Understanding the Mental Health Needs of American Muslims: Recommendations and Considerations for Practice

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©2007americancounselingassociation.allrightsreserved.

understandingtheMentalhealthneedsofamericanMuslims:recommendationsand

considerationsforpracticeSameeraAhmedandLindaA.Reddy

americanMuslimsrepresentaheterogeneouspopulationthatisunderservedby thementalhealthcommunity,despite increasedpsychologicaldistressreportedsince9/11.thisarticleoffersprofessionalsanunderstandingofthementalhealthneedsofamericanMuslims.recommendationsforconductingculturallyresponsiveassessmentsandtreatmentareoffered.

losMusulmanesamericanosrepresentanungrupodepoblaciónheterogéneoquenoseencuentrasuficientementeabastecidoporlacomunidaddeprofesionalesensaludmental,apesardeuncrecientemalestarpsicológicoobservadodesdeel9/11.esteartículoofrecealosprofesionalesunentendimientodelasnecesi-dadesensaludmentaldelosMusulmanesamericanos.seofrecentratamientosyrecomendacionesparallevaracaboevaluacionesculturalmentesensibles.

Since9/11,theUnitedStateshasbecomefocusedonMuslimsinAmericaandabroad.Mediacoveragehasfueledacombinationoffearandcuriosityformanywithregardtothesocialandculturalbehaviorsofthispopula-

tion (Hedayat-Diba, 2000). Despite increased attention, American Muslimscontinuetobemisunderstoodandmisrepresented.TheseindividualsrepresentahighlydiversegroupwhoareAmericanandfollowthereligionofIslam(Ali,Liu,&Humedian,2004).ThepublicmostoftenidentifiesAmericanMuslimsasimmigrantsorrefugeeswhohaverecentlymigratedfromdevelopingnations.However,manyAmericanMuslimsrefertothemselvesasindigenousMuslims.Indigenous Muslimsisagenerallyagreed-upontermintheMuslimcommunity,referringtoindividualsfromAfricanAmerican,European,orHispanicback-groundswhowerebornandraisedasAmericans(Ahmed,2000).

IslamisthefastestgrowingreligionandsecondmostpopularreligionintheUnitedStates(Al-Mateen&Afzal,2004;Erickson&Al-Timimi,2001).Approximately7to10millionAmericanMuslimsresideintheUnitedStates(CouncilonAmerican-IslamicRelations[CAIR],2001).Mentalhealthprofessionalsarechallengedwitheducatingothersaboutthisdiversepopulation,aswellasprovidingassessmentandinterventionservices.However,fewmentalhealthprofessionalshavetheknowledgeandtrainingtorendersuchservices(Ahmed,2007;Al-Mateen&Afzal,2004).

Whilethementalhealthprofessioncontinuestoserveincreasinglydiversepopula-tionswithinAmericansociety,AmericanMuslimsremainunderserved(Al-Mateen&Afzal,2004;Kelly,Aridi,&Bakhtiar,1996).LikeallAmericans,AmericanMuslims

Sameera Ahmed, The Family & Youth Institute, Canton, Michigan; Linda A. Reddy, Child ADHD and ADHD-Related Disorders Clinic, Rutgers, The State University of New Jersey. Correspondence concerning this article should be addressed to Sameera Ahmed, The Family & Youth Institute, PO Box 871878, Canton, MI 48187 (e-mail: [email protected]).

208 journalofMulticulturalcounselinganddevelopMent•october2007•vol.35

experiencedthetraumaof9/11andtheresultingwaronterror,bothdomesticallyandinternationally.However,unlikeotherAmericans,manyAmericanMuslimshave subsequentlyexperiencedreligiousharassmentandracialprofiling.TheFederalBureauof Investigation(FBI)reportsa1,600%volume increase since2000inthenumberofhatecrimesperpetratedagainstMuslims(FBIUniformCrimeReportingProgram,n.d.).Asaresult,manyAmericanMuslimsexperienceincreasedfeelingsofanxiety,fear,andrejection.

