Theoretical Model of Psychotherapy Eastern Asian Islamic (15 H)

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THEORETICAL MODEL OF PSYCHOTHERAPY: EASTERN ASIAN-

ISLAMIC WOMEN WITH MENTAL ILLNESS
David Carter; Anahita Rashidi
Online publication date: 21 June 2010
To cite this Article Carter, David and Rashidi, Anahita(2003) 'THEORETICAL MODEL OF PSYCHOTHERAPY: EASTERN
ASIAN-ISLAMIC WOMEN WITH MENTAL ILLNESS', Health Care for Women International, 24: 5, 399 — 413
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DOI: 10.1080/07399330390212180
THEORETICAL MODEL OF PSYCHOTHERAPY:

EASTERN ASIAN-ISLAMIC WOMEN WITH
MENTAL ILLNESS
David J. Carter, PhD, LMHP

University of Nebraska at Omaha, Omaha, Nebraska, USA
Anahita Rashidi, MSN, RN

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Richard-Young Hospital, Omaha, Nebraska, USA
The Muslim immigrant population is increasing in the United States.

To provide appropriate psychotherapy for this group, especially Islamic
women, treatment professionals must have a deeper understanding
of the culture of Eastern Islamic women. Islam is the lifestyle of this
population and it influences their thinking, the relationships among
themselves and with others, and all other activities of daily life.
The holistic approach of the Eastern Islamic population is incom-
patible with the individualistic approach of Western psychotherapy
in treating Islamic women. We explore a theoretical model of psy-
chotherapy for Eastern Asian-Islamic women suffering from mental
illness (MI) to develop an effective and appropriate therapy. Health
care providers, specifically those dealing with MI patients, will gain
insights from the suggested psychotherapeutic model and its rele-
vance to Islamic concepts and practices.
Discussion of the immigrant Muslim population belief system as it re-

lates to the practice of psychotherapy within Western culture is critical.
The Muslim immigrant population is increasing in the United States. To
Received 11 March 2002; accepted 2 May 2002.

Address correspondence to David J. Carter, University of Nebraska—Omaha, Kayser Hall,
Room 421, 6001 Dodge Street, Omaha, NE 68182, USA. E-mail: dcarter@mail.unomaha.edu
399
400 D. J. Carter and A. Rashidi
provide an appropriate therapy for this group, we must have a deeper un-
derstanding of the culture of Eastern Islamic women (Rashidi & Rajaram,
2001). A shift within the professional framework in the counseling of
clients within their value system is required. We encourage professionals
to meet their clients’ expectations through a holistic therapy approach. To
accomplish the therapeutic agenda, learning from the patient and search-
ing for resources that explain the client’s beliefs are imperative (Meser-
vey, 1999). The value of Eastern transpersonal experience has been less
appreciated in the past, but now Western society is more willing to in-
vestigate the significance of transpersonal and cross-cultural roles. As
Western thinkers begin to appreciate the philosophy, religion, art, and
history of other cultures (Walsh, 1999, p. 8), developing a model for
Muslim women with MI that integrates Islamic psychotherapeutic con-

cepts is crucial.
Islam is a major world religion (Shadzi, 1994, p. 45), but little is
known about its beliefs and practices in the United States. For profes-
sionals in health care systems, an understanding of Islam is the key to
counseling. Islamic belief is built on the Qur’an, Koran, the Holy book
of Muslims, and the Sunnah, which documents the life and practices of
the prophet (Lemu & Heeren, 1997, p. 2). The word “Islam” comes from
Salam (peace); however, it also means submission to Allah (God) and
the practice of monotheism (Sarwar, 1980, p. 19).
The Qur’an covers many concepts that incorporate human life as a
whole. The Qur’an views human life in a holistic way, which means a
balance of the spirit (Rouh), the mind (Aghl), the soul (Nafs), the in-
tellect (Aghel), the physical (badan), and the emotional (Atefah). The
Qur’an addresses many sources of conflict in human life. It integrates
the self with important views of morality, life obligations, politics, eco-
nomics, justice, equality, and the search for knowledge (Sarwar, 1980,
p. 33).
Omran (1980) claims that Arab-American Muslims and non-Muslims
share common sets of beliefs because of their traditional “folk” practices
that come mostly from the Islamic beliefs, common ancestry, place of
origin, and language. Therefore, we will concentrate on potential culture
care conflicts of Muslim women with MI in the psychotherapeutic setting.
While the Islamic population has been increasing in the United States,
little has been done to promote an understanding of the Muslim belief
system in order to provide appropriate care. The present rapid increases
in the Muslim population in the United States challenges mental health
care professionally, particularly psychotherapists.
Our primary purpose is to address some potential conflicts of Muslim
women experiencing MI who choose to undergo psychotherapy as part of
their recovery in the United States. Our secondary purpose is to suggest
Theoretical Model for Eastern Asian-Islamic Women 401
an effective therapeutic model based on Muslim beliefs and tradition for

