Religion and Spirituality in Psychiatry

306 Sasan Vaseghfamily because the client may be dependent onthem to come to psychotherapy. One importanttool to instill hope and a good transference in theclient or her family is to admire and encouragethem and reinforce their positive characteristicsand strong points. For example, the therapist cansay to the client’s husband, “Supporting your wifeto come to psychotherapy shows that you feelresponsible and love your family, because it maynot be easy nowadays to come to a psychiatrist orpsychotherapist.” Dwairy (pp. 116–117) (4) hasdescribed that this approach helped his clientsremain in therapy and receive effective help. Ifthe client feels positive toward his or her religionor culture, admiring and showing respect forthe religion/culture is another important way tocreate a positive transference.2.2.3. Admitting to One’s Lack of KnowledgeAdmitting to one’s lack of knowledge aboutthe patient’s culture or religion is another wayto establish a positive therapeutic alliance. Thiscan decrease the client’s inferiority feelings andencourage more open communication. The followingstatements indicate a non-Muslim psychotherapist’ssincerity and respect toward aMuslim client: “Because I am not a Muslim, myknowledge about Muslims’ practices and beliefsis limited and there may be some misunderstandings.I would be glad if you would let me knowshould I make a mistake regarding your cultureor religion.”2.2.4. Paying Attention to Negativeor Positive CuesEven when we try our best to help our clients,there may be some misunderstandings(pp. 31–41) (15) ; therefore, it is important to besensitive to the clients’ verbal and nonverbalcues. If a negative cue appears, help the patientto clarify it. Say, “You seem somewhat troubled.Was there anything in what I said or behavedthat caused a negative feeling in you? Could youplease explain your thoughts?” In addition, at theend of each session, it may be appropriate to askabout the client’s feelings and thoughts about thesession.2.2.5. Predicting and Anticipating ReactionsSome Arabs or Eastern Muslims may have difficultyspeaking about intimate or sexual subjectsto therapists of the opposite sex. They may alsoexpect the therapist to offer them direct advice andmay expect the number of therapeutic sessions tobe quite limited. If given homework or tests, theymay think that this is childish. Anticipating suchthoughts, feelings, or behaviors in the course ofthe therapy is another effective way of increasingclients’ compliance and preventing them fromdropping out. For example, the therapist may say,“Some clients may feel that doing homework ischildish. The exercises may sometimes seem useless.How do you think we should handle thesethoughts should they occur?” Or the therapistcould say, “You said you had marital problems forabout five years. How would you feel if I told youthat it may take up to six months to control theseproblems? Does this seem too long to you?” Suchquestions can help clients anticipate their ownreactions and manage them better.2.2.6. Similarities and DifferencesAll Muslims are not the same. Although thereare many similarities, these shouldn’t blind usto the differences. One difference is related toMuslims’ countries of origin. Usually the longer aMuslim has lived in a specific country or region,the more similar are his or her attitudes to theculture of that country. For example, ChristianArabs are culturally very similar to MuslimArabs (p. 5), (4) but when they immigrate toWestern countries, both gradually move towardthe Western culture. Yet Arabs account for only20 percent of all Muslims (3) and other Muslimsmay differ culturally from Arabs.Another important dimension is their religiosity.Muslims differ in their acceptance of variousIslamic beliefs and practices and in the degree ofthis acceptance. So before using religion-relatedtechniques in therapy, we should first take areligious history. (20) If the patient agrees, thetherapist should also obtain information fromother significant family members because thismay yield a very different picture of the patient’sproblem.