Inthisarticle,weexaminetheuniquementalhealthneedsof threesub-groupsofAmericanMuslims:immigrants,refugees,andindigenousMuslims.Toservethispopulation,weofferrecommendationsandconsiderationsforclinicalpractice.

sociocultural overview of american muslimsreligion

IslamisconsideredthelastoftheAbrahamicfaiths,revealedthroughtheProphetMuhammadintheformofaholybook,theQur’an.Muslimsarerequiredtoperformfouracts:(a)prayfivetimesaday,(b)fastintheIslamicmonthofRa-madan,(c)givecharity, and(d) performthe pilgrimagetoMakkahatleastonceintheirlifetime.Thesefouractstogetherwiththeverbalacclamation“ThereisnogodbutGod,andMuhammadisHislastandfinalMessenger”formthefivepillarsofIslam(�Abd al �A�Abdal�At. i , 1998). For a detailed description, see,1998).Foradetaileddescription,seeIslam in Focus(�Abd al �A�Abdal�At. i , 1998) or http://islam.about.com/od/basicbeliefs/p/intro.htm.,1998)orhttp://islam.about.com/od/basicbeliefs/p/intro.htm.

culture

TheaforementionedpillarsofIslamarethebasicbeliefsandpracticesen-joinedbyIslamonitsfollowers.However,becauseoftheindistinguishableintertwiningofcultureandreligionindifferentpartsoftheworld,Muslimtraditions differ depending on the cultural context of the individual. Asa result,AmericanMuslimsmayadhere todifferent values and traditions,whichareoftenmoreculturallyratherthanreligiouslybased(e.g.,marriagerituals,parentingstyle).Forexample,AmericanMuslimswhohaverecentlyimmigratedtotheUnitedStatesaremorelikelytohavearrangedmarriages(i.e.,marriageisarrangedbyparentsoreldersandthecouplehasminimalcontactbeforemarriage). Incontrast, indigenousAmericanMuslimshaveoftenknowntheirfuturespousesthroughfamilyandcommunityactivities.

mental health needsMusliMiMMigrants

Theprocessofimmigrationandsubsequentacculturationisdifficultforim-migrantsbecauseofchangesinphysicalspace(i.e.,differencesingeography,


housing,andpopulationdensity),climate,nutrition,medicalconcerns,poli-cies,laws,andcivilrights(Berry,1994;Roysircar-Sodowsky&Maestas,2000).Thesetransitionsarechallengingandconfusingforimmigrantswhocomefromfamilieswithdifferentsociopoliticalstructuresandnorms.Immigrantfamiliesmustcopewitheconomicchangessuchasnewformsofemploymentbecausepreviouseducationalandworkexperiencesmaynotbefullyrecognizedandacceptedbystatelicensureboards(e.g.,medicine,dental,engineering,andlaw).Thereductioninstatusoftenresultsinthelossofself-esteem,feelingsofhopelessnessandfailure,depression,andguilt.Immigrantparentsmustquicklylearnabouttheirnewcultures;becomefluentinforeignlanguages;andenrolltheirchildreninneweducationalsystemswithunfamiliareduca-tionalphilosophies,expectations,norms,andformsoftesting.

Unlike other immigrants, American Muslims are increasingly faced withintensediscrimination.SincethepassageoftheUSAPATRIOTActof2001,themajorityofindividualswhohavebeeninterrogatedbytheFBIhavebeenAmericanMuslimimmigrantsofArabandSouthAsianorigin(CAIR,2002).The interrogations have resulted in many American Muslim immigrantsfeelingunfairlytargetedbythegovernmentbecauseoftheirreligiousbeliefs(CAIR,2002).

