From my experience of working with Muslim clients, I explore in this article ways in which counsellors can more effectively understand presenting issues, the therapeutic process and relationship with their Muslim clients. This, I believe, comes from a better understanding of the client’s faith and culture within their sense of identity.
Faith in self and identity
Clients bring into counselling a combination of factors that contribute to their identity, such as age, ethnicity, gender, language, sexuality, culture and religion. Their identity has an impact on the counselling process and therapeutic relationship, and we need to be aware of the client’s identity and how factors affect their sense of self. How are we able to enter and understand the client’s frame of reference? How does the client experience the world?
For Muslim clients, we need to understand how their religion and culture have an effect on their identity and what aspects of religion and culture are significant or meaningful to them. This will help us to understand their frame of reference, how they view their presenting issue and how this may affect the therapeutic process and relationship.
A good technique to help us enter the client’s frame of reference is to start from the frame used by counsellors. A counselling frame of reference includes the use of theory, a therapeutic framework, boundaries, guidance and values, principles and morals (the ethical framework). These inform a clinical framework, which we work within. The faith of Islam also constructs a framework to live within, as it identifies boundaries, guidance, theoretical understanding and an ethical framework (morals, values, principles) to live by. This helps us to enter the client’s frame of reference with concepts that are already familiar, particularly from the BACP Ethical Framework, as it offers us the same values, morals and principles that are in line with Islamic manners and characteristics.
The five pillars of Islam are the framework of the religion, the basic tenets of religious belief and how to identify oneself as Muslim. The five pillars are the declaration of faith, prayer, fasting, giving to charity and pilgrimage to Mecca.
Culture
Religion provides the framework in life, but culture is also significant in establishing family and social roles, relationships and dynamics, and can influence the expression of faith within different cultures. The five pillars of Islam are fundamental to the Muslim faith, but we do need to be sensitive to the wide range of additional factors that influence their sense of self or identity, i.e. ethnicity, culture of the country they’re living in and/or were born in, culture of the country where their parents were born, and if the client or their family identifies, or not, as immigrants. Also Muslim families vary, depending on which sect of Islam they follow and their religious devoutness. All of these are influential factors on a client’s sense of self.
The culture we grow up in, surround ourselves with and which is handed down through generations, develops and influences our sense of self. Culture constructs our worldview, our experience of the external world, and how we interact with it, creating our frame of reference and internal world. Culture is therefore an integral part of a child’s sense of self, relationships and identity, just as religion is. And the cultural messages passed on to the young client are brought into the counselling room. These messages may or may not be readily accepted by the client, and the presenting problem may be a conflict between their own experiences and views and adhering to cultural norms and expectations.
Cultural values
Geert Hofstede1 identified key factors that are valued in cultures, and found several dimensions of opposing values present across different cultures. The original four are the power distance index, the uncertainty avoidance index, masculinity versus femininity, and individualism versus collectivism. Of these, the individualism-collectivism dimension is important to understanding our client’s frame of reference as it has a direct impact on their sense of self.
Individualist cultures place emphasis on a person’s individual and independent notion of self, creating a sense of ‘I’, whereas collectivist cultures place emphasis on a family notion of self, creating a sense of ‘we’. Western cultures tend to be individualist cultures and non-Western cultures tend to be collectivist. Clients from collectivist (we) cultures look to their own cultural group’s norms and rules, being concerned with loyalty and cohesion. But clients from the individualist (I) culture may be less sensitive to views of others and more concerned with personal ethics and comfort.
Collectivist culture and Islam
Within Muslim and non-Western cultures, the ‘we’ consciousness holds sway, which is reinforced through religious and cultural messages that a person belongs within the family. The family lives within the wider community, and communities live within the Ummah (the global family of Muslim brothers and sisters). In collectivist cultures, priority is the family, with a strong emphasis on duties, responsibilities and loyalty towards the family, before individuals. Individual desires and needs are therefore sacrificed for what is best for the family, where obedience to parents and conforming to expected roles and boundaries is valued. This is particularly illustrated by how success is measured in the ability to take care of your family and give back to the community. Therefore, education is highly valued, as it is the pathway to success (i.e. well-paid jobs and opportunities). This means that, for CYP clients, high value is placed on education, and there is pressure to achieve academic success.
