An Islamic CBT Approach for Helping Clients with Gender Identity And Sexual Orientation Problems

Nadiyah Elias

What Is Islamic Counseling?
‡ Overall goal of counseling is to help client become a better Muslim (def. of mental health) ‡ µIslamic¶ Strategies and Techniques ‡ Integrate with Islamic Lifestyle
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CBT: Why It Is Compatible with The Islamic Worldview (for Borrowing)
‡ Evidence based practice ‡ Flexible goals: depends on clients and counselors ‡ Flexible strategies and techniques (pick n choose) ‡ Cost effective and efficient (goal oriented) ‡ Simple and logical problem conceptualization
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More Reasons for Choosing CBT
‡ Compatible with Asian Clients
‡ Didactic Therapeutic style ‡ Immediate and concrete conceptualization of problems ‡ Structured sessions ‡ Goal directed ‡ Uses range of aids and techniques (preference of Asian Counselors!!!) ‡ Teach client to become own therapist (promote independence)
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Principles Of CBT
‡ ABC (Antecedents, beliefs, consequences) ‡ Three Levels of Thinking
‡ Automatic Thoughts (ATs) ‡ Intermediate Beliefs ( attitude expectation, assumption) [ aka IrB and RB] ‡ Core Beliefs ( in the Schema)

‡ Thinking Errors
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Thinking Errors
‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ All or nothing thinking Personalizing and blame Catastrophizing Emotional reasoning Should and must statements Mental filter Disqualifying Overgeneralization Mind reading/ jumping to conclusion/ fortune telling

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Illustration of An Islamic Counseling
‡ Pick a problem that is diametrically opposed in values for Contemporary Western Perspective and Islamic Perspective

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Comparing Values
Islamic Perspective ‡ Homosexual acts forbidden ‡ Therapeutic goals: to not engage in forbidden sexual acts Contemporary Western Perspective ‡ Homosexual acts condoned ‡ Therapeutic Goals: to adjust to lifestyle as a homosexual

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Older Western Interventions (prior to 1970)
Homosexuality as a sickness Goals: to change sexual orientation
‡ ‡ ‡ ‡ ‡ Psychoanalysis Castration Hormone therapy Insulin shock Electric shock

All the treatment did not work.
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Contemporary Western Interventions
‡ Acceptance of homosexuality (not a disease) ‡ Goals:
‡ ‡ ‡ ‡ ‡ Sexual identity exploration Coming out/ terminating marriage Lifestyle issues (same sex marriage, adoption) AIDS Spiritual issues ( homosexuality as God given)

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Islamic Dialectic Behavioral Therapy
Both acceptance and change in synthesis
‡ ‡ ‡ ‡ ‡ Acceptance of homosexual interest as natural Acceptance of homosexual acts as forbidden Acceptance of limitations in this temporary life Change in management of urges Change in self-concept

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Strategies of Intervention
‡ Assessment ‡ Cognitive Interventions:
± Normalize situation ± reframing ± Behavioral Change strategies

‡ Reassessment ‡ Prepare for termination
± Relapse intervention (prepare for setbacks)
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Case Study
1st year university male students, selfreferred, highly motivated:
‡ Being teased by friends due to his effeminate affectations, do not have friends ‡ Has been approached by a group of µeffeminate¶ students known for their practice of wearing feminine clothes, make-ups, and same gender pairing-offs. He would like to not get involved, but is lonely and would like to have friends «««.
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«. Case study
‡ Is romantically attracted to a µmasculine¶ male who have befriended him, and is sympathetic to him. Did not express his feelings for fear of driving this friend away. ‡ Would like to lead life as a good Muslim, but a bit confused on how to be true to his feelings and also be a good Muslim at the same time.
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Evaluation and Conceptualization
‡ Did not have a role model for masculine behavior (the youngest, all sister siblings, no father) ‡ Strength: is committed to Islamic shariah ‡ Is still very early in development (sexual identity) ‡ Has not committed any physical sexual acts
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‡ Psycho ed (normalizing) ‡ Differentiate between personal characteristics and sexual acts ‡ Explain both gender have masculine and feminine tendencies; and that both are okay ‡ Explain that both gender have heterosexual and homosexual tendencies; and that some of these tendencies are forbidden to us by God, and it¶s our duty to observe the limit. (ex: it is natural to want money, but you can¶t steal money)
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Differentiation between Shariah Limits and Social Expectations
‡ Differentiate between what is permissible in Islam and what is forbidden ‡ Discuss what is okay and not okay according to the Malay culture; deciding what to accept and what to challenge ‡ Client decide which part of him is okay and which part needs changing