ThestressorsofbeinganAmericanMuslimimmigrantareoftenmanifestedintheformofpsychologicaldistress.Forexample,ArabAmericansreporthigher rates of anxiety and depression in comparison with the normativepopulationintheUnitedStatesandwithArabsinArabcountries(Amer&Hovey,2006).Thisfindingislikelyrelatedtofeelingsofdiscriminationandalienationrelated to religionorethnicity; lossof social status, self-esteem,andsocialsupport;andfeelingsofhopelessness.RippyandNewman(2006)reported that American Muslims have higher rates of posttraumatic stressdisorder(PTSD)symptomsthandoesthegeneralpopulationintheUnitedStates.TheauthorssuggestedthatthesefindingsmayberelatedtoMuslims’uncertaintyabouttheirfuturesintheUnitedStates,due,inpart,togovern-mentalactions(i.e.,profilingandabuseofcivil liberties throughtheUSAPATRIOTActof2001).However,PTSDsymptomsarecommonlymanifestedinsomaticcomplaintsforimmigrants(Hedayat-Diba,2000).

FormanyAmericanMuslim immigrants, theirextended families in theircountriesoforiginplayedsignificantrolesintheirlivesbyassistingindailyhousework, child care, parenting, and school-related social and academicactivities(Yousif,1992).Thestressofparentinginadifferentculturalandreligiouscontextwithoutsupportandguidancefromextendedfamilymembersmayresultinfeelingoverwhelmed,feelingisolated,andlackingconfidencein parenting abilities. We have observed immigrant parents as sometimesexperiencingdifficultiesinraisingtheirchildrenbecauseofculturallydiffer-entparentinganddisciplinarymethods.Forexample,immigrantparentsaremorelikelytobeauthoritarianandfocusonthecollectivegoodandfamily


honor,asopposedtovaluingtheindividual(Daneshpour,1998).Immigrantparentsaremore likely tousecorporalpunishment todisciplinechildrenbecauseofitscondonedpracticeintheircountriesoforigin,althoughsuchpunishmentisnotacceptedbyU.S.orIslamiclaws.

Onthebasisofourclinicalexperience,weunderstandthatimmigrantparentsoftenexperiencemaritaldifficulties thatcanaffectparent–child interactions,familycohesion,andchildren’sschoolandsocialadjustment.Manyexperienceacculturativestress,definedasthemodificationofone’sculturebasedoncontactwithadifferentculture(Nwadoria&McAdoo,1996).Thisstressisexemplifiedwithinthemarriageasclashesbetweenoldandnewsocietalnormsandgenderrolesareplayedout.Acculturativestresscombinedwiththelackoffamilyandsocialsupportcanresultinisolationandincreasedmaritaldifficulties.InmanyMuslimimmigrantcultures,conflictbetweenspousesistypicallymediatedandresolvedbyextendedfamily.However,whenmaritaldifficultiesariseintheUnitedStates,mostcouplesdonothavetheirextendedfamiliespresenttomediateandthusrelyon friendsandreligiousguidance forassistance.Theyoftendonotseekmaritaltherapybecauseofalackoffamiliarityandconcernsregardingthetherapist’slevelofculturalcompetence(e.g.,Alietal.,2004;Kellyetal.,1996).

MusliMrefugees

UnlikeAmericanMuslimimmigrants,AmericanMuslimrefugeesareoftenforcedtoleavetheircountriesoforigin,families,andpossessions.AmericanMuslimrefugeessharewithotherrefugeestheexperienceofbeingexposedtowar-relatedviolence,suchasthreatofpersonalinjury,torture,sexualas-sault,malnutrition,anddisease(e.g.,Friedman&Jaranson,1994;Mollica,Wyshak,&Lavelle,1987).Theprocessofescapingwar-tornregions,livinginrefugeecamps,andcomingtotheUnitedStatesbypoliticalasylum,throughcharities,orbyillegalmeansisexceedinglydifficult(Mollica&Caspi-Yavin,1991).UponenteringtheUnitedStates,manyrefugeesoftenfacechronicunemployment, poverty, racial discrimination, and limited social support(Jaranson,Martin,&Ekblad,2000).Duringthepastdecade,AmericanMus-limrefugeesprimarilyoriginatedfromBosnia,Somalia,Iran,Iraq,Ethiopia,andAfghanistan(“RefugeesAdmitted,”2002).Eachsubgroupbringsitsownuniquesocial,cultural,medical,andmentalhealthneedsthatchallengetheassessmentandtreatmentprocess.

