evil" are out of bounds irrespective of whether the perspective is behavioristic, psychoanalytic, humanistic, biological or cognitive. They are all erected on a secular worldview.

I firmly believe that because of their rejection to the secular approach of Western trained therapists, most lay Muslim patients, particularly in rural areas are reluctant to be referred to modern psychiatrists and counselors. They would however be glad to be seen by traditional and religious healers. I have found this in a research study that I presented to the Traditional Medical Practices Committee of the World Health Organization in Geneva (Badri,, 1978). In all the Islamic countries I have studied, I found that the great majority of neurotic patients go to traditional healers. Though they deprive themselves from the modern psychotherapeutic techniques and subject themselves to harmful interventions by the quacks and imposters who pose as religious healers, they may get much benefit from the suggestive and spiritual help that are not available in modern clinics and counseling centers. They are ready to take these risks because they yearn for the spiritual explanations and therapy offered in traditional healing.

After this long introduction, let us go into some detail concerning the role of the Islamically oriented psychotherapist with respect to the three helpful areas on which there is a general consensus among psychotherapists. These, as I delineated, are: the role of the psychotherapist as a warm accepting good listening friend, his role as a behavior therapist and his role as a cognitive therapist.

The Muslim psychotherapist as a counseling psychologist The therapist as a warm accepting friend:

In this section, I wish to discuss the influence of Rogerian Client-Centered therapy and similar perspectives that influenced modern Muslim therapists and to show that its main merits are in fact teachings of Islam and its demerits an influence of secular western modernity that the Muslim therapist should reject. Since this perspective, unlike behavior therapy is rather saggy and too broad to lay down, I shall give it a large space in this paper.

A scholar studying this psychotherapeutic perspective can write volume upon volume to give its pertinent details from the Holy Qur'an, the Sunnah of the Blessed Prophet (PBUH) and the works of our early Muslim theologians, physicians and scholars. These teachings of being warm, friendly and accepting are so obvious that we do not need to spend much time and space over them. In the personality and life of our Prophet Muhammad, the Messenger of Allah (PBUH), modern Muslim psychotherapists can find the highest values and teachings about how to be friendly brothers or sisters to their clients and patients. Just one Verse from the Holy Qur'an is enough to summarize this whole field of Islamic counseling and exhibits its uniqueness. The Holy Qur'an Describes the character of the Prophet in dealing with his followers in these beautiful words:

"It is from the Mercy of God that you deal gently (and warmly) with them (his followers). But if you were severe and harsh-hearted, they would have broken away from you. So pass over their faults and pray for their forgiveness and consult them in affairs before taking a decision and when you decide put your trust on God for God loves those who put their trust on Him (Surat Alimran, Verse No. 159)".

What are the general principles that can be inferred from this single Verse of the Noble Qur'an. They are:

a. Be genuinely warm loving and gentle to your clients. You are not to be a detached empathic or even sympathetic observer as western counseling would suggest but a merciful involved brother or sister. Mercy is more comprehensive and spiritual. It gets its source from the Mercy of God Hi myself.

b. Be accepting and pass over their faults without being nonjudgmental. AS the Qur'an States in another Verse (28:87), "Call to the way of your Lord with fair exhortation, and reason with them in the best manner".

c. The counseling or psychotherapeutic session is a consultative venture in which the therapist does not act as an oppressive leader. So be humble and do not be authoritative. Let your advice come after consultation with the client.

d. The counseling or psychotherapeutic session is a spiritual endeavor in which the therapist or counselor is blessed by God in being selected to help a brother or sister to overcome an ordeal. So you should put your trust in God and should be grateful to Him for Giving you this opportunity.

What more do we need to add to this? We can only give more concrete examples from the sayings of the Prophet and his companions and the writings of early scholars. These scholars of Islam took the teachings of the Prophet and his deeds as the guide for their writings on being warm and accepting to others and on advising them by following the gentlest manner and strictly guarding their secrets. Listen for example to the following sayings or Ahadith of the Prophet:

"Show optimism and make things easy and not difficult and give good tidings and not the news that repel" (authenticated by Muslim).

"He who helps a Muslim to alleviate a hardship of this world, Allah Ta'ala will alleviate for him a hardship in the Hereafter" (authenticated by Muslim).

Influenced by these and similar ahadith and deeds of the Prophet, Abdal Gadir Aljailani writes in his AI-Ghuniah Litalibi Tariq Alhaq what is translated as follows:

"The conditions of good friendship are that you should be forgiving and you should accept whatever your friend says or does and to find an acceptable excuse for anything that does not look right (if it is not clearly contrary to Islamic teachings) (1956, p. 169)".

And as for his advice to the Shaikh or Guru who was actually the counselor or psychotherapist of his time, Jailani says in the same book:

"The sheikh should treat his disciple with mercy and love. If the disciple finds difficulty in changing his bad habits and do what the guru wants, he must be gentle and gradually help him in the way that a mother or a loving father treats their child" (P.168).

