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Counseling Muslim Americans: cultural and spiritual assessments.

As the counseling profession moves toward greater specificity in cross-cultural and multicultural counseling encounters, Muslim Americans and immigrant Muslims are a focus for culturally sensitive and ethical counseling considerations (Bushfield & Hodge, 2007; Graham, Bradshaw, & Trew, 2009; Hamdan, 2007; Kelly, Aridi, & Bakhtiar, 1996; Lee, Gibbons, Thompson, & Timani, 2009; Roysircar, 2003; Springer, Abbott, & Reisbig, 2009). Muslims were originally concentrated in Asia, Africa, the Middle East, and Eastern Europe, and they are now increasing in numbers in the West and especially in the United States. Several changes in the world have brought a significant number of Muslims to North America and Western Europe. These include globalization; migrations; wars; political, religious, and gender and sexual orientation oppressions; and poverty.

As immigrants or sojourners, Muslims stand out because their religious beliefs and cultural customs differ significantly from Western culture (Abu Raiya, Pargament, Mahoney, & Trevino, 2008; Halim, 2006). However, this is a complex group to understand, as Halim (2006) noted in his observations on the several different types of Muslims in the United States--immigrants, citizens who have been here several generations, children of immigrants, and the different levels of acculturation and socialization that are operating among the various groups among this religious population. A wide variety of beliefs and values are evident among those who identify as Muslims; these tend to be as varied as the cultures they come from, and the religious beliefs are mediated within the primary cultural context (Halim, 2006; Mernissi, 1996). There is no particular set of beliefs and values that is representative of all Muslims, because the Islamic community in the United States is composed of many smaller Muslim communities, each with its own distinct characteristics mediated by primary culture of origin first and religion second. Appreciation of both the uniqueness of a specific person in his or her environment and a generalized knowledge about the cultural group's worldview is necessary for effective practice. Currently, Muslims in the United States and in the West are facing significant exclusion and difficulties because of the events of 9/11 in the United States and July 2007 in the United Kingdom (Abu Raiya et al., 2008; Halim, 2006; Pena, 2007). Although the level of harassment and exclusion varies by ethnicity and culture of origin, it creates significant stress for Muslims in general; African, Arab, Iranian, South Asian, and South East Asian Muslims report significant stress and anxiety as they negotiate their lives in the post-9/11 atmosphere (Abu Raiya et al., 2008; Elias, 2006; Pena, 2007). Given their current status in U.S. society and in the West, it is argued that they are exposed to severe psychological stress, and the importance of increasing counselors' ability to provide culturally responsive services, with specific attention to the ACA (American Counseling Association) Advocacy Competencies (Lewis, Arnold, House, & Toporek, 2002), for this population becomes significant.

In this article, we propose that a cultural, spiritual/religious, worldview, and acculturation assessment may prove to be helpful in working with Muslim clients. The American Psychiatric Association requires a cultural formulation (understanding of client cultural identity and context) to be completed with a client before a diagnosis is given (American Psychiatric Association, 2000). Several clinicians and researchers have supported this position and proposed various assessment methods, especially to work with clients from nondominant cultures, lifestyles, religions, and so on, including the ethical standards of the counseling profession (ACA, 2005; American Psychological Association, 2002a; Castillo, 1997; Daneshpour, 1998; Hodge, 2005; Ibrahim, 2008a; Kaslow, 2004; Krishnamurthy et al., 2004; Oakes & Raphel, 2008; Pfeiffer, Whelan, & Martin, 2000).