In addition to the trauma associated with being a refugee, an AmericanMuslimrefugee’sexperienceisexacerbatedbyfeelingsofinsecurity,uncer-tainty, and hopelessness due to real or perceived religious discriminationin the United States. Cultural taboos regarding the use of mental healthservicesandthelackofeducationoncommonmentalhealthillnessesandtheirsymptomsalsopreventmanyrefugeesfromobtainingnecessarymentalhealthservicesandoftencontributetoanincreasedriskofanger,depression,anddomesticviolence.


American Muslim refugees often exhibit PTSD symptoms (i.e., intrusivethoughtsand images, sleepandconcentrationdifficulties) fromtraumaticevents such as torture, sexual violence, and other wartime atrocities. Forsuch individuals, traditional psychotherapy approaches, such as exposuretherapy,havenotbeenfoundtobeaseffectiveasusingnarrativeexposuretherapybasedoncognitivebehaviortherapy,testimonytherapy,forgivenessofcollaborators,andthefocusingoftheindividual’sangertowardretributivejusticeinordertogainmoreperceivedcontrol(Kira,2006).

indigenousMusliMs

Asmentionedearlier,indigenous MuslimisanincreasinglypopulartermusedinmostAmericanMuslimcommunities,referringtothoseindividualsofAf-ricanAmerican,European,orHispanicoriginwhowerebornandraisedintheUnitedStates.ThelargestindigenousethnicgroupofAmericanMuslimsisAfricanAmericans(CAIR,2001).

ThefirstdocumentedMuslimcommunityestablishedintheUnitedStatesconsistedofenslavedMuslimsfromAfrica(Diouf,1998).Theseindividualsvaried in background; they were often religious scholars, military leaders,kingsandqueens,andjudgeswhobecameprisonersofwarasaresultofthesociopoliticaleventsinAfricaandwereenslavedandsoldtoslavetradersbytheircaptors(Diouf,1998).Manystruggledtomaintaintheirreligiousbeliefs,despiteharshandinhumaneenslavement(Diouf,1998).Duringthe1960s,manyAfricanAmericansrediscoveredIslamaftertheconversionsofMalcolmXandMuhammadAli(Mahmoud,2005).BecauseofdiscriminationfacedbyAfricanAmericans,manyAfricanAmericanMuslimsreportthattheiridenti-ficationwithIslamhasplayedapowerfulroleinassertingwithinthemselvesaseparate,positive,andintegratedidentity(Al-Romi,2000).

Muslims of European descent differ in their educational backgrounds,introductionstoIslam,andreligioushistories.TheyareofteneducatedandareintroducedtoIslamthroughindividualsearch,interactionwithMuslimpeers,ormarriage(Anway,2000).

MuslimsofHispanicdecentprimarilyliveinlargemetropolitancitiessuchasNewYorkCity,Chicago,andLosAngeles(Barzegar,2003).SimilartothegeneralHispanicpopulation,HispanicMuslimsrepresentavarietyofdistinctculturesfromCentralAmerica,SouthAmerica,Cuba,andPuertoRico.ThemajorityofHispanicMuslimsarecollege-educatedwomenwithCatholicreligiousbackgroundswhowerepursuingaspiritualpathwhentheyencounteredIslamthroughoutreachactivitiesofotherHispanicMuslimsororganizations.BarzegarreportedthatAmericanMuslimsofHispanicheritageareoftenattractedtoIslambecauseofthemonotheisticorientation,structuredbeliefsystem,andhistoricalconnectionofIslamiccultureandcivilizationtoSpain.

