Yes!  We of course believe that giving and receiving counsel is congruent with our identity as Muslims.  Islamic texts are replete with encouragement to help each other. Mutual support is not possible to achieve as a community until we both give and accept help.  The Prophet Muhammad (sala Allahu alayhi wa sallam) both gave and received counsel in personal affairs.  For example, he matchmade between couples and mediated their disagreements; others did the same for him with his wives.  Engaging a professional counselor or psychotherapist is recommended by many prominent Muslim jurists worldwide for individuals experiencing mental health problems and their families.  Many masjid Imams and other Muslim community leaders in our DMV area network with mental healthcare workers and systems to provide needed services.  

Misconceptions around the acceptability of counseling in Islam have contributed to feelings of shame and behaviors of underutilization of mental health services in the Muslim community.  Underutilization of services can take the form of waiting until the situation is dire or the problem has caused irreparable harm or even abstaining from services altogether. Sadly, social stigma, misconceptions about mental healthcare, and other cultural barriers lead to preventable deaths in the Muslim community related to unaddressed mental health needs.  Many Muslims experience prolonged distress, decreased productivity, unnecessary conflict and relationship damage, and other problems that could be prevented by engaging in mental health support services. 

Psychotherapy is straightforward: it works through clients sharing their inner world with a trusted person who actively listens.  Talk therapists do not use invasive procedures or engage in coercive methods.  During the first session, clients typically review an informed consent to counseling agreement and articulate their goals or what brought them into therapy.  Depending on your situation, your mental healthcare clinician might ask that you bring along previous behavioral health records or certain other persons from your family system.  The average individual psychotherapy session runs 50 minutes.  You can decide to disengage or end your therapeutic work at any time.  Some people find that trying out therapy with multiple providers helps them find a good fit. Visiting your clinician’s website or professional profile online may give you an idea about their approach to treatment and what issues they have experience supporting.

Your mental healthcare clinician is there to help you reach your therapeutic goals.  Therapeutic goals generally have to do with creating positive change, healing, or growth to live happier, more fulfilling lives.  For some clients, therapy is a journey of self-discovery, relationship enrichment, vocational transition or other growth-oriented aims.  For others, it is more solution-focused, such as recovery from addiction.  People often seek relief from mood problems, like depression and anxiety, or resolution of traumatic experiences.  Families usually want to get along better.  Couples many times seek deeper connection or problem-solving strategies.  Adjusting to major life changes, grieving, meaning-making, developing insight, finding a direction forward in tough circumstances—these processes can be easier, faster and less painful with someone who is professionally trained walking alongside you for a while on your path. 

Counseling can be helpful for:

·  Couple or family communication;

·  Improved conflict resolutions skills;

·  Support with suicidal thoughts and/or behaviors to preserve life;

·  Relief from depression, anxiety, intense mood swings, rage or other difficult emotions;

·  Interpersonal effectiveness across settings (work, family, friendships);

·  Social skills and friendship building;

·  Cultivating romantic partnership;

·  Identity exploration;

·  Adjustment to life transitions as an individual, couple or family;

·  Recovery from substance use disorder, eating disorder, or self-harming behavior;

·  Trauma-related stabilization, processing and integration;

·  Family functioning and cohesion;

·  Marital satisfaction and romantic relationship enrichment;

·  Premarital counseling and relationship preparation;

·  Sexual wellbeing, intimacy and attunement;

·  Parenting and parent-child relationship issues;

·  Extracting oneself from a violent, controlling or demeaning relationship;

·  Support with behavioral aspects of health and wellness, such as medical treatment compliance or chronic pain management.

There are a multitude of reasons to seek help in counsel.  Once one realizes the scope of psychotherapy as a resource, the question becomes: why not?

Mental health problems are a normal part of life which cut across diverse religious affiliation and spiritual devotionality.  While religious/spiritual identity, community, and activities provide strong protective factors for one’s mental health, we cannot claim that religious devotion would prevent or cure mental health problems.  Blame, shame and guilt around mental health problems among Muslims and other religious/spiritual communities worldwide are a product of social stigmatization rather than sound religious/spiritual information.   