When one works with Muslims, a key concept to recognize is that traditionally their understanding of mental health issues is that all the solutions exist in revelations in the Qur'an as noted in the verse "We send down the Qur'an as healing and mercy to those who believe" (Abdel Haleem, 2004, p. 180; Cinnirella & Loewenthal, 1999). Although individuals may not all be relying on Quranic revelations, given the diversity among this population, the values of Muslims, immigrants, and sojourners reflect some core Islamic principles specific to mental health issues (Cinnirella & Loewenthal, 1999; Halim, 2006; Kelly et al., 1996). A culturally competent and responsive counselor works on a counseling relationship and a counseling process with a clear understanding of the client's religious and cultural beliefs to incorporate this healing resource into the therapeutic process (Bushfield & Hodge, 2007; Hamdan, 2007; Kelly et al., 1996; Springer et al., 2009). A prerequisite to providing counseling services to this population in the United States is that the counselor has confronted his or her own cultural identity, socialization, and the biases that he or she may be subject to as a result of the socialization process (ACA, 2005; Ibrahim, 2003, 2010). In addition, as Springer et al. (2009) recommended, a stance of not knowing is essential to create a readiness to understanding the cultural worlds of Muslims in the United States. The first step in the process of providing culturally responsive counseling to Muslim clients is to assess the cultural identity, worldview, spiritual and/or religious commitment, and acculturation to gain critical information to ensure a culturally sensitive intervention, including diagnosis, process, and goals (Cashwell & Young, 2005; Castillo, 1997; Dana, 1998; Ibrahim, 2008a; Kaslow, 2004).

* Critical Assessments

To conduct a cultural identity, worldview, spiritual/religious commitment, and acculturation assessment with Muslim Americans, counselors need background information to contextualize information about Muslims in the United States. Background information that can be helpful in working with the Muslim population includes the following: (a) demographics of the cultural group in the area and (b) the key tenets of Islam. This information helps to contextualize the client's world, the level of family and community support available to the client, along with core beliefs and assumptions that are derived from the specific culture of origin, and the religion and its impact on the client.

Muslim Demographics and Implications for Adjustment in a Western Culture

Muslims live in 180 countries of the world and constitute one fifth of the world's population (Johansen, 2005; Kelly et al., 1996; Kobeisy, 2004). Contrary to popular belief in the West, Arabs represent a minority of the Muslim population (Abudabbeh, 2005). It is estimated that there are between six and eight million followers of Islam, or Muslims, in the United States, of which 75% are immigrants and 25% were born in the United States (A1-Krenawi & Graham, 2005). The critical issue for the counseling profession, given the profession's ethical code and its requirements for social justice, cultural competence, and cultural responsiveness, is to recognize that this population is growing rapidly, and counselors must acquire accurate information about the cultural and religious values of this population (ACA, 2005; American Psychological Association, 2002b).

For Muslims in the United States, it is difficult to live according to the tenets of Islam and its recommended lifestyle and traditions because of the negative ascriptions by the larger social systems about Islam and Islamophobia in general, especially since 9/11 (Ali, Liu, & Humedian, 2004; Almeida, 2005; R. B. Carter & El Hindi, 1999; Kobeisy, 2004; Penn, 2007; Zine, 2001). One example of a negative ascription is the erroneous belief that Islam is a strange religion that has no commonality with the United States's Judeo-Christian heritage (Altareb, 1996; Barazanji, 1996; Penn, 2007; Zine, 2001). These negative perceptions of difference are predicated on Eurocentric norms because of the occupation of Europe by the Ottoman Empire (Abudabbeh, 2005). Such thinking represents a form of domination that is manifest and active simultaneously in many forms: political, economic, cultural, hegemonic, and symbolic (McIntosh, 1990; Zine, 2001).

Recent immigrant Muslim Americans have a belief that Islamic core values should be incorporated into societal values for Muslims. This belief represents a major challenge for countries in the West, given the separation of religion and state; the lack of integration between Islam and the values and lifestyle in the West; and the many different and varying cultures of American Muslims, including generation in the United States, culture of origin, education and acculturation level, and migration status (Halim, 2006; Khan, 2002; Nuruddin, 1994; Penn, 2007). Although Islam has been in North America since the arrival of African slaves, understanding about the religion and its tenets appears to be minimal among mental health professionals and the general public (Ali et al., 2004; Springer et al., 2009). Halim (2006) noted similarly that lack of knowledge about the religion persists in the United States; however, given the multicultural agenda of the counseling profession, it does bring up several concerns regarding stress for Muslims specifically, their integration into U.S. society in general, and services that would facilitate integration and lower psychological stress.