IndigenousMuslimswhoacceptIslamasareligionoftenfacethreecom-monmentalhealthchallenges:(a)familytension,(b)guilt,and(c)identity


issues(Ahmed,2000;Alietal.,2004).TheacceptanceofIslamisfrequentlycoupledwiththelossofsupportfromfamilyandfriends.Mostfriendsandfamily members are concerned with the individual’s acceptance of Islambecause of their fears and misconceived ideas about Islam. Some familymembersmayperceive theacceptanceof Islamasarejectionof their life-stylesandeventhemselves,resultinginincreasedfamilytension.Religiousholidays,suchasChristmasandHanukkah,areoftenemotionallytaxingforindigenousMuslimsbecauseindividualsmaystrugglebetweenmeetingfamilyobligationsandpartakinginactivitiesthatmaycompromisetheirreligiousbeliefs(Daneshpour,1998).

Despite being absolved of their past by Islam, some indigenous Muslimsmay experience guilt and anxiety over earlier behaviors and actions (e.g.,drugandalcoholuse,criminalactivity,andpremaritalorextramaritalsex)thatarecontrarytotheIslamicwayoflife(Ahmed,2007).WehaveobservedthatmanyindividualsmaybeoverwhelmedbytheirnewIslamiclifestylesandfeeltheneedto“catchup”withotherMuslimsintermsofknowledgeandpractice.Asaresult,theseindividualsmayengageinnegativeself-statements,whichmayaffecttheirself-worth.

AfteracceptingIslam,manyindigenousMuslimfeelcompelledtoreexam-inetheiridentitiesandmayhavedifficultyreacculturatingintomainstreamsociety.It is thefirstauthor’sexperiencethatsomeindividualsrejecttheirpre-Muslimculturalidentitiesbecausetheyviewtheirpreviouslifestylesandvaluesascontrary to theirnewlyacceptedreligion.These individuals tendtooveridentifywith thecultural identityof thosewho introduced themtoIslam.Although thereareexceptions to this rule, indigenousMuslimsareincreasinglybeingencouragedtointegrateaspectsoftheirpreviousculturalidentitieswiththeirnewMuslimidentities(Ahmed,2007).

considerations for clinical practice adoptaculturallyresponsiveassessMentapproach

EffectivetreatmentplansforAmericanMuslimsarepredicatedonthoroughandculturallyresponsiveassessments.It isdifficulttorecommendacorebatteryofspecificstandardizedassessmentsforevaluatingAmericanMus-lims.Likeallevaluations,acomprehensiveassessmentrestsonthetypeofreferralprovided,thereferringagency,andcommunitysystemcharacteris-tics.Evaluatorsareencouragedtoconductcomprehensiveassessmentsthatincludemultiplemethods,informants,andcontextsthatofferopportunitiestoobserveadaptiveandmaladaptivefunctioning(Reddy,2001).Apretestingassessment(i.e.,intake)isrecommendedtoassesswhethertheuseoftestsisappropriateforeachclient.Evaluatorsshouldincludereliableandvalidassessmentinstrumentsthataresensitiveto(a)social,gender,andculturaldifferences between subgroups; (b) clinical nuances found in comorbid


externalizing and internalizing disorders; (c) developmental and socialchangesobservedbetweensubgroups;(d)normativeadaptivefunctioningfoundbetweensubgroups;(e)linguisticandspiritualdifferencesobservedbetweensubgroups;and(f)medicalandhealthissuesfoundbetweensub-groups(Reddy&DeThomas,2007).