In fact, Islamic texts describe a full range of human emotion with tones of acceptance.  The dialectics of faith, hope, and trust in God are often juxtaposed with discouragement, fear, and loss.  For example, Allah gives a beautiful description of Islam and how its teachings and practices nurture personal growth and profound connection to Him:

“Even as We have sent unto you a messenger from among you, who recites unto you Our revelations and causes you to grow, and teaches you the Scripture and wisdom, and teaches you that which you did not know.  Therefore remember Me.  I will remember you.  Give thanks to Me, and do not reject Me.  O you who believe! Seek help in steadfastness and prayer.  Lo! Allah is with the steadfast” (Qur’an, 2:151-153)

Shortly after this passage, He reminds us that we cannot expect only pleasant experiences in life:

“And surely We will test you with something of fear and hunger, and loss of wealth and lives and crops; but give glad tidings to the steadfast” (Qur’an, 2:155).   

In fact, both the Qur’an and descriptions of the Prophet Muhammad’s life discuss a broad range of mental, emotional and psychological phenomenon—depression, anxiety, grief, psychosis, hallucinations, fear, suicidal ideation, sexuality, interpersonal dynamics, and more—with acceptance rather than reproach.  Difficult feelings and experiences are part of the universal human experience that cannot be avoided through religious/spiritual dedication.  The Qur’an says:

“Do men imagine that they will be left (at ease) because they say, ‘We believe,’ and will not be tested with affliction?  Lo, we tested those who were before you. Thus Allah knows those who are sincere and knows those who feign” (Qur’an, 29:1),

and

“Or do you think that you will enter the Garden without there coming to you the like of that which came to those before you? They were touched by difficulty and hardships and were shaken, until the messenger and those with him who securely believed cried, ‘When will the Help of Allah come?’ Ah, but surely the Help of Allah is near” (Qur’an, 2:214).

Further, the Prophet Muhammad (sala Allahu alayhi wa sallam) told us about his own powerful feelings of loss and grief, anxiety and fear, and even hallucinations.  Would anyone accuse him of having deficiencies of faith or “low Iman”?  For example, Prophet Muhammad (sala Allahu alayhi wa sallam) had difficulty sleeping due to anxiety for his safety when he first settled in Medina, because of life-threatening experiences while in Mecca just before migration.  So, in the middle of the night, he called out, “If only a pious man from my companions would guard me tonight!” and Sa’d ibn Abi Waqqas responded to guard him, fully armed (Bukhari, 2885).  Prophet Muhammad (sala Allahu alayhi wa sallam) did not treat his emotions, stress, or psychological experiences as sinful or shameful.  He actually expressed them, sometimes publicly, and engaged with social as well as religious/spiritual supports.  He gave us a positive role model for self-compassion and deconstruction of social stigmatization around mental health problems. 

“Verily, in the messenger of Allah you have a good example for him who looks to Allah and the Last Day and remembers Allah much” (Qur’an, 33:21). 

Many people feel uncomfortable engaging in couples therapy for a variety of reasons.  It may be most helpful to understand and empathize with the partner who does not want to engage in therapy.  Sharing the intimate workings of your romantic partnership, division of roles and labors, relationships with families of origin, and individual quirks and personal histories can seem daunting, invasive, or simply nobody else’s business.  Some people nervously anticipate being judged or even fear a pronunciation of hopelessness for a relationship that means everything to them but is clearly in a painful place.  A skillful couples therapist will help set you at ease, go at your pace, and respect your boundaries, personhood, and values as you gain trust and confidence in the therapeutic relationship. 

You might try to communicate your needs, perhaps even creating a quid pro quo of give and take in exchange for committing to a trial run of couples therapy.  What are your hopes for the outcome of a successful couples therapy?  What would it mean to you for your partner to cooperate with your wish in this matter? 