Key Tenets of Islam

Altareb (1996) clarified that the term Islam comes from the Arab word for peace (Salam) and Islamic spirituality is expressed through key elements of the Islamic worldview. Johansen (2005) encouraged therapists to consider the fact that "Muslims understand the Koran as the only truth. Consequently, it is important for the therapist to have an understanding and appreciation for the teachings of the Koran" (p. 182). Within the Islamic worldview, it is believed that "the Qur'an was revealed as guidance for mankind [humans]" (Abdel Haleem, 2004, p. 185). Allah (the Arabic word for God) is at the center of the universe; peace is achieved through submission to God's will (Abul Fadl, 1991). To understand the basic tenets of Islam, one needs to be familiar with the Five Pillars of Islam (Abudabbeh, 2005). Clients may be highly aware and committed to these Five Pillars of Islam, or they may emphasize only certain elements of the faith that they have been exposed to based on their culture, sociopolitical history, acculturation to Western values, and other variables from their specific culture of origin or their migration history to the United States (Halim, 2006; Khan, 2002; Mat*son, 2003). The most important issue is culture; Islam has developed in the context of the culture where it had taken root, which is the best way to understand how the teachings of the Qur'an are understood, accepted, and acted on (Mattson, 2003; Mernissi, 1996).

Islam means peace or submission to the will of God (i.e., Allah). There are Five Pillars of Islam: (a) a belief in one God and the final messenger, Mohammad (Muslims accept all the major prophets of the Judeo-Christian faiths that preceded Mohammad); (b) prayer five times a day; (c) charity, a percentage of yearly income and assets; (d) a month of fasting from sunup to sundown, with no food, water, and impure thoughts (e.g., hurting others, stealing, vengeful ideas, and sexual thoughts); and (e) Hajj, pilgrimage to the holy city of Mecca in Saudi Arabia at least once in a lifetime (Abudabbeh, 2005). Springer et al. (2009) noted that several of the general beliefs held by other religions are found in Islam, and these include a belief in resurrection and the importance of a moral life. Actions that are harmful to self and others are also rejected by Islam, such as pride, arrogance, gossip, slander, robbery, murder, adultery, greed, oppression of the poor and vulnerable, abuse of family members, and disrespect of parents.

A major area of difference with Western culture pertains to gender roles in Islam. Interaction between men and women is limited to immediate family and relatives, and cross-gender therapeutic relationships may pose a problem (Goodwin, 2002; Springer et al., 2009). Gender roles are mediated by the historical and cultural contexts in which Muslims live, and over time, as the generational status moves farther away from the culture of origin due to living in the West, the culture of Muslims is mediated by Western culture. However, in most situations, there is strict adherence to Islamic principles by recent immigrants, and in some cases, it has been observed that recent immigrants who may have been quite liberal in their practice of Islam in their home culture become much more overtly religious in a Western context (Nuruddin, 1994; Roald, 2001).

* Cultural Identity and Worldview Assessment

Conducting cultural identity and worldview assessments before developing an intervention ensures that the counselor will conduct a culturally relevant and sensitive intervention (American Psychiatric Association, 2000; Ibrahim, 2003, 2008a). The generic aspects of cultural identity assessment as exemplified by the Cultural Identity Checklist-Revised (CICL-R; Ibrahim, 2008b) are (a) ethnicity, race, or culture (R. T. Carter & Forsyth, 2009; Helms, 1995; Helms & Carter, 199l; Mobley & Cheatham, 1999; Phinney, 1992); (b) gender (Cannon & Singh, 2010; Hoffman, 2006; Scott & Robinson, 2001; Stephens & Phillips, 2003); (c) sexual orientation (Cass, 1979; McCairn & Fassinger, 1996; Troiden, 1989; Weinberg, Williams, & Pryor, 1996); (d) age and life stage (Erikson, 1993, 1994; Erikson & Erikson, 1998); (e) religion (Parks, 2000; Poll & Smith, 2003; Witmer, Sweeney, & Myers, 1994); (f) generation in the United States (Akhtar, 1999; Banks, 2003; Phinney, Horenczyk, Liebkind, & Vedder, 2001); (g) social class (Liu, 2004); (h) educational level (Gosine, 2002; Schwartz & Montgomery, 2004); (i) the environment the client lives in and grew up in (i.e., urban, suburban, or rural; Marten, 2001); and (j) ability/ disability status (Smart & Smart, 2006). Cultural assessment requires an exploration with the client of these dimensions and what they mean to the client, given the presenting problem and his or her culture, religion/spirituality, and acculturation to the United States; this is done to understand the intersections of culture, gender, sexual orientation, age, social class, religion, birth order, environment in which the client was socialized and the impact of this environment, and the client's abilities and disabilities. Usually, the assessment reveals that the presenting problem is linked to some specific cultural identity variables. This information will also require further exploration to understand the strengths and challenges that the client faces and how resolution can take place (Ibrahim, 2008a).