Evaluatorsareencouragedtoeducatetheirclientsontheassessmentprocessandgoals to increase theclients’comfortandmotivationduringtesting.Ob-servationofaclient’sresponses(i.e.,verbalandnonverbal)duringtheintakeandtestingprovidesvaluabledataontheclient’slevelofunderstandingofandcomfortwith testing(Reddy&DeThomas,2007;Roysircar-Sodowsky&Kuo,2001).Collaboratingwithothersprofessionals(e.g.,physicians,socialworkers,andschoolofficials),familymembers,andcommunityleadersisalsorecommended.Forexample,inacaseinvolvinganolderwomanwithseverepanicattacks,thecliniciancouldcollaboratewithherphysicianandfamily,aswellasreferhertoadditionalsupportsourceswithinherethnicandreligiouscommunity.Itisalsorecommended thatcliniciansdevelopcollaborative relationshipswith leadersofthelocalMuslimcommunitiesorconsultwithMuslimmentalhealthworkers(foraclinicaldirectory, seehttp://www.muslimmentalhealth.com/Directory/browse_region_us.asp).

Religiousand spiritual assessments areparticularly important inworkingwithAmericanMuslims.Hedayat-Diba(2000)advocated thatprofessionalsaskclientswhatitmeanstothemtobeMuslims.Answersmayfallintooneofthreecategories:(a)detachmentordenialofIslam,(b)acknowledgmentthatIslamcarriessomemeaning,and(c)recognitionthatIslamisthecentralprincipleintheirlives.OtherindicatorsofreligiouscommitmentmayincludepracticingthefivepillarsofIslam(i.e.,testimonyoffaith,prayer,fasting,almsgiving,andperformanceofthepilgrimage),attendingreligiousservicesandproximitytoamosque,observingIslam’sprohibitionofalcoholconsumption,andadheringtoIslamicdresscode(Haddad&Lummis,1987).Additionally,itisimportanttoassesshowimmigration,levelsofacculturation,andstress-relatedacculturationaffectclients’ethnicidentityandspirituality(Roysircar-Sodowsky&Kuo,2001).Cliniciansshouldalsoassesshowclientsviewtheirpresenting problems. It is the experience of the first author that Muslimimmigrantsandrefugeesoftenviewmentalhealthproblemsasillegitimatehealthconcernsandbelievetheproblemsare“aresultoflossoffaithinGod”(Hedayat-Diba,2000,p.300),whereasindigenousMuslimsarelesslikelytohavesuchbeliefsbecauseofsocietalconceptsofmentalhealth.

Evaluators of American Muslims must consider how a client’s language,culture,spirituality,andattitudestowardmentalhealthmayaffectdiagnosticdecisionmaking.Improvementsinculturallyresponsiveassessmentarefoundin theDiagnostic and Statistical Manual of Mental Disorders (4thed., text rev.;DSM-IV-TR;AmericanPsychiatricAssociation,2000);however,theapplicationofdiagnosticcriteriaandcultural-boundsyndromesmaynoteasilylenditself


tothispopulation(Roysircar-Sodowsky&Kuo,2001).Depression,anxiety,andsomaticcomplaintsareoftenpresentedtogetherandaredifficulttodistinguishseparatelyasoutlinedintheDSM-IV-TR.Forexample,AmericanMuslimim-migrants and refugees aremore likely topresent emotional issues throughsomaticcomplaints,suchasbodyaches,fatigue,orgastrointestinalconcerns.Somaticcomplaintsmayberelatedtoculturalstress,heightenedawarenessofmind–bodyconnection,ornuancesinlanguagetodescribeemotionalstatesfromphysicalstates(Erickson&Al-Timimi,2001).Incomparison,indigenousMuslimsaremorelikelytopresentsymptomsofanxietyanddepressioninamanner similar to mainstream Americans, depending on their levelsof ac-culturation(Ahmed,2007).Becauseofculturallydifferentwaysofreportingcomplaints,professionalsshouldcautiouslyinterpretclients’somaticcomplaintsas psychopathology. Instead, professionals should consider clients’ reportswithintheclient’sculturalcontextandusethis informationas indicatorsofhowclientspresentconcernsandsolveproblems.