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Romantic attraction
‡ Normalize: its normal to be attracted to someone you admire. A person is socialized to consider it a romantic interest or not. ‡ Reframe: It¶s a phase that he will grow out of. ‡ Change strategies: client did not need any for this

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‡ ‡ ‡ ‡ ‡ Feminine tendencies Good taste in clothing Dress immaculately Tender feelings Well behaved, courteous

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‡ Be proud of his characteristics, learn how to respond with dignity to teasings (discuss two µeffeminate¶ lecturer as a role models ‡ Learn how to find friends who respect him for himself ‡ Suppress romantic inclination with friend, and pursue close regular friendship ‡ Rethink that someday, he might be interested in women, but now is not the time. (instead of saying that he has no interest in women whatsoever)
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Other Techniques for other cases
‡ Unfairness - long term perspective (akhirat) ‡ I am a freak - ³everybody has a tendency to a certain degree´ ‡ God has given me this extra challenge I must face ‡ ³but I love him´ - ³I will love him as a brother´ ‡ ³ people who meet for the sake of Allah, and separate for the sake of Allah, Allah will bless them both ‡ Urge surfing- focus from hot thoughts to cold thoughts, other distractions, zikr etc
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What Is Islamic Counseling?
‡ The overall goal of counseling is to help client become a better Muslim ‡ µIslamic¶ Strategies and Techniques ‡ In order to be effective, it needs to be integrated with Islamic Lifestyle (wholistic approach)

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Integrate Intervention Strategies With Islamic Lifestyle
‡ Both Counselors and Clients need to practice Islamic Lifestyle (to their understanding and ability) ‡ Supplement with µnon-therapy¶ aids in change (dua, hajat prayer, reading Quran verses) ‡ Integrate with overall Islamic Practice of Ibadah (ex: volitional training in ibadah, zuhud, sufism etc)

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There are many other approaches and strategies that you can call Islamic counseling, this is just one illustration of one way to do it.

May Allah give us guidance

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‡ Curven, B.; Palmer, S. & Ruddell, P. (2000). Brief cognitive therapy. Thousand Oaks: Sage Publications. ‡ Evosevich, J.M. & Avriette, M. (2000) The gay and lesbian psychotherapy treatment planner. Singapore: John Wiley & Sons. ‡ Neenan, M. & Dryden, W. ( 2004). Cognitive Therapy: 100 key points and techniques. New York: Brunner & Routledge. ‡ Richards, P.S & Bergin, A. (1997). A spiritual strategy in counseling and psychotherapy. Washington D.C : APA ‡ Richards, P.S & Bergin, A. (2004). Casebook for A spiritual strategy in counseling and psychotherapy. Washington D.C : APA.
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Islamic Mental Health
‡ Live life according to Islamic principles ‡ Quality of mental health: i.e. peace of mind and harmony (salam)

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Criteria for Islamic Strategies and Techniques
‡ Derived from Quran and Sunnah
(counselor must be able to formulate therapeutic conceptions)

‡ Borrowed from other therapeutic framework
(counselor must certify that interventions are permissible according to Islamic shariah)
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Theoretical Conceptions
‡ What is the problem ‡ What causes the problem ‡ What are the steps that should be taken to solve/handle the problems ‡ Why these steps should work/ how it works

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‡ What is client¶s level of religious commitment and religious knowledge (especially on homosexuality) ‡ What is client¶s gender identity? ‡ What is client¶s stage of involvement in homosexuality tendencies? ‡ What is client¶s stage of act in homosexuality ««..
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«. Assessment
What are client¶s goals and expectation for therapy? ‡ Referred clients (reluctant clients)[ general religious motivation] ‡ Seeking answers/ clarification (religious ed ) ‡ Guilt issues (religious ed & reframing) ‡ Seeking for motives to change (religious ed & reframing) ‡ Seeking for strength to change (reframing & skills) ‡ Seeking for strategies to change (skills) ‡ Avoiding relapse (skills)
Nadiyah, UUM

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