Sensitivity and care are needed for the assessment phase, because without some modicum of trust, exploration of many of these issues can be seen as intrusive and lead to a breakdown in the therapeutic relationship (Daneshpour, 1998; Hedayat-Diba, 2000; Springer et al., 2009). Too much questioning can create an interrogative situation that may become oppressive for the client, so it is critical that the counselor uses good judgment and the counseling-specific communication skills of basic listening skills, positive asset search, paraphrasing, empathy, advanced accurate empathy, active listening, clarifying and pacing to determine the formation of cultural identity and the significant markers in the developmental process (Ivey, Ivey, & Zalaquett, 2010). Because differences in cultural values related to communication exist, especially when working with African, Asian, and Middle Eastern clients, indirect communication is most helpful and is perceived as courteous (Al-Rady & Mahdi, 1994). Confrontation, and sometimes direct communication, can be considered selfish (from a cultural perspective) and insulting, and counselors, especially those socialized in Western culture, will need to identify phrasing that is acceptable within the local Muslim cultural communities to effectively communicate concerns to a client or the family (Hedayat-Diba, 2000).

The CICL-R identifies for the counselor the client's cultural identification (race, culture, gender identity, sexual orientation, religion, age, languages spoken, region of world or country where socialization took place, and ability/disability). If counselors rely on published literature or personal bias, it can lead to stereotyping and imposition of a generic knowledge base on the sociopolitical history and the profile of a cultural group, and the client becomes a stereotype rather than a unique individual from a specific cultural group. This assessment is the key to cultural efficacy and responsiveness in counseling and therapy. The counselor's focus in reviewing these concepts, primarily by listening carefully to the client's narrative of the presenting problem and the crisis that has brought him or her to counseling, makes the process contextual. It is also important to understand the intersections of the various aspects of the client's cultural identity to identify areas that are meaningful or significant for the client, to understand the values and beliefs that are connected to these issues, and to gather information that will facilitate the therapeutic process and the intervention.

Some of the questions on the CICL-R may have been addressed as part of the initial intake, and the need to inquire about these items again is unnecessary (e.g., religion). It is important that the therapist reviews initial intake information carefully to reduce redundancies and undue stress on clients who are in a state of distress, seeking a solution to their crisis, and who can get frustrated by having to provide the same information repeatedly. Additional information is included in the CICL-R that will be helpful in understanding the client's perspectives, culture, and life experiences: (a) If the client is an immigrant, the length of time living in the North America or other countries (as is the case for several refugees from Afghanistan, Bosnia, Herzegovina, religious refugees from Iran and Pakistan); (b) number of languages spoken; (c) professional identification and educational level; (d) relationship with home culture; (e) conditions under which the client left his or her country; (f) socioeconomic status, both in home culture and in the host culture; (g) family composition; and (h) support groups available to the client in host culture. Exploration of the aforementioned dimensions and understanding of client experiences in the host culture are critical in understanding the client's overall cultural identity and level of social-emotional functioning and level of trust to expect. With Muslim American clients, an effective counselor will also address the client's commitment to the religion to understand its impact on the client's worldview and ways of being. These Islam-specific dimensions are (a) commitment to Islam; (b) gender identity and its acceptance in terms of the faith; and (c) the interplay &nationality, ethnicity, culture, and race (Ohnishi, Ibrahim, & Grzegorek, 2007).