Reportsof self-focused internalizeddistress (e.g.,depression,anxiety)orexternalizeddistress(e.g.,angermanagement,impulsivity)areunderreportedin immigrant and refugee populations (Mollica & Caspi-Yavin, 1991). Insomeimmigrantandrefugeecultures,revealingfamilyproblemstostrang-ers(i.e.,clinicians)isconsideredaculturaltaboo.Thus,itisrecommendedthatprofessionalsremainsensitivetothemannerinwhichinformationaboutfamilyhistoryandfamilydynamicsareobtained.Cliniciansareencouragedtoacknowledgethedifficultyclientsmayhaveinexpressingmentalhealthconcernsbecauseofculturalbeliefsandtohelpclientsunderstandtheneedtoshareinformationfortreatmenteffectiveness.Additionally,individualsmayhavedifficultyrevealingsuicidalideation,becauseofitsforbiddennatureinIslam,orsexualabuse,becauseoftheclearrulesofgenderinteractionandsanctityofsexualintercourse.ItisourexperiencethatAmericanMuslimim-migrantsoftenavoidrevealinginformationabouttheirpresentingproblemsonintakeformsandprefertoverballypresenttheirissuesbecauseofconcernsthattheirproblemswillbedocumentedandfearsthatthecontentscouldbeusedagainstthem(e.g.,deportationhearings).

useculturalandspiritualpracticesintreatMent

Atpresent,researchoneffectivetreatmentsforAmericanMuslimgroupsislacking.Theemergenceofempiricallybasedinterventionshasprovidedsomeguidelinesonimplementinginterventionsforspecificdisordersorsyndromes (e.g., anxiety and depression) largely in highly controlled,university-based training facilities (e.g., Barlow, 2001). However, thetransportabilityandefficacyoftheseinterventionswithindividualsfromdiverseculturalandspiritualbackgrounds(i.e.,Muslims)remainquestion-able(Pfeiffer&Reddy,2001).Asaresult,professionalsareleftadaptinginterventionsforthispopulation.


Onefactorrelatedtomentalhealthandoverallwell-beingistheclient’scul-turalandspiritualpractices.Forexample,researchhasfoundthatreligiouslycommittedindividuals(i.e.,thosewhoengageinprayer,readsacredwritings,meditate)tendtohavegreatersubjectivewell-beingandlifesatisfaction,adjustbettertocrisisandloss,exhibitlessdepression,andrefrainfromalcoholandillegaldrugs(Richards&Bergin,2000).ForsomeAmericanMuslims,theiroverallwell-beingisderivedfromconsistentpracticeofIslamicprinciplessuchasprayer(salah)andrememberingGod(dhikr).PrayerandrememberingGodareviewedaspowerfultoolsduringtimesofdistressandcanbeeffectivelyusedintreatingspirituallyorientedclients.Inaddition,encouragingclientstoseekgreaterknowledgeandunderstandingofIslamcanhelpreligiouslyorientedindividualsunderstandtheirmentalhealthchallengesandsolutionsthroughamorefamiliarparadigmand,thus,facilitatethetreatmentprocess.Therefore,itisimperativethatprofessionalsbecomecompetentonhowdif-ferentculturalandspiritualpracticesaffectMuslimclients’well-beingandhowthesepracticescanbeusedinthetreatmentprocess.

GiventheUnitedStates’growingmulticulturalarena,competencyinreligiousdiversityiscriticalandanethicalobligationforallmentalhealthprofession-als.Intheirseminalwork,RichardsandBergin(1997)describedaspirituallycompetentmentalhealthprofessionalasonewhoexhibitsanattitudeandapproach to therapy that respects, draws upon, and uses the cultural andspiritual resources of diverse populations. Professionals who are culturallyand spiritually competent enjoy more credibility, trust, and respect fromspirituallydiverseclients, leaders,andcommunities.AwarenessofcustomsandreligiouspracticesofdifferentMuslimgroupscanhelpestablisheffectivetherapeuticalliancesandoutcomes.