Similarly, Abu Hamid Al-Ghazali gives a detailed account on the duties of the Shaikh and his treatment to his disciples. His account can be a very useful guide to modern Muslim counselors and therapists. I am translating some of these duties as follows: "The first duty and attribute of a good sheikh is to be humble and gentle with those he is dealing with. He should not stress on giving knowledge or advising but rather choose the route of mild and tender gradualism. A good sheikh should also be ascetic and should not look at his disciple's money with greed. Another good quality of the guru is that if he comes to see or to know that one of his disciples committed some offense, he should not tell him directly about it. He must be indirect and rather meandering about helping him to see the wrong he had done. He can for example advise a whole group of disciples about the bad effects of what the person had done without making him feel that he is the one meant for the advice. This would be good to the whole group. And finally, the guru should keep the secrets of his disciples and his clients. These people trust him with personal experiences some of which may be embarrassing. The sheikh should put down a heavy lid over his heart and tongue in keeping these secrets in the dark." (AlIhya, Vol.5, P.206-28)

The myth of being totally nonjudgmental: /

It is rather sad to see Muslim therapists who possess such a rich heritage speaking about being trained to be warm and accepting to their clients by experts of Rogerian client-centered counseling. It is as if to be loving, understanding and accepting is a twentieth century discovery by the founder of non-directive counseling. Some of them naively boast about being totally and unconditionally accepting in a value-free nonjudgmental manner. This claim of nonjudgmental value-free attitude is of course a myth. Once you call yourself a counselor or psychotherapist and the one across the table a client or a patient, you have lost your nonjudgmental attribute.

Furthermore, as a humanistic school of psychotherapy, person-centered therapy, as we said earlier, aims at helping the client to actualize himself. But of course this cannot be achieved in a totally value-free way even in the west. The therapist and client will have to follow Western values. A client may wish to actualize himself as a photographer of heterosexual pornographic films and his therapist may say, "That is fine if your choice is the art of filming adults copulating". But no therapist will agree to be value free to the extent of conceding if the client wishes to be a photographer of pedophiles who have sex with children. Such atrocious video cassettes are now thriving in the western sexual industrial revolution. Also, painting is an art which many find self actualizing, but what about an artist who wishes to develop himself in the art of forging counterfeit money or one who would like to accomplish himself by perfecting the fine art of pick pocketing? All such modes of self actualization would not be allowed because they conflict with Western values.

Before I conclude this section I must say that this nonjudgmental approach is actually a symptom of westerners' animosity towards their religion that they have generalized to all other religions. One can understand their position. It is so because they are societies that are haunted by an ugly religious Church history of inquisitions and the burning of hundreds of thousands or even millions of innocent victims; they are societies that have lost much of their faith in their modern religious institutions of the large number of divergent faiths and denominations; societies that were able to scientifically progress only when they discarded religion; societies in which mental health workers are consequently trained to generally view religious persons as suffering from pathological religiosity. In such societies it is understandable that counselors and therapists may be advised to steer away from embarrassing religious topics and to pursue the secularized materialistic path of the overwhelming majority.

Culture-blind aping by Muslim psychotherapists:

What one cannot understand is why our Muslim therapists sheepishly behave in the same secular manner? In the length and breadth of their history, the Muslims have not experienced the moral dictatorship of a church or the barbarous executions of inquisitions. Islam is a simple straightforward rational religion that has an unequaled command over the hearts and minds of its followers. It is a religion in which all Muslims have no shreds of doubt about the Oness or Tawhid of the almighty God, the authenticity of the Holy Qur'an, the Divine message of Prophet Muhammad (PBUH) and other messengers. Just as they all face the same direction to Ka'bah in their daily prayers, they hold to the same worldview and way of life. Even the concept of Divine retribution and punishment is portrayed in Islam in the most optimistic, merciful and rational conceptions. The Holy Qur'an clearly states that God's punishment in this world is meant to ward off more serious future pains and agonies, and to coerce the sinful to repent and secure God's forgiveness:

And indeed We will make them taste of the Penalty (and pain) of this life prior to the supreme Penalty, in order that they may repent and return. ( SuratAssajdah, Verse No. 21)

Also, human anguish is a Divine test to wipe out sins and to elevate the spiritual position of the suffering person. As the Prophet, peace be upon him, said, there is always a reward to the Muslim from God for even the slightest pain he incurs, even if it is the prick of a thorn (Authenticated by Bukhari). These beliefs are deeply rooted in the hearts and minds of average Muslims and if the Muslim therapist does not make use of them in alleviating the psychological agonies of his patients, he would be like the ignorant man in the hot desert who throws away his water because he saw a lake of mirage. Or as the Arab poet describes it, like the camel that dies of thirst while water containers are strapped on its back..

Thus, a Muslim psychologist who rides the western wave of secular therapy is actually selling out his Islamic values and depriving these patients from useful psychospiritual therapy. A loving warm friend may actually be often better than him. This is so I think because the friend humbly sees the emotionally disordered as a person like himself and speaks to him in the simple language of his culture and religion. The trained counselor, as I said, alienates himself by accepting the patterns of a foreign culture as a'science' of psychotherapy!