Variations in Commitment to Islam

In a Western context, it is critical that the counselor understands the client's level of commitment to religious core Islamic values. Spirituality and religion need to be differentiated because in Islam, there can be no complete commitment to spirituality and a relationship with God without attention to religious rituals and practices (Cashwell & Young, 2005; Fukuyama & Sevig, 1999; Hodge, 2005). Commitment to religious practices or rituals is also no validation of belief in the faith or even an understanding of the complex ideas inherent in the religion. These issues do complicate the work of the counselor; however, a religious or spiritual assessment can help in clarifying the client's position on these issues (Cinnirella & Loewenthal, 1999; Gorsuch & Miller, 1999; Griffith & Griggs, 2001 ; Hodge, 2005). With this information, the counselor can determine if engagement in therapy can occur. If the client does not have a clear sense that the counselor can understand his or her spiritual or religious concerns and needs, the necessary working alliance will not be created (Cinnirella & Loewenthal, 1999; Hedayat-Diba, 2000). The positive formation of this alliance is crucial because the working alliance is the most robust predictor of therapeutic outcome (Havens, 2004).

In Islam, there is a strong belief that "God is the ally of those who believe: He brings them out of the depths of darkness and into the light" (Abdel Haleem, 2004, p. 29). Within the religion, there is a strong belief that through practice of the religion, one can overcome life's challenges and difficulties (Cinnirella & Loewenthal, 1999). Islam focuses on creating a religion-based cultural context for the believers. Thus, Islam has implications for the decisions that are made in therapy (Altareb, 1996). Cultural and religious identity and its continuity are important for Muslims living in the diaspora (Esposito, 1998;Yousif, 1993; Zinc, 2000). It is also important to recognize that religion may not be important or at the core of the client's presenting problem; however, if the person has a strong sense of spirituality or religiousness, it is a strength that can be mobilized in therapy (Banawi & Stockton, 1993; Cinnirella & Loewenthal, 1999). Many of the difficult conflicts that the client brings to counseling are caused by a struggle between what the client needs and what the external forces require, such as the family, the work, or the community. This disconnect becomes the core problem that confounds people and usually forces them to seek help beyond their own personal resources, such as family, friends, social circle, religious leaders, or their community. Altareb (1996) cautioned counselors to recognize that assessment of the extent of religious commitment is critical to the success of counseling when working with Muslims. She also noted that given the diversity of Muslim backgrounds and cultures in North America, it is imperative that counselors understand the client's level of commitment to Islamic principles. Clients who identify strongly with their faith need to be assured that their concerns and problem resolution will be addressed from a religious perspective (Bishop, 1992; Kelly et al., 1996).

Gender Issues

Gender issues can adversely affect the formation of an adequate working alliance if a counselor is unaware of Muslim beliefs (D. J. Carter & Rashidi, 2004). Two areas where a Westerner has the greatest likelihood of stumbling when trying to form a working alliance are male-female interactions and understanding the level of patriarchy in Muslim societies (Springer et al., 2009). The second pertains to an understanding of cultural and religious understanding of altemative sexual orientations (Ohnishi et al., 2007).

Male-female interaction. Gender can be a barrier to a therapeutic alliance in cross-gender counseling interactions specifically for Muslim women (D. J. Carter & Rashidi, 2004; Hassouneh-Phillips, 2001; Springer et al., 2009). As noted earlier, male-female interaction is severely restricted in traditional Muslim societies. Working across genders can pose problems, and the counselor may want to establish if the client is comfortable in working with him or her based on the counselor's gender (Springer et al., 2009). Several cultural rules exist that are derived from religious teaching about verbal and nonverbal behavior, level of modesty, eye contact, and so on, and reinforced by traditional cultures (Almeida, 2005; Altareb, 1996; D. J. Carter & Rashidi, 2004).

Sexual orientation and intersex status. Another area of extreme conflict for Muslims is the self-identification as gay, lesbian, transsexual, or intersex. There are severe prohibitions in the religion about acknowledging gay or lesbian tendencies, and this creates an intense conflict in youth who come from traditional cultural contexts, especially if they are the children of immigrant families (Almeida, 2005; Ohnishi et al., 2007; Weinberg et al., 1996). The severity of confusion and conflict that can be created for an immigrant with alternative sexual orientations was exemplified in the movie based on the book My Beautiful Launderette (Qureishi, 1977). Furthermore, in most third world cultures, all alternative sexual orientations are closeted and never discussed, except in the Indian subcontinent where a third gender is acknowledged (Cannon & Singh, 2010).