If your partner simply is not up for couples therapy, you can attend therapy as an individual to work on your relationship goals.  While some therapeutic goals are easier to address with both partners in the room to discuss their issues in live time with the therapist, it is often effective to treat couple issues in individual therapy with one partner.  Couplehood is a system, like gears in a clock.  Change one thing, even the smallest change, and the whole system must reorganize.  You can be the change you want in your own life and relationships. 

Groups are usually organized around a common therapeutic goal or theme.  Groups consist of one or two therapist leaders or facilitators and a limited number of members, usually 5-10.  When you reach out to join the group, the group leader should be able to give you details about group structure, such as how many sessions the group runs or if it is ongoing, expectations about commitment level and consistency in attendance, if it is open or closed to selective membership, and any screening procedures you need to do in order to join.  Some groups have psychoeducation components with information presented and then interactively processed.  Other groups are entirely interpersonal, where spontaneous emergence of social dynamics help members work through respective issues.  Groups usually have important ground rules to protect members’ confidentiality outside the group.  Group therapy entails less privacy than individual, couple or family therapy; however, group therapy offers several advantages, including: lower fees, social support of members, a sense of giving back to other members, normalization provided by connecting with others who are going through a similar experience.    

Sex therapy is an area of specialized psychotherapy and advanced training.  Many of the techniques utilized in sex therapy have no contradiction with Islam.  They involve giving a couple homework assignments, such as touching each other’s hands, requesting and consenting to touch as well as asserting personally-determined limits, and other communication exercises that integrate sensuality.  Sex therapy techniques do not ever involve physical contact between the therapist and the client/s.  Sex therapy emphasizes desire, pleasure, and sexual wellbeing.  Sex therapy can be very helpful to educate couples about sexuality and sexual functioning at various stages of their lifespan and relationship development.  Because sex is an important part of marital satisfaction, sex therapy can be an impactful experience towards a happier, more fulfilled life and relationship together.  That said, there are several techniques or branches of sex therapy approved by the American Association of Sexuality Educators, Counselors and Therapists (AASECT) that do not necessarily comply with Islamic jurisprudence in sexual behavior, such as sex with self or sex with a surrogate.  Sex therapy with Muslim couples can be adapted or modified to fit their needs and values.  Robust perspectives on sexuality discussed in Islamic texts and traditions can be integrated into sex therapy with Muslim couples, such as the Prophet’s recommendations about foreplay, rights of each partner in sexual gratification and pleasure and other encouragements toward sexual wellbeing.  

Mental healthcare in the DMV is a broad field of service.  Mental healthcare service settings include home-based agencies, adventure-style camps or farms, retreats, hospitals, residential facilities, community-based centers, telehealth, and private offices.  There are three basic levels of mental healthcare: residential (voluntary or involuntary), intensive outpatient or partial hospitalization, and outpatient.  Some providers work within larger healthcare systems and government services to provide comprehensive, wraparound care.  Some places offer 24-hour crisis response services.  Counseling can be delivered one-on-one in individual, couples, or family therapy or through group therapy with individuals, couples, or multi-family memberships.  Many service providers and centers specialize in treating particular presenting issues, such as eating disorders, reunification, developmental disability, trauma, substance abuse disorders, juvenile delinquent behaviors, sexual assault, domestic violence, and other issues.  Initial intake and assessment by the clinician will help you determine which services are most appropriate for your situation.  It is important to find a good fit between needs and services as a consumer of mental healthcare. 

Please check each individual provider’s personal website for their specialized training. Here is general information to consider:

There is a wide range of theories of change espoused by counselors and psychotherapists these days.  You can ask your care provider or potential care provider about their theoretical orientation.  Most clinicians integrate a variety of theories and models of counseling during the course of service.  Some use non-invasive electronic devices, such as neurofeedback and biofeedback devices, EMDR light tracks, and heart rate monitors.  Some use animal-assisted interventions (AAI), like the use of horses, dogs, rabbits, birds or other animals that are specially trained to emotionally soothe and reflect the client’s feelings.  Some therapists use sand trays and figurines, toys, clay and paint and other hands-on supplies.  Often readings, called bibliotherapy, accompany treatment.  Some counselors ask clients to bring real objects into the room to help with processing their thoughts and feelings.  Some use videos, images or actual objects with client permission.  The main “tool” of a psychotherapist, however, is themselves, their own connection with the client and their ability to listen and empathize.  Most psychotherapists in DC, Maryland and Virginia are not able to prescribe medications and, if needed, would instead network to provide appropriate referrals to a psychiatrist or other medical doctor. 