health care providers in counseling and therapy.
Our goal is to integrate Western and Eastern theoretical schools of
thought. The model covers the Eastern cognitive and behavioral ap-
proaches in counseling and the Western perspectives on therapy combin-
ing the cognitive, affective, and behavioral. The goals for mental health
professionals are to foster a body of knowledge, skills, and world view
in order to encourage culturally sensitive counseling care (Sue & Sue,
1999, p. 208) for Muslim women with MI.
The theoretical model of therapy for this population encompasses
Western and Eastern schools of therapy in order to provide a holistic
approach that is appropriate for this population. Western therapy will
be discussed, followed by Eastern therapy, and finally our Carter and

Rashidi theoretical model of psychotherapy for Asian-Islamic women
with MI will be presented. This new model incorporates appropriate con-
cepts from Western and Eastern schools of thought to provide a unique
and effective guide for counseling Asian-Islamic women in the United
States.
Few researchers have addressed the problems of Asian-Islamic women
with MI. The Asian-Islamic population lacks a knowledge base and
awareness regarding health issues (Rashidi & Rajaram, 2000), which can
lead to emotional distress. It must be noted that at present there are no
studies exclusively about Islamic women with MI receiving psychother-
apy in the United States.
WESTERN PHILOSOPHIES AND PSYCHOTHERAPY THAT