A clear evaluation of how clients have defined their gender identity and sexual orientation is critical to appropriate culturally sensitive counseling. Again, the critical variable is to evaluate similarity or distance between the client's core religious values, beliefs and attitudes, and U.S. societal assumptions. Alienation from religion or national culture can create severe conflicts for clients (Mernissi, 1996; Nuruddin, 1994). This assessment will also aid in helping the client resolve issues and make decisions that are aligned with the client's gender, cultural identity, and core cultural values and assumptions and that are culturally relevant.

Worldview Assessment

Worldview is a central construct of cultural identity and pertains to the beliefs, values, and assumptions that a client has as a result of the socialization process; it can be measured using an empirically validated instrument, that is, the Scale to Assess World View (SAWV; Ibrahim & Kahn, 1987; Ibrahim & Owen, 1994). The scale was derived from a universal human values framework of five dimensions around which all cultures have values: human nature; social relationships; and perception of nature, time, and activity (Ibrahim, 2003; C. K. Kluckhohn, 195 l; E R. Kluckhohn & Strodtbeck, 1961). The following comparison of U.S. and Islamic worldviews is based on the principles of the religion, not on how different cultures have incorporated the religion in their ongoing sociohistorical culture. The first worldview category pertains to human nature. Muslims consider all human beings to be intrinsically good. As noted earlier, they perceive the connection with God of all living things and accept that all living beings represent the unity of God (Rashid, 1988). North Americans believe that human nature is a combination of innately good and bad qualities or it can be bad, a view derived from Calvinistic influences on the culture (Calvin, 1960; Ibrahim, 2007; Ibrahim & Kahn, 1987; Ibrahim & Owen, 1994; E R. Kluckhohn & Strodtbeck, 1961; Takaki, 1979). In social relationships, Muslims accept a domestic patriarchy where men are the head of a family. This gender role ascription carries with it considerable power. Women have their place in Islam as mothers and the transmitters of the faith and culture and are to be treated with respect and honor (Abdul-Rauf, 2007; Engineer, 2008; Mernissi, 1996; Rashid, 1988; Springer et al., 2009). However, considerable media attention has focused on the emotional, psychological, and physical abuse of Muslim women, and this is where cultural traditions continue and Islamic prescriptions on the treatment of women are ignored; several women who come to the United States and Europe are refugees because of their gender (Goodwin, 2002; Hassouneh-Phillips, 2001; Mernissi, 1996). In social relationships, Muslims believe in treating people with respect and expect to be treated respectfully. Islam is a communal faith and requires ordered social relationships within familial and social systems (Esposito, 1998; Haneef, 1996). Although Muslims are communal and hierarchical in their social relationships, they also value mutuality in relationships (Abul Fadl, 1991; Barazanji, 1996). In North America, given the ideal of rugged individualism, social relationships tend to be individualistic. Although this value is more an ideal than reality, because most people in North America come from a family that they value and subscribe to, the overarching assumption is that people are not communal; however, Catholicism is a communal faith and creates an interdependent social structure (Langelier, 1996). In addition, when it comes to many familial and work settings, it is evident that there is hierarchy, with authority and power trickling down to the lowest levels of the family or organization (Clegg, Courpasson, & Phillips, 2006). Recognition of protocol and power bases in familial or organizational settings in the United States is critical to successful relationships in both domains (Ocasio & Pozner, 2005).

In considering perceptions of nature, one becomes aware of the vast differences between Muslim (from traditional societies) and Western worldviews. Muslims consider the beauty of nature as a sign of divinity and the unity of God with all things animate and inanimate (Halim, 2006). Nature is seen as a rejuvenating force, and living in harmony with nature is appreciated (Esposito, 1998). North Americans consider nature as a force that can be controlled and used to enhance life for humans (Hills, 2002; Ibrahim & Kahn, 1987; Ibrahim & Owen, 1994; Marten, 2001). In the quest to create a new world in North America, most Americans have treated nature as an obstacle to be removed or to be harnessed to serve humans (Ibrahim & Kahn, 1987; F. R. Kluckhohn & Strodtbeck, 1961). However, given global warming and other threats to the environment, this perspective is shifting (Marten, 2001).