There is a wide range of educational qualifications among mental healthcare workers.  Technicians, assistants and interns might have a high school diploma or bachelor degree as well as specialized training with or without certification.  To practice psychotherapy independently—meaning without a supervisor overseeing their work—requires a professional license.  Usually, a licensed counselor or resident working toward licensure holds a master or PhD in psychology, clinical social work, social work, counseling, marriage and family therapy, or related field.  Psychiatrists are medical doctors who specialize in mental healthcare and can prescribe medication as well as provide counseling.  Beyond general counseling qualifications and licensing, some clinicians choose to specialize in one or more focus areas through advanced training and certification in a specific therapeutic model, for example a registered play therapist (RPT) or certified addiction specialist (CAS).     

Seeking counseling as a support at times of high conflict, control and degradation in an important relationship can be particularly challenging but also very important.  Activating protective factors and resources to support healthy outcomes for all involved is something a skillful therapist can help you do.  It is also something you might do for yourself, in case you are unable to access therapy.  The National Domestic Violence Hotline (1-800-799-7233) is available 24/7, and their website is a good place to start exploring resources; it provides specific, concrete information on safety and relationships:  https://www.thehotline.org/help/path-to-safety/.  There are numerous non-profit organizations in the DMV area are dedicated to supporting women and children in particular.  Most support groups for people who think they may be in an abusive relationship are free-of-charge and open to new members but may require you to call in advance to join. 

You can call 9-1-1 and request psychiatric emergency services if you are experiencing an immediate threat to your own or your loved one’s safety or wellbeing.  Additionally, here are some 24-hour helplines for specific issues:

·  National Suicide Prevention Lifeline: 1-800-273-8255

·  Crisis Text Line: text HOME to 741741

·  National Domestic Violence Hotline: 1-800-799-7233

With hourly rates running anywhere from $60-$300 and most psychotherapy lasting at least six weeks and often months to years, paying out-of-pocket for mental healthcare can add up fast.  While that high cost might pay for itself in increased productivity and life satisfaction, not everyone can afford the price tag.  Mental healthcare accessibility is a big problem in the U.S., and our DMV area is no exception.  Here are some options to explore:

·  Insurance coverage—Some providers operate in network.  You can ask the provider when you call to schedule an appointment.  If the clinician does not accept third-party payment or is not in network with your insurance plan, you might still be able to obtain reimbursement yourself from your insurance provider by sending them the invoice or records. 

·  Sliding fee scale—Some providers offer reduced rates based on household income or other personal circumstances, such as spousal withholding of shared finances, recent unemployment, or high medical expenses.  You can ask potential providers if they might agree to a reduced or sliding scale or even explore pro bono possibilities.  If you cannot afford their lowest fee, they may still be able to point you towards providers with sliding scales or non-profit organizations with services that match your needs. 

·  Masjids and non-profit organizations—In addition to Islamic centers that have social service offices or pastoral counseling, there are many Muslim and mainstream secular non-profit and non-governmental organizations in the DMV area that care deeply about mental healthcare and offer various programs.  They may be running groups free of charge.  For example, there are support groups for cancer survivorship, bereavement, domestic violence and abuse, sexual assault and abuse, postpartum and peripartum, various chronic illness and more.        

·  Government services—Community mental health services are available in most DMV residential areas.  For example, Community Service Boards (CSB) are government bodies dedicated to issues around constituent mental health and social services.  You can research online to locate and call the appropriate community mental health agency for your county, city or district to determine what available programs and services you might find supportive. 

Thank you for your interest in joining the Potomac Muslim Counseling Link networking group.  Please contact info@mindbodysoultherapy.com for further information.