DERIVE FROM IT
Western psychotherapy employs many disciplines of therapeutic

thought. Although the history of the Western psychotherapy enriches
understanding in human resolution, we will present only cognitive, af-
fective, and behavioral therapy from the Western perspective.
Rational emotive behavior therapy (REBT) will serve as the founda-
tion for the cognitive approach. An activating event is one of the core
assumptions of cognitive therapy. During the activating event, the client
is required to make a decision to evaluate the event in either a ratio-
nal and/or irrational thinking pattern (Corsini & Wedding, 2000, p. 168;
Ellis, 1994, p. 18, 1996, p. 11, 1998, p. 27; Ellis & Dryden, 1987,
p. 8, Ellis & Lange, 1994, p. 7; Ellis & Yeager, 1989, p. 17). These
divergent beliefs influence strong feelings that work “for or against” the
client.
The multiple facets of REBT are effective in changing the individ-
ual’s unrealistic thoughts. These include providing the individual with
the skills for accepting full responsibility for emotional problems within
the framework of a nurturing environment, and personal acceptance for
changing the disturbances. Helping clients recognize the emotions rooted
in irrational beliefs and perceiving those beliefs explicitly is the essence
of the psychotherapy. If a person decides to choose a functional life,
then she needs to modify her thinking in order to alter her irrational
thought pattern. Therefore, therapy guides clients to learn that stressful
daily occurrences in their lives do not stimulate pessimistic feelings and
behaviors; it is what they rehearse in “their head” or obsess about that
promotes dysfunctional feelings and behaviors. Their belief system is
illogical because clients make the assumption that the event “must” be
different from its results (Corsini & Wedding, 2000, p. 199; Ellis, 1994,
p. 18).
For instance, when the Asian-Islamic woman is diagnosed with MI,
she may think, “Life is awful and terrible and my children will suffer
because of my illness.” The goal of therapy is to help her dispute her
irrational thinking, consequently reducing her stressful feelings and be-
haviors toward the problem. The patient learns to challenge her irrational
belief that having MI will jeopardize her children’s safety. Instead she
increases her awareness that life is as fair as it is and her children will
be able to grow from every experience they face. The cognitive view
of irrational thinking promotes objectivity and a perception of the prob-
lem as workable rather than as catastrophic and immobilizing because
of irrational fear. Once the client begins thinking rationally about her
life events, she will be able to take action and change her behavior in a
rewarding and happy manner.
Rogerian theory is the platform for affective therapy named after its
founder Carl Rogers. Affective therapy is based on the belief that hu-
mans strive to be fully functional individuals through self-direction by
obtaining, sharing, and surrendering power (Bandura, 1995; Capuzzi &
Gross, 2001, p. 133). Therapy encompasses several concepts that include
congruence, genuineness, self-disclosure, unconditional positive regard
and acceptance, accurate empathy and understanding, and active listen-
ing (Rogers, 1980, p. 116). The client strives for self-protection, plea-
sure, shared love and belonging, growth toward positive direction, and
self-actualization.
The therapist facilitates the client’s inner struggles with self-acceptance
while letting the client direct the therapy. This is due to the theory’s em-
phasis on responsibility and the capacity of the client to become a fully
functioning human being, socially and emotionally. The primary advan-
tage of affective therapy includes the patient’s ability to decide and direct
the therapy. In addition, a close relationship between the client and ther-
apist complements the client’s value and acceptance. See Figure 1.
A. Western psychotherapy
• Based on theories of individualism
Thinking/behaving: Reasoning as the meaning of life (rationality, responsibil-
ity), acting on new experience and learning experience to develop skills,
modify behavior, techniques, guided imagery, and homework, evaluation
Feeling: Person-centered therapy, resources within individual evolved by “self-
reflection” through empathy and “non-possessive caring.”
B. Eastern psychotherapy
• Based on theories of wholeness
Thinking/behaving: The process of reasoning with spiritual and social focus
(wisdom, healthy soul, preordained life, family harmony, and connected-
ness). Meditation and prayers, fasting, yoga, self-discipline/self-restraint,
and patience.
Feeling: Positivism, faith, responsible relationships, care for self/others
Appropriate psychotherapy model for Asian Eastern Islamic women with mental
illness
C. Eastern-Asian Islamic model of psychotherapy
• Elements of proposed Eastern/Western theories
Thinking/behaving: Acceptance of destiny and mortality.
Family responsibility to enhance individuality, self-acceptance, self-knowledge,
self-disclosure, sharing clear vision, wisdom, and spiritual emergence. Ac-
tion stimulates healthy mind and body through meditation, yoga, and re-
laxation.
Feeling: Tolerance of emotional states as empathy, sensitivity, selflessness,
unconditional love, congruence, and genuine caring.
Figure 1. The Carter and Rashidi theoretical model of psychotherapy

for Asian-Islamic women with MI.
Eastern Asian-Islamic Philosophies of Life
Despite the long history of Eastern Asian-Islamic psychotherapy, the

therapy remains virtually unknown in Western societies. Eastern Asian-
Islamic therapy is perceived as supplemental rather than a foundation
therapy. For Kao and Sinha (1997), Eastern culture emphasizes piety,
human-heartedness, empathy, and benevolence, while the Western fo-
cuses on autonomy, individuality, individual decision making, and taking
responsibility (p. 15). For the authors there are crucial similarities as well
as differences in the adaptation of Eastern and Western belief systems
to life (p. 280): Eastern society values teamwork, external and inter-
nal networking, and community services, while Western society values
individuality, independence, and self-sufficiency (Paranjpe, 1998).
The core of Islamic teaching is based on matters of society rather

than individuality. Islam provides a fair, balanced, and holistic world
view of life (Sarwar, 1980, p. 168). Walsh (1999) stresses that Eastern
psychotherapy is beneficial and provides tremendous power to clients; it
brings insight, concentration, reduced stress, balanced emotions, and a
healthy mind (p. 168).
Asian Eastern Islamic teaching, guided by the Qur-an, has a direct
effect on healing modality through the spirit, soul, and mind and provides
homeostasis of life (Athar, 1993, p. 118; Sarwar, 1980, p. 34). A client
with a balanced emotional and holistic lifestyle has a stronger immune
system and a healthier and happier life view. The healing approach of
soul, mind, body, homeostasis, and concerns with well-being are the main
scientific contributions of Islamic teaching.