American Muslim families often need a highly supportive, personalized,spirituallybased,andculturally sensitiveclimate in treatment(Daneshpour,1998).InsomeMuslimsubgroups,immediateandextendedfamilymembersplaysignificantrolesinindividuals’developmentandwell-being.Inthesecases,professionalsshouldapproachtreatmentfromafamilysystemsperspectiveinwhichthefamily’sandindividual’sgoalsareequallyconsidered(Daneshpour,1998).Cliniciansareencouragedtorespecttheroleofthefamilyandframethetreatmentsothatthefamilyfacilitatesindividualandfamilychange.FormanyAmericanMuslimimmigrantandrefugeefamilies,cohesion,interdependence,andtogethernessarehighlyvalued.Amultigenerationalgenogrammayhelpprofessionalsconceptualizetheimpactoftheimmediateandextendedfamilyondailyfunctioningandconveyappreciationfortransgenerationalfamilycus-toms(Hedayat-Diba,2000).Short-termstructuredtreatmentsthatarespecific,practical,presentfocused,andlinkedtothepresentingproblemsareusuallyviewedasmostdesirable(Pfeiffer&Reddy,2001).

OtherstrategiestotreatAmericanMuslimsmayincludeaddressingclients’expectationsof treatment, combatingnegativeperceptionsaboutmental


illnessandmentalhealthservices,andemphasizingissuesofconfidentiality(Erickson&Al-Timimi,2001).Cliniciansareencouragedtobeawareofcul-tural,spiritual,andgenderdifferencesbetweenthemselvesandtheirclients.AmericanMuslimclientsmaybeguardedduringinitialphasesoftreatmentbecauseofperceptionsofdiscrimination.Professionalsareencouragedtoaddressclients’concernsofreligiousandculturalsensitivitiesandexploretheimpactofgovernmentalpolicies(e.g.,USAPATRIOTActof2001)onclients’well-being(Ahmed,2007). It is important tonote thatAmericanMuslimimmigrantandrefugeeclientsmayoverlyrelyonprofessionalsforguidancebecauseofculturalnorms.Professionaljargonandlabeling(e.g.,abuse,dysfunction)shouldbeavoided,andclinicians shouldbemindfulthat translated words can hold different meanings for American Muslimimmigrantsandrefugees(Erickson&Al-Timimi,2001).

Whenappropriate,cliniciansareencouragedtoassessclients’ familygoalsandexpectationsandrefrainfrompushingclientstowardindividuationfromtheirfamiliesasatreatmentgoal(Erickson&Al-Timimi,2001).Professionalscanfacilitateintrafamilydiscussionbyhelpingfamilymembersrespecteachothers’wishes andexpectations (Ahmed,2007). Similarly, clinicians shouldremainsensitivetopotentialandrealizedchangesinthefamilypowerstructureandtheimpactofthesechangesonthetreatmentprocess.Clinicianscangainabetterunderstandingofthefamilysituationbycommunicating(i.e.,inpersonorbytelephone)withfamilymemberswhoareperceivedasunmotivatedorunwillingtoengageinthetreatmentprocess(Daneshpour,1998).

conclusionAmericanMuslimsrepresentaheterogeneouscommunityofferinguniqueandchallengingsocialandculturalfactorsthatinfluencetheassessmentandtreatmentprocess.ThisarticleoffersmentalhealthprofessionalsanoverviewofsomeofthesocialandculturaldifferencesobservedinAmericanMuslims.AstheMuslimpopulationcontinuestodiversifyandgrowintheUnitedStates,itisparamountthatprofessionalsmaintaina knowledge-seekingandflexibleapproachtoclinicalpractice.Itisourhopethatthisarticleenhancesprofes-sionals’knowledgeofandefficacyinservingthispopulation.

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Documents

Understanding the Mental Health Needs of American Muslims: Recommendations and Considerations for Practice