Islamically Integrated Psychotherapy
Medieval Muslim Scholars History
Medieval Muslim scholars from Islam’s rich intellectual history studied and practiced early forms of holistic psychotherapy and used cognitive strategies for the treatment of psychological conditions (Awaad & Ali, 2015). The scholars’ contributions to psychology were drawn from Islamic scriptural sources along with empirical and rational sources (Ivry, 2008). Modern psychology eventually broke away from metaphysics and introduced a secular psychology to the Muslim world. Muslim patients and practitioners struggled to accept or trust a discipline with principles that dismissed such an integral source of guidance in their lives (Haque, 2004). It is likely that this is one of the reasons why many Muslims today do not access mental health services (Keshavarzi & Ali, 2018).
However, in recent years, spiritually integrated psychological care and research have started to be explored and employed again (Keshavarzi & Ali, 2018; Pargament, 2011). The early contributions of Muslim scholars are starting to be rediscovered by practitioners and researchers, who are exploring and demonstrating its applicability and relevance to modern, spiritually integrated Islamic psychology. Therefore, understanding the origins and the historical contributions to Islamic psychology is a good first step towards providing and receiving holistic, spiritually integrated care in the Muslim community.
Islamically integrated Psychotherapy is an approach to Psychotherapy that integrates Islamic teachings, principles and interventions within Western therapeutic approaches. Teachings and interventions from the Quran and Sunnah are combined with mainstream therapeutic approaches to provide a holistic approach to therapy that addresses the spiritual needs of an individual, alongside the emotional, behavioural, and physical.
The aspects of the human psyche that have been identified include:
The ‘Aql: the intellect/cognition. Western Psychology and Psychotherapy typically engages in interventions at the level of the intellect. The ‘aql is a rational faculty by which humans are capable of attaining knowledge and reasoning (Keshavarzi & Ali, 2021). It allows individuals to appreciate the consequences of their actions, and controls and mediates the harmful whims of the nafs (Ibn Abidin et al, 2006). The reasoning ability attained through the ‘aql is necessary for ethical accountability.
The Nafs: the Nafs is that which is associated with behaviour, motivation, and impulse.
The Ruh: the spirit. The Ruh plays an essential role in the Islamic conception of the soul, and so it must be taken into consideration in a treatment plan within an Islamic framework. By engaging the Ruh, the therapist can bring the client into closer relationship with God, which is what defines optimal psychological health within the Islamic paradigm.
The Qalb: the heart. The qalb refers to the spiritual heart. In Islamic Psychology, the qalb is at centre stage. Rather than focusing solely on restructuring thoughts as a way of alleviating symptoms, the qalb is an access point to the inner spiritual reality of the person. Engaging the qalb allows the therapist to work within a more spiritual framework, with the person’s soul, rather than just the surface level experience of their reactions, impulses, and thoughts in their worldly life. The qalb is the receptacle of all health and pathology. Input from any of the other components results in either the illumination or darkening of the heart (Keshavarzi & Ali, 2021).
All of the four domains, ‘Aql, Nafs, Ruh and Qalb are interconnected. Therefore, a change in one domain is likely to have an impact on the others (Keshavarzi & Ali, 2021).
The Islamically integrated therapy will involve working with these four human domains where relevant in the treatment of a mental health condition, be it an anxiety disorder, depression, and/or addiction; alongside mainstream CBT if required.
Types of Islamic Intervention
Du’aas / Supplication / Prayer
Du’aas (supplication/prayer) can provide us with the trust that there is light at the end of the tunnel, that after hardship comes ease, as Allah (swt) has promised (Qur’an 94:5). Having that trust can be extremely effective in relieving symptoms of depression and anxiety, particularly feelings of hopelessness. Making prayers and other spiritual practices can be an important part of self-care.
Fa Inna ma’al ‘usri Yusra Verily, with every hardship comes ease
Tawaqqul / Trust in Allah (swt)
Trusting in Allah (swt) is important for our mental well-being, as well as our spiritual well-being. The Prophet (pbuh) encouraged us to also “tie our camels (actively take precaution), and then trust Allah (swt)” (Tirmidhi).
Self-care
There are other key aspects of self-care, some of which the Prophet (pbuh) himself incorporated into his daily routine. He took care of his diet, encouraging healthy eating and eating in moderation (Tirmidhi). The Prophet (pbuh) also encouraged exercise and physical activity (Sahih Muslim). Taking naps between Dhuhr and Asr (Qailulah) was encouraged to prevent fatigue. The Prophet (pbuh) also spent time meditating and reflecting. One such event was when he was alone in the cave of Hira, which followed the first revelation he received from Allah (swt). Self-awareness and reflection helps us understand ourselves and therefore, build on areas of strength and improve areas of weakness, giving us a sense of purpose, which can help with depression (lack of purpose is a common symptom of depression).
Levels of Intervention
The Nafs Level
The nafs level is where most of the clients’ presenting problems manifest. This can be in the form of behaviours or personality patterns. Interventions at this level are mostly behavioural in nature and may include things such as religious practices, reconditioning responses, and lifestyle changes.
The ‘Aql Level (Intellect/Cognition)
The level of ‘Aql is where cognitions related to problematic behaviour and personality patterns operate, contributing to the cause and maintenance of such behaviours/patterns. Cognitive Behavioural Therapy can be effective here in reframing distorted cognitions. Western models of psychotherapy tend to be limited to operating at this level, without going to deeper levels and engaging the deeper emotional content that is found at the level of the qalb (heart).
Cognitive Restructuring Using the ‘Aql
Challenging negative cognitions and soothing emotions such as anxiety or sadness can be done via meditative practices like dhikr. Employing the “positive opposites” of unhealthy negative cognitions can be another useful technique.
The Qalb Level (Heart)
While cognitive interventions applied at the ‘aql level can be helpful in identifying blocks to the fitrah (innately pure disposition), deeper level therapeutic interventions engaging the qalb can access deeper emotions and unblock any blocks to the fitrah. Therapeutic interventions applied at the level of the qalb may include Islamic contemplative practices such as muhasabah (self-introspection), tafakkur (contemplation), and/or muraqabah (meditation/watchfulness of the self). Blockages can be removed at this level; hence, the qalb plays a key part in Islamic Psychotherapy.
The Ruh Level (Spirit)
Access to the ruh can happen as a result of the unblocking that occurred at the qalb level, following removal of the emotional blocks that were preventing the individual from living in closer alignment to their fitrah state, and in remembrance of God. The ruh, the pure soul, is the deepest part, reflecting the truth of God. The ruh may be engaged in Islamic psychotherapy by integrating Islamic spiritual practices such as, ibadah (worship) or dhikr (remembrance of God) into therapy.
Scriptural Techniques/Interventions
Ritual ablution (wudhu) is recommended as a behavioural diffuser of the emotional state of anger. The act of giving to the needy is another recommended behaviour/action which is both motivated by – but also stimulates – emotions such as compassion, pity, gratitude, and reflection on the nature of wealth and need (al-Ghazali, 2011, vol. 3, p.40).
Ritual acts of Islamic worship such as the Muslim pilgrimage to Mecca (Hajj) and the daily prayer (Salah) can bring about cognitive, emotional, and behavioural changes. The daily prayer comprising of a series of incantatory phrases and bodily postures, when viewed in isolation, might bring about an altered emotional state, but when reflection on the meanings of the phrases and their relationship to the postures is joined to this, it becomes a transformational experience. In uniting the cognition, emotion and action, the ritual prayer may be viewed as a psychotherapeutic intervention (from a psychological perspective), or even as a sacrament (from a spiritual perspective – i.e. a transformational act of receiving divine grace).