In the Qur’an and Sunnah are established the universal fundamental
rights for humanity that are to be practiced and respected in all circum-
stances. One of the strongest Islamic beliefs is, “Islam seeks to firmly
implant in one’s heart the conviction that one’s dealings are with God,
who sees him at all times and in all places. A person may hide him-
self from the whole world but not from God” (Abdullah, 1999, p. 9).
The Qur’an and Sunnah also teach humility, serving others who need
help, modesty, control of passion and desire, truthfulness, integrity, pa-
tience, steadfastness, justice, and fulfilling moral values and promises
to self, others, and God. One of the fundamental concepts is that God
loves those who do good (Abdullah, 1999). Therefore, the Islamic life is
centered on pleasing God through helping his people.
Islamic beliefs are useful in supporting and assisting Muslims in the
health care settings. Eastern therapy encompasses several factors closely
interconnected with the client’s belief system. The belief system is de-
rived from the client’s background and spiritual values. Brook and Omari
(1999) stated that the Islamic belief system is the way of life for Muslims
and impacts all aspects of their life. The following statements from the
Qur’an and Sunnah can be used as tools for psychotherapists in treating
the Muslim population.
BELIEFS AND CONCEPTS THAT STRENGTHEN

PSYCHOTHERAPY FOR EASTERN
ASIAN-ISLAMIC WOMEN
• “An ounce of prevention is worth a ton of treatment” (Athar, 1993,

p. 95).
• “The body is a gift from God, you have to look after it; you can’t
ignore it and you can’t abuse it” (Athar, 1993).
• “There will be no form of abuse to the system; keeping healthy is

part of one’s religion” (Athar, 1993, p. 95).
• “Older, vulnerable, and weak parents and relatives are gifts from
God and must be cared for” (Abdullah, 2000).
Acknowledging these beliefs is crucial when the therapist deals with

Muslim patients. The pain of MI may interfere with beliefs and the ability
of a patient to carry out daily activities. It is the psychotherapist’s re-
sponsibility, in conjunction with the client, to return her to “psychosocial
homeostasis” (Dhar, 1997). The following are concepts we have defined
for the purpose of this article.
Cleanliness of the body and the mind (Athar, 1993, p. 119), medi-
tation and prayers, fasting, wisdom, self-restraint/discipline, unity, des-
tiny, empathy, faith, and trust and relationships will be included in this
model. An awareness of these concepts is crucial for psychotherapists
who treat Eastern Asian-Islamic women. Of these concepts, cleanliness
of the body and mind, meditation and prayers, fasting, and wisdom,
responsibility/relationships, and humility/selflessness are the most appli-
cable to psychotherapy and will be discussed.
Muslims must clean their bodies in preparation for prayer. This action
is called ablution, which every individual is required to practice five times
a day prior to prayers. This is a partial bathing that includes extremities
(face, hands, forehead, mouth, ears, nose and feet). In addition to the
ablution, Taharat is required in the Muslim population. This is the wash-
ing of genital areas each time after defecating and urinating. Otherwise,
prayer is not accepted (Lawrence & Rozmus, 2001, Rajaram & Rashidi,
1998). A therapist should be aware of the importance of cleansing not
only from the perspective of hygiene, which is congruent with Western
culture, but also within the Islamic perspective of purifying the soul. The
therapist is free to support the client’s concern with the ritual of hygiene
without fear of offending. This act may benefit the client spiritually and
lessen their guilt. The key concepts, which are the essence of Islamic
belief system, are the foundation of our Carter and Rashidi model of
psychotherapy for Asian-Islamic women with MI.
Meditation and prayers have been used in the Eastern belief system to
promote tranquility, joy, happiness, connection, mindfulness, and analytic
inquiry. They enhance the human emotional experience and can establish
a connection to a higher power when a person feels hopeless. Prayer
purifies the heart, the mind, and the soul (Sarwar, 1980, p. 74). It is a
source of hope, courage, confidence, and patience (Sarwar, 1980, p. 74).
It also controls anxiety, depression, and other emotional problems (Athar,
1993, p. 118). After belief in God and His prophets, prayer is considered
the second pillar of the Islamic belief system (Rashidi & Rajaram, 2000).
In the Qur-an prayers/meditation are mandated five times a day (Ra-

