As a therapist, I value working with clients of all different backgrounds. In fact, it is one of the best parts of my job as I meet someone and learn something new every day. The philosophy I find most helpful in working with clients is cultural humility. This is defined as the ability to have an accurate perception of our own cultural values as well as maintaining a client-oriented perspective that involves respect, lack of superiority, and attunement [1]. This stance takes away the pressure that “cultural competence” places on us as therapists to know everything (which of course is impossible).

Cultural humility is also a perfect starting point for working with Muslim clients for several reasons. Muslims have been in the news a lot lately. Unfortunately, the coverage is usually negatively skewed, which has influenced perceptions of Muslims in the United States [2]. This may also impact how therapists view Muslim clients who walk into their offices. Given that all of us are affected by implicit bias, it is critical for us to examine our biases, including how Islamophobia impacts the way we treat Muslim clients.

With a culturally humble stance, we as therapists are open to learning more about each Muslim client’s unique experiences as we monitor and challenge our stereotypes.

Here are four key points to consider as you begin working with Muslim clients:

1. Avoid Assumptions

It is not expected that you know everything about Muslims. However, it is helpful to have basic information which can help you avoid making inaccurate assumptions [3].

Do you think that most Muslims are Arab?

Muslims are actually the most diverse religious group in the United States. In 2017, Muslims were 25% African American, 24% White, 18% Asian, 18% Arab, 7% Mixed, and 5% Latino [4]. These percentages can help highlight how our perceptions may not always be accurate.

I appreciate the complexity of diversity by thinking of the intersectionality of identities that a person holds. This means understanding how their religion, culture, socioeconomic status, immigration history, sexual orientation, gender identity, ability status, etc., all impact the client’s problems as well as strengths. For example, an American-born Muslim may have different concerns than a Muslim immigrant who recently came to the US from Somalia.

Do you think that most Muslim clients would only want to work with a Muslim therapist?

This is not always true. Some Muslim clients may prefer a non-Muslim therapist due to fear that their problems will not be confidential. For example, they may be scared of seeing their therapist at the mosque or scared that their therapist knows their family members or friends. Though we can clarify the bounds of confidentiality, they may still feel uncomfortable and prefer a therapist who is outside their community and is not Muslim. Some Muslim clients may also fear of judgment from a Muslim therapist, particularly if they are not religious or if engaging in behaviors not traditionally allowed, like drinking alcohol or having premarital sex. However, Muslim clients still value therapists being familiar with their religion and culture.

What is the best way to avoid assumptions?

Ask open-ended questions! When we switch to open-ended questions, we can avoid missteps and assumptions. For example, instead of asking “What country were you born in?” which has hidden assumption that you are not born here in the US, you can ask, “Where were you raised?”

Sometimes, assumptions may come from us trying to show our knowledge. For example, we may ask, “How many times do you pray each day?” which implies that we expect the client prays, or should be praying. Instead, asking, “What, if any, spiritual or religious practices are helpful to you?” leaves it open to allow the client to share their level of religiosity. You can then demonstrate that you know about the five daily prayers or fasting in Ramadan by your follow-up questions.

The key here is to understand the client who is sitting in front of you. You can use your basic knowledge about Muslims to guide your questions about certain experiences, but do not assume you know their answers.

2. Pay special attention to building rapport

As therapists, we know that building rapport is our most important step in beginning the process of therapy. However, with Muslim clients, it is even more critical to pay special attention to the relationship.

Why?

Islamophobia and discrimination are real concerns for many Muslim clients. Research shows that Muslims currently experience the most discrimination of any religious group in the US. Sixty-two percent of Muslims surveyed had experienced some level of discrimination in the past year, with 14% experiencing regular discrimination [4]. As a comparison, 3% of Jews, 3% of Protestants and 3% of the general population reported regular discrimination in past year [4]. These experiences may make Muslim clients nervous to enter therapy for fear that they could be discriminated against by their therapist.

Additionally, they may fear that their religious values will not be respected. For example, if a client is struggling with how to fit the five daily prayers into their schedule, it may be more helpful to problem solve with the client. Advising that five prayers a day are too much would inadvertently involve inserting your values into the client’s problem. It would be different if the client decides on their own it is okay to miss one prayer.

Like other clients, Muslims may worry about the stigma of therapy, believing it represents a personal flaw or weakness of faith. Additionally, due to Islamophobia, they may fear that their decision to come to therapy could reflect negatively on Muslims as a whole. Therefore, it is important for us as therapists to help clients feel comfortable, safe, and welcomed when coming for therapy. It may also be helpful to ask them what fears they may have about being in therapy. This allows for an open discussion about how to make the therapeutic process more comfortable for them.

Furthermore, this may be the first experience with therapy for Muslim clients. Psychoeducation about how therapy will work may be needed. A common concern for Muslim clients is confidentiality, which should be explained in detail.

