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

Nadiyah Elias nadiyah@uum.edu.my

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
Nadiyah, UUM

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
Nadiyah, UUM

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)
Nadiyah, UUM

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

Homosexuality
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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 «««.
Nadiyah, UUM

«. 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.
Nadiyah, UUM

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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Intervention
‡ 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

Nadiyah, UUM

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

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Change
‡ 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)
Nadiyah, UUM

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
Nadiyah, UUM

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)

Nadiyah, UUM

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)

Nadiyah, UUM

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

Nadiyah, UUM

References
‡ 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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Assessment
‡ 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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