jaram & Rashidi, 1998). Prayer in Islam includes two types of rituals
called Salat, which is a formal ritual, and Zeker, which is informal (praise
of the higher power for his mercy). The word repetition used in prayer
affects the brain waves and calms the individual. Inducing relaxation re-
duces oxygen consumption, lowers respiratory rate, decreases heart rate,
lowers blood pressure, and increases alpha waves (Kao & Sinha, 1997,
p. 280).
Prayer can be considered a simple act that mentally and/or emotionally
connects an individual to the higher power in a monotheistic view of God
(Allah). Prayer could be used in therapy as one of the basic effective
tools. A devoted Muslim patient’s lack of desire to practice prayers may
be a symptom of her illness; not participating in prayer may enhance her

illness because of guilt. Therefore, the therapist may discuss with the
client the practices of daily prayers in order to uncover and lessen her
negative feelings and help her in personal growth. Some clients would
like to involve the therapist in informal prayer. We recommend that the
therapist be respectful of patients’ wishes in order to promote healing.
Meditation, as Walsh (1999) describes it, is the practice that enriches
awareness, attention, concentration, joy, and compassion by producing
psychological well-being, maturity, and consciousness (p. 180). Yoga
also is a type of meditation. Walsh describes the benefits as encompass-
ing ethics, lifestyle, body posture, diet, breath control, and intellectual
syntheses (Walsh, 1999, p. 131). Therefore, meditation, prayers, yoga,
and similar practices contribute to the recovery of the individual.
Fasting or Sawm, the third pillar of the Islamic belief system, is also
mandated. Fasting is believed to cleanse the soul and bring the self to
peace; at the same time, it is a reminder to help others who have less to
share and to care for the poor (Athar, 1993, p. 119). Sawm increases self-
control and selflessness and at the same time reduces greed, laziness, and
other faults (Sarwar, 1980, pp. 76–77). Fasting is considered to cleanse
the body and mind. Physically, fasting assists in the alleviation of peptic
and metabolic disorders and improves the immune system; this in turn
enhances mental well-being (Athar, 1993, p. 118).
In Western society, fasting is not widely understood; as a result, it
is not consistently practiced. The therapist who has good intentions and
looks after the client in a holistic approach, including nutritional needs,
may unknowingly discourage a client from fasting. This could cause psy-
chological harm; the harm of discouraging fasting may exceed the bene-
fit of nutritional gain. Consequently, the Western therapist would benefit
from being aware of the client’s practice without interfering with this act.
Wisdom is defined as both understanding and transforming knowledge.
Asians perceive achieving wisdom as a central goal in life. They are eager
to be accompanied by the wise, for instance, by being exposed to their

writings, by reflecting on the nature of life and death, and by silence and
solitude within themselves (Corsini & Wedding, 2000, p. 426). Wisdom
is highly valued by Islam. The wise person is given tremendous authority
and admiration. Elders are perceived to have wisdom and knowledge, and
they gain much respect with age. Consequently, the patient may listen to
parents or older relative rather than to the therapist.
Therapists who are aware of this issue will not discount the relatives or
elders since the patients may lose their trusting relationship with the ther-
apist, which is crucial. In keeping with the value of wisdom the therapist
can suggest reading, encourage introspection, and facilitate reflection on
life and death (Corsini & Wedding, 2000, p. 426). Some of these barri-
ers will be discussed as particularly applicable to psychotherapy so that

