Religion and Spirituality in Psychiatry

Psychotherapy from an Islamic Perspective 305looking at the bodies of persons of the oppositesex (except one’s spouse), supposedly toprevent sexual immorality and marital damage.Looking at the face is a lesser matter, althougheven this may be discouraged in many Islamicreligious societies. Islam encourages sexualrelationships between wife and husband,but prohibits any sexual relationships outsidethis boundary. In addition, in many religiousMuslim families, women and men have more orless separate social groups. For example, whenthey attend a family party, most conversationsoccur within each sex group, and many partiesmay be exclusively for men or for women.Also, many Muslim women do not work outsidethe home and have little contact withstrange men. All of these factors may cause theMuslim female patient to have less than usualeye contact with her male therapist, which cancause negative attitudes in the therapist or maybe interpreted by him as a sign of depression,avoidant personality, or lying.Islam also prohibits any bodily contact betweennon-relative opposite sexes. For example, aMuslim man is allowed to shake hands with hiswife or sister but not with his female cousin orteacher. In a case described by Ali et al., (12) themale counselor visiting Mona (a Muslim Arabgirl) for the first time wanted to greet her byshaking hands with her, but this approach causeddistrust in Mona and turned out to be his firstmistake. Nevertheless, he was eventually able tohelp Mona after he showed more interest in herMuslim culture and after Mona felt that he wasnot going to rescue her from “her religion that isoppressive to women.”When a Muslim family immigrates to aWestern country, the man often comes first and,after a period of stressful anticipation and preparation,other family members follow. Even if theyimmigrate together, men usually work outsideand women at home. Therefore many immigrantMuslim women are not fluent in English andmay bring a relative or child as a translator.This may also be interpreted as excessivedependency and create negative feelings in thetherapist.2.2. TransferencePhysicians are highly valued in Islamic culture.In addition, consultation with a physician ortherapist is generally favored and recommendedto Muslims and even to the Prophet Muhammadin the Koran (Holy Koran 3:159 and 42:38).These recommendations can be used to facilitatethe development of a working alliance withMuslim patients. However, Muslim clients mayhave negative stereotypes about Western cultureand Western therapists resulting from their feelingof oppression by Western politicians and mayuse terms such as you (Westerns or Americans)and we (Muslims or Arabs) (p. 23). (4) Therapistsshould not take these statements personally butrather should help the clients think less categorically.For example, the therapist may say to thepatient, “I understand you! I know some Westernpolicies may have hurt you. But … may you havenegative feelings toward me because I am alsoa Westerner? Because this negative feeling mayadversely affect the success of our sessions, can Ido anything to make you feel easier with me?”Muslim clients in Western countries are underpressure of the dominant Western culture, so theymay also feel shame and inferiority and fear punishmentfrom the Western therapist. By adoptinga sensitive and warm attitude, the therapist mayhelp decrease these negative feelings.2.2.1. Warm GreetingsWhen meeting a Muslim for the first time,warm greetings usually help to establish a morepositive transference. In many Muslim cultures,standing up from a sitting position when someonearrives implies respect for him or her andis encouraged. Shaking hands with the samegenderclient is also helpful.2.2.2. Admiring Strong PointsAt the end of the first session, we should havedetermined and negotiated the therapeutic goalswith the client, and the client should have gainedenough hope and developed a good enough transferenceto continue therapy. This good impressionalso usually needs to be impressed upon the client’s