Collectivist culture and counselling
Below are ways in which we can begin to identify how a ‘we’ sense of self may present in counselling, which helps us to understand the young client’s sense of self within their culture.
Role within the family: Young clients talk about themselves in the context of their family. They don’t regard themselves as having an individual identity; they are the role of son, daughter, brother or sister, where their self is expressed in relationship to their family.
Cultural differences in roles: Young clients, depending upon their role, may have different responsibilities and expectations placed upon them. For example, sons may be expected to stay with the family after marriage, and daughters expected to move in with their in-laws. The eldest sibling has the responsibility to look after their parents in old age, whereas the youngest may have more freedom or choice to move away from the family home.
Issues of choice/autonomy: Roles and expectations create less opportunity for choice and autonomy for clients. With no ‘I’, there is little or no choice, autonomy or independence, as this directly conflicts with the ‘we’ culture of their responsibilities and expectations within the family. The client may not want to or feel able to break away from their family and become an ‘I’. Having little autonomy means they might have no choice to access counselling, or feel they have no confidentiality in counselling, as sessions might get spoken about with family afterwards. Sometimes the aim of counselling is not about finding options to choose from (if they have no choices) but instead supporting the young client to understand their concerns within the context of their frame of reference (culture and family dynamics) and how that is affecting them. We perhaps need to reflect upon what choices are available and unavailable for the client.
We need to recognise that collectivist cultures reflect this sense of self as ‘we’, with a focus on family priorities, because this creates a knock-on effect upon the client’s ability to access counselling, feel empowered during the counselling process or identify a sense of achievable change, as the client will often prioritise what is best for the family rather than identifying what is best for themselves.
Barriers to accessing counselling
Muslim CYP clients face a number of barriers to accessing counselling. These include:
- Cultural stigma of mental health – where mental health issues are not identified or spoken about
- Family – where issues are kept within the family, not taken seriously, or the family thinks they can deal with issues within the family without outside professional help
- Family – where the family itself stops a young person from attending counselling, due to the family’s own negative perceptions, shame and/or lack of understanding of what counselling is
- Honour and shame – where seeking outside help is a taboo and may be seen as bringing shame upon, and dishonouring, the family
- Lack of privacy and confidentiality – fear that what is spoken about in counselling or their attendance at counselling will be made public or known to the client’s community, which may lead to the client and family feeling shame or may affect their perceived reputation within the community
- Fear of being judged or misunderstood by the counsellor because of their culture or religion.
Working with clients
Presenting problems
Presenting problems may be brought to counselling because of the client’s culture, whereby the client is stepping outside of their cultural norms, rules, boundaries and expectations. Examples are a CYP’s exploration of their sexuality, having conflicts within family relationships or engaging in a relationship or dating that would not be acceptable to the client’s family or community and is often conducted under secrecy. A client may bring a presenting problem to counselling with an idea or expectation of an end result that conforms to their cultural norms, rules and expectations.
I keep in mind that when working with any of these presenting issues, I may be the first person the CYP is sharing their problem or conflict with, outside of the family knowing, or the only person they tell if the issue would create further conflict if the family knew or if the issue is considered taboo, such as a relationship, sexual activity or exploration of sexuality.
Working with the therapeutic relationship
A client’s identity, culture and religion affect the therapeutic process and relationship. But there are still ways in which we can help build the therapeutic relationship and engage in an effective therapeutic process with Muslim CYP clients from a ‘we’ culture.
- Work with the family – whether parents come to the assessment or want to be present in sessions, there is usually a strong family involvement. It may require an explanation to the family as to why you have boundaries of confidentiality and privacy around the therapeutic space. Explain your assessment process and be clear on when parents can be in sessions (i.e. at the assessment or for part of a first session).
- Role of the father – he usually has the role of head of the family and many decisions on behalf of the family are made by him. It is important to get his trust, support and involvement, for the CYP to access counselling. If he’s not on side, this may prevent the CYP from accessing counselling.