therapists can understand the barriers for the patient’s benefit.
Responsibility and relationship as presented in the Qur-an are crucial
concepts for the Asian-Islamic woman. The teaching emphasizes social
responsibilities such as kindness and consideration for others. For ex-
ample, being kind is expressed not only toward family, relative, friends,
neighbors, or those who cannot take care of themselves, but also to-
ward animals and plants, who are recognized in Islam as having souls
(Abdullah, 1999).
The Qur-an stresses that people must be responsible for their parents,
take care of them, honor them, and be kind to them, especially during
their old age and times of sickness (Abdullah, 1999). Individuals must
be kind to neighbors and take care of their needs. The prophet, Peace Be
Upon Him (pbuh), said that a person is not a believer if he or she has suf-
ficient food or is safe and others are hungry and unsafe (Abdullah, 1999).
This belief system may interfere with therapy since Western therapy
encourages individuality, independence, and self-sufficiency (Paranjpe,
1998, p. 64); therefore, it may be difficult for the therapist to perceive that
taking care of the older or vulnerable person is the responsibility of the
client who herself already has a personal problem or is going through a
crisis. Consequently, the therapist prematurely may discourage the client
from fulfilling her duty, thereby adding more stress and negative feelings
to the situation. If the therapist is knowledgeable about the beliefs of the
client, the client is helped to make a rational decision and is freed from
guilt. If the psychotherapist is unaware of the client’s norm, he or she
may judge the client as dependent or codependent on the family.
Humility is a result of self-awareness and self-realization. Several
philosophers and great people in history have stressed self-realization,
which leads the individual to humility. For instance, Plato, a great philoso-
pher referring to humility, stated, “I must first know myself.” Prophet
Mohammed (pbuh) also emphasized learning about the inner self (Walsh,
1999, p. 228). The value of humility is great, but it cannot come without
knowledge of self and others. In the Islamic code, humility and self-
realization are crucial.
Humility brings self-awareness of weakness and helps in the devel-
opment of the self since ignorance and selfishness are destructive. The
patient may express her value system in a way that is not acceptable in
Western therapy practice, for example, by placing others’ needs above her
own. The therapist should not discourage her from pursuing her beliefs.
The Qur-an recommends that people be modest and reserved. Modesty
is believed to be the foundation of all virtues and is understood through
statements such as the following:
• Let your neighbors discover you before you make yourself known
to them.
• Serving others without expectation of recognition or praise is reward
in itself.
• Demonstrate limitless kindness toward all beings.
• Give limitless compassion for the suffering of all beings.
• Hold empathetic joy in the happiness and liberation of others.
Modesty is encouraged not only in behavior, but also in the thinking
pattern. Modesty may be perceived as a barrier in therapy or may be
misinterpreted in psychotherapy. For example, Islam discourages men
and women from directly looking at the face of the opposite gender unless
they are blood relatives who cannot marry, such as father, brother, sister,
mothers, aunts, or uncles. If the Muslim client comes to the therapist and
does not have eye contact, the psychotherapist may perceive low self-
esteem or other problems and treat the client for unrelated conditions
(Sue & Sue, 1999, p. 55).
The Western philosophy of life is based on individual reasoning, re-
sponsibility, self-direction, and action. The meaning of life is driven by
individual choices and personal freedom that leads to autonomous ex-
istence. Western cognition stresses rational and realistic thinking; the
internal locus of control is the core value of the population. The person
with crises is solely in charge of his decision making; less emphasis
is placed on involvement with others. The responsibility for healing is
an individual action rather than achieved through the support of others.
The Western thought process incorporates self-sufficiency, independence,
uniqueness, and fear of dependency.
Therefore, freedom of individual choice is the major component of
Western psychotherapy. Less emphasis is placed on seeking input and
consulting others because of fear of violating the privacy of others, yet
Rogers (1980) believed a major aspect of humanity is the expression of
emotions without feeling dependent on others. He encouraged human
empathy, unconditional positive regard, trust, and genuineness. In his

person-centered theory, feelings are considered a part of his therapy and
self-exploration is promoted, but he is neutral on the involvement of
others (Rogers, 1980, p. 116).
EASTERN PSYCHOTHERAPY
Eastern psychotherapy, predicated on the Eastern Islamic belief sys-

tem, has been practiced informally for centuries. Unfortunately, there
has been no model of therapy that a therapist could use when treating
the Eastern Asian-Islamic client. This situation provoked us to develop
a model in order to bridge the gap and thus enhance treatment of this
population. This model will include proposed Eastern theories, which