The time category addresses how the past, the present, or the future is viewed (Heidegger, 1985, 1992; Hills, 2002). Most cultures that have long histories and ancient civilizations tend to have a past focus, cultures that have forgotten their history or have become so immersed in the present tend to be present oriented, and cultures that have significant goals for advancement tend to plan extensively and are future oriented (C. K. Kluckhohn, 1951; F. R. Kluckhohn & Strodtbeck, 1961). For Muslims, looking back and recognizing the height of the Muslim civilization is a matter of great pride. They tend to look to the past to help them plan their course of action, and their goals of life emphasize compassion and mercy (to be like God, the merciful and the compassionate; Dwairy, 2006). For Muslims, the emphasis tends to be past and future orientation.

North American culture is relatively new when compared with other cultures of the world, and it focuses on the present and planning for the future (Ibrahim & Kahn, 1987; Ibrahim & Owen, 1994). Although most universities espouse the height of Western civilization (i.e., Greek culture as an ideal), the average person in the United States is focused on meeting their day-to-day needs and focused on the future (Shorr, 1992, 1998). The last worldview category pertains to the work and spirituality domain. The Islamic worldview focuses on working, making a living in line with the Islamic principle of the "straight path" or living in line with religious values (Zine, 2001). Earning interest is forbidden, and charity is one of the pillars of Islam (Al Faruqi, 1978; Rashid, 1988). In North America, success and materialism are synonymous and highly valued (Kasser, 2002; Smart & Smart, 2006); whether it is in line with religious beliefs or not is not a consideration, given the division of state and religion.

* Acculturation

One of the most important variables in working with Muslim American clients, especially given the pluralism among Muslims and the varying levels of acculturation based on migration and generation, is their acculturation level and their commitment to live their lives within the context of Islamic principles in North America or any Western European country (Halim, 2006). Berry and Sam (1997) defined acculturation as "behavioral and psychological changes in an individual that occur as a result of contact between people belonging to different culture groups" (p. 292). Berry (1990) has identified four acculturative styles: integration, assimilation, separation, and marginalization. His theory posits that integration occurs when an immigrant identifies with and is involved with both cultures--culture of origin and host culture. In assimilation, an immigrant chooses to identify solely with the new culture. When separation is the acculturation model adopted by an immigrant, there is only involvement with the culture of origin, and in marginalization, there is a lack of involvement and rejection of both cultures. Berry posited that changes in mental health vary across the four modes because of different levels of acculturative stress. The integration acculturative style is the best predictor of good mental health because it involves the lowest level of acculturative stress. Assimilation, separation, and marginalization are types where the poorest mental health might be expected. Berry weighed cultural and psychological factors in his definition of acculturation, and his model is concerned only with cultural identity (Sam & Berry, 2001). Dana (1998) noted that acculturation orientation can help in clarifying cultural identity along with the psychological state of the client as indicated by Berry.

Using the cultural identity assessment along with values derived from the SAWV, the counselor can understand the client's acculturation style and clarify his or her adjustment to the host culture by considering the distance between the client's values and assumptions and the mainstream or host culture. In addition, an assessment can be done to understand if the client considers the self as independent, interdependent, or dependent on the family or the social group to define reality and rules for life based on individualism versus collectivism (Hofstede, 2001). The cultural assessments help identify the client's core assumptions (cultural, religious, and goals for life based on their socialization) and assist the counselor in helping the client resolve the conflicts and issues that are the presenting problem in counseling. This information is the key to determining the goals and process for counseling and ensures that the client will receive culturally responsive interventions.

