Moving toward Culturally Competent Practice with Muslims: Modifying Cognitive Therapy with Islamic Tenets
Hodge, David R., Nadir, Aneesah, Social Work
Cultural competence is a fundamental social work value. The NASW Code of Ethics (2000) emphasizes the provision of services that are sensitive to clients' cultures. Similarly, the NASW Standards for Cultural Competence in Social Work Practice (2001) underscores utilization of interventions that are congruent with clients' cultural narratives.
One particularly distinct cultural narrative is provided by Islam (Nadir & Dziegielewski, 2001; Williams, 2005). The number of Muslims in the United States has increased dramatically over the course of the past three decades (Carter & El Hindi, 1999; Hedayat-Diba, 2000; Hodge, 2005). Although estimates vary significantly, somewhere in the range of 2 to 8 million Muslims now reside in the United States (Hodge, 2005; Richards & Bergin, 2005; Smith, 2002).
Despite the size of the Islamic community, most practitioners appear to have been exposed to relatively little content on Islam during their educational careers (Canda & Furman, 1999; Carlson, Kirkpatrick, Hecker, & Killmer, 2002; Furman, Benson, Grimwood, & Canda, 2004; Heyman, Buchanan, Musgrave, & Menz, 2006; Murdock, 2004). Similarly, a number of content analyses suggest that relatively little material exists in the academic literature that would help equip therapists to engage in culturally competent practices with Muslims (Cnaan, Wineburg, & Boddie, 1999; Hodge, Baughman, & Cummings, 2006; Nadir & Dziegielewski, 2001; Sheridan & North, 2004).
The lack of content represents a critical oversight. According to a variety of commentators, many Muslims are hesitant to trust mental health professionals (Hedayat-Diba, 2000; Hodge, 2005; Kelly, Aridi, & Bakhtiar, 1996; Mahmoud, 1996). Widespread belief exists that helping professionals may not respect Islamic values. Many Muslims believe that practitioners are unfamiliar with the values implicit in their therapeutic modalities. Consequently, concerns exist that this unfamiliarity may result in the inadvertent imposition of therapeutic strategies incongruent with an Islamic worldview.
To help practitioners select culturally relevant strategies, four common therapeutic modalities are discussed in light of their level of congruence with Islamic values--psychoanalytic, group, strengths based, and cognitive. We suggest that, in principle, cognitive therapy is particularly congruent with Islamic discourse, but the self-statements central to this approach need to be "repackaged" to reflect Islamic values. The research on cognitive therapy that has been modified to incorporate beliefs from clients' spiritual belief systems is reviewed and suggestions are provided to help practitioners construct statements that reflect Islamic values. Before beginning, however, we discuss some of the values that tend to inform Western therapy and Islam.
THE THERAPEUTIC ENTERPRISE--A VALUE-INFORMED PROJECT
The Western counseling project, like all other human constructions, is supported by a particular set of epistemologically derived values regarding what constitutes appropriate human functioning (Inayat, 2000; Kuhn, 1970). Rooted in the European enlightenment, Western counseling affirms certain values at the expense of others (Jafari, 1993). Selected characteristics are implicitly held up as representing norms for healthy human functioning.
Among these characteristics are values such as individualism, self-determination, independence, self-expression, egalitarian gender roles, explicit communication that clearly expresses individual opinion, and identity rooted in work and love (Al-Abdul-Jabbar & Al-Issa, 2000; Hodge, 2005). Western counseling, influenced by theorists such as Freud (1966) and Maslow (1968), often emphasizes the role of the individual "self" in therapy. Concepts such as self-actualization and self-efficacy are generally viewed positively as are psychodynamically oriented insight strategies designed to raise clients' level of self-understanding. …