are core values since they influence spiritual practices. This population’s
perception of spiritual concepts is more global in contrast to the Western
perception that spiritual concepts are only one dimension of life. Eastern
spiritual life is the essence of body, spirit, soul, and mind (Athar, 1993;
Walsh, 1999). A healthy spirit merges with healthy thinking, feeling, and
behavior, which are part of the spiritual life.
From the Eastern perspective, sharing and contributing thoughts with
the family, rather than individual thinking, is the norm. Eastern individ-
uals perceive family collaborative thinking as the essence of meaningful
problem solving associated with wisdom. Wisdom that comes from in-
dividuals, particularly older members of society, and from nature are
valued. The healthy soul, another focus, is not only a connection to the
higher power but also enhances respect and harmony toward self and the
environment. The Eastern foundation of preordained beliefs encourages
harmony with the environment rather than controlling it; everything in
life has its purpose.
Asian-Islamic Eastern philosophy states that there is a reason for every
life event; a person does not blame self or others for a crisis or disease.
Yet this does not interfere with the concept of responsibility, for taking
action in a positive direction, or for the treatment or the cure of illness.
Prophet Mohammed (pbuh) promoted the treatment and cure of disease
by stating that there is a cure for every disease and a person has the
responsibility to seek a cure. This concept may be used in therapy to
motivate clients to strive for recovery.
EASTERN ASIAN-ISLAMIC PROPOSED MODEL

OF PSYCHOTHERAPY
The proposed Carter and Rashidi model incorporates Western and

Eastern theories of psychotherapy to develop the most effective therapy
for the Eastern Asian-Islamic population with MI. This psychotherapy

model merges all critical aspects of life, value systems, and culture in
order to facilitate Eastern Asian-Islamic women’s healing.
The thinking pattern of the population is geared toward family relation-
ships, low expectation, humility, preordained concepts, external locus of
control (i.e., believing in a higher power), self and other acceptance, and col-
laborative thinking with others for redirection and guidance. Asian-Islamic
women perceive life in several dimensions and in a holistic way. There is a
high regard for wisdom and the experience of others, specifically for elders.
Preordained thinking is highly encouraged and is a great part of exis-
tence. Mortality is another stage of the journey of life. The acceptance
and willingness to work toward mortality in a healthy way is recom-
mended. Incorporating preordained beliefs from a higher power, which

connect with spiritual reasoning, are the ultimate goal and purpose.
Good mental health is accepted as an essential component of a healthy
life. One must take care of oneself, live a healthy life, and search for
treatment and recovery. One must employ a proactive search for cure and
recovery to carry out responsibility toward the body as a gift from God
to be cared for.
Eastern Asian women are highly disciplined since discipline/self-
restraint is built into their daily life by practicing meditation and prayers.
Waking up mornings as early as three o’clock to pray assists them to
be self-disciplined. This quality could be used in therapy to encourage
clients to practice guided imagery for healing (Rashidi & Rajaram, 2001).
The healing also can help motivate the client to work more efficiently
through relaxation and homework assignments and to connect to the
higher power. Connecting to the higher power has its own benefits. It not
only assists in redirecting behavior toward a more productive outcome,
but it also promotes acceptance of the illness not as a failure and fate, but
as preordained destiny. The outcome product of preordained philosophy
guides the client to be less self-critical for having the illness and gives
hope to pursue spiritual life.
Robbins (2000) demonstrated that electrical signals within the brain
change clients’ brain waves. These electrical changes within neurons pro-
duce feedback, which can reduce stress and enhance rational thoughts of
the client. Studies in meditation and yoga reveal the reduction in individ-
ual stressors and the integration and synchronization of the brain during
transcendental meditation (Khare & Nigam, 2000; McEvoy, Frumkin, &
Harkins, 1980; Waxman, 1979). Therefore, the therapist’s recommenda-
tion to support a client in practicing meditation and relaxation will pro-
mote recovery. Even though initial concentration is necessary in effective
meditation, the outcome of meditation and concentration will eliminate
psychological pain.
It is less common for the Western psychotherapist to welcome prayer