* Secondary Factors to Consider

When one works with Muslim American clients, it is essential to determine their level of identification with their nationality (culture of origin), ethnicity, culture, and race. Given that the large percentage of Muslims (about half the U.S. Muslim population) are immigrants or children of immigrants, their identification with culture of origin may be strong and thus may lead to some cultural struggles in the therapeutic process and in their social encounters. It is necessary for counselors to spend some time clarifying the socialization influences on the client, because it has a significant influence on the client's values and worldview (Altareb, 1996; Halim, 2006; Ibrahim, 2003). Understanding the role of socialization, which has a direct impact on cultural identity development, worldview, spiritual/religious commitment, and acculturation, is essential to the development of a productive working alliance.

Another important variable in this context is physical appearance. Because the majority of Muslim Americans come from cultures that have very different physical characteristics from the majority European population in North America (except for European Muslims), it is important to find out if a Muslim client has experienced racism, prejudice, and discrimination (Abu Raiya et al., 2008; Halim, 2006; Lee et al., 2009; Pena, 2007; Sheridan & North, 2004; Zine, 2000, 2001). Negative experiences of exclusion, rejection, and emotional and psychological abuse are everyday stressors for people who are racially different immigrants, have accents, or have foreign-sounding names, especially Muslim or Arab names (R. T. Carter, 2008; Hays, Chang, & Decker, 2007; Ibrahim, 2008a; Zine, 2000, 200l). Such experiences can negatively influence adjustment in the host culture and require a discussion of privilege and oppression variables when working with immigrant client populations in the therapeutic interventions; to help build resilience, coping strategies, and empowerment to enhance the immigrant Muslim's racial/cultural identity can become the subtext goals in the counseling intervention. Counselors working with non-European culturally and religiously diverse clients will need to confront their own biases and assumptions, especially about immigrants, and will need to explore issues of trust with clients to establish a positive therapeutic relationship (Abu Raiya et al., 2008; Altareb, 1996; Hedayat-Diba, 2000; Pena, 2007; Sheridan & North, 2004; Springer et al., 2009).

* Using This Material in Counseling

As noted earlier, cultural factors impinging on the cultural identity of the client, the worldview (beliefs, values, and assumptions), spiritual/religious assumptions, and acculturation are critical to understanding the client and developing a culturally sensitive and meaningful intervention. Most clients do not respond well to paper-and-pencil instruments, but if they are open to this medium, it would help the counselor in gathering some data points by clients filling out the CICL-R (Ibrahim, 2008b) and the SAWV (Ibrahim & Kahn, 1987; Ibrahim & Owen, 1994); furthermore, the counselor will need to facilitate a discussion on the implications of the findings and how they impinge on the presenting problem. In other situations, listening carefully to the clients' narratives will help identify what they value, how they see themselves culturally and socially, and deductions that can be made and then clarified with the clients' cultural identity (e.g., race/ethnicity, gender, sexual orientation, age, and life stage), worldview (beliefs, values, and assumptions), acculturation level and type, and spiritual/religious commitment to Islam.

* Conclusion

The effective and culturally competent professional working with Muslim American clients conducts a cultural assessment to clarify intersections of the client's identity (e.g., race/ ethnicity, gender, sexual orientation, and age), worldview, and acculturation. This professional also understands the basic assumptions of the religion and recognizes issues of spiritual and religious importance for the client before setting up the process and goals for counseling. With such an assessment, a professional counselor can understand the client as an individual and not as a stereotype of the Muslim community, or a specific culture, based on nationality. Such an understanding is the foundational building block of a meaningful working alliance between the counselor and the client and sets the stage for effective therapeutic progress.

Received 09/29/09

Revised 05/05/10

Accepted 11/23/10


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Farah A. Ibrahim, Counseling Psychology and Counselor Education, University of Colorado Denver; Cass Dykeman, Counselor Education, Oregon State University. This article was presented at the American Counseling Association as a workshop in 2008 and at the American Psychological Association annual conference in 2009. Correspondence concerning this article should be addressed to Farah A. Ibrahim, Counseling Psychology and Counselor Education, University of Colorado Denver, Campus Box 106, PO Box 173364, Denver, CO 80217-3364 (e-mail:
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Title Annotation:Practice
Author:Ibrahim, Farah A.; Dykeman, Cass
Publication:Journal of Counseling and Development
Article Type:Report
Geographic Code:1USA
Date:Sep 22, 2011
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