Islamic psychotherapy requires that the therapist be a Sincere role model and give his clients enough time:

It should therefore be stated that the Muslim psychologist should be aware of the Islamic role that is styled by the spiritual teachings of Islam and the work of early Muslim therapists. He should consider himself a sincere brother or sister or friend and not to be boastful about his specialty. He should concentrate his effort on how to help the Muslim client with his problem rather than how to diagnose him or apply his sophisticated theory and practice on him. He should not be a slave to his specialization or to the stereotyped rituals of western psychotherapy. For example, if he feels that to bring another friend of the patient or his relative or spouse in the therapeutic session would be helpful, he should do so and he should treat them with respect as co¬therapists. If he feels that visiting an old sick authoritative parent of the patient in his house can be therapeutically helpful to the young patient who suffers from his unrealistic control, he should do so.

Furthermore, the clinic or counseling room should not always be a formal strict place of therapist and patient. It can also be a blessed room where the therapist and his client may say their obligatory prayers together or eat and drink and chat together. Also the time taken for treatment should not be the fixed 45 minutes per session as is the case in modern psychotherapy. Quite often traditional healers and sheikhs can do a better job at helping the emotionally disordered because they spend more time with them. Patients get the chance to see the respected spiritually inspired healer as a role model in his social intercourse with others, in his prayers, in his patience with difficult persons and his love and guidance to his disciples. The patients and disciples pray together, eat together and sleep in the same compound.

In a study of traditional healing practices in Sudan that I carried out for a WHO Expert Committee in the eighties, I was astonished to find a number of the patients whom we failed to help in the Khartoum Psychiatric Hospital completely cured or much improved through the traditional Islamic therapy of a famous Sheikh. When I visited his far-off compound to collect information for my research, I was astonished to be greeted by the smiling cheerful faces of the same persons that I had been accustomed to see as perpetually debilitated with chronic anxiety and the sad pessimism of depression.

I know that what I am proposing may not be accepted by modern Muslim psychotherapists who would raise the objection that they do not have the time for such consuming therapy. Some of them would like to stick to the 45-minute session in which they keep glancing at their watches and frequently ending the session just as the patient begins to emotionally loosen up. Traditional Islamic healers find all the time they need for their clients because they also engage in group therapy. They only close their doors with one patient when the latter wishes to reveal personal secrets. That is why I believe that if the patient is not so severely disordered that he needs to be alone with the psychologist, group therapy led by a committed Muslim therapist can often be far superior to stereotyped one-to-one therapeutic sessions. However in a number of cases a combination of both methods can bring about good results.

I think that much informal counseling and psychotherapy of this kind is going on in our Muslim countries. May be for this reason, we find that there are few practicing psychotherapists and counselors. People get free useful counseling from friends, teachers and elderly relatives. As it was once said, "The psychotherapist is an expensive friend but the friend is an inexpensive therapist".

In western countries on the other hand, the materialistic competitive way of life does not give friends and relatives the time or effort to help a friend in need. That is why troubled people there are ready to pay expensively to counselors just to find someone to talk to and to seek his warm relationship even if they know about the research on the limitations of counseling and psychotherapy. Torrey puts this issue in a mocking manner. He says:

"Saying that psychotherapy does not work is like saying that prostitution does not work; those enjoying the benefits of these personal transactions will continue doing so, regardless of what the experts and researchers have to say" (1986, p. 198).

As Muslim therapists we should learn from the traditional healers:

As modest Muslims who are happy to acquire wisdom and knowledge from any source, we should learn from the long pertinent experience of our Muslim traditional healers. The righteous ones among them are the true descendants of Ibni-Sina and Ghazali. Much of what they do with their patients is influenced by the religious traditions of olden days. They know their culture and traditions better than us since their worldview has not been contaminated by modernity and western thought. I have personally learnt much from them and was often amazed by the creative ways they think of to solve the problems of their clients.

I will give the reader a recent example about a Sudanese Sheikh and healer living in a small town about 130 kilometers from the capital city of Khartoum. A disabled partly crippled young beautiful lady in his town used to travel weekly to the Capital to receive physiotherapy in a specialized center run by a German humanitarian organization. A young man working in this center fell in love with her and married her. She moved to his house in the capital. Life went smoothly for a few months after which they often quarreled and he brutally beat her. She would then travel back to her parents, but soon he would come begging her to come back to him and humbly apologizing to her parents and relatives. However, after going back the episode is repeated until in one occasion he was so brutal in hitting her that she needed medical intervention. She came to her parents and vowed not to return to him and asked for a divorce. The parents and uncles were quite happy and relieved by her decision. Village people in Sudan live together as one big family, so everybody knew about her case and supported her demand for divorce. However, after a few months, her physical and psychological wounds healed and she wanted to go

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