and meditation as a means of effective therapy, but a psychotherapist
must appreciate cultural differences. If it works for the client, then it is
unethical to ignore the usefulness and power of this practice. The clients’
thinking is less likely based on individualism and is more connected to
taking care of family.
The emotional awareness and expression of this population is influ-
enced by a genuine regard for the welfare of self and others. Knowledge
of the appropriateness of feelings comes from storytelling and family
interaction in different settings and asking for guidance and direction.
These stories are congruent with the expression of their emotion and
feelings. Feelings are expressed openly as long as it does not hurt elders.
Decision making through collaborative thinking of all members is valued

while being respectful and sensitive to the emotional needs of others.
In Western perception, placing the emotional needs of others before the
individual’s emotional needs conveys a lack of control of emotion and
feelings. For instance, the client who comes to the therapist for crisis
resolution may have family or extended family to care for. The West
values individualism and discourages taking care of others before self.
Great sensitivity and effort should be made in order to not interfere with
the value system, which may result in delayed therapy and recovery.
The concept of taking care of others is related to unconditional love,
which is an expectation of Islam. Finally, a healthy lifestyle includes
the expression of emotion by elders, stories, encouraging taking care of
others, and tolerance of crises.
FUTURE STUDIES AND LIMITATIONS OF THIS ARTICLE
This article is limited because we address only the behaviors and phi-
losophy of life, but we suggest no techniques for implementation. Future
studies may be crucial to develop and test techniques to address the needs
of the growing cultural diversity of the United States. There is a high
demand for skilled psychotherapists who understand clients with MI who
have different backgrounds. Even though we state that Eastern and West-
ern psychotherapy have some similarities, there are many differences. If
differences are discounted, therapy will not be effective with this unique
and diverse population.
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Health Care for Women International

THEORETICAL MODEL OF PSYCHOTHERAPY: EASTERN ASIAN-

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Health Care for Women International, 24:399–413, 2003

THEORETICAL MODEL OF PSYCHOTHERAPY:

David J. Carter, PhD, LMHP

Anahita Rashidi, MSN, RN

Richard-Young Hospital, Omaha, Nebraska, USA

The Muslim immigrant population is increasing in the United States.

Discussion of the immigrant Muslim population belief system as it re-

Received 11 March 2002; accepted 2 May 2002.

Muslim women with MI that integrates Islamic psychotherapeutic con-

an effective therapeutic model based on Muslim beliefs and tradition for

be discussed, followed by Eastern therapy, and finally our Carter and

WESTERN PHILOSOPHIES AND PSYCHOTHERAPY THAT

Western psychotherapy employs many disciplines of therapeutic

Figure 1. The Carter and Rashidi theoretical model of psychotherapy

Eastern Asian-Islamic Philosophies of Life

Despite the long history of Eastern Asian-Islamic psychotherapy, the

The core of Islamic teaching is based on matters of society rather

scientific contributions of Islamic teaching.

BELIEFS AND CONCEPTS THAT STRENGTHEN

• “An ounce of prevention is worth a ton of treatment” (Athar, 1993,

• “There will be no form of abuse to the system; keeping healthy is

Acknowledging these beliefs is crucial when the therapist deals with

In the Qur-an prayers/meditation are mandated five times a day (Ra-

be a symptom of her illness; not participating in prayer may enhance her

to be accompanied by the wise, for instance, by being exposed to their

ers will be discussed as particularly applicable to psychotherapy so that

empathy, unconditional positive regard, trust, and genuineness. In his

Eastern psychotherapy, predicated on the Eastern Islamic belief sys-

population. This model will include proposed Eastern theories, which

EASTERN ASIAN-ISLAMIC PROPOSED MODEL

The proposed Carter and Rashidi model incorporates Western and

for the Eastern Asian-Islamic population with MI. This psychotherapy

mended. Incorporating preordained beliefs from a higher power, which

It is less common for the Western psychotherapist to welcome prayer

Decision making through collaborative thinking of all members is valued

FUTURE STUDIES AND LIMITATIONS OF THIS ARTICLE

Athar, S. (1993). Islamic perceptive in medicine. A survey of Islamic medicine: Achieve-

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