Working with Muslim Clients: Grief, Terminal Illness & Bereavement

Psychology

from an

Islamic Perspective Interest Group

CBT InterventionsShehzi Yusaf & Wendy Sawtell

Clinical Psychologists

Program Outline

Normal Grief Complications Therapeutic Approaches Cognitive Behavioural Therapy CBT-Islamic application Islamic Beliefs – the basics Case Scenarios Religious Assessment Interventions – putting it together Therapist Considerations

Normal Grief

Cognitive Sx Disbelief / Confusion/Memory Preoccupation / Obsessive thoughts Sense of presence / Hallucinations / Dreams

Behavioural/ Physiological Sx Sleep / appetite disturbance Social withdrawal / loss of interest Avoidance of reminders Crying / sighing / agitation / restlessness

Emotional Responses Sadness / shock / anger / guilt / anxiety /

denial / irritability / worry /

Risk Factors

Hx of; psychopathology Stress related medical cond.

Unexpected or violent death. Death of spouse / child High dependency on deceased Lack of social support

Complications

Post Traumatic Stress Reaction Sudden traumatic death Diagnosis of terminal illness

Complicated Grief Lack of acceptance

Major / Clinical Depression Premorbid risk factors

Therapeutic Approaches

Psychodynamic

Rogerian / Humanistic

Systems Family Therapy

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy

Empirically Derived Scientist practitioner model Evidence based interventions /

optimised outcomes Emphasizes Ax / Outcome

CBT Model

Situation

Thoughts

Emotions Physiology

Behaviour

Cognitive Restructuring

Identifying and challenging; automatic negative thoughts, dysfunctional attitudes, Unrealistic expectations Irrational beliefs / schemas

Muslim scholars have long held that emotional dysfunction is a by-product of irrational negative thinking (eg. Al Ghazali 11th Century).

What Works for Muslims

Cognitive Behaviour Therapy! (Badri.M,2000)

Highly detailed Islamic belief / schematic system

Islamic teachings / practices embody potent cognitive & behavioural prescriptions: decreases physiological arousal (anxiety) and enhanced emotional functioning (mood management).

Used by early Muslim scholars: exposure, cognitive restructuring.

Cognitive restructuring is fundamentally characteristic of Islamic thinking style.

Cognitive Schemas

Muslims prescribe to religious schema above all other competing schema (eg. Political, traditional etc)

Islam is a powerful instrument for cognitive realignment

Islamic psychology uses CBT, offering key to unlock / access / modify schema for enhanced pt wellbeing / outcomes.

Issue of CONGRUENCE.

Islamic Beliefs the basics

Journey of life Purpose to be Allah’s viceroy Meaning of

illness,disability,adversity Death is a beginning of eternal of life Time of death preordained;

“No human being can die save by Allah’s leave at term preordained” (Q 3:145)

All creation / circumstance in accordance with Allah’s Will.

Muslims total submission and trust in Allah (Tawakul)

Islamic Beliefscont:

No individual is burdened beyond its capacity to cope

Accountability – for all deeds Concept of Free Will Good deeds rewarded many fold Repentence & Forgiveness

“..Despair not of the mercy of Allah, for Allah forgives all sins, for He is Oft Forgiving most merciful.” (Q,39:53)

Islamic Beliefs cont;

Patience (Sabr)“..to those who patiently persevere – who say, when afflicted with calamity: “To Allah we belong, and to Him is our return – they are those on whom (descend) blessings from their Lord, and mercy, and they are the ones that receive guidance”

(Q 2:155-157) “After hardship comes ease: surely after hardship comes ease” (Q, 94:5-6).

Actions benefiting the deceased Sadaqa: charityDua: supplication Ongoing blessings / rewards

Assessment

Standard Biopsychosocial Ax Spiritual Ax

How do you make sense of what is going on for you?

Are you religious? (What religion are you?) How does Islam guide you in looking at this? How is this way of looking at things helpful?

(thoughts, feelings, behaviours) How does this help you cope with the pain?

Deal with your stress? What sorts of things do you do that you find

helpful in relaxing you?

Islamic Interventions

Wudu – ablution (spiritual / physical cleansing)

Initiation / motivation / self-care /refreshing / distraction / diversion

Salat – Prayers 5 times per day Mindfulness / relaxation / decrease physiological

arousal / exercise –stretchesRecitation of the Quranic verses

Dua –Supplication – direct communication / connection to Allah

No intercession neededZikr- Rememberance of Allah (99 attributes of Allah) eg. Recitation and contemplation of the names illicit same attributes in us. Eg. Saabir, Shaafi, Salamu,

Breathing; “Allah Hu”

Community Support

Protective Factors Social support – typical of Islamic

community Rituals – gatherings, religious

service, assisting the family (food, practical assistance), reading of the Quran, Zikr, normalizing death.

Case Study #1

Mona 32 yo mo., 6 ch’n b/w 15 and 2 yrs Multiple trauma / grief;

Eldest – Hodgkin's 12 months of Rx at age 12.

Daughter with moderate intellectual disability

Displacement – left homeland Jan. ’06 backed van over 3 yo son

Playing the holy shuffle – got it!

Case Study #2

Nargis, 55 years old, married with 3 adult daughters, all married and settled. Had cervical cancer which she survived a decade ago. Oncologist did not order the relevant tests on the latest follow up visit resulting in secondary tumours not being picked up in her abdomen and gut. She collapsed a work a week later then she was taken to hospital and the cancer was discovered. Prognosis was very poor.

Main psychological symptom was anger at oncologist but sense of frustration and injustice when he would not see her.

Also depression because of late detection

Scenarios

Irrational Belief“I can’t take this anymore…”Islamic Reframe “..no soul is burdened with

more than it can bear…”Irrational Belief “.. I could have saved her, if

only…if only…my fault”Islamic Reframe“..it is Allah’s Will….her time had

come..nothing / no one could have prevented it”

Scenarios

Irrational Belief“Too late.. Not time to repent…haven’t

done enough..I will got to hell..”Islamic Reframe “..Allah loves all those who repent…

Oft giving most merciful…”Irrational Belief “.. Why me? I’m being punished… I am

bad”. Islamic Reframe“Illness and suffering cleanses a

Muslims soul by diminishing their misdeeds… Allah is testing me… I must be patient… persevere”

Therapist Considerations

Awareness of own sensitivities / biases – resolve them

Don’t be afraid to ask Convey curiosity, interest,

respect Use Socratic questioning,

reflection, summarizing, empathic listening

Illicit self-affirming beliefs

References

Psychology from an Islamic Perspective

Interest Group (PIPIG); www.groups.psychology.org.au/ipig/

Books & Articles; Badri, M (2000). Comtemplation: An Islamic

Psychospiritual Study. Madeena Books, KL.

www.quranicstudies.com\article42

by Salma Yakoub