A Literature Review: A. deMena-Daswani
A Summary and Review: Mental health practice with Arab families: The implications of spirituality vis à vis Islam. Published in The American Journal of Family Therapy.
Extensive research has shown that members of ethnic minority groups tend to underutilize mental health care services. In light of both the great amount of trauma that many Muslim Arab Americans have experienced and the amount of discrimination this population has faced since September 11, 2001 their relative underutilization of therapeutic services has been examined. The study intended to prove that a greater cultural understanding of Muslim Arab Americans’ reasons for not choosing psychotherapy could help inform designs for more successful outreach efforts between mental health practitioners and people of Muslim and Arab-American backgrounds (Hall et al, 2006).
The relationship between Muslim-Arab-American culture and the greater American culture is a relatively complex one tied to a complex history of interactions between Eastern and Western world. There are now over 3.5 million people of Arab descent living in the United States, about 24% of whom are Muslim (Arab American Institute, Demographics, 2006).
These Arab-Americans must deal with the stress of acculturation, accompanied by the challenges of alienation, loss of social status, loss of social support, and sometimes unemployment and poverty (Ahmed & Reddy, 2007).
Many Muslim Arab Americans also must confront some degree of prejudice given the United States’ complex political and social relationship with Arab nations and Islam, especially since September 11. In actuality, only one in four Arab Americans is Muslim, so a lot of non-Muslim Arabs are facing a stereotype that is not justified. This stereotype not only affects Arabs in the US but also in other countries such as Israel. According to research by Al Krenawi (2002) non-Jewish Arabs in Israel were less likely to use mental health services than Jewish people in Israel.
Practitioners who work with clients of Arab/Muslim descent in the West are expected to encounter some emotional, cognitive, and behavioral styles that are not typical to Western clients. Judging these styles according to Western theories may lead to a lot of misunderstandings on the part of the practitioners. It may also lead to alienation on the part of the clients. Of course, not all Arab/Muslims are alike.
At times, the distinction between the individual and his/her family is vague. Collective Arab/Muslim clients are directed by an external control so they are concerned with social approval. In this case, level of individuation, ego strength, and strictness of the family are the important factors that need to be evaluated. Based on these three factors, clinicians and counselors can tailor the therapy to fit the client. In the case of a traditional client who is more dependent, has poor personal resources, and lives within a strict family, therapists are recommended to avoid “digging” into the unconscious or intimate personal issues and avoid working to achieve independence, self-actualization, or assertiveness. Instead, it is recommended that they work with the family. Therapists are recommended to utilize members within the family and factors within the client’s cultural system to enhance change.
The article also mentions how we as counselors should identify the individual characteristics of our clients and locate them on a collective/shared cultural map. These maps are not the reality of our clients, they are simply backgrounds to which we may relate and categorize the clients’ needs. There is need for a culturally sensitive revision of interventions and therapy. The article explains how much research is still needed in order to develop more grounded theories and techniques.
The article helps break down some things that need revision. These topics vary from chemical imbalances, the role of Allah, possession and curses, and the role of isolation and support, the healing power of faith and imams. There is also a need to address the culturally-rooted tendency to speak to family or friends before going to therapy and a preference of medical doctors to psychotherapists. The shame associated with admission of a mental illness was seen as a particularly strong barrier for Arab people in particular in the article, so this needs to be addressed as well.
The findings of this research suggest that in general, the Muslim-Arab-American population may have little exposure to the concept of psychotherapy. There is a huge stigma which is often tied to ideas of mental illness resulting from poor adherence to religion or the mistakes made by family members seeking mental health services. This indicates weakness and self-absorption. As a result, it is strongly suggested that psychotherapists collaborate with imams or Arab or Islamic cultural centers to provide in-services on the causes and symptoms of mental illness. There must be an attempt to normalize the use of mental health services. It may also be helpful for psychologists to teach imams some basic psychotherapeutic techniques. Counselors and psychologists should build relationships with cultural liaisons, help normalize psychotherapy with religious leaders, and offer to receive referrals for clients who have more severe disorders that imams cannot address.
Therapists should also make concerted efforts to educate themselves in the customs and beliefs of Arabs and Muslims, as stated in the APA Guidelines. Therapists working with Muslim clients in particular should learn about some of the basic beliefs and practices of Islam
Another issue is sensitivity. Although questions about substance or alcohol use, suicidality, dating, and premarital sex should not be avoided there is a need to approach these subjects in a sensitive format with the understanding that in Islam these practices are not accepted. Al Krenawi, Graham, & Kandah, 2000 noted that cognitive-behavioral approaches may be most appropriate with this population, because people from collectivistic cultures tend to revere authority and prefer active, directive treatment. However, it is also important to note that narrative or postmodern approaches may also be very appropriate in this population given the participants’ apparent tendency to externalize problems. The level of acculturation would play an important role in deciding what type of intervention to use.
Al-Krenawi, A. (1999b). Culturally sensitive mental health therapy with Arabs. In C. Rabin (Ed.), Being different in Israel: Ethnicity, gender and therapy (pp. 65-82). Tel-Aviv: Ramot, Tel-Aviv University Press (in Hebrew).
Hall, R. E., & Livingston, J. N. (2006). Mental health practice with Arab families: The implications of spirituality vis à vis Islam. The American Journal of Family Therapy, 34, 139–150. doi:10.1080/01926180500357883
Jafari, M. F. (1992). Counseling values and objectives: A comparison of Western and Islamic perspectives. The American Journal of Islamic Social Sciences, 10, 326–339.
Khan, Z. H. (2003). Sociodemographic differences in attitudes toward help-seeking among Muslims in Toledo, Ohio. Unpublished doctoral dissertation, University of Texas.
Krueger, R. A. (1994). Focus groups: A practical guide for applied research (2nd ed.). Thousand Oaks, CA: Sage Publications.
Lee, M. Y. (1996). A constructivist approach to clients’ help-seeking process: A response to cultural diversity. Clinical Social Work Journal, 24, 187–202.
Tumush, F. (1989). The psychological struggle of the divorced women in Arab society. Algeria: University of Algeria Press (in Arabic).