- Be a learner – ask clients to tell you more about their culture and religion to build a clearer frame of reference about how religious or cultural messages may be impacting upon current problems.
- Openness – due to honour and shame, clients may not quickly open up and divulge family problems. They may not respond openly to direct questions. They may be reluctant to express what they perceive to be bad or negative thoughts and feelings, as they are loyal to the family. This can easily be misinterpreted as psychological resistance or defensiveness, so we need to take time with the client to build up a safe space, so they are able to share their feelings with us.
- Be patient in asking personal questions – when doing an assessment, take time to build up trust first before asking questions that may seem sensitive or broaching taboo topics (eg drinking alcohol, abuse, sexual or intimate relations), as these questions directly affect family honour and personal shame. Clients may feel they are betraying their family in disclosing this information. Enquire gently, be patient and do not expect answers immediately.
Culture can also have an impact on how the client and family might initially engage with the therapeutic process:
- ‘White coat’ position – we often get placed in the authority role of ‘doctor’, i.e. an expert who has all the solutions to the family’s concerns. The CYP and family may look to us for all the answers. They may present their issue at the assessment and then expect us to provide an answer or solution by telling them what to do. So we may need to educate the CYP and family about counselling and how to use the therapeutic space, to be actively involved in the work, so that the CYP knows they are to participate in the process.
- Change/growth/goals – therapeutic goals in Western models of counselling may be unfamiliar to clients. Whereas insight, self-awareness or personal growth may be part of the process or the end goal, the young client might want solutions to practical problems without any reference to internal change. This is linked to seeing us as experts and wanting answers.
- Mixed-gender environment – we need to be respectful of the religiosity of families, as some parents may not wish for an opposite gender counsellor to be working with their son/daughter due to religious customs placed on segregation. Parents may request a male or female counsellor for this reason.
- Personal questions – families not being aware of therapeutic boundaries may approach the counselling scenario applying a cultural concept of relationship between client and counsellor. If they come from a ‘we’ identity, they will also identify the counsellor as a ‘we’ and so may ask personal questions (for example, relationship status, if you have children, or your ethnicity or religious beliefs), as they understand themselves as part of a group, and to be able to relate to the counsellor they may also need to place the counsellor within the context of the counsellor’s ‘family’ or community.
- Confidentiality – clients may feel unsafe that counselling takes place in their local community and that their attendance may ‘get back’ to their community and people will find out. We need to reassure clients about confidentiality and use our contracts to explain this policy thoroughly. This is particularly important when contracting with parents and so they know what you are able and not able to disclose to them. They may find this difficult, but reassure them under what circumstances you would disclose information to them.
Useful pointers for working with Muslim children and young people
To summarise, my experience in working with Muslim CYP reflects the need to understand their presenting issues within the context of their religion and culture, and in particular to identify their sense of self from within an ‘I’ or ‘we’ culture. This has led to identifying key questions (or useful pointers) to take away and help build up an understanding of a client’s frame of reference and presenting issue:
- What are the family dynamics?
- Is the client identifying with an ‘I’ or ‘we’ sense of self/identity?
- Whose needs are they thinking of (their own or their family’s)?
- What is the client’s role within the family? (This may differ depending on their own and their sibling’s gender.)
- Choice or autonomy – what is the client’s position?
- How does the client’s religion or culture have an impact on their presenting problem?
Myira Khan is a BACP accredited counsellor, working from her private counselling service in Leicester, with adults, couples, children and young people. Myira is also a supervisor and qualified online counsellor, offering sessions to adults, young adults and couples. She works across all communities in Leicester with particular experience of working with Muslim and BME client groups.
She is the founder of the Muslim Counsellor and Psychotherapist Network, which aims to connect and support Muslim counsellors, therapists and psychologists (trainee and qualified), alongside increasing the visibility and representation of the diverse Muslim practitioners in the mental health field.
Myira was awarded a Mental Health Hero Award (2015) by the then Deputy Prime Minister, Nick Clegg, for her work in raising awareness of counselling and mental health in Muslim and BME communities.
In November 2016, Myira was elected to the BACP Board of Governors.
References
1 Hofstede G. Cultures and organisations. London: Profile Books; 2003.