3. Understand the role of religion

Though not all Muslims practice their religion, many Muslims do consider their religion significant to them. Research shows that Muslims are more likely to rate religion as important in their lives (an average 88% versus an average of 69% of the general population) [4]. Therefore, it is important to understand how the client relates to their religion by asking, “What role does your faith play in your life?”

It is often helpful to understand how Muslim clients use religious beliefs and practices to cope. Research shows that religious practices can help clients with both physical and emotional difficulties [5]. For example, one client may find reading or listening to the Qur’an (holy book) when upset to be calming. Another client may find prayers grounding when anxious (which may have a meditative effect).

Guiding clients to identify what Islamic practices and beliefs they utilize as part of therapy will not only help them feel better but will also build collaboration and trust as you offer other therapeutic interventions. In fact, there are ways to use Islamic beliefs to examine thoughts using a CBT model [6]. For example, you could challenge hopeless beliefs of a depressed client by having the client remember how merciful God is or by using the Islamic phrase, “With hardship comes ease,” to get through difficult times.

4. Understand the roles of family and community

As with other cultures, the roles of family and community are important to Muslims. You will want to understand how the family supports the client as well as where there may be room to improve relationships.

The definition of family may include those outside the traditional nuclear family. Therefore, it may be helpful to ask, “Who are the important people in your family?” This open-ended question leaves room for the client to tell you about their specific family configuration. It may also be helpful to include family members in treatment. This may be particularly critical with intergenerational conflicts. It can be useful to help clients communicate across generations to build understanding and empathy in effort to work through these conflicts.

Similarly, it would be helpful to understand if community is important to the client. Given the Islamophobia and discrimination Muslims may face, some clients may benefit from being a part of a supportive community where they feel a sense of belonging. This may also provide opportunities for social justice advocacy work, which can help counter feelings of helplessness that arise from oppression. Community can also provide support if families are contentious for the client.

If the client notes that their community is not supportive in any way, it may be helpful to link them to a community that fits their needs. For example, I have linked clients to Muslim LGBTQIA-friendly spaces when their home communities were not accepting of them. Options for community connections may also include online resources and online communities.

Working with clients who are different from us can sometimes be a challenge, but it is often an opportunity for us to grow and learn. Being culturally humble has helped me maintain a welcoming, respectful, and open stance with my clients. With these four key points, you can expand your scope of practice to include Muslim clients, and you will be off to a good start by treating them from a position of cultural humility.

References

[1] Hook, J.N., Davis, D., Owen, J., & DeBlaere, C. (2017). Cultural Humility: Engaging Diverse Identities in Therapy. Washington, D.C.: American Psychological Association.

[2] Nisbet, E.C., Ostman, R., & Shanahan, J. (2009). Public opinion toward Muslim Americans: Civil liberties and the role of religiosity, ideology, and media use. Muslims in Western Politics. 161-199.

[3] Khan, Z. (2014). An Exploratory Study of Therapists’ Practices with Muslim Clients: Building Rapport and Discussing Religion In Therapy. Retrieved from https://doi.org/doi:10.7282/T3C53HZ4

[4] Mogahed, D. & Choudhoud, Y. (2017). American Muslim Poll 2017: Muslims at the Crossroads. Washington D.C.: Institute for Social Policy and Understanding. Retrieved from https://www.ispu.org/wp-content/uploads/2017/06/AMP-2017_Full-Report.pdf

[5] Richards, P.S., & Bergin, A.E. (Eds). (2000). Handbook of psychotherapy and religious diversity. Washington, DC: American Psychological Association.

[6] Hodge, D.R., & Nadir, A. (2008). Moving toward culturally competent practice with Muslims: Modifying cognitive therapy with Islamic tenets. Social Work, 53 (1), 31-41.

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Zaynab Khan, PsyD

Zaynab Khan, PsyD

Zaynab Khan, Psy.D. is a psychologist at Rutgers University CAPS (Counseling Center) in New Brunswick, NJ. At the counseling center, she works with college students of diverse backgrounds and has a special interest in working with Muslim clients as well as LGBTQIA population. She is the coordinator of the Excellence in Transcare team. Additionally, she has a private practice, Khan Therapy LLC, in East Brunswick, NJ. She currently teaches the Multicultural Supervision course at GSAPP – Rutgers University. She also does diversity trainings with the trainees at the counseling center as well as UBHC predoctoral internship program in Piscataway, NJ. She graduated with Psy.D. in Clinical Psychology from the Graduate School of Applied and Professional Psychology (GSAPP) – Rutgers University. She completed a specialization in multicultural psychology with her dissertation research centered on working with Muslim clients. In her free time, Zaynab enjoys yoga, traveling, and being in nature.
Zaynab Khan, PsyD

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